cardiology

Question 1

what meds have been shown to reduce mortality chronic heart failure

Answer 1

ACE inhibitors (SAVE, SOLVD, CONSENSUS)
spironolactone (RALES)
beta-blockers (CIBIS)
hydralazine with nitrates (VHEFT-1)

Question 2

how do you mx heart failure?

Answer 2

first-line treatment for all patients is both an ACE-inhibitor and a beta-blocker
second-line treatment is now either an aldosterone antagonist, angiotensin II receptor blocker or a hydralazine in combination with a nitrate
if symptoms persist cardiac resynchronisation therapy or digoxin* should be considered
diuretics should be given for fluid overload
offer annual influenza vaccine
offer one-off** pneumococcal vaccine

*digoxin has also not been proven to reduce mortality in patients with heart failure. It may however improve symptoms due to its inotropic properties. Digoxin is strongly indicated if there is coexistent atrial fibrillation

**adults usually require just one dose but those with asplenia, splenic dysfunction or chronic kidney disease need a booster every 5 years

Question 3

Causes of dissection

Answer 3

Htn
Atherosclerosis
Conn tissue disease marfans sle ehlers danlos
Cong. Cardiac abnorms
Aortitis in tertiary syphillis and takyasus
Iatrogenic
Trauma
Cocaine