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.
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
| Factor | Points |
|---|---|
| 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 Class | IV = 59; III = 39; II = 20; I = 0 |
| Cardiac arrest | Yes = 39; No = 0 |
| ST deviation | Yes = 28; No = 0 |
| Elevated biomarkers | Yes = 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
Aspirin + Ticagrelor
ASA 75–100 mg OD + Ticagrelor 90 mg BD
Preferred in ACS — superior to Clopidogrel. Avoid if prior haemorrhagic stroke.
Aspirin + Prasugrel
ASA 75–100 mg OD + Prasugrel 10 mg OD
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
Alternative if Ticagrelor/Prasugrel not tolerated or in UA.
| Drug | Dose | Indication |
|---|---|---|
| Aspirin | 75–100 mg OD indefinitely | All post-ACS patients |
| P2Y12 inhibitor | As above — 12 months post-ACS | All post-ACS (dual antiplatelet) |
| Beta-blocker | Metoprolol 25–200 mg BD or Carvedilol 6.25–25 mg BD | All post-MI — reduce mortality 25% |
| ACE inhibitor/ARB | Ramipril 2.5–10 mg OD or Perindopril 4–8 mg OD | All post-MI, especially EF <40%, HF, diabetes, HTN |
| High-intensity statin | Atorvastatin 40–80 mg OD or Rosuvastatin 20–40 mg OD | All post-ACS regardless of baseline LDL — target <1.4 mmol/L |
| Eplerenone/Spironolactone | Eplerenone 25–50 mg OD | Post-MI with EF <40% and HF or diabetes (if no hyperK/renal failure) |
| SGLT2 inhibitor | Empagliflozin 10 mg OD or Dapagliflozin 10 mg OD | Post-MI with HF/diabetes — reduces CV death & HHF |
From the Blog
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.