Term
| which tool do you use to assess 10 year risk for CVD? |
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Definition
QRSISK2.
those exempt from this tool include:-
those already with CVD
type 1 diabetes
CKD
familial hypercholestereamia
> 85 years |
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Term
| how often should the QRISK2 be repeated? |
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Definition
| every 5 years or if any significant changes occur then do it earlier |
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Term
| if someone has a 20% score from QRISK2 how can this be interpreted to pt? |
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Definition
| 20 in 100 or 2 in 10 people with the same risk factors will develop a CVD in the next 10 years |
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Term
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Definition
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Term
| what is primary prevention of CVD? |
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Definition
primary prevention: those aged 40 and over but < 84years who are likely to have a 10% risk of CVD using QRISK2 score.
20mg Atorvastatin and lifestyle/diet advice |
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Term
| apart from those with 10% risk of CVD on QRISK2 who else is rx using 20mg Atorvaststain as primary prevention? |
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Definition
those with Type I diabetes
CKD eGFR< 60ml |
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Term
| what is secondary prevention in cvd? |
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Definition
| Those with known IHD, CVD or PVD. they are treated with 80mg Atorvastatin |
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Term
| QRISK2 tool not recommended in the following people? |
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Definition
Type 1 diabetes
familial hypercholestereamia
age > 85 years
CKD eGFR < 60 |
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Term
| QRISK2 may underestimate CVD risk in which conditions |
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Definition
HIV
AI disease
mental health
those on antipsychotics that can cause hyper lipideamia |
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Term
lifestyle modifications for CVD - Diet
encourage smokers to quit |
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Definition
fat intake <30% total and <7% saturated
wholegrain
5portion fruit/veg day
2 portion fish (1 portion oily) a week |
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Term
| lifestyle modification for CVD - physical activity |
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Definition
each week
150min moderate intensity or 75 vigorous intensity aerobic
do muscle strengthening 2 or more days a week |
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Term
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Definition
male
FHx
smoking
diabetes
poor nutrition, alcohol xs
HTN
cholesterol
ethnicity |
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Term
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Definition
stable angina
valvular disease: aortic stenosis
heart failure
obesity
asthma
copd |
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Term
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Definition
stage 1 - clinic >140/90 home >135/85
stage 2 - clinic >160/100 home >150/95
severe HTN- clinic >180/110 |
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Term
| how to diagnose HTN e.g the BP is 140/90 in clinic |
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Definition
offer ambulatory BP measurement > 135/85 is HTN grade 1
if they cannot tolerate ambulatory then home BP monitoring is ok |
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Term
| if a person has severe HTN >180/110 what should you do? |
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Definition
| consider starting rx without waiting for results of ambulatory or home BP results. |
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Term
| for all pt with diagnosis of HTN what should be done? |
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Definition
urine albumin:creatinine ratio
Bloods: glucose, creatinine, electrolytes, eGFR, total and HDL cholesterol
examine fundi for hypertensive retinopathy
arrange a 12 lead ECG |
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Term
| lifestyle advise to people with HTN? |
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Definition
smoking cessation
reduce salt intake
avoid xs consumption of caffeine and coffee |
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Term
| you should offer anti HTN meds to those who are less than 80 with stage 1 HTN (>140/90) and one or more of the following |
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Definition
target end organ damage
established CVD
renal disease
diabetes
10 year CVS risk of 20% or > |
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Term
T/F
offer anti HTN meds to all pts with stage 2 HTN (>160/100)? |
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Definition
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Term
| what are the target BP for people rx for HTN aged > and < 80? |
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Definition
| < 80 target: > 80 target: <150/90 |
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Term
| pt is white and < 55 years which anti HTN med? |
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Definition
| ACE-i or ARB if ACE-i is intolerated |
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Term
| pt is > 55 years or black. what is 1st line anti htn med? |
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Definition
Calcium channel blocker.
if not tolerated then thiazide like diuretic |
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Term
| if diuretic rx is to be initiated in HTN rx which ones are preferred? |
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Definition
indapamide and cholrtadilone
as opposed to bendroflumethiazide or hydrochlorthiazide |
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Term
| beta blockers arnt preferred as initial therapy in hen but may be used in the young when? |
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Definition
intolerence or CI to ACE-i/ARB
women of child bearing potential
those with increased sympathetic drive.
if on beta blocker for HTN and a second drug needs to be added then you should add calcium channel blocker rather than thizaide. this is to reduce the risk of the person developing diabetes |
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Term
a person is on beta blocker to reduce HTN but its not working. you need to add another drug.
the options are calcium channel blocker and thiazide diuretic. which one is the suitable choice and why? |
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Definition
| calcium channel blocker because beta blocker and thizaide diuretic increase chances of the person getting diabetes. |
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Term
| 1st, 2nd, 3rd and 4th line hen DRUGS |
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Definition
1st ace-i or CCB if black or > 55
2nd ace and CCB
3rd ACE, CCB and thiazide diuretic
4th resistant HTN: Add spininolactone if K < 4.5. if > 4.5 increased thizide diuretic. if intolerated try alpha blocker
4th: specialist referal |
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Term
normal BNP levels are < 100
raised: 100-400
high: >400
what would you do if you had raised or high results? |
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Definition
raised: echo within 6 weeks
high: echo within 2 weeks |
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Term
| non drug management of HF |
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Definition
cardiac resynchronisation therapy
exercise training |
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Term
dx HF: what should you order if there has been a previous mi?
if no previous MI you do BNP levels
if raised: echo within 6 weeks
if high: echo within 2 weeks
if normal: HF unlikely |
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Definition
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Term
| staging of HF NYHF classification |
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Definition
class 1 - no symptoms on ordinary physical activity
class 2 - slight SOB from physical activity
class 3 - SOB with less than ordinary activity
class 4 - sob at rest |
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Term
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Definition
lifestyle: smoking, exercise, diet, travel and alcohol
drugs: ACE-i, diuretics, beta blockers |
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Term
| what vaccines offered in HF? |
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Definition
| influenza and single pneumococcal vaccine |
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Term
| all pts with HF and LVEF <40% should get which med> |
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Definition
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Term
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Definition
check U&E prior to starting then 1-2 weeks of treatment or dose adjustment.
recheck U&E 1,3 and 6 months then 2x yearly thereafter
an increase of unto 50% increase from BL is acceptable |
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Term
| drugs shown to improve mortality in HF? |
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Definition
beta blockers
spirinolactone
ACE-i
hydrazine with nitrates |
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Term
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Definition
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Term
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Definition
aldosterone antagonist or ARB or hydralazine in combo with a nitrate
if symptoms persist then cardiac resynchronisation therapy or digoxin |
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Term
| ivabradine is allowed as an alternative to cardiac resynchronisation therapy or digoxin. what is the criteria? |
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Definition
pt already on
ACE-i, beta blocker and aldosterone antagonist therapy, HR > 75 and left ventricular fraction <35% |
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Term
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Definition
| selective funny channel inhibitor |
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Term
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Definition
| acutely neurohormonal mechanism is beneficial to maintain CO/peripheral perfusion but sustained activation results in increased wall stress, dilatation and ventricular remodelling. these contribute to disease progression in the heart and leads to further RAAS activation. |
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Term
| a complication of ventricular remodelling and the heart assuming a more globular shape is regurg associated with which valve? |
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Definition
the mitral valve.
this results in increased volume over load on the LV and further contributes to remodelling and progression of disease. |
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Term
causes of Aortic regurg can be due to valve disease and root disease.
what are causes of valve disease? |
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Definition
bicuspid valve
rheumatic fever
endocarditis
CT disease: RA/SLE |
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Term
| causes of Aortic regurg due to aortic root disease? |
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Definition
aortic dissection
spondyloarthropathies eg ank spond
HTN
syphylis
Marfans, EDS |
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Term
| features of Aortic regurg? |
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Definition
Early diastolic murmur
collapsing pulse (water hammer)
wide pulse pressure
Austin Flint murmur in severe AR |
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Term
| in severe aortic regurg which mid diastolic murmur may you hear in addition to the early diastolic murmur of aortic regurg? |
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Definition
| Austin Flint mid diastolic murmur due to partial closure of anterior mitral valve cusps. |
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Term
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Definition
symptomatic pts need surgery
options: valve replacement or repair. those who are high risk for surgery can get TAVI (transcatheter aortic valve implant) |
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Term
| if a pt with symptomatic aortic regurg is not a surgical candidate due to comorbities how are they treated? |
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Definition
| with long term vasodilators or ACE-i e.g enalapril |
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Term
| causes of aortic stenosis |
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Definition
degenerative
bicuspid valve
post rheumatic disease
supravalvular: williams syndrome
subvalvluar: HOCM |
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