Cardiovascular

Question 1

Chronic stable angina treatment

Answer 1

1st line: selective BBB (metoprolol, bisprolol…)
2nd line: add CCB (DHF; dipine)
3rd: add long acting nitrate (isosorbide, nitroglycerin patch–not sublingual); ADR: watch orthostatic hypotension

(Nitrate’s MOA: dilate coronary artery and peripheral veins); never stop it suddenly

Question 2

BBB’s effects

Best friend when treating stable angina

Answer 2

Reduce HR, heart contractility, reduce O2 need, antiaryththmic

When treat stable angina, best friend is use with nitrate. Nitrate can have reflex tarchycardia. BBB can help that (Nitrate is a vasodilator)

Question 3

Drugs cause fluid retention

Answer 3

BBB
NSIAD
Hydralazine
Nifedipine
TCA
Non-DNF CCB

Question 4

Heart failure; left vs right

Answer 4

Left HF: initially occur in lung. S3 heart sound. All about breathing

right HF: peripheral; ascites, spleenomegaly, peripheral edema, abdominal discomfort, distended jugular veins

Question 5

Heart failure treatment

Answer 5

1st line: ACE inhibitor: inhibit fluid retention, vasodilation, increase blood to vital organs (improve mean BP); EF< 35% should use this. (If can’t tolerate ACE, ARB)

2nd line: BBB: never use in unstable patients! Or acutely ill patients. Not a rescue therapy. Carvedilol is 3 rd generation (cardioprotective): this drug can cause fluid retention at first, so patient needs to weight themselves daily for 3-5 days after taking this, if weight gain, even it’s temporary, reduce dose!

3rd line: diuretic
—-thiazide: mild HD with HTN
—-loop diuretic: lax is 20-40mg/d; increase dose until weight decrease & urinary output increase. When adjusting dose, adjust it everyday

4th line: hydralazine/ isobide dinitrate combination: a. Good choice for black people. You have to try 1st line first.
* if patient is taking ACE inhibitor, if add diuretic, know that ACE inhibit takes time to show max effect, so don;’t add diuretic too much.

5th line: nitrates: alone can’t treat HF
6th line: digoxin: for class 2 3 patient. (Slight limitation with physical activity; marked limitation of physical activity)

Question 6

Heart failure stage

Answer 6

1. No physical limitation
2. Light physical limitation
3. Marked physical limitation
4. SOB at rest

Question 7

ASA role in HF treatment

Answer 7

ASA has no role in HF treatment

Question 8

Heart failure treatment algorithm

Answer 8

Question 9

Ejection fraction

Definition
Normal range
Low ejection fraction indicate

Answer 9

% of blood pumped out at each heart contraction

Normal: 55-75%
Borderline: 50-55%
<=40%: start treatment

Low means heart is not pumping enough blood out. Usually indicate left ventricular problem.

Question 10

Dyslipidemia

Answer 10

Aortvastatin 5mg, 10-20mg, 40-80mg.

Question 11

Isolated systolic HTN

Answer 11

Thiazide: indapamie 1.25mg OD in am, to max 2.5 mg OD

Question 12

Cerebral vascular disease HTN

Answer 12

ACE+ thiazide

Question 13

Avoid CCB when

Answer 13

Recent MI

Question 14

BBB’s schedule

Answer 14

BID

Question 15

Hyperglycemia

Answer 15

Metformin 250mg BID , max 1000mg BID

DPP-4 inhibitor: sitagliptin (januvia) 100mg OD

GLP-1R agonist: liraglutide:

SLGT-2 inhibitor: dapagliflozin 5-10mg OD
Basal insulin: starting 10 unit/ d: determir, glargine

Question 16

DVT diagnostic test and diagnosis

Answer 16

Do the Well score:
Hx of DVT
On cancer treatment
Hx of travel
Swelling entire leg
Bedbound
Localized tenderness in deep vein system
Calf swelling > 3cm than the unaffected leg

> =2 likely—> D-dimer, Doppler

Question 17

Treatment of ACS

Answer 17

Given ASA 160-325mg and send them to ER