the practise in treating CV patients

Question 1

what are 2 different clot strategies?

Answer 1

1- anti-thrombotic
2- thromboprophylaxis

Question 2

3 types of anti- thrombotic?

Answer 2

1) thrombectomy (only in brain vessels)
2) thrombolysis (in brain and heart)
3) angioplasty + stent (heart especially)

Question 3

2 types of thromboprophylaxis?

Answer 3

1) anti-clotting factor drugs (Warfarin, NOAC like riveroxiban)
2) anti-platelet drugs (Aspirin, Clopidogrel, Ticagrelor, Prasugrel)

Question 4

when can ace inhibitors be used?

Answer 4

hypertension
heart failure
angina

Question 5

when can B-blockers be used?

Answer 5

hypertension
heart failure
angina

Question 6

when can calcium antagonists be used? (CCB)

Answer 6

hypertension
angina

Question 7

when can diuretics be used?

Answer 7

hypertension
heart failure

Question 8

overview of hypertension treatment?

Answer 8

ABCD
A= ACE inhibitor
B = beta blocker
C = CCB
D= diuretic esp thiazide diuretic

Question 9

hypertension treatment, patient is <55yrs?

Answer 9

1) start ACE
2) add CCB
3) add diuretic
4) add spironolactone
5) then B or A blocker if necessary

Question 10

hypertension treatment, if patent is >55yrs?

Answer 10

1) start CCB
2) add ACE
3) add diuretic
4) add spironolactone
5) then B or alpha blocker if necessary

Question 11

what are the 4 pillars in the treatment of chronic Heart failure?

Answer 11

1) ACE or ARB or Sacubitril-Valsartan (never and ACE and SV)
2) Beta blocker
3) Aldosterone Receptor Blocker
4) SGLT2 inhibitor

Question 12

what other drug should you give in chronic HF?

Answer 12

Furosemide or another diuretic if there is fluid retention

Question 13

what are “devices” that are used to treat Chronic Heart Failure?

Answer 13

1) Cardiac Resynchronisation Therapy to long QRS patients = Biventricular Pacing

2) Implantable Cardiac Defibrillators to highly selected patients

3) heart transplant

Question 14

what is biventricular pacing?

Answer 14

when the left and right ventricles contract a few secs apart making the CO even worse.

Question 15

how will a Implantable Cardiac Defib work?

Answer 15

it senses the rhythm of the heart and if it is slightly off, then the patient will get a slight shock.

Question 16

what is Sacubitril-Valsartan?

Answer 16

• used to replace ACE or ERB in severe heart failure
• Valsartan = ARB
• Sacubitril = inhibits Neprilysin

Question 17

what does Sacubitril inhibiting Neprilysin do?

Answer 17

it degrades BNP and other vasoactive peptides

Question 18

side effect of Sacubitril-Valsartan?

Answer 18

angioneurmtic oedema (like an ACE)

Question 19

what drugs are given to prolong life for people chronic angina pectoris?

Answer 19

SAAB
- Aspirin
- Statin
- ACE inhibitor
- Beta blocker

Question 20

angina pectoris?

Answer 20

chest pain due to oxygen supply to the heart being too low for its demand.

Question 21

what drugs are given to relieve symptoms of angina pectoris?

Answer 21

• beta blocker
• CCB
• nitrates
• coronary angioplasty (putting a stent in)
• ivabridine or ranolazine
• coronary artery surgery

Question 22

if there is
- cardiac pain
- negative troponin levels
then would is it most likely to be?

Answer 22

unstable angina

Question 23

if there is
- cardiac pain
- positive troponin levels
- ST elevation on ECG
then would is it most likely to be?

Answer 23

STEMI
ST elevation elevation MI

Question 24

if there is
- cardiac pain
- positive troponin levels
- no ST elevation on ECG
then would is it most likely to be?

Answer 24

NSTEMI
no ST elevation MI

Question 25

treatment of STEMI?

Answer 25

Emergency =
- Aspirin
- angioplasty (if near hospital)
- thrombolysis (if far away)
- aspirin
- low MW heparin
- statins
- ACE
- B-blockers
(SAAB)

Question 26

treatment of NSTEMI?

Answer 26

• aspirin
• angioplasty
  statin
  ACE
  Beta blocker
  (SAAB + non urgent angioplasty))

Question 27

3 things to do for treatment of atrial fibrillation?

Answer 27

1) prevent emboli = warfarin/ riveroxaban/NOAC

2) control rate (crucial) = Beta blocker, digoxin

3) control rhythm = DC cardio version acutely, amiodarone if heart failure, stall, flecainide (only if heart function is normal), radioblation

Question 28

most likely causes of stroke?

Answer 28

cerebral thrombosis
cerebral embolus
cerebral haemorrhage

Question 29

treatment for stroke

Question 30

side effects of ACE?

Answer 30

• dry cough
• renal dysfunction
• Angioneurotic oedema
• never give when pregnant

Question 31

angiotensin blocker side effects?

Answer 31

renal dysfunction
never give in pregnancy

Question 32

Beta Blocker side effects?

Answer 32

bradycardia
tired
asthma

Question 33

CCB side effects?

Answer 33

ankle oedema for amlodipine
heart block for diltiazem & verapamil

Question 34

diuretic side effects?

Answer 34

hypokalaemia
diabetes
gout