Cardiology

ACS

• ECG within 10 minutes for chest pain.
• STEMI: reperfusion now.
• NSTEMI/UA: antiplatelet therapy, anticoagulation, statin, beta blocker if appropriate, risk stratification.
• Avoid nitroglycerin with recent PDE-5 inhibitor use, severe hypotension, or suspected RV infarct.

Heart Failure

• Acute pulmonary edema: oxygen, nitrates if hypertensive, loop diuretic, noninvasive ventilation if needed.
• Chronic HFrEF mortality benefit: ACE/ARB/ARNI, evidence beta blocker, MRA, SGLT2 inhibitor as appropriate.
• Avoid non-dihydropyridine calcium channel blockers in HFrEF.

Atrial Fibrillation

• Unstable: synchronized cardioversion.
• Stable: rate control, anticoagulation decision using stroke risk, evaluate triggers.
• New AF with WPW: avoid AV nodal blockers; consider procainamide or cardioversion.