Cardiology Flashcards
(36 cards)
What is the main management plan in hypertension?
- A or C
- A + C
- A + C + D
- A + C + D + additional diuretic or B-blocker or A-blocker
What tool do you use in assessing risk of Stroke?
ABCDE2 tool:
- Age >60
- Blood Pressure >140 systolic
- Clinical Features > unilateral weakness, speech impairment without weakness
- Duration >60mins, 10-59mins
- Diabetes
> 4 = HIGH RISK
What is the difference between preload and afterload?
- Preload = Blood pressure acting on the ventricular wall prior to contraction/end of diastole
- Afterload = Pressure on the ventricular wall during contraction/systole
What is the most common cause of HF?
MI - most common location of MI is LAD = Left sided heart failure more common
What classification system is used in HF?
New York Heart Association functional classification of heart failure
What should be reviewed in HF?
- Functional capacity
- Fluid status
- Cardiac rhythm
- Cognitive status
- Nutritional status
What is the 3rd line treatment for HF
- Digoxin if worsening or very severe + Ivabradine
- Pace-maker if serious ventricular arrhythmia
- Cardiac resynchronisation therapy (CRT) with defibrillator or with pacing if LV ejection fraction <35%
What is the 2nd line treatment for HF?
- aldosterone antagonist if NYHA is mod-severe or if they have had MI in past month OR
- ARB if mild-mod OR
- Hydralazine + nitrate esp in Afro-Caribbean/mod-severe
In HF, what can you prescribe if the patient is intolerant to both ACEi and ARB?
Hydralazine + nitrate
When are ACEi contraindicated in heart failure?
Valvular disease - Prescribe ARB
What is the first line treatment for LVSD?
- Low dose ACEi and titrate up every 2 weeks monitoring renal function
- B-Blockers: start low, titrate up slowly and re-assess HR/BP/clinical status following every change. Chance B-blockers for co-morbidities to those suitable for HF –> bisoprolol
How would you manage PEF HF
- Treat co-morbidities - HTN, CHD, DM II
- Give lowest dose furosemide
What is the main blood investigation for diagnosing HF?
Natriuretic peptide - BNP
If high, refer for echocardiogram
What are the 2 main types of HF?
- Left ventricular systolic Dysfunction
- Preserved Ejection Fraction
What are 3 causes of diastolic HF?
- Constrictive pericarditis
- Tamponade
- HTN
What are 3 causes of systolic HF?
- IHD
- MI
- Cariomyopathy
What are the symptoms of right-sided heart failure?
- Peripheral oedema, ascites
- Facial engorgement, JVP, epistaxis
- Abnormal heart sounds, heaving heart
What are the main symptoms of left-sided heart failure?
- Nocturnal cough with pink frothy sputum
- Dyspnoa
- Paroxysmal nocturnal Dyspnoea
- Nocturia, cold peripheries, weight loss
Before starting a statin, what should be measured in the blood?
ALT
After changes in lifestyle, what is the first therapy recommended for coronary heart disease?
- 20mg atorvastatin
What contra-indicates the starting of a statin?
- Pregnancy
- Erythromycin
List 5 conditions that increase the risk of coronary heart disease
- Hypothyroidism
- Nephrotic syndrome
- Dyslipidaemia
- Uncontrolled DM
- Liver disease
What level of cholesterol is deemed as familial hypercholesterolaemia?
> 7.5mmol
What assessment is essential in a patient who has suffered a stroke or TIA?
SALT
Swallowing assessment
