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Primary Care HG > CHD + HF > Flashcards

CHD + HF Flashcards

1
Q

Causes of high output HF

A

Anaemia, pregnancy

Hyperthyroidism

Pagets Beri beri

Arteriovenous malformation

Causes RVF then LVF

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2
Q

Symptoms of HF

A

SOB

Fatigue Exercise intolerance

Fluid retention Orthopnoea Paroxysmal nocturnal dyspnoea

Nocturnal cough + pink frothy sputum

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3
Q

Signs of HF

A

Raised JVP

Tachycardia, 3rd heart sound, displaced apex beat

Pitting oedema

Fine crackles

Hepatomegaly/ ascites

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4
Q

NY Heart association classification of HF - classes

A

1 = no limitations

2 = slight limitations, comfortable at rest

3 = less than ordinary activity will lead to symptoms

4 = symptoms when at rest

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5
Q

Types of HF

A

Left ventricular = causes a backup, pulmonary oedema

Right ventricular failure = result of left sided HF

Both L + R are systolic

Congestive = mix of LVF + RVF

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6
Q

Most common cause of LVF

A

Myocardial ischaemia - most common

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7
Q

Common cause of RVF

A

LVF

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8
Q

Causes of systolic + diastolic HF

A

Systolic = IHD, MI, cardiomyopathy

Diastolic = constrictive pericarditis, tamponade, restrictive cardiomyopathy, HTN

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9
Q

Causes of low output HF

A

Pump failure, decreased HR (B blockers)

Negatively inotropic drugs (antiarrhythmics)

Excessive preload (mitrl regurg, fluid overload)

Chronic excessive afterload (aortic stenosis, HTN)

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10
Q

Non pharmacological management of HF

A

Exercise

Low salt diet

Daily weights

Stop smoking

Alcohol reduction

Flu vaccine

Inform DVLA if large goods vehicle

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11
Q

Pharmacological management of HF

A

LMNOP if symptomatic

ACEi + B blockers (ARBs 2nd line) + Furosemide

In preserved ejection fraction: can add: spironolactone, ivabradine, digoxin

AVOID CCB

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12
Q

Complications of furosemide, cautions + SE

A

Monitor renal function, electrolytes + BP

Ototoxic + sensitivity to sun

Gout from hyperuricaemia

Hyperglycaemia

Hypokalaemia

Caution in kidney disease, urinary retention, cirrhosis, liver disease

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13
Q

SE of spironolactone

A

Renal failure

Agranulocytosis

Alopecia

Gynaecomastia, breast pain, changes in libido

Confusion, dizziness

Electrolyte + GI disturbance

Hyperkalaemia - discontinue

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14
Q

SE + cautions of digoxin

A

Arrhythmias

Blurred vision

Conduction disturbances

Dizziness

GI disturbances

Yellow vision

Eosinophilia + rash

Caution in hypercalcaemia, hypokalaemia, hypomagnesaemia + hypoxia

Monitor plasma conc in renal impairment

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15
Q

SE of ACEi

A

Hypotension Dry cough GI side effects

Altered LFTs

Monitor U+Es

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16
Q

SE + cautions + CI with B blockers

A

Prolongs QT

GI disturbance

Bradycardia Hypotension

Sexual dysfunction

Cold extremities

Caution in asthma, diabetes + renal impairment

CI in heart block, uncontrolled asthma or diabetes, unstable HF

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17
Q

What is a TAVI used for?

A

Transcatheter aortic valve implantation - severe airotic stenosis

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18
Q

Investigations in acute heart failure

A

ECG Bloods = BNP or NT-proBNP CXR

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19
Q

CXR findings for acute HF

A

Alveolar oedema

Kerly B lines

Cardiomegaly

Diversion to upper lobes

Effusions

20
Q

Management of acute HF

A

Pain = diamorphine

Pee = furosemide 40-80mg IV

Puff = GTN 2 puffs

PAP = CPAP if severe acidaemia/ dyspnoea

Posture = sit up, oxygen

21
Q

What is QRISK2?

A

Risk assessment to assess CVD risk

22
Q

What are common secondary causes of dyslipidaemia?

A

Excess alcohol

Uncontrolled diabetes

Hypothyroidism

Liver disease

Nephrotic syndrome

23
Q

How to diagnose CVD?

A

Measure total + HDL

If total >9 mmol = specialist assessment

24
Q

How to prevent CVD?

A

Cardioprotective diet: reduced saturated fat, more wholegrains, reduce sugar, 2 portions of fish, 5 fruit + veg

Exercise

Smoking cessation

Alcohol advice

Atorvastatin 20mg for primary prevention in those with >10% 10 year risk of developing CVD

25
Q

Primary prevention in T1DM

A

Offer statins if: >40 y/o

Established nephropathy/ other CVD RF

26
Q

What is secondary prevention of CVD?

A

Atorvastatin 80mg in people with CVD

27
Q

Monitoring whilst on atorvastatin

A

Measure liver transaminase within 3 months of starting treatment + at 12 months

Aiming for >40% reduction in non-HDL cholesterol

28
Q

General advice for statins

A

Check for persistent generalised unexplained muscle pain

Measure CK levels

Contraindicated in pregnancy

29
Q

ECG results for angina

A

Pathological Q waves ST + T abnormalities

30
Q

Management of angina

A

Beta blockers

Ca channel blockers

GTN spray

31
Q

Acute LV failure - presentation + pathophysiology

A

Pulmonary oedema due to increasing pressure in alveoli, causing fluid to leak out

Presentation: PND, orthopnoea, pulmonary congestion, pitting oedema, SOB, pink frothy sputum

32
Q

Causes of pulmonary oedema

A

Cardiogenic: LVSD, MI

Non cardiogenic: fluid overload, ARDS

33
Q

CXR for LVF

A

ABCD

Alveolar oedema - Bat wing

B - Kerley B lines

Cardiomegaly (should be less than 50%)

Diverted upper lobe vessels

34
Q

Management of pulmonary oedema

A

LMNOP

Loop diuretics 40mg furosemide

Morphine (+antiemetic)

Nitrates - GTN spray or infusion if systolic >100

Oxygen

Posture - sit up

35
Q

How to diagnose chronic HF

A

ECG - are they in AF?

BNP - brain naturolytic peptide, released by atria under stress - will be high in HF

CXR - ABCD signs

Echo - measures ejection fraction + output

36
Q

What does inotropic mean + give example of positive + negative inotropes?

A

Affecting contraction of heart

Positive inotropes increase force of contraction

Digoxin = positive

Negative = beta blockers, diltiazem + verapamil

37
Q

What does chronotropic mean + give example of positive + negative chronotropes?

A

Affect heart rate

Positive = adrenaline

Negative = beta blockers, digoxin

38
Q

Pulsus paradoxus causes

A

Cardiac tamponade
Pericarditis
Asthma

39
Q

What is Pulsus bisferiens + what causes it?

A

Double peak per cardiac cucle
Due to aortic stenosis existing with aortic regurgitation

40
Q

What is Pulsus alternans and what causes it?

A

Physical finding of alternating strong and weak beats
Left sided heart failure

41
Q

What is Unstable vs stable angina?

A

Stable - occurs with exertion
Unstable - occurs randomly

42
Q

What is Variant angina?

A

Also called Prinzmetal’s
Occurs at rest
Caused by spasm of coronary vessels

43
Q

What is Decubitus angina?

A

Occurs when patient lies down
Complication of HF

44
Q

When do you start statins?

A

CKD, T1DM for more than 10 years, stroke/ TIA

QRISK2 >10%

45
Q

What is the target cholesterol?

A

<5

<3 if they have heart problems

Primary Care HG (23 decks)

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