ILA 1 - HF & HTN

Question 1

secondary causes of HTN

Answer 1

glomerulonephritis, polycystic kidneys, Cushing’s, phaeochromocytoma, pregnancy, steroids, OCP

Question 2

Stage 1 HTN

Answer 2

clinic BP greater than 140/90 and ABPM average greater than 135/85

Question 3

Stage 2 HTN

Answer 3

clinic BP greater than 160/100 and ABPM average greater than 150/95

Question 4

Severe HTN

Answer 4

clinic BP greater than 180 over 110

Question 5

Accelerated HTN

Answer 5

severe HTN with visible end organ damage

Question 6

Who to treat for HTN

Answer 6

Any stage 2. Stage 1 if under 80 and have end organ damage, CVD, renal disease, DM, QRisk2 score over 20%

Question 7

QRisk2 score

Answer 7

10 year risk of having a CV event. Incoperates age, sex, smoking, DM, AF, CKD, blood pressure, cholesterol/HDL ratio.

Question 8

Microvascular effects of HTN

Answer 8

retinopathy, nephropathy, neuropathy.

Question 9

Microvascular effects of HTN

Answer 9

Atherosclerosis, stroke, MI, peripheral vascular disease

Question 10

HTN treatment 1st pharmacological step

Answer 10

If under 55 ACE inhibitor e.g. ramipril or angiotensin 2 receptor blocker e.g. losartan. If over 55 or afro-carribean give CCB e.g. nifedipine.

Question 11

Patient group where ACEi won’t work

Answer 11

Those with renal artery stenosis will see BP increase on ACEi

Question 12

HTN 2nd line pharmacological treatment

Answer 12

ACEi + CCB or if afro-cab ARB + CCB

Question 13

HTN 3rd line pharmacological treatment

Answer 13

add thiazide-like diuretic e.g. indapamide

Question 14

4th line HTN pharmacology treatment

Answer 14

potassium sparing diuretic (if baseline K+ levels good), alpha or beta blocker. If poor K+ levels increase thiazide like diuretic dose.

Question 15

Investigations in HTN patient and findings

Answer 15

ECG: left ventricular hypertrophy causing big T waves or post MI. Urinalysis: protein. Echovardiogram: LV hypertrophy. Bloods: U&E, creatinine, fasting glucose, cholesterol.

Question 16

Target BP for HTN patients

Answer 16

less than 140/90 if under 80yrs. Less than 150/90 if over 80yrs. If diabetic less than 130/80.

Question 17

Systolic V diastolic heart failure

Answer 17

systolic = unable for ventricles to maintain cardiac output needed. causes = cardiomyopathy, MI, IHD. diastolic= unable to relax and fill with required volume, have preserved ejection fraction. Causes = constrictive pericarditis, HTN, tamponade.

Question 18

Left V right ventricular heart failure

Answer 18

Left = dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea (ask about pillows and night time sleeping as fluid moves when lying horizontal), cough. Right = peripheral oedema, nausea, raised JVP, hepatomegaly, ascites.

Question 19

CXR of left HF

Answer 19

Alveolar oedema, Kerley B Lines (interstitial oedema), cardiomegaly, dilated prominent upper lobe vessels, pleural effusions.

Question 20

HF causes

Answer 20

CAD with MI history, nephrotic syndrome, alcohol, anaemia (high output), thyroid disease, NSAIDs exacerbate.

Question 21

Criteria for Congestive HF

Answer 21

Framingham Criteria. 2 major or 1major and 2 minor symptoms

Question 22

Major symptoms in Framingham Criteria for HF

Answer 22

Paroxysmal nocturnal dyspnoea, crepitations, cardiomegaly, S3 gallop, increased central venous pressure, weight loss, neck vein distension, acute pulmonary oedema, hepatojugular reflex.

Question 23

Minor symptoms for Framingham Criteria fro HF

Answer 23

bilateral ankle oedema, dyspnoea, tachycardia, decrease VC, nocturnal cough, hepatomegaly, pleural effusion,

Question 24

Investigating/Diagnosis of HF

Answer 24

Natriuretic peptide (BNP or NTproBNP). ECG. Doppler 2D echocardiogram. CXR.

Question 25

Causes of false high BNP

Answer 25

diabetes, COPD, sepsis, under 70years, liver failure.

Question 26

Causes of false low BNP

Answer 26

beta-blockers, aldosterone antagonist, ACEi, diuretics, obesity.

Question 27

Classification of Heart Failure

Answer 27

New York Heart Association Classification of Heart Failure. class 1 to 4 based on limits to physical activity and occurrence of symptoms at rest

Question 28

Life style advice with HF

Answer 28

FLUID BALANCE, increase exercise, decrease salt intake, increase fruit and veg, smoking cessation, reduce alcohol, annual influenza vaccine.

Question 29

Prognosis for HF

Answer 29

50% die within first 5 years of diagnosis. 30-40% die within first year. Worst mortality if obese or under weight, co-morbidities and are smoker.

Question 30

Causes of death in HF patients

Answer 30

VT, systole from fluid overload, MI, hypoxia from pulmonary oedema, stroke.

Question 31

Primary drug management of HF

Answer 31

Loop diuretic e.g. Furosemide to relieve symptoms. Reduce M&M ACEi e.g. ramipril or beta-blocker e.g. carvedilol but do not start both simultaneously. Consider antiplatlet drug e.g. aspirin and statin. CCB e.g. amlodipine

Question 32

Management of severe HF

Answer 32

Aldosterone receptor antagonist e.g. spironolactone. Digoxin for symptoms relief in inactive patients.

Question 33

issues with poly pharmacy

Answer 33

Worse adherence and compliance. More side effects and interaction. less guidance for professionals.

Question 34

Ways to improve compliance

Answer 34

Dosette box, annual review for medication or disease, education.

Question 35

Cardiac tamponade

Answer 35

Fluid in the pericardium