cardiovascular - general

Question 1

orthostatic hypotension definition
- normotensive
- hypertensive
(ref BMJ Best Practice)

Answer 1

normotensive - SBP drop of >= 20mmHg
hypertensive - SBP drop of >= 30mmHg
from sitting -> standing

Question 2

acute Chest pain - ddx (8)

Answer 2

Myocardial ischaemia/infarction - stemi, nstemi
Unstable angina
Pericarditis

Pulmonary embolism
Pneumothorax

aortic dissection/rupture

GORD

Anxiety

Question 3

Pulmonary hypertension - causes

cardiac (2)
resp (5)

Answer 3

Cardiac -
Valvular heart disease
ASD - cardiac shunts

Respiratory - 
Pulmonary interstitial fibrosis
COPD - cor pulmonale
chronic PE
OSA
Idiopathic pulm hypertension

Question 4

Drugs classes - which have shown to be effective in MX of pulmonary hypertension (3)

Answer 4

PD5i
prostacyclin receptor agonists
endothelin receptor antagonists
prostanoid analogues
soluable guanylate cyclase stimulators

Question 5

conditions that equate to high risk CVD (15% in 5yrs)

Answer 5

DMT2 + >60yrs old
DMT2 + albuminuria
mod-severe CKD (eGFR <45)
BP ≥180/110
Total chol >7.5
PMHx - AMI, CCF, IHD, CAD, CVA/TIA, PVD, aortic disease,
Age>75yrs
FHx premature CVD 1st degree relative

Question 6

CVD risk factors (8)

- the ones used in framingham risk score calc

Answer 6

Age
sex
SBP
Total cholesterol
HDL
DMT2 status
Smoking status
LVH on ECG/ECHO

Question 7

CVD +/or hypertension - lifestyle advice for all patients

Answer 7

Stop smoking
nutrition - low salt diet <6g/day
alcohol <1-2 sd per day, 2 etoh free days per week
physical activity - 30/60 daily, moderate intensity
weight control BMI ≤25

Question 8

CCF - Rx ( 3 drug classes)

Answer 8

beta blocker
ace inhibitor
+/- diuretic if overloaded

Question 9

What beta blockers are best/effective for CCF Mx (3)

Answer 9

metoprolol 50mg bd
carvedilol 25mg bd
bisoprolol 10mg od

Question 10

Atrial fibrillation - causes (16)

Answer 10

atherosclerosis related

• hypertension
• coronary artery disease
• ischaemic heart disease

structural heart

• Pericarditis
• myocarditis
• cardiomyopathy
• mitral valve disease
• congestive cardiac failure

lung disease
- Pulmonary disease
- COPD
- pulmonary hypertension
- OSA
endocrine
- Thyrotoxicosis 
- Metabolic/electrolyte disturbance hypokalaemia, hyponatraemia

Infection

substance use - ETOH, drug, caffeine

Question 11

hypertriglyceridaemia - causes (9)

Answer 11

genetic

• familial hypertriglyceridaemia
• familial combined hyperlipidaemia

endocrine

• hypothyroidism
• DMT2

solid organ disease

• CKD
• Alcohol Liver disease and NAFLD

medication SE - b blockers, spironolactone, thiazide diuretics, glucocorticosteroids
Excessive ETOH consumption

Obesity

Question 12

hypertriglyceridaemia - mx

Answer 12

omega 3 fish oil 2-4g daily

fenofibrate 145mg

Question 13

hyperlipidaemia - non-rx mx (6)

Answer 13

Diet (reduce)

• reduce trans and saturated fat intake
• limit ETOH

Diet (increase)

• increase soluble fibre intake
• introduce plant-sterol enriched milk or margarine products

Lifestyle

• weight loss
• increase physical activity/exercise

Question 14

hyperlipidaemia - Rx mx

Answer 14

statin, treat to target, max tolerated dose
if not to target add
ezetimibe 10mg

Question 15

cardiac tamponade - Becks triad

Answer 15

elevated JVP
hypotension
muffled heart sounds

Question 16

kussmaul’s sign

• what is it
• ddx

Answer 16

paradoxical rise in JVP when you inspire

ddx

• cardiac tamponade
• constrictive pericarditis
• right sided heart failure
• restrictive cardiomyopathy

Question 17

expected behaviour of JVP in normal individual who inspires

- explain the mechanism

Answer 17

inspiration -> bigger thoracic cage volume -> lower pressure -> greater venous return to heart -> JVP goes lower