Heart failure, AF, CHD and HTN

Question 1

What is QRISK score

Answer 1

Risk that a patient will have a stroke or MI in next 10 years

Question 2

What QRISK is treated and with what

Answer 2

Over 10%

Atorvastatin 20mg at night

Question 3

When starting a statin, what is an acceptable cholesterol drop

Answer 3

40% at 3 months in non HDL

Question 4

What other patients should have a statin if a QRISK is below 10% and haven’t had a stroke/ MI

Answer 4

CDK or T1DM for more than 10 years

Question 5

Tests when starting a statin

Answer 5

LFTs at 3/12 and 12/12. Do not need to continue afterwards

Question 6

Secondary prevention after MI

Answer 6

4 As

Aspirin (plus clopidogrel for 12/12)
Atorvastatin 80mg
Atenolol
Ace inhibitor

Question 7

Gold standard investigation for stable angina

Answer 7

CT coronary angiogram

Question 8

How many times can patients with stable angina take GTN before 999

Answer 8

5

Question 9

Management of stable angina

Answer 9

GTN
BB or CCB
4 As for secondary prevention

Question 10

4 most common causes of HF

Answer 10

IHD, valvular heart disease, HTN, arrhythmias

Question 11

First line management of HF

Answer 11

ABAL

ACE I
BB
Aldosterone antagonist
Loop diuretic

Question 12

HTN definition

Answer 12

above 140/90 in clinic or 135/85 at home

Question 13

Causes of secondary hypertension

Answer 13

Renal disease (renal artery stenosis)
Obesity
Pregnancy
Endocrine (Conns)

Question 14

How do diagnose Conns syndrome

Answer 14

Renin aldosterone blood test

Question 15

What is Conns syndrome

Answer 15

Hyperaldosterism

Question 16

When should you consider a secondary cause of HTN

Answer 16

All patients under 40

Question 17

How often should patients be screened for HTN

Answer 17

Every 5 years

Every 1 year if t2DM

Question 18

How to manage pts with a raised clinic BP

Answer 18

24 hours ambulatory BP

If greater than 180/120 999

Question 19

Stages of HTN

Answer 19

1: 140-160 clinic or 135-150 home
2: 160-180 clinic or 150+ home

Question 20

What should all patients with HTN be investigated for

Answer 20

Urine ACR and dipstick.

HbA1C, lipids, UEs

ECG

Fundus

Question 21

Whop gets medical management of HTN

Answer 21

All patients with stage 2

Over 80 with stage 1 with increased QRISK or end organ damage

Question 22

Medical management of HTN

Answer 22

Under 55: A
Over 55 of Black or African:C

A+C. If black use an ARB instead of A

A C D

A C D spiro if K+ is less than 4.5; BB otherwise

Question 23

Cut off potassium level for using spirolactone in HTN

Answer 23

4.5 or less

Question 24

BP targets in HTN patients

Answer 24

Less than 80 140

Greater than 80 150

Question 25

5 most common causes of AF

Answer 25

SMITH

Sepsis
Mitral valve pathology
Ischaemia heart disease
Thyrotoxicosis
Hypertension

Question 26

What type of treatment should new AFs have

Answer 26

rate control first

1: BB
2: CCB
3: digoxin

Anticoagulant

Question 27

What AF patients should get rhythm control

Answer 27

Reversible AF cause
New onset
Causing heart failure
Systematic despite rate controlled

Question 28

When patients are for delayed cardio version of AF what must be open first

Answer 28

Anticoagulated for 3 weeks as risk of dislodging clot

Question 29

2 drugs form pharmacological cardioversion

Answer 29

Flecanide and amiodarone

Question 30

When must flecanide not be used

Answer 30

Atrial flutter

Question 31

Drugs to reverse DOACs

Answer 31

Andexanet alfa (apixaban and rivaroxaban)

Idarucizumab (a monoclonal antibody against dabigatran)

Question 32

When to use aspirin in AF

Answer 32

Never

Question 33

New bleeding risk tool

Answer 33

ORBIT