CVS conditions (FCM))

Question 1

What is HF?

Answer 1

A condition where the heart is unable to pump blood around the body properly.

Question 2

How do you diagnose HTN?

Answer 2

Ambulatory BP monitoring

Question 3

When would you consider doing ABPM?

Answer 3

If the patient has 2 high blood pressure readings in clinic between 140/90-180/120

• Ensure that 2 measurements are taken per hour during the patients normal waking hours.

Question 4

When would you refer a patient for same day specialist review if you are concerned about hypertension?

Answer 4

1. If their BP is 180/120 or higher
2. Theres signs of retinal haemorrhage or papilloedema

Question 5

How would you manage a patient with a BP reading of 180/120 or higher with no signs of target organ damage?

Answer 5

Repeat the BP reading in 7/7

Question 6

What are the clinical and ABPM readings to diagnose HTN?

Answer 6

Clinic:
140/90 or higher (Stage 1)
160/100 or higher (stage 2)
180/120 or higher (stage 3)

ABPM:
135/85 or higher (stage 1)
150/95 (stage 2)

Question 6

What are the clinical and ABPM readings to diagnose HTN?

Answer 6

Clinic:
140/90 or higher (Stage 1)
160/100 or higher (stage 2)
180/120 or higher (stage 3)

ABPM:
135/85 or higher (stage 1)
150/95 (stage 2)

Question 7

What blood pressure medication can cause Tall tented T waves (hyperkalaemia) on ECG?

Answer 7

Ramipril

Question 8

First line treatment for a patient with heart failure with preserved ejection fraction (HFpEF)?

Answer 8

1. First lifestyle
2. Then medication (ACEi- Ramipril + Furosemide)

Question 9

How would you manage atrial fibrillation if it occurred in the last 48 hours?

Answer 9

1. If hemodynamically unstable:
   - HR >150
   - sob
   - dizziness
   -low BP

Admit to AMU for electrical cardioversion

Note: symptomatic people are likely to present to and initially managed in secondary care

Question 10

What is aortic coarctation? what exam findings may you find? (3 things)

Answer 10

Narrowing of the aorta.

• Radial-femoral delay
• Systolic murmur
• Difference in BP between the upper and lower extremities

Question 11

What is a characteristic ECG change in relation to Digoxin treatment?

Answer 11

Down-slopping of the ST segment (reverse ticks)

Question 12

How would you differentiate an NSTEMI from unstable angina?

Answer 12

NSTEMI causes a rise in Troponin whereas unstable angina does not

Question 13

When would a CABG be more suitable over PCI in a patient with stable angina? (3 things)

Answer 13

1. > 65 yrs old
2. Diabetics
3. Complex 3 vessel disease

Question 14

How do you diagnose HF? What levels would confirm the diagnosis? and what would you do next?

Answer 14

-Bnp
- 400–2000 ng/L (47–236 pmol/L)

• refer urgently for specialist assessment and for ECHO (within 6 weeks)

Question 15

First line management for angina?

Answer 15

CCB or BB

IF, both are contraindicated use one of the following-
- Nicorandil
- Ivabradine
- Ranolazine

Question 16

What drug should be given as secondary prevention in a patient with angina? and what is the alternative in those with diabetes?

Answer 16

Aspirin 75mg OD

In Diabetics:
ACEi

Question 17

What does a pathological Q wave on ECG tell you?

Answer 17

That there was a previous MI

Question 18

If a patient has HTN and diabetes, what medication would you start them on?

Answer 18

ACEi (ramipril)

Question 19

Mid diastolic murmur?

Answer 19

Mitrial or tricuspid stenosis

Question 20

What causes a diastolic murmur?

Answer 20

a narrowing (stenosis) of the mitral or tricuspid valves, or regurgitation of the aortic or pulmonary valves.

Question 21

What causes a systolic murmur?

Answer 21

Mitrial valve prolapse

Question 22

How does permanent Afib present?

Answer 22

sinus rhythm cannot be restored or maintained and AF is the accepted final rhythm

Question 23

How does paroxysmal Afib present?

Answer 23

recurrent episodes (≥30 seconds in duration) that terminate spontaneously or with intervention within 7 days

Question 24

How does persistent Afib present?

Answer 24

AF that fails to self-terminate within 7 days. If lasts >12 months known as ‘long-standing persistent AF’

Question 25

How do you confirm Afib ?

Answer 25

12 lead ECG

Question 26

What do you do if paroxysmal AF is suspected and AF is not detected on standard electrocardiography?

Answer 26

Ambulatory ECG

Question 27

How would you manage a patient with A fib If the onset of atrial fibrillation (AF) was within the last 48 hours?

Answer 27

1. Urgently admit to an acute medical unit for emergency electrical cardioversion
2. Where an underlying cause for AF is identified, manage where possible, or refer as appropriate (using clinical judgement to determine urgency)

Question 28

What are the 3 things you need to manage in A fib? (Give details on what drugs? )

Answer 28

1. Rate control

• Beta-blockers
• Or Rate-limiting calcium channel blockers (CONTRAINDICATED IN HF!)
  -Digoxin (if they do little/no exercise)

2. Rhythm control
   - Cardoversion
   - Fleccanide or Amioderone drug (only if structural heart disease)
3. Prevention of thromboembolic events
   - DOAC - apixaban etc.

Question 29

When would you do Cardioversion in a patient who presents after 48hrs of onset of A fib?

Answer 29

After 3 weeks.
Because they need to be anti coagulated for at least 3/52 before it can be done