Coronary Heart Disease & Heart Failure

Question 1

How is stable angina relieved?

Answer 1

GTN spray within 5 minutes

Question 2

How is decubitus angina brought on?

Answer 2

Lying flat

Question 3

What is QRISK2?

Answer 3

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

Question 4

What causes coronary heart disease?

Answer 4

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

Question 5

What is variant/Prinzmetal’s angina?

Answer 5

caused by coronary artery vasospasm - can occur at anytime

Question 6

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

Answer 6

> 10%

Start on statin

Question 7

What can occur with GTN?

Answer 7

Tolerance - important to have GTN free periods

Question 8

What are the side effects of GTN?

Answer 8

Flushing
Dizziness
BP drop

Question 9

What are the 2 types of calcium channel blockers?

Answer 9

Dihydropiridine - amlodipine

Non-dihydropiridines - verapamil

Question 10

What is the first line treatment of angina?

Answer 10

B-blocker or non-dihydropridine CCB (verapamil)

Question 11

What are dihydropiridines most effective at doing?

Answer 11

Reducing BP

Question 12

What is the 2nd line treatment of angina?

Answer 12

dihydropiridine CCB - amlodipine

Question 13

When is liver function monitered when commencing a statin?

Answer 13

Before
3 months
12 months

Question 14

What is CABG and when is it used?

Answer 14

Coronary artery bypass graft

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

Question 15

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

Answer 15

MI

Heart failure

Question 16

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

Answer 16

Vasodilators - e.g. Sildenafil (viagra)

Question 17

What are the risk factors for heart failure?

Answer 17

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

Question 18

What is the prognosis of heart failure?

Answer 18

25-50% 5 year mortality

Most likely to die in first year

Question 19

What is systolic heart failure?

Answer 19

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

E.g. IHD, MI, cardiomyopathy

Question 20

What is diastolic heart failure?

Answer 20

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

htn, constrictive pericarditis, cardiomyopathy

Question 21

What are the symptoms of left sided heart failure?

Answer 21

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

Question 22

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

Answer 22

R

Question 23

What are the symptoms of R sided HF?

Answer 23

Peripheral oedema
Ascites
Fatigue
Increased JVP

Question 24

What is the other name or R sided HF?

Answer 24

Cor pulmonale

Question 25

What 2 investigations should be performed if suspecting HF?

Answer 25

BNP | Doppler echo - identifies cause

Question 26

What would be present on a CxR in HF?

Answer 26

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

Question 27

What is the management of acute HF?

Answer 27

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

Question 28

What is the initial management of chronic HF?

Answer 28

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

Question 29

What is 2nd line management of HF?

Answer 29

aldosterone antagonist - spironolactone ARB if intolerant to ACE-i OR hydralazine +/- nitrate - especially if afro-caribbean

Question 30

How might the heart sounds differ in HF?

Answer 30

Gallop rhythm | may hear 3rd and 4th heart sound

Question 31

A BNP of which value would indicate urgent doppler?

Answer 31

400

Question 32

Which classification system is used in heart failure?

Answer 32

New York Heart Association

Question 33

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

Answer 33

Verapamil | Risk of complete heart block