Cardiology

Question 1

Recent Chest pain red flag Qs

Answer 1

Chest pain at rest
Chest pain now or within the last 72 hours

Question 2

Heart Failure Ix

Answer 2

Bloods inc BNP
2WW Echo - HF + BNP >400
6ww Echo - HF + BNF >100

Question 3

Heart Failure lifestyle advice

Answer 3

Smoking - stop
Alcohol - reduce
Salt - reduce
Cardiac rehab
Annual flu and pneumococcal vaccine

Question 4

Heart failure HFrEF Mx

Answer 4

ACEi (or ARB)
B Blocker
Spironolactone (if NYHA III/ IV)
Aspirin - if vascular disease
DIuretics - symptom releief

Question 5

Atrial fibrillation Ix

Answer 5

ECG
24 hr ECG monitoring
Bloods - FBC, TFT, UE
Echo - if suspected structural disease

Question 6

Atrial fibrillation Mx

Answer 6

Rate control
- B Blocker (bisoprolol)
- CCB (diltiazem)
- Digoxin - sedentary lifestyle

Question 7

HTN Mx (stage 1)

Answer 7

Stage 1: BP >140/90 or ABP > 135/85
- Treat if:
Adult <80 years with persistent stage 1 hypertension AND ≥1 of:
target organ damage
established cardiovascular disease
renal disease
estimated 10-year risk CVD ≥10%
Use clinical judgement if frailty or multimorbidity.

Question 8

HTN Mx (stage 2)

Answer 8

BP >160/100 or ABP 150/95
- start treatment

Question 9

HTN Mx (stage 3)

Answer 9

SBP >180 or DBP >110
- treat immediately.
- if papilloma/ retinal haemorrhage/ suspected phaeochromocytoma - need admission

Question 10

HTN Mx

Answer 10

Step 1:
<55/ Diabetic/ CKD - ACEi/ ARB
>55/ Black - CCB

Step 2:
add CCB or ACEi

Step 3:
Thiazide like diuretic - eg Indapamide

Step 4:
K < 4.5 - Spironolactone
K > 4.5 - Alpha blocker/ Beta Blocker

Step 5:
Refer to Cardiology

Question 11

Angina Ix

Answer 11

Rapid access clinic to confirm diagnosis

Question 12

Angina Fx

Answer 12

Typical (3)
Constricting pain
Precipitated by exertion
Relieved by rest

If pain at rest = unstable angina = 999 admission

Question 13

Angina Mx

Answer 13

Rapid access chest pain clinic

GTN spray - symptom relief
Risk factor Mx - Smoking, BP, diabetes, cholesterol, exercise
Secondary prevention - Aspirin 75mg od (unless already on Clopidogrel, then continue this). Atorvastatin 20mg OD. ACEi (if Diabetes, CKD etc)

1st - BBlock (bisoprolol/ atenolol) or CCB (diltiazem/ verapamil)

2nd - Ranolazine, Ivabradine, Nicorandil, long acting CCB

Question 14

CHADSs VASc score (anticoag risk in AF)

Answer 14

Congestive heart failure
Hypertension
Age 65-74 (1)
Diabetes
Stroke/ TIA (2)
Vascular disease
Ages >75 (2)
Sex female

Female >2 = anticoag
Male >1 = coag

Question 15

Orbit score (bleeding risk in AF)

Answer 15

Older age - >75 (1)
Reduced Hb - <130 Male or < 120 Female (2)
Bleeding Hx (2)
Insufficient Kidney function - eGFR <60 (1)
Treatment with antiplatelets (1)

Score:
0-2 = low
2-4 = med
>4 = high