Cardiology

Question 1

First line therapy for heart failure (with reduced LVEF)

Answer 1

ACE inhibitor + beta-blocker
Start one drug at a time

Question 2

Second-line therapy for heart failure

Answer 2

Aldosterone antagonists e.g. spironolactone + eplerenone
Initiated if symptoms not controlled with ACEi and beta-blocker

Question 3

Ejection fraction considered to be heart failure with reduced ejection fraction

Answer 3

<50%

Question 4

What causes heart failure with preserved ejection fraction

Answer 4

Diastolic dysfunction - impaired left ventricular filling during diastole

Question 5

NYHA Class I for heart failure

Answer 5

No limitation on activity

Question 6

NYHA Class II for heart failure

Answer 6

Comfortable at rest but symptomatic with ordinary activities

Question 7

NYHA Class III for heart failure

Answer 7

Comfortable at rest but symptomatic with any activity

Question 8

NYHA Class IV for heart failure

Answer 8

Symptomatic at rest

Question 9

Referral criteria for NT-proBNP result

Answer 9

400-2000 –> seen and have echo within 6 weeks
>2000 –> within 2 weeks

Question 10

In which patients are ACE inhibitors avoided in heart failure

Answer 10

Patients with valvular heart disease until initiated by a specialist

Question 11

What blood test is especially important to monitor in people with HF?

Answer 11

U+Es esp. potassium as both ACEi and aldosterone antagonists increase potassium

Question 12

Class of diabetes medication useful in heart failure

Answer 12

SGLT2 inhibitors e.g. dapaglifozin

Question 13

Soft 1st heart sound

Answer 13

Long PR interval
Mitral regurgitation

Question 14

Loud 1st heart sound

Answer 14

Mitral stenosis

Question 15

Soft 2nd heart sound

Answer 15

Aortic stenosis

Question 16

What causes 3rd heart sound

Answer 16

Diastolic filling of the ventricle

Question 16

Split 2nd heart sound

Answer 16

Normal if during inspiration

Question 16

When is 3rd heart sound normal

Answer 16

If <30 years old
May persist in women up to 50 years old

Question 17

Abnormalities associated with 3rd heart sound

Answer 17

Left ventricular failure e.g. dilated cardiomyopathy
Constrictive pericarditis
Mitral regurgitation

Question 18

What causes 4th heart sound

Answer 18

Atrial contraction against a stiff ventricle - coincides with P wave on ECG

Question 19

Abnormalities associated with 4th heart sound

Answer 19

Aortic stenosis
Hypertrophic obstructive cardiomyopathy - may also have a double apical impulse
Hypertension