Cardiology

Question 1

Define malignant hypertension. What are some symptoms?

Answer 1

BP >180/120, associated with signs of retinal haemorrhages and/or papilloedema on fundoscopy.

• Red flag symptoms of malignant HTN:
  
  • Headache
  • Visual disturbances
  • Seizures
  • Nausea & vomiting
  • Chest pain

Question 2

What are blood pressure targets in those under & over 80 years old with hypertension?

Answer 2

• <80 years old → clinic BP < 140/90
• > 80 years old → clinic BP <150/90

Question 3

What medication is given in any patient with diabetes for their hypertension?

Answer 3

ACE inhibitor

Question 4

What are the two main types of HF?

Answer 4

• HF with reduced ejection fraction (HFrEF)
  
  • Weakness of heart muscle, resulting in impaired ventricular emptying.
  • Ejection fraction <50%
• HF with preserved ejection fraction (HFpEF)
  
  • Poor contractility of myocardium, resulting in impaired ventricular filling.
    
    • Ejection fraction >50%
    • Diastolic dysfunction

Question 5

What is the key blood test used in suspected heart failure? What do the results mean?

Answer 5

• N-terminal pro-B-type natriuretic peptide (NT-proBNP)
  
  • Should be measured in all patients presenting with symptoms & clinical signs of HF to inform type & urgency of further investigations
  • <400 ng/L → HF unlikely
  • 400-2000 → refer routinely for specialist assessment & echo within 6 weeks
  • > 2000 → refer urgently for specialist assessment & echo within 2 weeks.

Question 5

What medications are started in someone with Chronic Heart Failure? What is added if symptoms fail to be controlled?

Answer 5

1. Furosemide if fluid overloaded.
2. ACEi + BB
3. Aldosterone antagonist if symptoms are still bothersome (spironolactone, eplerenone)

Question 5

What classification system is used to determine the severity of Chronic Heart Failure?

Answer 5

New York Heart Association’s Classification System:

• Class 1 → no symptoms during ordinary PA
• Class 2 → slight limitation of PA by symptoms
• Class 3 → less than ordinary PA leads to symptoms
• Class 4 → inability to carry out any activity without symptoms.