3) Cardiovascular Conditions

Question 1

Describe the management of Heart Failure.

Answer 1

1st line - ACEi AND Beta blockers
2nd line - Spironolactone
3rd line - Hydralazine with nitrates

Question 2

Name THREE medications used in Heart Failure that IMPROVE MORTALITY.

Answer 2

• ACEi (first line)
• Beta blockers (first line)
• Spironolactone
• Hydralazine w/ nitrates (if used, have to be clustered together)

Also accepted - ARBs

Question 3

What is the first-line investigation for suspected Heart Failure.

Answer 3

BNP levels

Question 4

Which blood result determines in what time frame an echo would be performed in someone with suspected Heart Failure? Describe the different scenarios possible.

Answer 4

BNP:

• Previous MI - do an echo within two weeks
• No previous MI, but high level of BNP (400+) - do an echo within two weeks
• No previous MI, but raised level of BNP (100-400) - do an echo within six weeks

Question 5

Name THREE of the major Framingham criteria features.

Hint: SAW PANIC

Answer 5

• S3 heart sound present (‘gallop’ sound)
• Acute pulmonary oedema (left side of heart is unable to clear fluid from lungs)
• Weight loss of more than 4.5kg in 5 days when treated (patients lose their retained fluids)
• PND
• Abdominojugular reflux (JVP rises when pressure applied over liver area)
• Neck vein distended (JVP at rest)
• Increased cardiac shadow on X-ray (Cardiomegaly)
• Crackles on auscultation