Cardiovascular Health

Question 1

Atrial fibrillation

Answer 1

Rate 160-180
Irregularly irregular pulse
ECG ill defined p waves
Causes: IHD, valvular heart disease, infection, HTN
Types: first episode, recurrent - paroxysmal, permanent
Complications: Stroke; heart failure; mesenteric ischaemia
Investigations and assessment: pulse, ECG, Echo, FBC, U&E, LFT
Treatment: Resuscitation, rate control - beta blocker, diltiazem, digoxin - 1 or 2 drug, prevention of stroke with anticoagulants, antiplatelet.
Rate limiting approach preferred unless acute <48 hrs - cardioversion ( pharmacological: amiodarone/ sotalol, electrical; if >48 hrs antiplatelet for 3 weeks then anticoagulant (DOAC preferred)
Relevant Scores CHAD2VAS2C, ORBIT

Question 2

NT-proBNP

Answer 2

NT-pro-BNP levels may be reduced by:
✓ Body mass index (BMI) greater than 35 kg/m2.
✓ Drugs including diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II receptor antagonists (AIIRAs), beta-blockers, and aldosterone antagonists (such as spironolactone).
✓ African-Caribbean family origin.
✓ NT-pro-BNP levels may be elevated by:
✓ Age over 70 years.
✓ Left ventricular hypertrophy, myocardial ischaemia, or tachycardia.
✓ Right ventricular overload.
✓ Hypoxia.
✓ Pulmonary hypertension.
✓ Pulmonary embolism.
✓ Chronic kidney disease (eGFR < 60 mL/min/1.73m2).
✓ Sepsis.
✓ Chronic obstructive pulmonary disease.
✓ Diabetes mellitus.
✓ Liver cirrhosis.

Question 3

Palpitations - Red flags

Answer 3

SPecialist referral:
history of palpitations, referral to Cardiology is indicated in the following situations:
✓ A history of syncope or near syncope.
✓ Palpitations precipitated by exercise.
✓ Pre-existing heart disease (such as Heart failure or valve disease)
✓ A family history of sudden cardiac death under the age of 40 years.
✓ A resting ECG abnormality
✓ Suspected paroxysmal Atrial Fibrillation
✓ Ventricular extrasystoles

Question 4

QRISK2 - assessment tool

assess CVD risk for the primary prevention in +nce of T2DM upto 84 yrs

Answer 4

QRISK2 not used in:
Type 1 diabetes.
Familial hypercholesterolaemia
CKD
T2DM with established heart ds
In people with an eGFR < 60 ml/min/1.73 m2 and/or albuminuria.

Question 5

Reducing CVD risk

Answer 5

metformin - in obese diabetics1
ramipril - in hypertensive diabetics2
statins - reduce CV mortality
stopping smoking - most effective in reducing CV risk.

Question 6

Restless Legs Syndrome

Answer 6

Hypothyroidism
Anaemias
Renal failure
Polyneuropathies
Rheumatoid arthritis
Sjögren’s syndrome
Amyloidosis.