Public health CVD

Question 1

Cardiac failure definition?

Answer 1

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.

Question 2

What are the 3 main types of cardiac failure and what causes them?

Answer 2

1. LVSD - often due to IHD
2. RVSD - secondary to LVSD
3. Diastolic HF

Question 3

Pathophysiology of cardiac failure in x4 steps:

Answer 3

1. Sympathetic activation
2. RAAS activation
3. Natriuretic peptide release
4. Ventricular hypertrophy

Question 4

Cardinal symptoms of heart failure?

Answer 4

1. SOB
2. Fatigue
3. Peripheral oedema
4. PND
5. Orthopnea

Question 5

Signs of heart failure? (x4)

Answer 5

1. Tachycardia
2. Raised JVP
3. Displaced apex beat
4. Added heat sounds

Question 6

Ix for HF?

Answer 6

1. BNP
2. CXR
3. ECG
4. Echo

Question 7

Describe each of the NYHA classifications of cardiac failure?

Answer 7

1. Class 1: no limitation, ASx.
2. Class 2: slight limitation, mild HF
3. Class 3: marked limitation, moderate HF
4. Class 4: inability to carry out physical activity without discomfort, severe HF.

Question 8

HF management:

Answer 8

1. Lifestyle modification
2. 1st line medication: ACEi, beta blockers
   2nd line medication: aldosterone agonists, ARB
   Diuretics to help with symptom relief
3. Surgery: valve replacement, LV remodeling

Question 9

Ramipril - what should be monitored?

Answer 9

Renal function: eGFR, U&E

Question 10

What should be monitored in a patient taking beta blockers?

Answer 10

HR and BP

Question 11

Someone with HTN what lifestyle modifications may be suggested?

Answer 11

• Reduced salt intake
• Reduce weight loss
• Reduce alcohol intake
• Stop smoking
• Increase exercise

Question 12

What are 3 SE of ACEi?

Answer 12

1. Hypotension
2. AKI
3. Hyperkalemia
4. Cough (ramipril dry cough)
5. Rash

Question 13

What are 3 ARB used in treatment of HTN?

Answer 13

Candesartan
Valsartan
Losartan

Question 14

What 3 beta blockers can be used in the treatment of HTN?

Answer 14

1. Atenolol
2. Propranolol
3. Bisoprolol

Question 15

SE of beta blockers?

Answer 15

1. Fatigue
2. Headache
3. Bradycardia
4. Hypotension
5. ED
6. Cold peripheries

Question 16

Name 3 CCB that could be used in the treatment of HTN:

Answer 16

1. Dihydropyridines e.g. amlodipine and felodipine
2. Diltiazem
3. Verapamil

Question 17

What channels doe CCB act on?

Answer 17

L-type Ca2+ channels

Question 18

What diuretics are used in the treatment of HTN?

Answer 18

Thiazide-like diuretic e.g. Indapamide

Question 19

Definition of polypharmacy:

Answer 19

> =5 drugs taken regularly

Question 20

Name some complications with polypharmacy;

Answer 20

1. Drug interaction
2. Compliance and patient interaction due to too many medications
3. Pill burden

Question 21

What is the 5 yr mortality of HF?

Answer 21

75%

Question 22

Give examples of primary prevention methods for heart failure?

Answer 22

1. Healthy lifestyle
2. Reduced alcohol intake
3. Smoking cessation
4. QRISK
5. Statins
6. Correct aggravating factors e.g. AF, HTN, DM

Question 23

QRISK >10 advice?

Answer 23

Start taking statins and modify their lifestyle

Question 23

QRisk purpose?

Answer 23

Determine patients risk of a CV event in the next 10 years.

Question 24

Give examples of secondary preventative methods for cardiac failure:

Answer 24

1. Regularly check BP 2. Regularly check blood cholesterol

Question 25

What is ED?

Answer 25

Inability to attain and maintain erection sufficient for satisfactory sexual performance

Question 25

Give examples of tertiary prevention methods for cardiac failure:

Answer 25

1. Exercise based cardiac rehabilitation 2. Revascularization procedures (e.g. PCI, CABD) 3. Implantable defibrillators

Question 26

What might point towards a psychogenic cause of ED?

Answer 26

1. Sudden onset 2. Early collapse 3. Problematic relationship

Question 26

What x5 may cause ED?

Answer 26

1. Neuro: brain injury/spinal cord disease 2. CVD 3. Psychogenic: depression, anxious, psychosexual 4. Endocrine: thyroid 5. Meds: beta blocker, diuretic, anti-depressant

Question 27

RF for ED?

Answer 27

1. Lifestyle e.g. smoke, fat, alcohol 2. Hypercholesterolemia 3. HTN 4. DM

Question 28

What is tadalafil and how does it work?

Answer 28

Phosphodiesterase inhibitor for ED which increases the blood flow to the corpus cavernosum

Question 28

What may point towards an organic cause of ED?

Answer 28

1. Gradual onset 2. Normal ejaculation 3. Normal libido 4. RF present

Question 28

What Ix to determine cause of ED?

Answer 28

1. FSH/LH/prolactin 2. Fasting glucose 3. HbA1c 4. Lipid profile

Question 29

Management of ED?

Answer 29

1. Treat RF 2. Refer for counselling 3. Phsophodiesterase inhibitor (tadalafil) 4. Vacuum devices 5. Injection 6. Penile prosthesis