Cardiovascular Medicine Flashcards

A 72-year-old man with heart failure presents with worsening dyspnoea, orthopnoea and bilateral basal crepitations. Which investigation best confirms decompensated heart failure?

Answer: B-type natriuretic peptide

Elevated BNP or NT-proBNP supports a diagnosis of decompensated heart failure.

Which class of drug is first-line for symptomatic relief of pulmonary congestion in acute heart failure?

Answer: Intravenous loop diuretic

IV loop diuretics such as frusemide relieve pulmonary congestion in acute decompensated heart failure.

A patient with HFrEF is already on an ACE inhibitor and beta-blocker but remains symptomatic with an ejection fraction of 30%. Which agent reduces mortality next?

Answer: Spironolactone

A mineralocorticoid receptor antagonist like spironolactone reduces mortality in symptomatic HFrEF.

Which examination finding most specifically indicates elevated right atrial pressure in heart failure?

Answer: Raised jugular venous pressure

A raised JVP directly reflects elevated right atrial pressure and is a specific sign of congestion.

A patient on an ACE inhibitor develops a persistent dry cough. What is the most appropriate substitute?

Answer: Angiotensin receptor blocker

An ARB provides similar benefit without the bradykinin-mediated cough of ACE inhibitors.

Which addition to standard therapy has been shown to reduce hospitalisation in HFrEF by inhibiting sodium-glucose co-transport?

Answer: SGLT2 inhibitor

SGLT2 inhibitors such as dapagliflozin reduce heart failure hospitalisation regardless of diabetes status.

A patient with heart failure has a regular pulse, QRS duration of 160 ms with left bundle branch block, and EF of 28% despite optimal medication. Which device therapy is indicated?

Answer: Cardiac resynchronisation therapy

CRT improves outcomes in HFrEF with a wide QRS and LBBB by resynchronising ventricular contraction.