Cardiovascular

Question 1

Risk factors for atherosclerosis

Answer 1

Male
FHx
Smoking 
DM
Hyperlipidaemia
HTN

Question 2

Characteristics of STABLE angina

Answer 2

Onset with exercise (increased demand)
Relieved by rest
CCP radiating to arm & neck

Question 3

Complications of angina

Answer 3

Thrombotic - clot enlarges, blood flow reduces, ischaemia increases - AMI
Embolic - downstream clot causing claudication/DVT or PE or TIA/CVA or gut ischaemia

Question 4

Why are men at greater risk of angina?

Answer 4

oestrogen in premenopausal women is protective

Question 5

Why does DM increase risk of angina?

Answer 5

DM causes endothelium damage (increasing risk of atherosclerotic plaques) AND DM causes microvascular disease (blocks small cardiac vessels - too small for stent or lysis)

Question 6

Why does smoking increase risk of angina?

Answer 6

smoking increases endothelial damage - increasing risk of atherosclerosis

Question 7

How does UNSTABLE angina differ from stable angina

Answer 7

Unstable angina occurs at rest or minimal exertion - is not exercise/demand induced - so it is less predictable.

Question 8

What ECG changes are seen for angina (ACS)?

Answer 8

None - ECG is normal

Question 9

Define HTN

Answer 9

BP > 140/90
SBP increments in 19
DBP increments in 10
140-159/90-99 etc

Question 10

Name the complications of HTN

Answer 10

CVA
IHD & ICardioMyopathy
Coronary Artery Disease

Question 11

Rx for HTN

Answer 11

Lifestyle modification PLUS
ABCDE (based on Dx & SEs)
A = ACEI or ARB
B = beta blockers
C = calcium channel blockers
D = diuretics
E = ezetimibe & everything else

Question 12

Name FIVE lifestyle modifications to Rx HTN

Answer 12

Diet - low salt, low fat
Exercise
Quit smoking

Question 13

Dx where ACEI are useful

Answer 13

DM - helps with GFR
CCF - improves EF (ejection fraction) & survival
post MI - improves survival
CT diseases (scleroderma) - protects kidneys
young people

Question 14

Dx where beta blockers are useful?

Answer 14

CCF - improves survival (carvedilol, metoprolol best)
post MI - improves survival
young people

Question 15

Dx where calcium channel blockers (CCBs) are useful

Answer 15

survival NOT demonstrated in any subtypes BUT good for elderly

Question 16

Dx where diuretics are useful for HTN Rx

Answer 16

survival NOT demonstrated in any subtypes BUT good for elderly

Question 17

SE of ACEI/ARB

Answer 17

Angioedema (swelling in tongue, face)
cough (30% of ACEI) - switch to ARB
hyper K
hypo Na
dec CrCl (esp c/ renal artery stenosis - CI where bilateral)
Inc Cr = ARF [paradoxical; used in CRF to protect function, esp in DM]

Question 18

SE of beta blockers

Answer 18

bradycardia
hypoTN
dyslipidaemia
depression (exacerbation)
exacerbate asthma & COPD
[bronchospasm]
hyper K

Question 19

SE of CCBs

Answer 19

DHPs:
peripheral vasodilation - odema, constipation, HF [b/c of the decrease to contractility/inotrophy]
HR same or increase
[except amlodopine - dec HR, used in IHD]
non-DHPs:
dec inotropes (contractility)
see HR decrease - good for AF;
oedema
constipation
HF [negative inotrophy/contractility]

Question 20

Name the TWO types of CCBs

Answer 20

DHP - dihydroperadines [all end in pines; nifed, amlodo, felo]
non-DHP - dihydroperadines

Question 21

SE of thiazide diuretics

Answer 21

HYPO K
HYPO Na
Inc sCa
Inc sCr
Inc sUric Acid, slipids, sGlucose

Question 22

Name the TWO major diuretic classes used for HTN

Answer 22

Hydochlorothiazide - ascending limb

Frusemide - loop

Question 23

SE of loop diuretics

Answer 23

HYPO K
HYPO Na
Dec sCa [dumps Ca into urine, CI for Hx of renal stones]
Inc Cr

Question 24

Alpha1 blockers in HTN:
what suffix identifies them?
How do they work?

Answer 24

‘osin’ [tamulosin]

Vasodilation by blocking the alpha receptors on the vessel - preventing vasoconstriction

Question 25

What is a potential SE of alpha blockers?

Answer 25

First dose HYPOTN - can cause syncope, so should be given before bed time

Question 26

Other than HTN, what other use do alpha blockers have?

Answer 26

Rx BPH - used to relax the smooth muscle of the urethra to aid urination (relieve prostatic SEs)

Question 27

Alpha 2 agonists in HTN:
How do they work?
Where are the receptors?
Name a common one.
What other use do they have?
What is a problem when using clonidine?

Answer 27

Stimulate brain A2 receptors to decrease PVR and CO to lower BP
Pre-synaptic A2 receptors in brain stem feedback to downplay SNS tone by reducing Ca in cleft, inhibiting release of NA, lowering the BP
Clonidine
Opiod wdl
Central action means that cessation needs to be weaned IOT avoid wdl

Question 28

Nitrates in HTN (& IHD):
How do nitrates work in HTN mngt?
What nitrates are commonly used?
When are nitrates absolutely CI?
How often should there be a nitrate free interval?

Answer 28

By causing dilation [venodilation > vasodilation, to INC pressure in coronary arteries]
decreases PRELOAD by dilating the veins, reducing pressure in RA, making more flow to the myocardium
decrease AFTERLOAD
GTN (typically as a patch)
ISMN - isosorbide mononitrate
CI in RV failure (or AMI)
Nitrate interval should be every day (why patches come off)

Question 29

Spironolactone in HTN:
What type of drug is it?
How does this act?
When is it indicated?
SE?
What similar drug does not cause gynaecomastica?

Answer 29

K sparing diuretic that acts in the DCT by blocking aldosterone;
Indicated in CHF with EF < 35%
SE include:
HYPER K
inc Cr causing ARF
Gynaecomastica (blocking one steroid hormone - affecting others)
Eplerenone

Question 30

What is ezetimibe?

What drug is it sometimes combined with?

Answer 30

A drug that lowers the absorption of cholesterol

Simvastatin