Cardiology Long Case 2

Question 1

How would you manage Babak’s CV risk?

Answer 1

• Secondary prevention
	○ BP<130
	○ Lipid
	○ Med Diet
	○ Exercise
	○ Weight
	○ Smoking/alcohol
• Control comorbids
	○ DM (Hba1c/SGLT2/GLP1)
	○ ESRF (PTH/ACE/Transplant)
Education

Question 2

What are some potential causes of this patient’s heart failure?

Answer 2

• IHD
	• Myocarditis
	• Valve pathology/IE
	• Cardiomyopathic state
		○ Hypertrophic
		○ Dilated
			§ ETOH/drugs like cocaine
			§ Peripartum CM
			§ Autoimmune- SLE
			§ OSA
			§ Viral CM
		○ Tachycardia meditated
		○ Takotsubo
Infiltration
Poorly controlled HTN

Question 3

How would you manage this patients heart failure?

Answer 3

Manage underlying cause
CV risk reduction
a. Lifestyle- FR, daily weights, low salt, cardiac rehab
b. Medications- use to interpret HFpEF vs HFrEF
a. Standard- ACEI, BB, Spiro
b. Consider- ARNI, SGLT2, Ivabradine etc for optimisation
c. Always uptitrate to max dose if able (ie if on another antihypertensive like CCB can consider ceasing to uptitrate ACE/BB)
d. Iron/TSH
c. Devices - ICD + CRT
d. Has transplant been discussed (if pt is end stage)