238 HF

Question 1

Which 2 drugs should be prescribed asap following Dx of HF?

Answer 1

ACEI

Beta blocker

Question 2

Which drug should be added into ACEI and beta blockers treatment for HF?

Answer 2

Spirinolactone

Question 3

What should be considered before starting Spirinolactone?

Answer 3

Blood pressure - causes drop

Question 4

At which level of LVEF should ACEI be started in HF?

Answer 4

Moderate LV dysfunction ie LVEF less than 45%

Question 5

What is the main adverse effect of ACEI?

Answer 5

Cough caused by build up of bradykinin

Question 6

Which other enzyme in the RAAs is active even when ACEI are in situ?

Answer 6

Chymase

Question 7

Which ACEI is used in paeds?

Answer 7

Captopril

Question 8

Which ACEI is a non-peptide antagonist?

Answer 8

Captopril

Question 9

Name 2 C/I of ACEI

5 listed

Answer 9

Pregnancy 
Bilateral renal artery stenosis
Severe AS, MS, LVOT
Hx of idiopathic/hereditary agioedema
Creat >220

Question 10

Which 2 drugs are used in HF to relieve symptoms?

Answer 10

Diuretics

Digoxin

Question 11

What type of drug is Candesartan?

Answer 11

Angiotensin 2 receptor blocker

Question 12

Which 2 cardiac drugs can cause gyneacomastia?

Answer 12

Spironolactone

Digoxin

Question 13

What is the alternative to spironolactone and causes less gyneacomastia?

Answer 13

Emplerenone

Question 14

Name 2 C/I of beta blockers

6 listed

Answer 14

Asthma
Cardiac condition defects
Severe HF
Severe peripheral vascular disease
Raynauds
Unopposed pheochromocytoma

Question 15

Which beta blocker is used in pregnancy?

Answer 15

Labetolol

Question 16

Which drug inhibits the I (f) channel to decrease HR in sinus rhythm?

Answer 16

Ivabradine

Question 17

Phosphenes (flashing lights) are a side effect of which drug?

Answer 17

Ivabradine

Question 18

What is the only drugs which have evidence to support treatment in diastolic HF?

Answer 18

Diuretics

Question 19

What does pulmonary venous congestion lead to?

Answer 19

Left ventricular failure

Question 20

What is does systemic venous congestion cause?

Answer 20

Right ventricular failure

Question 21

Name 3 S+S of LHF

Answer 21

Dyspnoea
Orthopnoea
PND

Question 22

Name 3 S+S of RHF

4 listed

Answer 22

Peripheral oedema
Elevated JVP
Hepatomegaly
Ascites

Question 23

Name 4 of the commonest causes of HF

6 listed

Answer 23

IHD
HTN
Valvular heart disease
Cardiomyopathy
Toxic
DM

Question 24

What type of heart failure is caused by:

• COPD
• Pulmonary HTN (PE)
• ASD/VSD
• Chronic valvular heart disease

Answer 24

Right heart failure

Question 25

What is cardiac cachexia?

Answer 25

W/L and anorexia commonly seen in HF

Question 26

What do these signs indicate? - Displaced apex beat - Tachycardia - PSM - Basal inspiratory crackles

Answer 26

Left ventricular failure

Question 27

What is diastolic HF?

Answer 27

- HF with preserved ejection fraction | - Increased LV wall thickness with diastolic dysfunction

Question 28

What type of HF (high output/low output) do the following cause? - Anaemia - Thyrotoxicosis - Liver failure - Septicaemia

Answer 28

High output

Question 29

What is HF-PEF (HF with preserved ejection fraction) associated with? 1. CAD, HTN, DM 2. HTN and AF

Answer 29

2

Question 30

What percentage of people who are hospitalised due to HF are readmitted/dead within 1 year?

Answer 30

40%

Question 31

Name 4 features you would see on a CXR of a pt with HF

Answer 31

- Cardiomegaly - Pulmonary oedema - Pleural effusions - Kerley B lines - Pulmonary venous congestion

Question 32

Which investigation would be useful for a sensitive and specific prediction of CAD than a ETT?

Answer 32

Perfusion scintigraphy

Question 33

Why should alcohol be avoided in HF?

Answer 33

Negatively inotropic | Raises BP and arrythmogenic

Question 34

What is CRT-P

Answer 34

Cardiac resynchronisation therapy - pacemaker. Resynchronises inter and intraventricular contraction

Question 35

What is a CRT-D?

Answer 35

Cardiac resynchronisation therapy - defibrillator

Question 36

Why are opiates useful in the treatment of acute HF?

Answer 36

Useful in pulmonary oedema to relieve anxiety and distress due to dyspnoea

Question 37

Which anti-emetic should be used in conjunction with diamorphine during acute HF?

Answer 37

Metoclopromide - don't use cyclizine as causes vasoconstriction

Question 38

What is nesiritide?

Answer 38

Human BNP - vasodilator to reduce dyspnoea