GP - cardiology Flashcards
What is tachycardia in < 12 months, 12-24 months and 2-5 years?
< 12 months = > 160bpm
12-24 months = > 150 bpm
2-5 years = > 140 bpm
Name 3 causes of heart failure
MI, coronary heart disease, hypertension, congenital, arrhthmyias, cardiomyopathy
How would you classify heart failure?
New York Heart Association Class I to Class IV
I - no limitation
II - slight limitation
III - marked limitation
IV - unable to carry out any physical activity without discomfort
What is the prognosis of severe heart failure?
90% die within 1 year
What is the treatment for heart failure?
ACEi then beta blocker
seek specialist advice
diuretics e.g. spitinalactone
What is the hypertension pathway, give an example?
A or C then A&C then A,C,D
A = angiotensin conducting enzyme inhibitor e.g. ramapril
C = calcium channel blocker e.g. amlodipine
D = thiazide-like diuretic e.g. bendoflumethiazide
Give an example of an ACE-i
When would you use it?
ramapril
first line treatment of heart failure
First line treatment of hypertension in <55, non-Afro-Caribbean
What is the main side effect of ACE-is?
prolonged dry cough
kidney problems
Give an example of a BB
When would you use it?
bisoprolol
2nd line treatment of heart failure
How do ACE-i work?
Angiotensin converting enzyme inhibitors
ACE causes retention of salt and water and vasocontriction so inhibiting the enzyme results in decreased in blood volume and vasodilation
How does bisoprolol work?
B1 adrenergic selective beta blocker - cardiospecific
Normally adrenaline and noradrenaline activate B1 receptors increasing contractility and increase HR
What are some side effects of beta blockers?
“fuzzy head”
impotence
Give an example of CCB
When would you use it?
amlodopine
First line treatment of hypertension if >55 or Afro-Carribbean
How does amlodopine work/
Calcium channel antagonist - inhibit calcium influx in smooth muscle cells so inhibit contraction
What is the main SE of amlodopine?
ankle swelling
do not prescribe with beta blockers as they both slow HR
What are the 3 main types of diuretic and give an example of each
Thiazide like - bendrofluromethiazide
Potassium sparing - spironolactone
Loop - furosemide
When would you prescribe diuretics?
Third stage treatment for hypertension or heart failure
- loop diuretics better for heart failure
- bendrofluromethazide better for hypertension
What is the main SE of diuretics?
electrolyte imbalance
increased urinary frequency
How does bendrofluromethazaide work?
Inhibit sodium resorption in distal convoluted tubule = more sodium in collecting ducts so more water lost = lower BP
How do loop diuretics work?
Inhibit resorption of sodium chloride and potassium in loop of henle - release of renin - increase in GFR
Increase production of prostaglandins = vasodilation and incrased blood supply to kidney
How does spironolactone work?
Antimineralcorticoid
potassium sparing so can cause hyperkalaemia
What are the screening questions for heart failure?
How many pillows do you sleep with? do you have frothy pink sputum? Are you urinating more than normal? How far can you walk without getting out of breath? Do you have swollen ankles? Do you get cold extremities?
What are two tests for DVT?
doppler scan of leg
D-dimer
What are 3 anticoagulants and their contraindications?
heparin - liver failure
Warfarin - pregnancy
Rivaroxaban - hepatic disease
