CVS LC

Question 1

CVD targets

Answer 1

BP:
≤140/90 mmHg,
≤130/80 mmHg if diabetes, micro/macroalbuminuria

Lipids:
TC <4.0 mmol/L
HDL-C ≥1.0 mmol/L;
LDL-C <2.0 mmol/L;
Non HDL-C <2.5 mmol/L;
TG <2.0 mmol/L

Smoking:
stop

Alcohol:
<2 std drinks/day

Exercise:
30 minutes moderate intensity activity “most days”

Abdominal circumference
<94 cm in men (<90 cm in Asian men), <80 cm in women

+ limit saturated fat and salt

Question 2

Metabolic syndrome definition

Answer 2

3/5 of

Increased Central Adiposity / Obesity
– waist circumference > 102cm in men, 88cm in women

Fasting blood glucose >6.1mmol/L.

Reduced HDL-C (or drug treatment for reduced HDL-C)
< 1.0mmol/L.

Raised Triglycerides >1.7mmol/L.

HTN - BP ≥130 systolic or ≥85 diastolic

Question 3

Indications for ICD in ischemic HFrEF as primary prevention

Answer 3

• LVEF ≤35% + NYHA II or III
• LVEF ≤30% + NYHA I*
• LVEF ≤40% + non-sustained VT assoc. with previous MI + inducible sustained VT/VF on EP*

Can be beneficial if syncopal episodes occurring suspected to be due to ventricular arrythmia

*Must be post acute phase of MI i.e. 40 days post MI AND >3/12 post revascularization + medical therapy

Question 4

Indications for ICD in ischemic HFrEF as secondary prevention

Answer 4

Sustained VT/VF after reversible causes excluded (i.e. AMI, electrolyte disturbances, medication effects)

Question 5

Indications for CRT

Answer 5

LVEF ≤35% NYHA II or III and QRS >130 msec (highest level of evidence with QRS >150msec)

Question 6

11 triggers of exacerbation of heart failure

Answer 6

Myocardial ischemia
Anemia
Valvular pathology
Embolism (PE), endocarditis
Rhythm - particularly AF, also heart block
Infection
Compliance (lack of, particularly diuretic)

Others:

• Pregnancy
• Thyrotoxicosis
• Anesthesia/surgery
• Drugs (NSAIDs), high salt intake

Question 7

TTE signs of heart failure (other than reduced EF)

Answer 7

Reduced fractional shortening (% change from diastole to systole)
RWMA (i.e. antero-apical)
Increased LVEDD

Question 8

PBS criteria for entresto

Answer 8

LVEF <40%
NHYA 2 or greater
Con-comittent treatment with beta blocker
DON’T use with ARB or ACE-I

Question 9

Heart failure specific beta blockers

Target doses?

Answer 9

bisoprolol 10mg

carvedilol 25mg BD (<85kg) or 50mg BD (>85kg)

metoprolol XR 200mg

nebivolol 10mg

Question 10

Indicators of advanced heart failure

Answer 10

Hospital - ≥ 2 hospital admissions in ≤ 12 months.

Pump failure - hypotension, prior or ongoing inotrope need

Symptoms - persistent ≥ NYHA 3.

Arrythmias - recurrent ≥ 2 AICD shocks.

Organs - end organ dysfunction (incl. right heart failure).

Objective - LVEF < 20%, high/rising BNP/NT-proBNP.

Refractory RAAS - low Serum Na+, increasing diuretic need.

Drugs - down-titration of ACE/ARB, β-blocker (as unable to tolerate)