01 CARDIOVASCULAR 01.08 03 GASTROINTESTINAL MEDICINE 04 NEUROLOGY 04.13
• Deep vein thrombosis (DVT) & GENERAL SURGERY • Spinal disorders
01.01 • Pulmonary embolism (PE) 04.01 Headaches - Brown-sequard syndrome
• Acute coronary syndrome • Infective endocarditis 03.01 - Subacute combined degeneration
- STEMI, NSTEMI, unstable angina • Pericarditis • Gallbladder disorders 04.02 Neurodegenerative disorders - Friedrich's ataxia
- ECG cardiac territories - Acute cholecystitis • Dementias • Delirium - Anterior spinal artery occlusion
• Hypertension 01.09 - Ascending cholangitis - Syringomyelia
• Cardiac tamponade - PSC & PBC 04.03 Neurodegenerative – movement - Tabes dorsalis
01.02 • Constrictive pericarditis • Liver cancers – hepatocellular disorders, incl Parkinson's, • Neurofibromatosis
• Ischaemic heart disease • Antihypertensives (continued) carcinoma & cholangiocarcinoma Huntington's and motor neuron disease • Tuberous sclerosis
• Atrial fibrillation • Other drugs (adenosine, amiodarone,
• Adult life support digoxin, anti-platelets) 03.02 04.04 Infections 04.14
• DVLA rules on cardiovascular disorders • Alcohol-related liver disease • Bacterial & viral meningitis • Restless legs syndrome
01.03 • Wilson’s disease • Encephalitis • Abnormal involuntary movements
• Ventricular fibrillation 01.10 Vascular surgery • Haemochromatosis • Brain & spinal epidural abscesses • DVLA rules for neurological disorders
• Ventricular tachycardia • Peripheral arterial disease • Aphasia DDx
• Bradycardia: peri-arrest • Aortic aneurysm 03.03 04.05 Infections • Wernicke's encephalopathy
• Tachycardia: peri-arrest • Aortic dissection • Hepatitis A, B, C, E • Specific infxns: toxoplasmosis, primary • Charcot-Marie-Tooth syndrome
© quackquackmed.com
• Pacemakers • Varicose veins • Autoimmune hepatitis CNS lymphoma, cryptococcosis, PML
• Cardiac enzymes • Lower leg ulcers • Non-alcoholic fatty liver disease • Glasgow Coma Scale (GCS)
05 OPHTHALMOLOGY
• Ankle-brachial pressure index (ABPI) • CSF interpretation table
01.04 03.04
05.01 Blindness
• Electrocardiogram (ECG) • Paracetamol overdose 04.06 Epilepsy / seizures
• Retinal detachment
• Arrhythmias, including Wolff-Parkinson- 02 RESPIRATORY • Disorders of the pancreas • Seizures, incl status epilepticus
• Retinal artery & vein occlusion
White syndrome, Wellens syndrome, - Acute & chronic pancreatitis • Psychogenic non-epileptic seizures
• Retinal migraine
junctional escape rhythm 02.01 - Pancreatic cancer • Anticonvulsants / antiepileptics
• Giant cell arteritis • Optic neuritis
• Asthma • COPD - Neuroendocrine tumours
• Papilloedema
01.05 • Small bowel bacterial overgrowth 04.07
• Vitreous haemorrhage
• Long QT syndrome 02.02 syndrome • Syncope
• DDx – loss of colour vision
• Short QT syndrome • Pneumonia – CAP + HAP • Brain tumours
• DDx – blurred vision
• Brugada syndrome - In immunocompromised patients 03.05 • IBD – Crohn's & UC • Brain lesions localisation (smx)
• Atrial flutter - Lung abscess / empyema • Coeliac disease 05.02 Red eye
• Shock (÷ different types) • Aspiration pneumonia 04.08 Strokes
• Glaucoma – closed-angle
• Acute bronchitis 03.06 • TIA & ischaemic stroke
• Anterior uveitis
01.06 • Appendicitis - Classifications by arteries, smx
• Episcleritis & scleritis
• Valve disorders – mitral stenosis, mitral 02.03 • Small & large bowel obstructions • Haemorrhagic stroke • Keratitis
regurg, aortic stenosis, aortic regurg • Tuberculosis • Cystic fibrosis • Hernias
• Common meds in ophthalmology
• Murmurs (DDx) • Sarcoidosis 04.09 Brain bleeds
• Conjunctivitis (on 05.03)
• Rheumatic fever • Alpha-1 antitrypsin deficiency 03.07 • Subarachnoid haemorrhage
• Prosthetic heart valves • Anal fissures & fistulae, haemorrhoids • Subdural & extradural haemorrhage
05.03 External eye problems
• Jugular venous pressure (JVP) 02.04 • Colorectal cancer • Cerebral aneurysm
• Blepharitis • Blepharospasm
• Pulses (different types, eg pulsus • Lung cancers • Pancoast tumour
v10.3 – last updated Sep 2025
• Ectropion & entropion
paradoxus) • Mesothelioma 03.08 04.10 Weakness DDx
• Pingucela • Hordeolum / stye
• Heart sounds • Bronchiectasis • GORD, gastritis, peptic ulcer disease
• Ophthalmic shingles
• Idiopathic pulmonary fibrosis • Oesophageal conditions 04.11 Neuroinflammatory disorders
01.07 • ERCP, TIPS • Multiple sclerosis
05.04 Age-related conditions
• Hypertrophic obstructive 02.05 • Guillain Barre syndrome • Glaucoma – open-angle
cardiomyopathy (HoCM / HCM) • Pneumothorax •Pleural effusion 03.09 – Upper & lower GI bleeding • Chronic inflammatory demyelinating
• Age-related macular degeneration
• Arrhythmogenic right ventricular • Acute respiratory distress syndrome (poly)neuropathy
• Cataracts
cardiomyopathy (ARVC) • Oxygen delivery • Chest drains 03.10 • Myasthenia gravis
• Diabetic neuropathy
• Dilated cardiomyopathy • Irritable bowel syndrome (IBS)
• Orbital & periorbital celluitis
• Chronic heart failure 02.06 • Diverticular disease 04.12
• Obstructive sleep apnoea • Ischaemic bowel disease • CT head – indications
05.05 • Thyroid eye disease
• Smoking cession • Abdominal pain DDx • Head injury
• Strabismus / squints
• Respiratory failure • Intracranial pressure – ↑ &↓
• Pupil problems
3a – Primer on anaesthetics
• Tropical eye diseases
• General anaesthesia & airway adjuncts
• Regiona/local anaesthesia
• Post-op nausea & vomiting
, Acute coronary syndrome D: spectrum of acute myocardial R: • Unmodifiable: ↑age, males, FHx Hypertension Diagnosing hypertension
ischaemia or infarction • Modifiable: smoking, DM, HTN, see further note below • If clinic BP ≥140/90, measure
hypercholesterolaemia, obesity again after 5 min, measure on
Stage 1 HTN Stage 2 HTN Stage 3 HTN
STEMI: ECG+ve [ST- NSTEMI: ECG inconclusive Unstable angina: normal both arms, and check cuff
Clinic BP ≥140/90 Clinic BP ≥160/100 Clinic BP ≥180/120
elevation], trops+ve [normal or other ∆], trops+ve ECG, normal trops P: • Atherosclerosis in coronary vessels placement
ABPM ≥135/85 ABPM ≥150/95 = severe HTN
2/2 endothelial dysfunction (smoking, • Use ambulatory BP monitoring
HTN, hyperglycaemia) Treat (ABPM) to Dx (clinic BP - ?white
STEMI criteria – ECG features in ≥2 contiguous leads coat syndrome)
• Plaque formation causes physical Treat if
• ≥ 2.5 mm ST elevation in V2-3 in men ≤40yo, or ≥ 2.0 mm in men >40yo blockage → ↓blood flow to <80yo AND • target organ damage heart, brain, • Alternatively, home BP
• ≥ 1.5 mm ST elevation in V2-3 in women myocardium → ischaemia & angina • established CVD, AKI/CKD, T2DM kidneys, eyes monitoring – 2 readings in the
• ≥ 1 mm ST elevation in other leads • new LBBB (always pathological) • 10y cardiovascular risk ≥10% morning, 2 at night, for 4-7d
• Plaque rupture may cause complete
occlusion → myocardial infarction
S/Smx: angina at rest (>20 min) not relieved by GTN. Gripping/heavy pain, a/w without T2DM Hypertensive retinopathy
nausea, sweating, dyspnea, palpitations, etc ECG cardiac territories • Grade I: barely detectable arterial
+T2DM <55yo, ≥55yo Black narrowing
I aVR V1 V4 not black • II: obvious narrowing + focal
© quackquackmed.com
Ix: ECG, ABG, bloods (trops [baseline ± repeat], FBC, lipids, HbA1c, U&E, LFT, irregularities
Lateral Anterior/
TFT), CXR, echo (before discharge), blood glucose 1. ACEI / ARB CCB • III: flame haemorrhages, dot and blot
= LCir septal = LAD
haemorrhages, hard and soft
All: Aspirin 300 mg, O2 if sats <94%, paracetamol 1g PO/IV [morphine if severe + CCB or thiazide-like + ACEI or ARB [if black] exudates, cotton wool spots
II aVL V2 V5 2. • IV: papilloedema
Mx pain only], GTN 1 spray (caution hypotension), ± ondansetron 4 mg IV
Inferior Lateral Lateral
3. all classes (ACEI/ARB + CCB + thiazide) Target BP <80yo ≥80yo
= RCA
PCI possible within 2h no Fibrinolysis
HTN (± T2DM) <140/90 <150/90
STEMI: • Prasugrel • Alteplase etc III aVF V3 V6 4. + spironolactone if K ≤4.5 mmol/L
- tica/clopi if pt is high risk bleeding + antithrombin or + alpha/beta-blocker if K >4.5mmol/L T1DM ACR <70 <140/90 <150/90
(1) <12h of smx Lateral
AND - clopidogrel if pt is on PO anticoag • Ticagrelor after ACR ≥70 <130/80 <150/90
(2) is PCI possible • Obtain radial access • If no ECG resolution V1-6, aVL = Proximal LAD
CKD ACR <70 <140/90
• UFH + bailout GPIIb/IIIa inhibitor after 60-90 min, cor D: persistently raised BP
within 2h? ACR ≥70 <130/80
• PCI: Drug eluting stent angio ± PCI Posterior STEMI:
• Reciprocal V1-3 changes: ST depression; tall, R: obesity, metabolic syndrome,
BP ≥180/120
If pt presents >12h but has ongoing smx of STEMI or has cardiogenic shock, broad R waves; upright T waves ↓exercise, ↑alcohol, DM, black ancestry, • Only requires A&E referral (for specialist Ax) if
consider sending for PCI anyway • Confirmed by ST elevation and Q waves in >60yo, FHx (HTN, CKD), sleep apnoea
posterior leads (V7-9) - Grade III/IV retinopathy (see above)
If unstable: PCI immediately (see STEMI PCI) - Life-threatening smx, eg new onset confusion, chest
NSTEMI Low risk (≤3% 6mo mortality): fondaparinux & ticagrelor Aetiology: pain, s/smx of HF or AKI (eg oliguria)
Inferior MIs are associated with AV block
(1) GRACE Int/high risk (>3%) but stable: Aim PCI within 72h • Essential HTN - no specific cause - Suspicion of phaeochromocytoma (eg if a/w
≤3% or >3%? • Give fondaparinux, prasugrel/ticagrelor, and UFH when • Secondary HTN headache, palpitations, sweating, etc)
DDx:
in cath lab. Use drug-eluting stent. - Primary hyperaldosteronism • Can be Mx & Ix in community otherwise
• Global T wave inversion: think non-cardiac
- Renal disease, eg glomerulonephritis, Hypertensive urgency/emergency
GRACE score predicts all-cause mortality 6mo after discharge for ACS cause
renal artery stenosis • = Elevated BP a/w new/progressive target organ
• Pericarditis: global ST elevation
Unstable angina & 2' prevention: Other Mx - Endocrine disorders, eg Cushing's, dysfunction
• PE: sinus tachy (most common), S1Q3T3
• Cardiac rehab + "6As" • MI a/w cocaine use: as per ACS phaeochromocytoma, acromegaly • Mx is often guided by local guidelines, depends on
• ACEI indefinitely, eg ramipril + give IV benzos, avoid βB - Drugs, eg steroids, COCP the end organ that is affected and how high the BP is
• Aspirin 75 mg OD indefinitely • Diet: Mediterranean style diet. Complications "DREAD": death, rupture - Others: pregnancy, coarctation of the • Examples of agents used
• Another antiplatelet, eg clopidogrel, No rec for omega-3, fish, or other of myocardium, edema, arrhythmia and aorta - Labetalol infusion, eg 0.5 mg/min
for up to 12mo specific dietary supplements aneurysms, Dressler's syndrome - Nicardipine, fenoldopam, etc
• Beta-blocker, eg atenolol • Exercise: 20-30 min daily Ix – to look for evidence of target organ • Treat under specialist supervision
Post-MI ACS risk stratification – Killip classes
- Indefinitely if reduced LVEF • Sex: ok to resume in 4w. damage ± causes of secondary HTN
I: no clinical signs of HF 6% • Urinary albumin-to-creatinine (uACR)
- Otherwise continue at least 12mo, • PDE-5 inhibs (eg sildenafil) can II: lung crackles + S3 17% P: uncontrolled HTN is a significant risk
re-evaluate be used 3-6mo after MI. • Urinalysis: protein & haematuria
III: frank pulmonary edema 38% factor for development of cardiac (IHD, HF),
• Statin indefinitely, eg atorvastatin - CI if pt on nitrates or nicorandil. • U&Es & eGFR • Lipid panel & HbA1c
IV: cardiogenic shock 81% 30d mortality vascular, kidney (CKD) and cerebrovascular
• Aldosterone antagonist, eg - CI if pt is having unstable • ECG
(TIA/stroke), retinal disease.
eplerenone angina or angina occurring P: ~10% morbidity. ↑ risk for future • If 2ndary cause suspected: TSH, renin,
- If HFrEF on echo, indefinitely during sex events aldosterone, phaeochromocytoma
- Start 3-14d after MI, preferrably screen Antihypertensives on 01.09
after ACEI
Mean arterial pressure = average arterial pressure throughout systole & diastole
MAP = DBP + 1/3(SBP - DBP)
01.01 Cardiology – Acute coronary syndrome, Hypertension last updated 02/09/2025
• Deep vein thrombosis (DVT) & GENERAL SURGERY • Spinal disorders
01.01 • Pulmonary embolism (PE) 04.01 Headaches - Brown-sequard syndrome
• Acute coronary syndrome • Infective endocarditis 03.01 - Subacute combined degeneration
- STEMI, NSTEMI, unstable angina • Pericarditis • Gallbladder disorders 04.02 Neurodegenerative disorders - Friedrich's ataxia
- ECG cardiac territories - Acute cholecystitis • Dementias • Delirium - Anterior spinal artery occlusion
• Hypertension 01.09 - Ascending cholangitis - Syringomyelia
• Cardiac tamponade - PSC & PBC 04.03 Neurodegenerative – movement - Tabes dorsalis
01.02 • Constrictive pericarditis • Liver cancers – hepatocellular disorders, incl Parkinson's, • Neurofibromatosis
• Ischaemic heart disease • Antihypertensives (continued) carcinoma & cholangiocarcinoma Huntington's and motor neuron disease • Tuberous sclerosis
• Atrial fibrillation • Other drugs (adenosine, amiodarone,
• Adult life support digoxin, anti-platelets) 03.02 04.04 Infections 04.14
• DVLA rules on cardiovascular disorders • Alcohol-related liver disease • Bacterial & viral meningitis • Restless legs syndrome
01.03 • Wilson’s disease • Encephalitis • Abnormal involuntary movements
• Ventricular fibrillation 01.10 Vascular surgery • Haemochromatosis • Brain & spinal epidural abscesses • DVLA rules for neurological disorders
• Ventricular tachycardia • Peripheral arterial disease • Aphasia DDx
• Bradycardia: peri-arrest • Aortic aneurysm 03.03 04.05 Infections • Wernicke's encephalopathy
• Tachycardia: peri-arrest • Aortic dissection • Hepatitis A, B, C, E • Specific infxns: toxoplasmosis, primary • Charcot-Marie-Tooth syndrome
© quackquackmed.com
• Pacemakers • Varicose veins • Autoimmune hepatitis CNS lymphoma, cryptococcosis, PML
• Cardiac enzymes • Lower leg ulcers • Non-alcoholic fatty liver disease • Glasgow Coma Scale (GCS)
05 OPHTHALMOLOGY
• Ankle-brachial pressure index (ABPI) • CSF interpretation table
01.04 03.04
05.01 Blindness
• Electrocardiogram (ECG) • Paracetamol overdose 04.06 Epilepsy / seizures
• Retinal detachment
• Arrhythmias, including Wolff-Parkinson- 02 RESPIRATORY • Disorders of the pancreas • Seizures, incl status epilepticus
• Retinal artery & vein occlusion
White syndrome, Wellens syndrome, - Acute & chronic pancreatitis • Psychogenic non-epileptic seizures
• Retinal migraine
junctional escape rhythm 02.01 - Pancreatic cancer • Anticonvulsants / antiepileptics
• Giant cell arteritis • Optic neuritis
• Asthma • COPD - Neuroendocrine tumours
• Papilloedema
01.05 • Small bowel bacterial overgrowth 04.07
• Vitreous haemorrhage
• Long QT syndrome 02.02 syndrome • Syncope
• DDx – loss of colour vision
• Short QT syndrome • Pneumonia – CAP + HAP • Brain tumours
• DDx – blurred vision
• Brugada syndrome - In immunocompromised patients 03.05 • IBD – Crohn's & UC • Brain lesions localisation (smx)
• Atrial flutter - Lung abscess / empyema • Coeliac disease 05.02 Red eye
• Shock (÷ different types) • Aspiration pneumonia 04.08 Strokes
• Glaucoma – closed-angle
• Acute bronchitis 03.06 • TIA & ischaemic stroke
• Anterior uveitis
01.06 • Appendicitis - Classifications by arteries, smx
• Episcleritis & scleritis
• Valve disorders – mitral stenosis, mitral 02.03 • Small & large bowel obstructions • Haemorrhagic stroke • Keratitis
regurg, aortic stenosis, aortic regurg • Tuberculosis • Cystic fibrosis • Hernias
• Common meds in ophthalmology
• Murmurs (DDx) • Sarcoidosis 04.09 Brain bleeds
• Conjunctivitis (on 05.03)
• Rheumatic fever • Alpha-1 antitrypsin deficiency 03.07 • Subarachnoid haemorrhage
• Prosthetic heart valves • Anal fissures & fistulae, haemorrhoids • Subdural & extradural haemorrhage
05.03 External eye problems
• Jugular venous pressure (JVP) 02.04 • Colorectal cancer • Cerebral aneurysm
• Blepharitis • Blepharospasm
• Pulses (different types, eg pulsus • Lung cancers • Pancoast tumour
v10.3 – last updated Sep 2025
• Ectropion & entropion
paradoxus) • Mesothelioma 03.08 04.10 Weakness DDx
• Pingucela • Hordeolum / stye
• Heart sounds • Bronchiectasis • GORD, gastritis, peptic ulcer disease
• Ophthalmic shingles
• Idiopathic pulmonary fibrosis • Oesophageal conditions 04.11 Neuroinflammatory disorders
01.07 • ERCP, TIPS • Multiple sclerosis
05.04 Age-related conditions
• Hypertrophic obstructive 02.05 • Guillain Barre syndrome • Glaucoma – open-angle
cardiomyopathy (HoCM / HCM) • Pneumothorax •Pleural effusion 03.09 – Upper & lower GI bleeding • Chronic inflammatory demyelinating
• Age-related macular degeneration
• Arrhythmogenic right ventricular • Acute respiratory distress syndrome (poly)neuropathy
• Cataracts
cardiomyopathy (ARVC) • Oxygen delivery • Chest drains 03.10 • Myasthenia gravis
• Diabetic neuropathy
• Dilated cardiomyopathy • Irritable bowel syndrome (IBS)
• Orbital & periorbital celluitis
• Chronic heart failure 02.06 • Diverticular disease 04.12
• Obstructive sleep apnoea • Ischaemic bowel disease • CT head – indications
05.05 • Thyroid eye disease
• Smoking cession • Abdominal pain DDx • Head injury
• Strabismus / squints
• Respiratory failure • Intracranial pressure – ↑ &↓
• Pupil problems
3a – Primer on anaesthetics
• Tropical eye diseases
• General anaesthesia & airway adjuncts
• Regiona/local anaesthesia
• Post-op nausea & vomiting
, Acute coronary syndrome D: spectrum of acute myocardial R: • Unmodifiable: ↑age, males, FHx Hypertension Diagnosing hypertension
ischaemia or infarction • Modifiable: smoking, DM, HTN, see further note below • If clinic BP ≥140/90, measure
hypercholesterolaemia, obesity again after 5 min, measure on
Stage 1 HTN Stage 2 HTN Stage 3 HTN
STEMI: ECG+ve [ST- NSTEMI: ECG inconclusive Unstable angina: normal both arms, and check cuff
Clinic BP ≥140/90 Clinic BP ≥160/100 Clinic BP ≥180/120
elevation], trops+ve [normal or other ∆], trops+ve ECG, normal trops P: • Atherosclerosis in coronary vessels placement
ABPM ≥135/85 ABPM ≥150/95 = severe HTN
2/2 endothelial dysfunction (smoking, • Use ambulatory BP monitoring
HTN, hyperglycaemia) Treat (ABPM) to Dx (clinic BP - ?white
STEMI criteria – ECG features in ≥2 contiguous leads coat syndrome)
• Plaque formation causes physical Treat if
• ≥ 2.5 mm ST elevation in V2-3 in men ≤40yo, or ≥ 2.0 mm in men >40yo blockage → ↓blood flow to <80yo AND • target organ damage heart, brain, • Alternatively, home BP
• ≥ 1.5 mm ST elevation in V2-3 in women myocardium → ischaemia & angina • established CVD, AKI/CKD, T2DM kidneys, eyes monitoring – 2 readings in the
• ≥ 1 mm ST elevation in other leads • new LBBB (always pathological) • 10y cardiovascular risk ≥10% morning, 2 at night, for 4-7d
• Plaque rupture may cause complete
occlusion → myocardial infarction
S/Smx: angina at rest (>20 min) not relieved by GTN. Gripping/heavy pain, a/w without T2DM Hypertensive retinopathy
nausea, sweating, dyspnea, palpitations, etc ECG cardiac territories • Grade I: barely detectable arterial
+T2DM <55yo, ≥55yo Black narrowing
I aVR V1 V4 not black • II: obvious narrowing + focal
© quackquackmed.com
Ix: ECG, ABG, bloods (trops [baseline ± repeat], FBC, lipids, HbA1c, U&E, LFT, irregularities
Lateral Anterior/
TFT), CXR, echo (before discharge), blood glucose 1. ACEI / ARB CCB • III: flame haemorrhages, dot and blot
= LCir septal = LAD
haemorrhages, hard and soft
All: Aspirin 300 mg, O2 if sats <94%, paracetamol 1g PO/IV [morphine if severe + CCB or thiazide-like + ACEI or ARB [if black] exudates, cotton wool spots
II aVL V2 V5 2. • IV: papilloedema
Mx pain only], GTN 1 spray (caution hypotension), ± ondansetron 4 mg IV
Inferior Lateral Lateral
3. all classes (ACEI/ARB + CCB + thiazide) Target BP <80yo ≥80yo
= RCA
PCI possible within 2h no Fibrinolysis
HTN (± T2DM) <140/90 <150/90
STEMI: • Prasugrel • Alteplase etc III aVF V3 V6 4. + spironolactone if K ≤4.5 mmol/L
- tica/clopi if pt is high risk bleeding + antithrombin or + alpha/beta-blocker if K >4.5mmol/L T1DM ACR <70 <140/90 <150/90
(1) <12h of smx Lateral
AND - clopidogrel if pt is on PO anticoag • Ticagrelor after ACR ≥70 <130/80 <150/90
(2) is PCI possible • Obtain radial access • If no ECG resolution V1-6, aVL = Proximal LAD
CKD ACR <70 <140/90
• UFH + bailout GPIIb/IIIa inhibitor after 60-90 min, cor D: persistently raised BP
within 2h? ACR ≥70 <130/80
• PCI: Drug eluting stent angio ± PCI Posterior STEMI:
• Reciprocal V1-3 changes: ST depression; tall, R: obesity, metabolic syndrome,
BP ≥180/120
If pt presents >12h but has ongoing smx of STEMI or has cardiogenic shock, broad R waves; upright T waves ↓exercise, ↑alcohol, DM, black ancestry, • Only requires A&E referral (for specialist Ax) if
consider sending for PCI anyway • Confirmed by ST elevation and Q waves in >60yo, FHx (HTN, CKD), sleep apnoea
posterior leads (V7-9) - Grade III/IV retinopathy (see above)
If unstable: PCI immediately (see STEMI PCI) - Life-threatening smx, eg new onset confusion, chest
NSTEMI Low risk (≤3% 6mo mortality): fondaparinux & ticagrelor Aetiology: pain, s/smx of HF or AKI (eg oliguria)
Inferior MIs are associated with AV block
(1) GRACE Int/high risk (>3%) but stable: Aim PCI within 72h • Essential HTN - no specific cause - Suspicion of phaeochromocytoma (eg if a/w
≤3% or >3%? • Give fondaparinux, prasugrel/ticagrelor, and UFH when • Secondary HTN headache, palpitations, sweating, etc)
DDx:
in cath lab. Use drug-eluting stent. - Primary hyperaldosteronism • Can be Mx & Ix in community otherwise
• Global T wave inversion: think non-cardiac
- Renal disease, eg glomerulonephritis, Hypertensive urgency/emergency
GRACE score predicts all-cause mortality 6mo after discharge for ACS cause
renal artery stenosis • = Elevated BP a/w new/progressive target organ
• Pericarditis: global ST elevation
Unstable angina & 2' prevention: Other Mx - Endocrine disorders, eg Cushing's, dysfunction
• PE: sinus tachy (most common), S1Q3T3
• Cardiac rehab + "6As" • MI a/w cocaine use: as per ACS phaeochromocytoma, acromegaly • Mx is often guided by local guidelines, depends on
• ACEI indefinitely, eg ramipril + give IV benzos, avoid βB - Drugs, eg steroids, COCP the end organ that is affected and how high the BP is
• Aspirin 75 mg OD indefinitely • Diet: Mediterranean style diet. Complications "DREAD": death, rupture - Others: pregnancy, coarctation of the • Examples of agents used
• Another antiplatelet, eg clopidogrel, No rec for omega-3, fish, or other of myocardium, edema, arrhythmia and aorta - Labetalol infusion, eg 0.5 mg/min
for up to 12mo specific dietary supplements aneurysms, Dressler's syndrome - Nicardipine, fenoldopam, etc
• Beta-blocker, eg atenolol • Exercise: 20-30 min daily Ix – to look for evidence of target organ • Treat under specialist supervision
Post-MI ACS risk stratification – Killip classes
- Indefinitely if reduced LVEF • Sex: ok to resume in 4w. damage ± causes of secondary HTN
I: no clinical signs of HF 6% • Urinary albumin-to-creatinine (uACR)
- Otherwise continue at least 12mo, • PDE-5 inhibs (eg sildenafil) can II: lung crackles + S3 17% P: uncontrolled HTN is a significant risk
re-evaluate be used 3-6mo after MI. • Urinalysis: protein & haematuria
III: frank pulmonary edema 38% factor for development of cardiac (IHD, HF),
• Statin indefinitely, eg atorvastatin - CI if pt on nitrates or nicorandil. • U&Es & eGFR • Lipid panel & HbA1c
IV: cardiogenic shock 81% 30d mortality vascular, kidney (CKD) and cerebrovascular
• Aldosterone antagonist, eg - CI if pt is having unstable • ECG
(TIA/stroke), retinal disease.
eplerenone angina or angina occurring P: ~10% morbidity. ↑ risk for future • If 2ndary cause suspected: TSH, renin,
- If HFrEF on echo, indefinitely during sex events aldosterone, phaeochromocytoma
- Start 3-14d after MI, preferrably screen Antihypertensives on 01.09
after ACEI
Mean arterial pressure = average arterial pressure throughout systole & diastole
MAP = DBP + 1/3(SBP - DBP)
01.01 Cardiology – Acute coronary syndrome, Hypertension last updated 02/09/2025
