CVASC6 Flashcards

Question

Whats the starting dose of ACE in heart failure with reduced ejection fraction

Answer 1

TWICE DAILY 2.5 ramipril Ramipril 2.5mg bd orally (Max of 5 bd)

Answer 2

ACE BD Diuretics Then when euvolaemic - stop the diuretic and commence beta blocker

Answer 3

ACE 1st bd then BBlocker

Answer 4

Cease the loop for 24 hours (to avoid hypotension) then add BD aceI

Answer 5

NO Can cause **angioedema** if used within 36 hours of eachother

Answer 6

Cardioselective ones Metoprolol succinate, carvedilol, bisoprolol Use Metoprolol Succinate 23.75 daily

Answer 7

Worsen HF initially Hypotension Bradyarrhythmia Attenuate these by: Not starting during an acute decompensation, wait till they are euvolaemic Low dose, go slow, Monitor ADR and interactions with other drugs

Answer 8

In congestion Not alone! Frusemide 20 - 40mg mane

Answer 9

In Mild HF its ok IF patient develops NEW HFrEF and they are taking a fixed dose of ACE plus HCT or indamide ---\> Replace the thiazide with Loop and represcribe the ace on its own

Answer 10

Recommended in HFrEF - can be added to ACE and BB if patients are still in NHYA 2 (symptomatic) Epleronone 25mg orally daily or Spironolactone 25mg orally daily BUT Contraindicated if **EGFR less than 30** OR if **K is over 5.5** _NOTE That Adding aldosterone antagonist to an ACE or ARB in renal impairment can cause life threatening hyperkalaemia_ Once you start - ***_check UEC (K and GFR) in a week, then a month then six monthly_***

Answer 11

**Angiotensin Receptor Neprolysin Inhibitor** _If HFrEF symptomatic despite ACE and BB_ _then consider changing the ACE to an ARNI_ **WAIT 36 hours before changing** as you can cause angioedema from the interaction of the two. WATCH for _hypotension, hyperkalaemia and renal impairment_ **SACABUTRIL AND VALSARTAN 49 + 51 mg twice daily**

Answer 12

1. For HF AND AF - to control rapid ventricular rate 2. For patients who are on max therapy and STILL have congestion - so ACE, BB, LOOP, Aldosterone Antagonist and congestion Start at 62.5 micrograms orally daily **MONITOR Dig concentration in patients with High dose, renal impairment or Elderly** normal half life is 24 hrs - in renal impairment can be lot longer - and therefore cause toxicity.

Answer 13

Hydrazaline 50mg TDS PLUS isosorbide dinitrate 20mg TDS can be trialled for ppl who have congesetion despite maximal treatment with diuretics, ace, and beta

Answer 14

Its a Specific Sinus Node Inhibitor SO you can use it if **Resting heart rate** is elevated over **70** and the patient **doesnt have:** unstalbe angina, severe hepatic disease, unstable HF, hypotension (below 90/50) or not in sinus

Answer 15

Bring down Resting heart rate - when over 70 in patient with HFrEF - **HFrEF, NHYA 2 or 3, stable HF (not acute hf), in sinus rhythm, HR over 70, BP over 90/50, not with severe liver impairment, on maximum BBlocker, and no unstable angina**

Answer 16

ACE/ARB - **Reduce symtoms, hospitalisation, mortality** Ivabradine (through its effect on heart rate) - **Reduces hospitalisation and mortality** BBlocker - **reduces hospitalisation and mortality** _ACE prevents **HIGH risk patients** developing HF_ _BBlocker prevents post **MI patients** developing HF_ **ACE, ARNI, BB, AA**, - _improve outcomes in HFrEF_ patients

Answer 17

Death and hosptiatlisation

Answer 18

This is diastolic failure and drug therapy has not been proved to improve outcomes. Mainly elderly females with HT, DM, IHD - **mainstay of treatment is CCB** (mainly diltiazem and verapamil) (Careful that they're stable - due to negative ionotropic, decompensatory effect!) - Can also add a **Betablocker**

Answer 19

PRIMARY PREVENTION FOR: * _One month after AMI with an EF less than 30_ * _HFrEF associated with IHD with EF less than 35%_ SECONDARY PREVENTION in: After **cardiac arrest**; **sustained VT** with haemodynamic compromise, and **VT with syncope** and EF less than 40

Answer 20

Symptomatic HF with **EF less than 35 AND broad complex QRS/LBBB** Reduces mortality

Answer 21

Intractable, severe HF despite medical and pacemaker therapy. AND no major comorbidities

Answer 22

Must be a response to treatment Minimal symptoms associated with driving CONDITIONAL license with review

Answer 23

Minimal symptoms related to driving, Satisfactory response to treatment AND **LVEF over 40** **adequate exercise tolerance** **Had underlying cause considered**

Answer 24

FH is a hereditary condition affecting one in 250 patients (50% of first-degree relatives).

Answer 25

No The cholesterol burden present from birth accelerates the onset of CVD. Diet and lifestyle modifications alone are not sufficient for management.

Answer 26

**Ask** – enquire about and document the smoking status of all patients. **Assess** – evaluate nicotine dependence and assess and address barriers to quitting. **Advise** – counsel all patients who smoke to quit in a way that is clear but not confrontational. **Assist** – offer assistance in quitting, agree on a quit plan and recommend pharmacotherapy if the patient is nicotine dependent. If the patient is not willing to quit, use a motivational approach, explore barriers and review at future visits. **Arrange** – for patients making a quit attempt, arrange follow-up contact starting within a week of the quit day. At these visits, congratulate and encourage the patient, review progress and problems, encourage continued use of pharmacotherapy, and monitor and manage any medication side effects.

Answer 27

Specific Determine what will be done (type), how often (frequency), how hard (intensity) and for how long (time)? It is also important to identify at this level the ‘why’. For example, ‘To have more energy to play with my sons, I want to increase my number of steps (type) each day (frequency), including some brisk walks and some stairs (intensity), by 10% each week (time)’. Measurable Aim to quantify a physical activity goal. This can be measured in minutes per day, frequency of specific activity (eg use the stairs at least five times at work) or number of steps. Technology can be useful to collate activity. Watches can count steps, heart rate or both, and some free health apps available on smartphones can count steps. Achievable Start with a manageable amount of activity. This will vary from person to person depending on their fitness, perceived readiness to change, opportunity to accumulate non-exercise activity, and personal values. It is better to start with an achievable goal to build confidence and self-efficacy and work to extend this over time. Relevant Ensure the activity goal is relevant to the desired clinical outcome, evidence based for the specific presentation and relevant to the individual’s values and motivators. Time-based Incorporate a time-based factor. This might be based on working towards a particular goal over time, such as adding five minutes or 200 steps each few days, or might be how long to sustain a certain activity behaviour until checking in and reviewing, for example, ‘Let’s see if you can increase your step count and number of flights of stairs by 10% each week for the next four weeks and we can revisit at that point’.

Answer 28

keep their heart rates at least 15 beats below (usually 165 beats per minute) the rate at which the device is programmed, to provide an intervention (usually 180 beats per minute or higher) avoid contact sports do moderate physical activity only, which would preclude most competitive sports (exceptions include cricket and golf).

Answer 29

92% Routine use of oxygen is no longer recommended unless oxygen saturations are measured at \<93% (\<88–92% in chronic obstructive airways disease).

Answer 30

cardiac: acute myocardial infarction coronary artery spasm (eg due to cocaine or methamphetamine use) Takotsubo cardiomyopathy coronary vasculitis (eg systemic lupus erythematosus, Kawasaki disease) acute or chronic heart failure tachyarrhythmia or bradyarrhythmia frequent defibrillator shocks cardiac contusion or surgery rhabdomyolysis with cardiac involvement myocarditis or infiltrative diseases (eg amyloidosis, sarcoidosis, haemochromatosis) cardiac allograft rejection hypertrophic cardiomyopathy non-cardiac: cardiotoxic agents (eg anthracyclines, trastuzumab, carbon monoxide poisoning) aortic dissection or severe aortic valve disease severe hypotension or hypertension (eg haemorrhagic shock, hypertensive emergency) severe pulmonary embolism, pulmonary hypertension or respiratory failure dialysis-dependent renal failure severe burns affecting \>30% of the body surface severe acute neurological conditions (eg stroke, cerebral bleeding or trauma) sepsis prolonged exercise or extreme exertion.

Answer 31

male patients \>65 years with history of smoking patients \>65 years with a primary relative with a history of AAA adult patients with a personal history or primary relative with a history of Marfan, Loeys-Dietz or similar syndromes patients with known popliteal or thoracic aortic aneurysm.

Answer 32

AAA diameter treatment threshold is usually considered to be 5.0 cm in women and 5.5 cm in men.

Answer 33

Standard care following detection of AAA includes: optimising cardiovascular and medical risk factors referral to a vascular surgeon for counselling, surveillance management, treatment planning and complex aneurysm decision making current discrepancy in surveillance intervals suggest continuing with the 2010 European Society for Vascular Surgery guidelines for now screening for synchronous TAA or popliteal artery aneurysm, suggest familial screening expediting surgical review if there is: unexplained abdominal pain/tenderness rapid expansion (generally defined as \>1 cm/year) a diameter close to treatment threshold (5.0 cm in women, 5.5 cm in men).

Answer 34

Female patients tend to have more aggressive aneurysmal growth, poor outcome from rupture, and rupture earlier than men.

Answer 35

There is no strong, clinically viable human evidence that pharmacotherapy can slow or stop aneurysmal degeneration. Medical management can serve to improve cardiovascular outcomes and ensure optimisation prior to surgical intervention.

CVASC6 Flashcards

(61 cards)