Public health CVD Flashcards
Cardiac failure definition?
Clinic syndrome/ S&S suggestive that the efficacy of the heart as a pump is impaired so the is not able to match the metabolic demands of the body.
What are the 3 main types of cardiac failure and what causes them?
- LVSD - often due to IHD
- RVSD - secondary to LVSD
- Diastolic HF
Pathophysiology of cardiac failure in x4 steps:
- Sympathetic activation
- RAAS activation
- Natriuretic peptide release
- Ventricular hypertrophy
Cardinal symptoms of heart failure?
- SOB
- Fatigue
- Peripheral oedema
- PND
- Orthopnea
Signs of heart failure? (x4)
- Tachycardia
- Raised JVP
- Displaced apex beat
- Added heat sounds
Ix for HF?
- BNP
- CXR
- ECG
- Echo
Describe each of the NYHA classifications of cardiac failure?
- Class 1: no limitation, ASx.
- Class 2: slight limitation, mild HF
- Class 3: marked limitation, moderate HF
- Class 4: inability to carry out physical activity without discomfort, severe HF.
HF management:
- Lifestyle modification
- 1st line medication: ACEi, beta blockers
2nd line medication: aldosterone agonists, ARB
Diuretics to help with symptom relief - Surgery: valve replacement, LV remodeling
Ramipril - what should be monitored?
Renal function: eGFR, U&E
What should be monitored in a patient taking beta blockers?
HR and BP
Someone with HTN what lifestyle modifications may be suggested?
- Reduced salt intake
- Reduce weight loss
- Reduce alcohol intake
- Stop smoking
- Increase exercise
What are 3 SE of ACEi?
- Hypotension
- AKI
- Hyperkalemia
- Cough (ramipril dry cough)
- Rash
What are 3 ARB used in treatment of HTN?
Candesartan
Valsartan
Losartan
What 3 beta blockers can be used in the treatment of HTN?
- Atenolol
- Propranolol
- Bisoprolol
SE of beta blockers?
- Fatigue
- Headache
- Bradycardia
- Hypotension
- ED
- Cold peripheries
Name 3 CCB that could be used in the treatment of HTN:
- Dihydropyridines e.g. amlodipine and felodipine
- Diltiazem
- Verapamil
What channels doe CCB act on?
L-type Ca2+ channels
What diuretics are used in the treatment of HTN?
Thiazide-like diuretic e.g. Indapamide
Definition of polypharmacy:
> =5 drugs taken regularly
Name some complications with polypharmacy;
- Drug interaction
- Compliance and patient interaction due to too many medications
- Pill burden
What is the 5 yr mortality of HF?
75%
Give examples of primary prevention methods for heart failure?
- Healthy lifestyle
- Reduced alcohol intake
- Smoking cessation
- QRISK
- Statins
- Correct aggravating factors e.g. AF, HTN, DM
QRISK >10 advice?
Start taking statins and modify their lifestyle
QRisk purpose?
Determine patients risk of a CV event in the next 10 years.
Give examples of secondary preventative methods for cardiac failure:
- Regularly check BP
- Regularly check blood cholesterol
What is ED?
Inability to attain and maintain erection sufficient for satisfactory sexual performance
Give examples of tertiary prevention methods for cardiac failure:
- Exercise based cardiac rehabilitation
- Revascularization procedures (e.g. PCI, CABD)
- Implantable defibrillators
What might point towards a psychogenic cause of ED?
- Sudden onset
- Early collapse
- Problematic relationship
What x5 may cause ED?
- Neuro: brain injury/spinal cord disease
- CVD
- Psychogenic: depression, anxious, psychosexual
- Endocrine: thyroid
- Meds: beta blocker, diuretic, anti-depressant
RF for ED?
- Lifestyle e.g. smoke, fat, alcohol
- Hypercholesterolemia
- HTN
- DM
What is tadalafil and how does it work?
Phosphodiesterase inhibitor for ED which increases the blood flow to the corpus cavernosum
What may point towards an organic cause of ED?
- Gradual onset
- Normal ejaculation
- Normal libido
- RF present
What Ix to determine cause of ED?
- FSH/LH/prolactin
- Fasting glucose
- HbA1c
- Lipid profile
Management of ED?
- Treat RF
- Refer for counselling
- Phsophodiesterase inhibitor (tadalafil)
- Vacuum devices
- Injection
- Penile prosthesis
