Treatment (Conservative, Medical, Surgical)

Question 1

Conservative treatment of Heart failure

Answer 1

Smoking cessation advice
Weight loss
Promotion of healthy diet and exercise

Question 2

Medical treatment of HF

Answer 2

ABCD DS
Angiotensin converting enzyme (ACE) inhibitors
Beta-blockers
Candesartan (Angiotensin receptor blocker)
Digoxin
Diuretics
Spironolactone

Question 3

What are only 2 Beta blockers licensed in UK

Answer 3

Bisoprolol

Carvedilol

Question 4

When would you use Candsartan and what is it?

Answer 4

Angiotensin Receptor Blocker

Use if person intolerant to ACE inhibitors

Question 5

What is Digoxin

Answer 5

Cardaic glycoside

Question 6

Example of diuretic used to treat HF

Answer 6

Furosemide

Question 7

What is Spironolactone

Answer 7

Aldosterone Receptor Antagonist

Question 8

Surgical treatment of HF

Answer 8

Heart transplantation

Question 9

Conservative Treatment of Myocardial Infarction (MI)

Answer 9

Lifestyle measures such as smoking cessation and increased exercise

Question 10

Immediate Medical treatment of Myocardial Infarction (MI)

Answer 10

MONA B for immediate management:
Morphine
Oxygen (if hypoxic)
Nitrates (glyceryl trinitrate - GTN)
Anticoagulants
-
Beta blockers (if no contraindication)

Question 11

Example of Nitrate spray

Answer 11

Glyceryl Trinitrate

Question 12

Example of Anticoagulants for immediate management

Answer 12

Aspirin and an Antiemetic

Question 13

Medical treatment of Myocardial Infarction on discharge

Answer 13

On discharge all patients should be prescribed:
Aspirin
ACE inhibitor
Beta-blocker (if no CIs)
Statin

Question 14

If contraindication for beta blockers is present, what could be prescribed instead

Answer 14

Calcium channel blocker

Question 15

Surgical treatment of MI

Answer 15

Reperfusion with PCI if STEMI
PCI may also be used in NSTEMI, but if NSTEMI patients are not having immediate PCI
Drugs to prevent blood clots

PCI = Percutaneous Coronary Intervention

Question 16

Surgical treatment of MI - what can be given to prevent blood clots (2 options) and via what route of admin

Answer 16

Fondaparinux - Factor Xa inhibitor
Low Molecular Weight Heparin (LMWH)
Subcutaneously

Question 17

Conservative treatment of Angina Pectoris

Answer 17

Modify risk factors, e.g:

• Control cholestrol
• Control diabetes
• Smoking cessation advice
• Weight loss
• Increase exercise
• Control hypertension

Question 18

Medical treatment of Angina Pectoris

Answer 18

Nitrates (Glyceryl Trinitrate spray)
ABC:
Aspirin
Beta-blockers
Ca2+ antagonists (especially if BB is CI)
K+ channel agonist

Question 19

Side effects of GTN spray

Answer 19

Headache

Hypertension

Question 20

When are Beta-Blockers contra-indicated

Answer 20

Asthma

Chronic Obstructive Pulmonary Disease

Question 21

Examples of a K+ channel activator

Answer 21

Nicorandil

Question 22

2 Surgical treatment options of Angina Pectoris

Answer 22

Percutaneous Transluminal Coronary Angioplasty
OR
Coronary Artery Bypass Graft (CABG)

Question 23

Conservative Treatment of Infective Endocarditis

Answer 23

Maintain good oral hygiene

General/All treatment of Infective Endocarditis depends on causative agent

Question 24

Main Medical treatment of Infective Endocarditis

Answer 24

Benzylpenicillin and Gentamicin

Question 25

Medical treatment of Infective Endocarditis for Staphlococci

Answer 25

Flucloxacillin | Gentamicin

Question 26

Medical treatment of Infective Endocarditis for Streptococci

Answer 26

Benzylpenicillin | Amoxicillin

Question 27

Medical treatment of Infective Endocarditis for Aspergillus

Answer 27

Miconazole

Question 28

Conservative treatment of Aortic Stenosis

Answer 28

Manage cardiovascular risk factors e.g. smoking cessation

Question 29

Medical treatment of Aortic Stenosis

Answer 29

Manage cardiovascular risk factors e.g. control BP

Question 30

Surgical treatment of Aortic Stenosis

Answer 30

Valve replacement

Question 31

Conservative treatment of Aortic regurgitation

Answer 31

Manage cardiovascular risk factors e.g. smoking cessation

Question 32

Medical treatment of Aortic regurgitation

Answer 32

Manage heart failure by following NICE guidelines

Question 33

Surgical treatment of Aortic regurgitation

Answer 33

Valve replacement

Question 34

Conservative treatment of Mitral Stenosis or Regurgitation

Answer 34

Manage CVS risk factors such as smoking cessation

Question 35

Medical treatment of Mitral Stenosis or Regurgitation

Answer 35

Manage AF and heart failure by following NICE guidelines

Question 36

Surgical treatment of Mitral Stenosis

Answer 36

Valve replacement

Question 37

Surgical treatment of Mitral Regurgitation

Answer 37

Valve repair preferred | Valve replacement may interfere with function of papillary muscles

Question 38

Conservative treatment of hypertension

Answer 38

``` Lifestyle advice including: smoking cessation encouraging weight loss decreases alcohol consumption salt restricted diet ```

Question 39

Surgical treatment of hypertension (when?)

Answer 39

Surgical excision (if related to cause)

Question 40

Medical treatment of hypertension in <55 year old | 4 steps

Answer 40

A or C A+C A+C+D Refer for add-on therapy ``` A = ACE inhibitor or ARB C = Calcium channel blocker D = thiazide-type diuretic ```

Question 41

What could be added on at end of hypertension medical treatment

Answer 41

Spironolactone Alpha-blocker Beta-blocker

Question 42

Side effect of Spironolactone

Answer 42

Hyperkalemia

Question 43

Medical treatment of hypertension in >55 year old or black patients (4 steps)

Answer 43

D A+D A+C+D Refer for add-on therapy ``` A = ACE inhibitor or ARB C = Calcium channel blocker D = thiazide-type diuretic ```

Question 44

Conservative treatment of atrial fibrillation

Answer 44

Patient education and management of cardiovascular risk factors e.g. smoking cessation and decreased alcohol intake

Question 45

Medical treatment of atrial fibrillation

Answer 45

Treat underlying cause and: Restore rate Restore rhythm Anticoagulant

Question 46

Medical treatment of atrial fibrillation - how would you restore rate

Answer 46

Beta-blocker Calcium antagonist Digoxin Amiodarone

Question 47

Medical treatment of atrial fibrillation - how would you restore rhythm

Answer 47

Beta-blocker Cardioversion Amiodarone

Question 48

Medical treatment of atrial fibrillation - anticoagulant given

Answer 48

Warfarin Apixaban Dabigatran Rivaroxaban