Cardiovascular Medicine

ESC 2023 · ACC/AHA 2022 · NICE 2023

17.9M
Annual CV deaths globally
32%
Of all deaths worldwide
80%
Preventable with lifestyle + treatment
1 in 4
Lifetime risk for CVD events

Cardiovascular Disease — Leading Cause of Global Mortality

CVD kills more people than any other disease. In primary care, GPs are uniquely positioned to identify risk, initiate life-saving treatments, and prevent the first event. Hypertension, smoking, diabetes, and dyslipidaemia drive 80% of preventable CV events.

STEMI: Door-to-Balloon <90 minHFrEF: 4-Pillar TherapyAF: DOACs Over WarfarinVery High Risk LDL <1.4 mmol/L
STEMI — Diagnostic Criteria

Diagnostic Criteria

  • ST elevation ≥1 mm in ≥2 contiguous limb leads
  • ST elevation ≥2 mm in ≥2 contiguous precordial leads
  • New LBBB with typical symptoms
  • Posterior MI: ST depression V1–V3 + tall R

Immediate Management

  • 1Call for PCI centre immediately — door-to-balloon <90 min
  • 2Aspirin 300 mg stat + Ticagrelor 180 mg (or Clopidogrel 600 mg)
  • 3Anticoagulation: UFH 60 U/kg IV bolus (max 4000 U)
  • 4Oxygen only if SpO₂ <90%
  • 5Morphine 2–4 mg IV for refractory pain (use cautiously)
  • 6GTN sublingual if no hypotension (SBP >90)

Thrombolysis

If PCI unavailable within 120 min: Tenecteplase IV (weight-based), then transfer

GRACE Score Risk Stratification (NSTEMI/UA)
FactorPoints
Age≥75 yrs = 75 pts; 65–74 = 39; 45–64 = 26; <45 = 2
Heart Rate≥200 = 46; 150–199 = 37; 110–149 = 23; 90–109 = 12; <90 = 0
Systolic BP<80 = 63; 80–99 = 58; 100–119 = 47; 120–139 = 37; ≥200 = 0
Creatinine≥354 µmol/L = 28; 177–353 = 21; 106–176 = 14; 53–105 = 5; <53 = 1
Killip ClassIV = 59; III = 39; II = 20; I = 0
Cardiac arrestYes = 39; No = 0
ST deviationYes = 28; No = 0
Elevated biomarkersYes = 14; No = 0

Low Risk

Score <109

In-hospital mortality: <1%

Conservative; discharge with outpatient stress test

Intermediate Risk

Score 109–140

In-hospital mortality: 1–3%

Angiography within 72 hours

High Risk

Score >140

In-hospital mortality: >3%

Urgent angiography within 24 hours

Dual Antiplatelet Therapy (DAPT)

Aspirin + Ticagrelor

ASA 75–100 mg OD + Ticagrelor 90 mg BD

12 months post-ACS

Preferred in ACS — superior to Clopidogrel. Avoid if prior haemorrhagic stroke.

Aspirin + Prasugrel

ASA 75–100 mg OD + Prasugrel 10 mg OD

12 months post-ACS

Use after PCI only. Avoid in age ≥75, weight <60 kg, prior stroke/TIA.

Aspirin + Clopidogrel

ASA 75–100 mg OD + Clopidogrel 75 mg OD

12 months post-ACS (min 1 month)

Alternative if Ticagrelor/Prasugrel not tolerated or in UA.

Bleeding risk: Use HAS-BLED score. If high bleeding risk after 3–6 months, consider DAPT de-escalation (drop P2Y12, continue aspirin) after specialist review.
Secondary Prevention Post-ACS (Long-term)
DrugDoseIndication
Aspirin75–100 mg OD indefinitelyAll post-ACS patients
P2Y12 inhibitorAs above — 12 months post-ACSAll post-ACS (dual antiplatelet)
Beta-blockerMetoprolol 25–200 mg BD or Carvedilol 6.25–25 mg BDAll post-MI — reduce mortality 25%
ACE inhibitor/ARBRamipril 2.5–10 mg OD or Perindopril 4–8 mg ODAll post-MI, especially EF <40%, HF, diabetes, HTN
High-intensity statinAtorvastatin 40–80 mg OD or Rosuvastatin 20–40 mg ODAll post-ACS regardless of baseline LDL — target <1.4 mmol/L
Eplerenone/SpironolactoneEplerenone 25–50 mg ODPost-MI with EF <40% and HF or diabetes (if no hyperK/renal failure)
SGLT2 inhibitorEmpagliflozin 10 mg OD or Dapagliflozin 10 mg ODPost-MI with HF/diabetes — reduces CV death & HHF

Hypertension

Full HTN module

ECG Interpretation

Rhythms, STEMI patterns

Drug Database

Full dosing reference

Emergency

ACLS & crash protocols

Based on ESC 2023, ACC/AHA 2022, NICE 2023, and AHA/ACC guidelines. Always individualise management. Refer complex cases to cardiology.