Tuesday [6/6/23]

Question 1

chronic heart failure Tx

Answer 1

1. first-line is ACE-inhibitiro and beta-blocker, generally one drug should be started at a time; licensed to treat heart failure include bisoprolol, carvedilol and beivolol
2. second-line is now either aldosterone antagonist, angiotensin II receptor blocker or a hydrazine in combination with a nitrate
3. if symptoms persist cardiac resynchronisation therapy or digoxin should be considered.
4. diuretics should be used for overload
5. offer annual influenza vaccine and offer one-off pneumococcal vaccine

Question 2

when is ivabradine considered?

Answer 2

already on suitable therapy [ACE-inhibitor, beta-blocker and aldosterone antagonist], has a heart rate over 75 and LVF under 35%

Question 3

short-term management of acute heart failure

Answer 3

oxygen, diuretics, opiates, vasodilators, inotropic agents, CPAP, ultrafiltration, mechanical circulatory assistance e.g. intra-aortic balloon counterpulsation

consideration should eb given to discontinuing beta-blocker in the short-term

Question 4

how much of body weight is water?

Answer 4

60^, 1/3 is extracellular fluid, 2/3 is intracellular fluid inside cells

Question 5

normally, what should the osmolality be?

Answer 5

extra and intracellular osmolality should be similar