Cardiovascular

Question 1

What are the symptoms of stroke?

Answer 1

FAST
- Face
- arm
- speed
- time to call 99

Question 2

Initial treatment of TIA

Answer 2

Aspirin 300mg immediately
- + PPI if dyspepsic
- clopidogrel 75mg used if hypersensitive/ intolerant to aspirin

Once daily until diagnosis is confirmed

Avoid if they If they have a bleeding disorder or are already taking anticoag

Question 3

Treatment of TIA following a confirmed diagnosis

Answer 3

Secondary prevention
- statin
-

Question 4

Initial management of ischaemic stroke

Answer 4

Alteplase if presenting within 4.5 hours

Within 24 hours of symptom onset- Aspirin 300mg or Clopidogrel 75mg OD

Question 5

Long-term management of TIA and Ischaemic stroke NOT ASSOCIATED with AF

Answer 5

Anti-platelets
- clopidogrel 75mg (OD)
- If CI, Dipyridamole 200mg (BD) + aspirin 75mg (OD)
- If clopidogrel and aspirin both CI, Dipyridamole alone
- if Dipyridamole and clopidogrel both CI, aspirin alone

HIGH INTENSITY STATIN
BLOOD PRESSURE
LIFESTYLE

Question 6

When should a statin be initiated following a TIA/ Icheamic stroke?

Answer 6

48 HOURS after

Question 7

Long-term management of TIA and Ischaemic stroke ASSOCIATED with AF

Answer 7

DOAC or warfarin

Question 8

Initial management of intra-cerebral haemorrhage stroke

Answer 8

Surgery- may be required to remove the haematoma and to lower intracranial pressure

Long term: manage blood pressure

Avoid STATINS

Question 9

High intensity statins

Answer 9

Atorvastatin 20, 40 and 80mg
Simvastatin 80mg
Rosuvastatin 10, 20 and 40mg

Question 10

MHRA warning with simvastatin

Answer 10

Increased risk of myopathy with 80mg simvastatin

Question 11

DOAC contraindicated with eGFR below 30ml/min

Answer 11

dabigatran
- Other DOACs such as apixaban, rivaroxaban, and edoxaban may still be used with dose adjustments and caution, while warfarin remains a safe and effective option in severe renal impairment as it is not renally excreted