Cardiology

Question 1

What are the 3 stages of hypertension

Caveat for >80

Answer 1

1. Clinic BP >= 140/90 mmHg OR average BP >= 135/85 mmHg
2. Clinic BP >= 160/100 mmHg OR average BP >= 150/95 mmHg
3. Clinic systolic BP >= 180 mmHg

> 80 Clinc BP 150/90 mmHg OR average 145/85 mmHg

Question 2

What is the first-line for treating hypertension in diabetics, (exceptions for Afro-Caribbean origin and women of child-bearing age)

Answer 2

Ramipril (ACE-i)

Question 3

Advanced Life Support; 4Hs and 4Ts

Answer 3

Hypoxia
Hypovolaemia
Hyper/hypokalaemia, and other metabolic disorders
Hypothermia

Thrombosis (coronary or pulmonary)
Tension pneumothorax
Tamponade – cardiac
Toxins

Question 4

What are the side-effects of statins

Answer 4

1. myopathy
2. Rhabdomyolysis
3. Liver impairment
4. Increased risk of Intracranial haemorrhage if history of one

LFTs should be monitored 3 months and 12 months after treatment

Question 5

Who should get Statins?

Answer 5

1. all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
2. following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
3. patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
4. patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

Question 6

What does of statins should be prescribed for primary and secondary prevention?

Answer 6

20mg od - primary

80mg od - secondary

Question 7

Nitrates use in angina and heart failure

Answer 7

Vasodilator + reduces preload

Side-effects

• hypotension
• tachycardia
• headaches
• flushing

Can develop resistance to it

Question 8

What are the blood pressure targets for diabetics

Answer 8

End organ-damage < 130/80

Otherwise <140/80

Question 9

What are the treatment indications for the CHA2DS2-VA2Sc

Answer 9

0 = No treatment 
1 = Anticoagulation (females No treatment) 
2 = anticoagulation

Warfarin or NOAC

Question 10

Long QT syndrome

Answer 10

Drug causes:
amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron

electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
acute myocardial infarction
myocarditis
hypothermia
subarachnoid haemorrhage

Question 11

heart failure drug management

Answer 11

ACE inhibitors, beta blockers, and spironolactone all help to reduce long-term mortality and slow disease progression and therefore patients should make sure they continue these medications even when symptoms subside.