Heart failure and HTN

Question 1

Causes of LVF

Answer 1

1. IHD
2. Dilated cardiomyopathy
3. HTN
4. Mitral/aortic valve disease

Question 2

Gold standard Ix in heart failure

Worse prognostic factor

Answer 2

ECHO

Hyponatraemia

Question 3

NYHA classification

Answer 3

1. No limitation
2. Slight limitation on ordinary activity
3. Moderate limitation on less than ordinary
4. Severe limitation/breathless at rest

Question 4

Ejection fraction =

Answer 4

SV/End diastolic volume

Question 5

Management of chronic heart failure 1st line

Answer 5

1. ACE I/ARB (hydralazine+ISDN if not tolerated)
   + beta blocker - carvediol/bisoprolol
   + Loop diuretics

Question 6

Mx chronic heart failure 2nd line

Answer 6

Spironolactone/eplerenone
ACE I+ARB
Vasodilator (hydralazine+ISDN)

Question 7

Mx chronic heart failure 3rd line

Answer 7

Digoxin

Cardiac resynchronisation

Question 8

Resistant to furosemide

Answer 8

Switch to bumetanide + add metolazone

Question 9

Acute heart failure management

Answer 9

DANO CD

diuretic, morphine, nitrates, oxygen, CPAP, digoxin

Question 10

HTN stages

Answer 10

1 - 140/90 (ABPH - 135/85)
2 - 160/100 (ABPH 150/95)
3 - 180/110
Malignant - Severe + papilloedema +/- retinal haemorrhage

Question 11

HTN stage in >80’s

Answer 11

150/90

Question 12

BP target

Answer 12

Normal - 140/85
Diabetes - 130/80
Over 80 - 150/90

Question 13

Mx of HTN

Answer 13

STEP 1 A (or B) C (or D)
STEP 2 A + C (or D)
STEP 3 A (or B) + C + D (thiazide like diuretic - chlorthalidone/indapamide instead of conventional thiazide like bendroflumethiazide)
STEP 4 Consider further diuretic treatment
If potassium less than 4.5mmol/l add spironolacone 25mg if over 4.5 add higher does thiazide diuretic
If further diuretic therapy not tolerated/contraindicated
Alpha or beta blocker

Question 14

Type of Ca blocker used

Answer 14

Nifedipine