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CCC - LM > Coronary Heart Disease & Heart Failure > Flashcards

Coronary Heart Disease & Heart Failure Flashcards

1
Q

How is stable angina relieved?

A

GTN spray within 5 minutes

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2
Q

How is decubitus angina brought on?

A

Lying flat

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3
Q

What is QRISK2?

A

A screening test that calculates % risk of MI within 10 years

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4
Q

What causes coronary heart disease?

A

Atherosclerosis in the coronary arteries - narrowed lumen & reduced BF to heart - causes angina

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5
Q

What is variant/Prinzmetal’s angina?

A

caused by coronary artery vasospasm - can occur at anytime

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6
Q

What is a significant QRISK2? And what measures are taken at this stage?

A

> 10%

Start on statin

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7
Q

What can occur with GTN?

A

Tolerance - important to have GTN free periods

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8
Q

What are the side effects of GTN?

A

Flushing
Dizziness
BP drop

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9
Q

What are the 2 types of calcium channel blockers?

A

Dihydropiridine - amlodipine

Non-dihydropiridines - verapamil

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10
Q

What is the first line treatment of angina?

A

B-blocker or non-dihydropridine CCB (verapamil)

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11
Q

What are dihydropiridines most effective at doing?

A

Reducing BP

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12
Q

What is the 2nd line treatment of angina?

A

dihydropiridine CCB - amlodipine

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13
Q

When is liver function monitered when commencing a statin?

A

Before
3 months
12 months

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14
Q

What is CABG and when is it used?

A

Coronary artery bypass graft

If coronary angiography shows left main stem disease or proximal 3 vessel disease

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15
Q

What can ischaemic heart disease (CAD) develop in to?

A

MI

Heart failure

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16
Q

What should you not prescribe in patients using nitrates (isosorbide/GTN)?

A

Vasodilators - e.g. Sildenafil (viagra)

17
Q

What are the risk factors for heart failure?

A

IHD, MI, htn, DM
Obesity, high cholesterol, smoking, alcohol
FH
valvular disease

18
Q

What is the prognosis of heart failure?

A

25-50% 5 year mortality

Most likely to die in first year

19
Q

What is systolic heart failure?

A

Enlarged ventricles unable to contract fully - causes decreased CO and ejection fraction <40%

E.g. IHD, MI, cardiomyopathy

20
Q

What is diastolic heart failure?

A

stiff ventricles cannot relax fully - increased filling pressure
Ejection fraction >50%

htn, constrictive pericarditis, cardiomyopathy

21
Q

What are the symptoms of left sided heart failure?

A 
pulmonary oedema 
PND
Nocturnal cough - pink frothy sputum 
Wheeze
tachycardia, tachypnoea 
Weight loss
22
Q

Weight gain would be seen in R or L sided HF?

A

R

23
Q

What are the symptoms of R sided HF?

A

Peripheral oedema
Ascites
Fatigue
Increased JVP

24
Q

What is the other name or R sided HF?

A

Cor pulmonale

25
Q

What 2 investigations should be performed if suspecting HF?

A

BNP

Doppler echo - identifies cause

26
Q

What would be present on a CxR in HF?

A 
Alveolar oedema (bat wing)
Kerley B lines 
Cardiomegaly 
Dilated upper lobe vessels 
Pleural effusion
27
Q

What is the management of acute HF?

A

Loop diuretic - furosemide
If already on loop - increase dose or add thiazide

Monitor renal function

28
Q

What is the initial management of chronic HF?

A

B-blocker (bisoprolol) and ACE inhibiter (ramipril)

29
Q

What is 2nd line management of HF?

A

aldosterone antagonist - spironolactone
ARB if intolerant to ACE-i

OR hydralazine +/- nitrate - especially if afro-caribbean

30
Q

How might the heart sounds differ in HF?

A

Gallop rhythm

may hear 3rd and 4th heart sound

31
Q

A BNP of which value would indicate urgent doppler?

A

400

32
Q

Which classification system is used in heart failure?

A

New York Heart Association

33
Q

What should you not prescribe to a patient already on atenolol? Why?

A

Verapamil

Risk of complete heart block

CCC - LM (14 decks)

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