Acc cardiac conditions

Question 1

Htn treatment in > 55 y/o or of black afro carribean decent

Answer 1

> 55 years old or black

1. ca chanel blocker
2. calcium chanel and ARB (losartan)
3. ARB + calcium channel blocker + thiazide
4. ARB + calcium channel and thiazide + spironelactone
5. ARB + calcium channel +thiazide + spironelctone/beta blocker

Question 2

Medications that cause HTN (CELESS)

Answer 2

c - cyclosporin 
e-estrogen 
L- liquorice
E- epo 
S- steroids 
S- sympathomimetics

Question 3

Stages of HTN and treatment

Answer 3

STAGE 1 - 140/90 HBPM > 135/85 -meds if >85 y/o, kidney disease, diabetes, CVD, end organ damage
STAGE 2 - > 160-100 HMBP >150/95- meds
STAGE 3 - >180/ 100 -meds

Question 4

What are the bp targets after treatment?

Answer 4

bp targets <80 y/o 140/90 or 135/85 abpm

> 80 y/o 150/90 or 145/85

Question 5

How to counsel for ace inhibitors?

Answer 5

e. g ramipril
1. take first dose before bed
2. cough is a se
3. impotence
3. blood test at 2 weeks - U&E- check renal a.stenosis
4. follow up bp

Question 6

Htn treatment if < 55 y/o

Answer 6

1. ace inhibitor
2. ace inhibitor + calcium channel blocker
3. ace inhibitor +calcium channel blocker + thiazide
4. ace inhibitor + calcium channel blocker + thiazide + spironelactone
5. ace inhibitor + calcium channel blocker + thiazide _ spironelactone/betablocker

Question 7

Lifestyle management of HTN

examination of HTN

Answer 7

Sodium restriction
weight loss
smoking
alcohol

QRISK- Rx > 20%
BMI
cardiac exam
fundoscopy

Question 8

Differentiate between NSTEMI, STEMI and unstable angina

Answer 8

unstable - prolonged angina at rest

NSTEMI - inc troponin and ischaemic symptoms or ECG changes

STEMI - increased troponin and stemi on ecg

Question 9

Causes of raised troponin (HEART DIES)

Answer 9

heart failure, embolus, atrial fibrilation, renal failure, thrombus, dissection of aorta, inlflammation, excersize, sepsis

Question 10

Investigations in all mi

Answer 10

1. ECG
2. TROPONIN - peaks 12-24
3. LIPIDS- cholesterol dips 24 hrs post mi

Question 11

Initial MI Treatment

Answer 11

Antiplatelet therapy
analgesia
oxygen

Question 12

Initial treatment STEMII

Answer 12

Reperfuse and anticoagulant (LMWH)

If less than 12 hrs since onset within 2hrs of thrombolysis do PCI

If less than 12 hrs since onset and PCI not available within 2 hrs - thrombolysis with ALTEPLASE

Question 13

Initial treament NSTEACS

Answer 13

Anticoagulation and/or angiography and/or reperfusion for 4 days