p.4
Treatment Approaches for Heart Failure
What are common pharmacological treatments for chronic heart failure?
ACE inhibitors, beta-blockers, and diuretics.
p.7
Prevention of Cardiovascular Events
What is the recommended long-term medication combination for the prevention of cardiovascular events?
Aspirin + Statin forever.
p.9
Hypertension Treatment Guidelines and Targets
What are some signs that require same-day referral for severe hypertension?
Retinal hemorrhage, papilloedema, life-threatening symptoms, phaeochromocytoma.
p.7
Prevention of Cardiovascular Events
What is the first-line treatment for rapid relief of angina?
300 mcg sublingual GTN tablets.
p.3
Drug Interactions and Monitoring Requirements
What are the first-line drug treatments for heart failure?
ACE-I/ARB, Beta Blocker, and Amlodipine (Calcium Channel Blocker).
p.3
Prevention of Cardiovascular Events
What vaccinations are recommended for heart failure patients?
Influenza and Pneumococcal Disease vaccines.
p.6
Management of Unstable Angina and STEMI
What anticoagulants can be used in the management of unstable angina?
Unfractionated Heparin, LMWH, or Fondaparinux.
p.4
Treatment Approaches for Heart Failure
What role does patient education play in chronic heart failure management?
It empowers patients to manage their condition and recognize symptoms of worsening heart failure.
p.5
Acute Coronary Syndrome (ACS) Overview
What are the three types of Acute Coronary Syndrome (ACS)?
1) Unstable Angina 2) N-STEMI 3) STEMI
p.5
Acute Coronary Syndrome (ACS) Overview
What is a key diagnostic tool for ACS?
ECG changes and measurement of biochemical cardiac markers such as Troponin.
p.7
Prevention of Cardiovascular Events
What is the mechanism of action (MOA) of nitrates?
Potent coronary vasodilators that reduce venous return and left ventricular work.
p.3
Treatment Approaches for Heart Failure
How often should heart failure patients weigh themselves?
Daily, and report any weight gain of 1.5 – 2.0 kg in 2 days to their GP.
p.3
Drug Interactions and Monitoring Requirements
What should be added if first-line treatments fail?
Digoxin, Sacubitril Valsartan (Entresto), Hydralazine, Ivabradine, and Nitrates.
p.3
Drug Interactions and Monitoring Requirements
What is the role of diuretics in heart failure treatment?
To manage breathlessness and edema due to fluid retention.
p.3
Treatment Approaches for Heart Failure
What lifestyle changes are recommended for heart failure patients?
Smoking cessation, exercise, and reducing alcohol consumption.
p.2
Causes and Diagnosis of Heart Failure
What are some non-heart conditions that can cause reduced cardiac output?
Hypo/hyperthyroidism and severe anemia.
p.8
Hypertension Treatment Guidelines and Targets
What is the immediate treatment for severe hypertension?
Systolic ≥ 180 mmHg or Diastolic ≥ 120 mmHg; treat ASAP with IV antihypertensives.
p.6
Management of Unstable Angina and STEMI
What is the purpose of nitrates in the management of unstable angina?
To relieve ischaemic pain.
p.5
Acute Coronary Syndrome (ACS) Overview
What distinguishes STEMI from NSTEMI?
STEMI is more serious and involves complete blockage, while NSTEMI is less serious with partial blockage.
p.5
Acute Coronary Syndrome (ACS) Overview
How does stable angina differ from unstable angina?
Stable angina occurs during exercise/stress and is predictable, while unstable angina occurs at rest and is unpredictable.
p.7
Prevention of Cardiovascular Events
What combination is licensed for the prevention of atherothrombotic events following an ACS?
Low dose Rivaroxaban + Aspirin alone or DAPT.
p.2
Heart Failure: Types and Symptoms
What are common symptoms of heart failure?
Shortness of breath, persistent coughing or wheezing, ankle swelling, reduced exercise tolerance, fatigue, chest pains, and palpitations.
p.8
Hypertension Treatment Guidelines and Targets
What should be done if ABPM is unsuitable?
Confirm diagnosis and hypertension stage.
p.4
Drug Interactions and Monitoring Requirements
How often should patients with chronic heart failure be monitored?
Regularly, to assess symptoms and adjust treatment as necessary.
p.9
Hypertension Treatment Guidelines and Targets
What should be done for severe hypertension (≥ 180/120)?
Refer patients on the same day.
p.2
Heart Failure: Types and Symptoms
What is heart failure?
A progressive clinical syndrome caused by structural or functional abnormalities of the heart, resulting in reduced cardiac output.
p.2
Heart Failure: Types and Symptoms
How are types of heart failure defined?
By how sudden symptoms present (chronic or acute) and the amount of blood the heart pumps with each heartbeat (reduced or preserved ejection volume).
p.8
Hypertension: Measurement and Risk Factors
What is the follow-up for patients with no hypertension and no organ damage?
Measure clinic BP every 5 years, more frequently if BP is close to 140/90 mmHg.
p.5
Acute Coronary Syndrome (ACS) Overview
What is the primary consequence of obstruction in ACS?
Restriction of blood supply to the heart, leading to ischaemia (chest pain/angina).
p.9
Hypertension Treatment Guidelines and Targets
What should be done if there is target organ damage?
Start antihypertensives ASAP.
p.7
Prevention of Cardiovascular Events
What is the treatment for unstable angina/NSTEMI?
ACE-I + DAPT for 12 months (alternatives include Prasugrel or Ticagrelor).
p.1
Drug Interactions and Monitoring Requirements
What are some enzyme inhibitors that affect statin metabolism?
Ketoconazole, Itraconazole, Erythromycin, Grapefruit Juice.
p.8
Hypertension: Measurement and Risk Factors
What are some risk factors for hypertension?
Age, ethnicity, dietary salt, exercise, alcohol, smoking, caffeine, and weight gain.
p.3
Drug Interactions and Monitoring Requirements
What should be done with drugs that worsen heart failure?
Stop all drugs that worsen heart failure.
p.5
Acute Coronary Syndrome (ACS) Overview
What causes Acute Coronary Syndrome (ACS)?
Plaque ruptures within a coronary artery, causing partial or complete obstruction.
p.5
Acute Coronary Syndrome (ACS) Overview
What triggers angina symptoms?
Physical exertion or stress.
p.1
Drug Interactions and Monitoring Requirements
Which drugs can interact with Simvastatin and increase the risk of rhabdomyolysis?
Amlodipine, Amiodarone, Colchicine, Nicotinic acid, Fibrates.
p.2
Heart Failure: Types and Symptoms
What are the two types of heart failure?
Acute heart failure (AHF) and chronic heart failure (CHF).
p.8
Hypertension: Measurement and Risk Factors
What are the methods to measure hypertension?
Clinic BP, Ambulatory BP Monitoring (ABPM), and Hospital BP Monitoring (HBPM).
p.2
Treatment Approaches for Heart Failure
What are the aims of heart failure treatment?
Reduce mortality, relieve symptoms, improve exercise tolerance, and reduce acute exacerbations.
p.8
Hypertension Treatment Guidelines and Targets
What is the treatment approach for Stage 2 hypertension?
Clinic BP ≥ 160/100 – 180/120; ABPM/HBPM ≥ 150/95 mmHg; treat all.
p.6
Management of Unstable Angina and STEMI
What should be administered if sublingual GTN is ineffective?
I.V./buccal GTN or I.V. Isosorbide Dinitrate.
p.6
Management of Unstable Angina and STEMI
What is the recommended antiplatelet therapy for unstable angina?
Aspirin 300 mg or alternatives like Clopidogrel, Prasugrel, or Ticagrelor.
p.6
Management of Unstable Angina and STEMI
What should all patients with stable angina receive?
Low dose Aspirin and Statin.
p.5
Acute Coronary Syndrome (ACS) Overview
What does ST elevation on an ECG indicate?
It can indicate a serious condition, potentially leading to death.
p.7
Prevention of Cardiovascular Events
What are common side effects of nitrates?
Flushing, headaches, and postural hypotension.
p.8
Hypertension: Measurement and Risk Factors
What should be done while waiting for ABPM results?
Investigate target organ damage and conduct CV risk assessment using QRISK & JBS3 risk calculators.
p.4
Treatment Approaches for Heart Failure
What is the primary focus of chronic heart failure management according to NICE?
To improve symptoms, quality of life, and reduce hospital admissions.
p.1
Drug Interactions and Monitoring Requirements
What monitoring is required for patients on statins?
Lipid profile, LFTs, creatinine kinase, and fasting blood glucose/HbA1c for at-risk patients.
p.7
Prevention of Cardiovascular Events
What should patients do if they experience pain after the third dose of GTN?
Call emergency services (999).
p.8
Hypertension Treatment Guidelines and Targets
What is the treatment approach for Stage 1 hypertension?
Clinic BP ≥ 140/90 – 160/100; ABPM/HBPM ≥ 135/85 mmHg; refer to treatment table.
p.8
Hypertension: Measurement and Risk Factors
What should be done if there is no hypertension but organ damage is present?
Investigate causes related to the heart, brain, kidneys, and eyes.
p.4
Treatment Approaches for Heart Failure
What lifestyle changes are recommended for managing chronic heart failure?
Dietary modifications, regular physical activity, and smoking cessation.
p.5
Acute Coronary Syndrome (ACS) Overview
What are common symptoms of angina?
Chest pain that can be tight, sharp, stabbing, dull, or heavy, and may spread to the left arm, neck, jaw, or back.
p.9
Hypertension Treatment Guidelines and Targets
What is the follow-up for patients with no target organ damage?
Repeat clinic BP measurement within 7 days.
p.7
Prevention of Cardiovascular Events
What is the dosing instruction for sublingual GTN tablets?
1 tablet or 1-2 sprays, not more than 3 doses at any one time.
p.8
Hypertension Treatment Guidelines and Targets
What is the hypertension threshold for treatment based on clinic BP?
Patients with a clinic BP ≥ 140/90 should be offered ABPM/HBPM.
p.1
Drug Interactions and Monitoring Requirements
What is the effect of grapefruit juice on Simvastatin?
It increases exposure to Simvastatin.
p.2
Causes and Diagnosis of Heart Failure
What is the most common cause of heart failure?
Coronary Heart Disease (CHD), especially after a heart attack.
p.3
Drug Interactions and Monitoring Requirements
What are examples of ACE-I/ARB medications?
Valsartan, Losartan, and Candesartan.
p.8
Hypertension: Measurement and Risk Factors
What are secondary causes of hypertension?
Renal disease and endocrine causes.
p.1
Drug Interactions and Monitoring Requirements
What are some enzyme inducers that affect statin metabolism?
Carbamazepine, Sodium Valproate, Rifampicin, Isoniazid, Alcohol (Chronic).
p.2
Causes and Diagnosis of Heart Failure
What factors increase the risk of heart failure?
Men, smokers, diabetes, and increasing age.
p.7
Prevention of Cardiovascular Events
How can tolerance to nitrates be prevented?
By taking MR Isosorbide once daily and leaving the patch off for 8-12 hours overnight.
p.2
Causes and Diagnosis of Heart Failure
What are some diagnostic methods for heart failure?
Physical examination, blood tests for BNP or NT-proBNP, ECG, chest x-ray, and blood and urine tests.
p.8
Hypertension: Measurement and Risk Factors
What organs can be damaged by hypertension?
Heart, brain, kidneys (chronic kidney disease), and eyes (retinopathy).
p.6
Management of Unstable Angina and STEMI
What is the memory trick for remembering the management steps for a heart attack?
C – OSAMA BIN: Clopidogrel, Oxygen, Statin, ACE-I, Metoclopramide, Aspirin, Beta blocker, I.V. Heparin, Morphine, Nitrite.
p.8
Hypertension Treatment Guidelines and Targets
What are the treatment options for hypertension?
Urine/blood tests, lifestyle interventions, and drug treatment.
p.6
Management of Unstable Angina and STEMI
What combination is used if beta blockers are ineffective against angina?
Beta blockers and rate-limiting CCBs (e.g., Verapamil/Diltiazem).
