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Question 1
Incorrect
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A 72-year-old man presents with palpitations and feeling dizzy. An ECG reveals atrial fibrillation with a heart rate of 130 beats per minute. His blood pressure is within normal limits and there are no other notable findings upon examination of his cardiorespiratory system. He has a medical history of controlled asthma (treated with salbutamol and beclomethasone) and depression (managed with citalopram). He has been experiencing these symptoms for approximately three days. What is the most suitable medication for controlling his heart rate?
Your Answer: Amiodarone
Correct Answer: Diltiazem
Explanation:Prescribing a beta-blocker is not recommended due to her asthma history, which is a contraindication. Instead, NICE suggests using a calcium channel blocker that limits the heart rate. Additionally, it is important to consider antithrombotic therapy.
Atrial fibrillation (AF) is a heart condition that requires prompt management. The management of AF depends on the patient’s haemodynamic stability and the duration of the AF. For haemodynamically unstable patients, electrical cardioversion is recommended. For haemodynamically stable patients, rate control is the first-line treatment strategy, except in certain cases. Medications such as beta-blockers, calcium channel blockers, and digoxin are commonly used to control the heart rate. Rhythm control is another treatment option that involves the use of medications such as beta-blockers, dronedarone, and amiodarone. Catheter ablation is recommended for patients who have not responded to or wish to avoid antiarrhythmic medication. The procedure involves the use of radiofrequency or cryotherapy to ablate the faulty electrical pathways that cause AF. Anticoagulation is necessary before and during the procedure to reduce the risk of stroke. The success rate of catheter ablation varies, with around 50% of patients experiencing an early recurrence of AF within three months. However, after three years, around 55% of patients who have undergone a single procedure remain in sinus rhythm.
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This question is part of the following fields:
- Cardiovascular Health
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Question 2
Incorrect
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You see a 70-year-old male smoker in clinic who describes symptoms of pain in his left leg which is exacerbated by exercise and relieved by rest.
On examination his pulses are weak in the left leg compared to the right. Suspecting intermittent claudication you arrange leg Dopplers. These show an ABPI (ankle brachial pressure Index) of 0.84.
What is the appropriate diagnosis for this man based on these findings?Your Answer:
Correct Answer: Peripheral arterial disease
Explanation:Understanding ABPI and its Interpretation
The Ankle-Brachial Pressure Index (ABPI) is a ratio that compares the systolic pressure in the ankle to that in the arm. It is a non-invasive test that helps diagnose peripheral arterial disease (PAD), a condition that affects blood flow to the legs and feet.
An ABPI of less than 0.9 indicates the presence of PAD, while an ABPI of less than 0.8 suggests a higher risk of developing ulcers. An ABPI of less than 0.5 indicates critical ischaemia, a severe form of PAD that can lead to tissue damage and even amputation.
On the other hand, an ABPI of more than 1.5 is likely due to non-compressible vessels, which means that the arteries are too stiff to be accurately measured. In such cases, the ABPI cannot be relied upon to guide clinical decisions.
In summary, the ABPI is a useful tool in diagnosing and assessing the severity of PAD. Healthcare professionals should interpret the results carefully and take appropriate action based on the patient’s individual circumstances.
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This question is part of the following fields:
- Cardiovascular Health
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Question 3
Incorrect
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A 59-year-old man visits his General Practitioner to discuss his medication for hypertension. He is currently taking ramipril 10 mg daily, amlodipine 10 mg daily, and immediate-release indapamide 1.5 mg daily. Despite tolerating this treatment without any side-effects, his clinic blood pressure remains high at an average of 155/100 mmHg. The patient has no adverse lifestyle factors and a family history of hypertension and stroke. Secondary causes for hypertension have been ruled out, and routine blood tests including renal function, electrolytes, lipids, and glucose are all normal. His serum potassium level is 4.7 mmol/l (normal range 3.5-5.5 mmol/l). What is the most appropriate modification to this patient's treatment?
Your Answer:
Correct Answer: Increase indapamide to 2.5 mg daily
Explanation:Treatment options for resistant hypertension
Resistant hypertension can be a challenging condition to manage, and the National Institute for Health and Care Excellence (NICE) has provided guidelines to help healthcare professionals make informed decisions. In step 4 of the guidelines, NICE recommends a combination of ACE inhibitor, calcium channel blocker, and diuretic therapy, with the addition of further diuretic or alpha or beta blocker if necessary.
If further diuretic therapy is required, NICE suggests a higher-dose thiazide-like diuretic or spironolactone, depending on the patient’s serum potassium level. However, if spironolactone is not licensed for use or not tolerated, increasing the dose of indapamide is a suitable alternative. It’s important to note that the maximum dose of modified-release indapamide is 1.5mg daily.
If further diuretic therapy is not tolerated or contraindicated, NICE recommends considering an alpha or beta blocker. In cases of resistant hypertension, seeking expert advice may also be beneficial. By following these guidelines, healthcare professionals can provide effective treatment options for patients with resistant hypertension.
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This question is part of the following fields:
- Cardiovascular Health
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Question 4
Incorrect
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A 42-year-old white male is diagnosed with hypertension.
He is usually fit and well with no significant past medical history. His ECG is normal, he has no microalbuminuria, and clinical examination is otherwise unremarkable.
Assuming there are no contraindications, place the following in the correct order in which they should be initiated to manage his high blood pressure:
A ACE-inhibitor
B Calcium channel blocker
C Thiazide-like diuretic
D Alpha blockerYour Answer:
Correct Answer: C A B D
Explanation:NICE Guidelines for Hypertension Treatment
There are established guidelines published by NICE for managing high blood pressure. The guidelines outline a stepwise approach to pharmacological treatment. For patients under 55 years old and not of black African or Caribbean ethnic origin, the first-line treatment is an ACE inhibitor or a low-cost angiotensin receptor II antagonist. If additional treatment is needed, a calcium-channel blocker should be added, followed by a thiazide-like diuretic. If a fourth agent is required, options include a further diuretic, an alpha-blocker, or a beta-blocker. Spironolactone can be used if the patient’s potassium level is 4.5 mmol/L or less. If not, an alpha- or beta-blocker can be considered.
For patients of black African or Caribbean ethnic origin of any age (and all those over 55), the first-line antihypertensive treatment is a calcium-channel blocker. If the calcium-channel blocker is not tolerated or contraindicated, then a thiazide-like diuretic would be first-line. If additional treatment is required, an ACE-inhibitor (or a low-cost angiotensin receptor II antagonist) should be added, followed by a thiazide-like diuretic. If necessary, a further diuretic (spironolactone), an alpha-blocker, or a beta-blocker can be considered.
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This question is part of the following fields:
- Cardiovascular Health
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Question 5
Incorrect
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You see a 65-year-old gentleman who you have recently diagnosed with heart failure and an ejection fraction of 35%. You have titrated him up to the maximum dose of ACE-I and his renal function, sodium and potassium have all remained within normal limits for the past three months.
According to NICE, how often should he now have his treatment monitored?Your Answer:
Correct Answer: No further monitoring required
Explanation:Monitoring ACE-I Treatment
According to NICE guidelines, it is recommended to monitor ACE-I treatment every 6 months once the maximum tolerated dose has been reached. This ensures that the treatment is still effective and that any potential side effects are identified and managed promptly. Additionally, it is important to review the treatment if the person becomes acutely unwell. This allows for adjustments to be made to the treatment plan as needed. Regular monitoring and review of ACE-I treatment can help improve patient outcomes and prevent complications.
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This question is part of the following fields:
- Cardiovascular Health
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Question 6
Incorrect
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A 72-year-old woman is being seen for a routine medical check-up at her new GP practice. During the examination, her blood pressure is found to be 146/94 mmHg, which is confirmed on a second reading. According to the latest NICE recommendations, what would be the most suitable course of action?
Your Answer:
Correct Answer: Arrange ambulatory blood pressure monitoring
Explanation:NICE guidelines from 2011 acknowledge the issue of overtreatment of ‘white coat’ hypertension and recommend the use of ambulatory blood pressure monitoring (ABPM) to address this problem. ABPM is also considered a more reliable predictor of cardiovascular risk compared to clinic blood pressure readings, based on strong evidence.
NICE released updated guidelines in 2019 for the management of hypertension, building on previous guidelines from 2011. These guidelines recommend classifying hypertension into stages and using ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension. This is because some patients experience white coat hypertension, where their blood pressure rises in a clinical setting, leading to potential overdiagnosis of hypertension. ABPM and HBPM provide a more accurate assessment of a patient’s overall blood pressure and can help prevent overdiagnosis.
To diagnose hypertension, NICE recommends measuring blood pressure in both arms and repeating the measurements if there is a difference of more than 20 mmHg. If the difference remains, subsequent blood pressures should be recorded from the arm with the higher reading. NICE also recommends taking a second reading during the consultation if the first reading is above 140/90 mmHg. ABPM or HBPM should be offered to any patient with a blood pressure above this level.
If the blood pressure is above 180/120 mmHg, NICE recommends admitting the patient for specialist assessment if there are signs of retinal haemorrhage or papilloedema or life-threatening symptoms such as new-onset confusion, chest pain, signs of heart failure, or acute kidney injury. Referral is also recommended if a phaeochromocytoma is suspected. If none of these apply, urgent investigations for end-organ damage should be arranged. If target organ damage is identified, antihypertensive drug treatment may be started immediately. If no target organ damage is identified, clinic blood pressure measurement should be repeated within 7 days.
ABPM should involve at least 2 measurements per hour during the person’s usual waking hours, with the average value of at least 14 measurements used. If ABPM is not tolerated or declined, HBPM should be offered. For HBPM, two consecutive measurements need to be taken for each blood pressure recording, at least 1 minute apart and with the person seated. Blood pressure should be recorded twice daily, ideally in the morning and evening, for at least 4 days, ideally for 7 days. The measurements taken on the first day should be discarded, and the average value of all the remaining measurements used.
Interpreting the results, ABPM/HBPM above 135/85 mmHg (stage 1 hypertension) should be
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This question is part of the following fields:
- Cardiovascular Health
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Question 7
Incorrect
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A 67-year-old man who experiences Stokes-Adams attacks has received a pacemaker that is functioning properly. What guidance should he be provided regarding driving?
Your Answer:
Correct Answer: Cannot drive for 1 week
Explanation:If you have had a pacemaker inserted or the box has been changed, it is important to inform the DVLA. It is also necessary to refrain from driving for a minimum of one week.
DVLA Guidelines for Cardiovascular Disorders and Driving
The DVLA has specific guidelines for individuals with cardiovascular disorders who wish to drive a car or motorcycle. For those with hypertension, driving is permitted unless the treatment causes unacceptable side effects, and there is no need to notify the DVLA. However, if the individual has Group 2 Entitlement, they will be disqualified from driving if their resting blood pressure consistently measures 180 mmHg systolic or more and/or 100 mm Hg diastolic or more.
Individuals who have undergone elective angioplasty must refrain from driving for one week, while those who have undergone CABG or acute coronary syndrome must wait four weeks before driving. If an individual experiences angina symptoms at rest or while driving, they must cease driving altogether. Pacemaker insertion requires a one-week break from driving, while implantable cardioverter-defibrillator (ICD) implantation results in a six-month driving ban if implanted for sustained ventricular arrhythmia. If implanted prophylactically, the individual must cease driving for one month, and Group 2 drivers are permanently barred from driving with an ICD.
Successful catheter ablation for an arrhythmia requires a two-day break from driving, while an aortic aneurysm of 6 cm or more must be reported to the DVLA. Licensing will be permitted subject to annual review, but an aortic diameter of 6.5 cm or more disqualifies patients from driving. Finally, individuals who have undergone a heart transplant must refrain from driving for six weeks, but there is no need to notify the DVLA.
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This question is part of the following fields:
- Cardiovascular Health
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Question 8
Incorrect
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A 55-year-old man presents to his General Practitioner to discuss the uptitration of his medication as advised by cardiology. He suffered an anterior myocardial infarction (MI) four weeks ago. His history reveals that he is a smoker (20 per day for 30 years) and works in a sedentary office job, where he often works long days and eats ready meals to save time with food preparation.
On examination, his heart rate is 62 bpm and his blood pressure is 126/74 mmHg, body mass index (BMI) is 31. His bisoprolol is increased to 5 mg and ramipril to 7.5 mg.
Which of the following is the single non-pharmacological intervention that will be most helpful in reducing his risk of a future ischaemic event?
Your Answer:
Correct Answer: Stopping smoking
Explanation:Reducing Cardiovascular Risk: Lifestyle Changes to Consider
Cardiovascular disease (CVD) is a leading cause of death worldwide, but many of the risk factors are modifiable through lifestyle changes. The three most important modifiable and causal risk factors are smoking, hypertension, and abnormal lipids. While hypertension and abnormal lipids may require medication to make significant changes, smoking cessation is the single most important non-pharmacological, modifiable risk factor in reducing cardiovascular risk.
In addition to quitting smoking, there are other lifestyle changes that can help reduce cardiovascular risk. A cardioprotective diet should limit total fat intake to 30% or less of total energy intake, with saturated fat intake below 7%. Low-carbohydrate dietary intake is also thought to be important in cardiovascular disease prevention.
Regular exercise is also important, with 150 minutes or more per week of moderate-intensity aerobic activity and muscle-strengthening activities on at least two days a week recommended. While exercise is beneficial, stopping smoking remains the most effective lifestyle change for reducing cardiovascular risk.
Salt restriction can also help reduce risk, with a recommended intake of less than 6 g per day. Patients should be advised to avoid adding salt to their meals and minimize processed foods.
Finally, weight reduction should be advised to decrease future cardiovascular risk, with a goal of achieving a normal BMI. Obese patients should also be assessed for sleep apnea. By making these lifestyle changes, individuals can significantly reduce their risk of developing cardiovascular disease.
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This question is part of the following fields:
- Cardiovascular Health
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Question 9
Incorrect
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A 65-year-old man comes to his General Practitioner complaining of erectile dysfunction. He has a history of angina and takes isosorbide mononitrate. What is the most suitable initial treatment option in this scenario? Choose ONE answer only.
Your Answer:
Correct Answer: Alprostadil
Explanation:Treatment Options for Erectile Dysfunction: Alprostadil, Tadalafil, Penile Prosthesis, and Psychosexual Counselling
Erectile dysfunction affects a significant percentage of men, with prevalence increasing with age. The condition shares the same risk factors as cardiovascular disease. The usual first-line treatment with a phosphodiesterase-5 (PDE5) inhibitor is contraindicated in patients taking nitrates, as concurrent use can lead to severe hypotension or even death. Therefore, alternative treatment options are available.
Alprostadil is an effective treatment for erectile dysfunction, either topically or in the form of an intracavernosal injection. It is the most appropriate treatment to offer where PDE5 inhibitors are ineffective or for people who find PDE5 inhibitors ineffective.
Tadalafil, a PDE5 inhibitor, is a first-line treatment for erectile dysfunction. It lasts longer than sildenafil, which can help improve spontaneity. However, it is contraindicated in patients taking nitrates, and a second-line treatment, such as alprostadil, should be used.
A penile prosthesis is a rare third-line option if both PDE5 inhibitors and alprostadil are either ineffective or inappropriate. It involves the insertion of a fluid-filled reservoir under the abdominal wall, with a pump and a release valve in the scrotum, that are used to inflate two implanted cylinders in the penis.
Psychosexual counselling is recommended for treatment of psychogenic erectile dysfunction or in those men with severe psychological distress. It is not recommended for routine treatment, but studies have shown that psychotherapy is just as effective as vacuum devices and penile prosthesis.
In summary, treatment options for erectile dysfunction include alprostadil, tadalafil, penile prosthesis, and psychosexual counselling, depending on the individual’s needs and contraindications.
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This question is part of the following fields:
- Cardiovascular Health
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Question 10
Incorrect
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A 68-year-old woman presents to the GP clinic for a follow-up on her heart failure management. She is currently on lisinopril 20 mg and carvedilol 25 mg BD. Her main symptoms include shortness of breath on minimal exercise and occasional episodes of paroxysmal nocturnal dyspnoea. During the examination, her BP is 136/74, her pulse is 80 and regular. There are bibasal crackles but no other significant findings. The test results show a haemoglobin level of 128 g/L (115-165), white cells count of 7.9 ×109/L (4-11), platelets count of 201 ×109/L (150-400), sodium level of 139 mmol/L (135-146), potassium level of 4.2 mmol/L (3.5-5), creatinine level of 149 μmol/L (79-118), and an ejection fraction of 38% on echocardiogram. What is the most appropriate next step?
Your Answer:
Correct Answer: Add spironolactone to her regime
Explanation:Treatment Guidelines for Chronic Heart Failure
Chronic heart failure can be managed with a combination of medications, including beta blockers and ACE inhibitors. However, if heart failure control is not optimised on this dual therapy, NICE guidelines (NG106) recommend adding an ARB or aldosterone antagonist. For patients who cannot tolerate ACE inhibitors or ARBs, nitrate and hydralazine can be used earlier in the treatment pathway.
It is important to note that routine referral for revascularisation is not recommended in patients without symptoms of angina. Additionally, cardiac resynchronisation therapy should not be recommended until the patient’s therapy is further optimised. By following these guidelines, healthcare professionals can effectively manage chronic heart failure and improve patient outcomes.
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This question is part of the following fields:
- Cardiovascular Health
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Question 11
Incorrect
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A 67-year-old man with diabetes is seen for his annual check-up. He is generally in good health, but experiences occasional cramping in his calf after walking about a mile on flat ground. He continues to smoke five cigarettes per day. During the examination, his blood pressure is measured at 166/98 mmHg, with a pulse of 86 bpm and a BMI of 30.2. Neurological examination is normal, and his fundi appear normal. Examination of his peripheral circulation reveals absent foot pulses and weak popliteal pulses. He was started on antihypertensive therapy, and his U+Es were measured over a two-week period, with the following results:
Baseline:
Sodium - 138 mmol/L
Potassium - 4.6 mmol/L
Urea - 11.1 mmol/L
Creatinine - 138 µmol/L
2 weeks later:
Sodium - 140 mmol/L
Potassium - 5.0 mmol/L
Urea - 19.5 mmol/L
Creatinine - 310 µmol/L
Which class of antihypertensives is most likely responsible for this change?Your Answer:
Correct Answer: Angiotensin converting enzyme (ACE) inhibitor therapy
Explanation:Renal Artery Stenosis and ACE Inhibitors
This man has diabetes and hypertension, along with mild symptoms of claudication and absent foot pulses, indicating arteriopathy. These factors suggest a diagnosis of renal artery stenosis (RAS), which can cause macrovascular disease and mild renal impairment.
When an antihypertensive medication was introduced, the patient’s renal function deteriorated, indicating that the drug was an ACE inhibitor. This is because hypertension in RAS is caused by the renin-angiotensin-aldosterone system trying to maintain renal perfusion. Inhibiting this system with ACE inhibitors can result in relative renal ischemia, leading to further deterioration of renal function.
In summary, patients with diabetes and hypertension who present with arteriopathy symptoms should be evaluated for RAS. The use of ACE inhibitors in these patients should be carefully monitored, as it can exacerbate renal impairment.
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This question is part of the following fields:
- Cardiovascular Health
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Question 12
Incorrect
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A 56-year-old man collapses in the hospital during a nurse-led hypertension clinic. He is unresponsive and has no pulse in his carotid artery. What is the appropriate ratio of chest compressions to ventilation?
Your Answer:
Correct Answer: 30:02:00
Explanation:The 2015 Resus Council guidelines for adult advanced life support outline the steps to be taken in the event of a cardiac arrest. Patients are divided into those with ‘shockable’ rhythms (ventricular fibrillation/pulseless ventricular tachycardia) and ‘non-shockable’ rhythms (asystole/pulseless-electrical activity). Key points include the ratio of chest compressions to ventilation (30:2), continuing chest compressions while a defibrillator is charged, and delivering drugs via IV access or the intraosseous route. Adrenaline and amiodarone are recommended for non-shockable rhythms and VF/pulseless VT, respectively. Thrombolytic drugs should be considered if a pulmonary embolism is suspected. Atropine is no longer recommended for routine use in asystole or PEA. Following successful resuscitation, oxygen should be titrated to achieve saturations of 94-98%. The ‘Hs’ and ‘Ts’ outline reversible causes of cardiac arrest, including hypoxia, hypovolaemia, and thrombosis.
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This question is part of the following fields:
- Cardiovascular Health
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Question 13
Incorrect
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A 35-year-old woman visits her doctor for a check-up. She is worried about her risk of developing cardiovascular disease after hearing about a family member's recent diagnosis.
Which of the following factors would most significantly increase her risk of cardiovascular disease?
Your Answer:
Correct Answer: Rheumatoid arthritis
Explanation:Patients with rheumatoid arthritis may have an increased risk of developing accelerated atherosclerosis, which is believed to be linked to the inflammatory process. The QRisk2 calculator, used to predict the 10-year risk of developing cardiovascular disease, includes rheumatoid arthritis as a risk factor. However, a blood pressure reading of 130/80 mmHg and a BMI of 24 kg/m2 are within the normal range and not a cause for concern. Additionally, the HbA1c level of 41 mmol/mol is normal and doesn’t indicate an increased risk of diabetes. While a family history of myocardial infarction is significant, it is only considered a risk factor if the relative was diagnosed before the age of 60, not at 65.
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This question is part of the following fields:
- Cardiovascular Health
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Question 14
Incorrect
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A 72-year-old man presents to the General Practitioner with complaints of leg pain while walking. Upon examination, his feet appear cool and dusky, with the right foot being more affected than the left. An ankle brachial pressure index is measured at 0.8 on the right and 0.9 on the left. Both femoral pulses are present, but posterior tibial and dorsalis pedis pulses are absent in both legs. His blood pressure is 140/85 mmHg.
Which of the following medications is LEAST likely to provide relief for his symptoms?Your Answer:
Correct Answer: Amlodipine
Explanation:Treatment options for Peripheral Arterial Disease (PAD)
Peripheral Arterial Disease (PAD) is a condition that causes intermittent claudication. Antiplatelet therapy is recommended for those with symptomatic disease to reduce major cardiovascular events. Clopidogrel is suggested as the drug of first choice by the National Institute for Health and Care Excellence (NICE). Angiotensin converting enzyme inhibitors have been shown to reduce cardiovascular morbidity and mortality in patients with PAD. However, they should be carefully monitored as more than 25% of patients have co-existent renal artery stenosis. Statins are also recommended as they reduce the risk of mortality, cardiovascular events and stroke in patients with PAD. Naftidrofuryl oxalate is an option for the treatment of intermittent claudication in people with PAD for whom vasodilator therapy is considered appropriate. Amlodipine, a calcium channel blocker, is not indicated for this case.
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This question is part of the following fields:
- Cardiovascular Health
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Question 15
Incorrect
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A 60-year-old man has recently been discharged from hospital with a new diagnosis of heart failure with reduced ejection fraction. His symptoms of breathlessness and ankle swelling have now resolved and he has been commenced on ramipril, bisoprolol and furosemide. He also has type 2 diabetes, for which he is already taking metformin and gliclazide. His renal function is normal and his serum potassium is 4.9 mmol/L.
What ongoing care interventions should be included for this patient?Your Answer:
Correct Answer: Annual influenza vaccination
Explanation:An annual influenza vaccine should be offered as part of the comprehensive lifestyle approach to managing heart failure.
Individuals diagnosed with heart failure with reduced ejection fraction should receive an annual influenza vaccine and a one-time pneumococcal vaccination.
Typically, only those with asplenia, splenic dysfunction, or chronic kidney disease require pneumococcal revaccination every five years.
Following a myocardial infarction, patients are typically advised to abstain from sexual activity for four weeks, rather than heart failure.
While patients should limit their salt intake to no more than 6 g per day, they should not replace it with potassium-containing salt substitutes due to the risk of hyperkalemia when used concurrently with ACE inhibitors.
For group 1 entitlement (cars, motorcycles), driving may continue as long as there are no symptoms that could distract the driver’s attention, and there is no need to notify the DVLA.
Chronic heart failure can be managed through drug therapy, as outlined in the updated guidelines issued by NICE in 2018. While loop diuretics are useful in managing fluid overload, they do not reduce mortality in the long term. The first-line treatment for all patients is an ACE-inhibitor and a beta-blocker, with clinical judgement used to determine which one to start first. Aldosterone antagonists are the standard second-line treatment, but both ACE inhibitors and aldosterone antagonists can cause hyperkalaemia, so potassium levels should be monitored. SGLT-2 inhibitors are increasingly being used to manage heart failure with a reduced ejection fraction, as they reduce glucose reabsorption and increase urinary glucose excretion. Third-line treatment options include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin, and cardiac resynchronisation therapy. Other treatments include annual influenza and one-off pneumococcal vaccines.
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This question is part of the following fields:
- Cardiovascular Health
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Question 16
Incorrect
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A 56-year-old man comes in for a follow-up on his angina. Despite taking the maximum dose of atenolol, he still experiences chest discomfort during physical activity, which is hindering his daily routine. He wishes to explore other treatment options. He reports no chest pain at rest and his vital signs are within normal limits.
What would be the most suitable course of action for managing his condition?Your Answer:
Correct Answer: Add amlodipine
Explanation:If a beta-blocker is not effective in controlling angina, the recommended course of action is to add a longer-acting dihydropyridine calcium channel blocker to the treatment plan. Among the options listed, amlodipine is the only dihydropyridine available.
It is not advisable to add diltiazem due to the risk of complete heart block when used with atenolol. Although the risk is lower compared to verapamil, the potential harm outweighs the benefits.
Verapamil should also not be added as it can cause complete heart block due to the combined blockade of the atrioventricular node with beta-blockers.
While switching to diltiazem or verapamil is possible, it is not the best option. Dual therapy is recommended when monotherapy fails to control angina.
Angina pectoris can be managed through lifestyle changes, medication, percutaneous coronary intervention, and surgery. In 2011, NICE released guidelines for the management of stable angina. Medication is an important aspect of treatment, and all patients should receive aspirin and a statin unless there are contraindications. Sublingual glyceryl trinitrate can be used to abort angina attacks. NICE recommends using either a beta-blocker or a calcium channel blocker as first-line treatment, depending on the patient’s comorbidities, contraindications, and preferences. If a calcium channel blocker is used as monotherapy, a rate-limiting one such as verapamil or diltiazem should be used. If used in combination with a beta-blocker, a longer-acting dihydropyridine calcium channel blocker like amlodipine or modified-release nifedipine should be used. Beta-blockers should not be prescribed concurrently with verapamil due to the risk of complete heart block. If initial treatment is ineffective, medication should be increased to the maximum tolerated dose. If a patient is still symptomatic after monotherapy with a beta-blocker, a calcium channel blocker can be added, and vice versa. If a patient cannot tolerate the addition of a calcium channel blocker or a beta-blocker, long-acting nitrate, ivabradine, nicorandil, or ranolazine can be considered. If a patient is taking both a beta-blocker and a calcium-channel blocker, a third drug should only be added while awaiting assessment for PCI or CABG.
Nitrate tolerance is a common issue for patients who take nitrates, leading to reduced efficacy. NICE advises patients who take standard-release isosorbide mononitrate to use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimize the development of nitrate tolerance. However, this effect is not seen in patients who take once-daily modified-release isosorbide mononitrate.
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This question is part of the following fields:
- Cardiovascular Health
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Question 17
Incorrect
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A 50-year-old woman has a mid-systolic ejection murmur in the third left intercostals space. It radiates into the left arm and shoulder.
Select from the list the single associated symptom that this woman is most likely to have.Your Answer:
Correct Answer: Angina
Explanation:Understanding Symptoms of Aortic Stenosis
Aortic stenosis is a condition where the aortic valve becomes narrowed, leading to restricted blood flow from the heart. One of the most common symptoms of aortic stenosis is a murmur heard in the aortic area. This is often due to calcification of the valve. However, symptoms usually only appear when the stenosis becomes severe.
Patients with aortic stenosis may experience dyspnea on exertion, which is difficulty breathing during physical activity. More concerning symptoms include angina, syncope, or symptoms of heart failure. Angina is caused by left ventricular hypertrophy, while syncope is thought to be due to a failure to increase cardiac output during times of peripheral vasodilation and subsequent hypotension. It’s important to note that drugs that cause peripheral vasodilation, such as nitrates or ACE inhibitors, can increase the risk of syncope.
Dysphagia is a rare complication of left atrial hypertrophy due to mitral valve disease. Palpitations and transient ischemic attacks are not symptoms that are typically associated with aortic stenosis. The most common source of emboli with transient ischemic attacks is the carotids. Vertigo is not caused by aortic stenosis.
In summary, understanding the symptoms of aortic stenosis is crucial for early detection and treatment. If you experience any concerning symptoms, it’s important to speak with your healthcare provider.
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This question is part of the following fields:
- Cardiovascular Health
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Question 18
Incorrect
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A 45-year-old man presents with complaints of dyspnea.
On auscultation, you detect a systolic crescendo-decrescendo murmur that is most audible at the right upper sternal border. The murmur is loudest during expiration and decreases in intensity when the patient stands. The second heart sound is faint. The apex beat is forceful but not displaced.
What is the probable diagnosis?Your Answer:
Correct Answer: Aortic sclerosis
Explanation:Aortic Stenosis: Symptoms and Signs
Aortic stenosis is a condition characterized by the narrowing of the aortic valve, which can lead to reduced blood flow from the heart to the rest of the body. One of the typical features of aortic stenosis is a systolic crescendo-decrescendo murmur that is loudest at the right upper sternal border. This murmur is usually heard during expiration and becomes softer when the patient stands. Additionally, the second heart sound is typically soft, and the apex beat is thrusting but not displaced.
To summarize, aortic stenosis can be identified by a combination of symptoms and signs, including a specific type of murmur, a soft second heart sound, and a thrusting apex beat.
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This question is part of the following fields:
- Cardiovascular Health
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Question 19
Incorrect
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A 78-year-old gentleman visited his GP last week and was referred for 24 hour ambulatory blood pressure monitoring. The results showed a daytime average of 144/82 mmHg. He is currently taking amlodipine 10 mg once a day and ramipril 10 mg once a day. What would be the best course of action for managing this patient?
Your Answer:
Correct Answer: Continue current therapy
Explanation:ABPM vs Solitary Clinic Blood Pressure
Note the difference between a solitary clinic blood pressure and ABPM. ABPM stands for ambulatory blood pressure monitoring, which is a method of measuring blood pressure over a 24-hour period. This is different from a solitary clinic blood pressure, which is taken in a medical setting at a single point in time.
For patients over the age of 80, their daytime average ABPM or average HBPM (hospital blood pressure monitoring) blood pressure should be less than 145/85 mmHg. This is according to NICE guidelines, which state that for people under 80 years old, the daytime average ABPM or average HBPM blood pressure should be lower than 135/85 mmHg.
It’s important to note that ABPM targets are different from clinic BP targets. This is because ABPM provides a more accurate and comprehensive picture of a patient’s blood pressure over a 24-hour period, rather than just a single reading in a medical setting. By using ABPM, healthcare professionals can better monitor and manage a patient’s blood pressure, especially for those over the age of 80.
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This question is part of the following fields:
- Cardiovascular Health
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Question 20
Incorrect
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A 44-year-old man has an irregular tachycardia with a ventricular rate of 130. He played in a football match the previous day and consumed 28 units of alcohol on the evening of the match. On examination his blood pressure is 95/50 mmHg.
Select from the list the single most likely diagnosis.Your Answer:
Correct Answer: Atrial fibrillation
Explanation:Common Cardiac Arrhythmias and Their Characteristics
Acute atrial fibrillation is characterized by a sudden onset within the past 48 hours and may be triggered by excessive alcohol or caffeine intake. An ECG is necessary for diagnosis. Atrial flutter is less common than atrial fibrillation and typically presents with a rapid, irregular or regular pulse with a ventricular rate of approximately 150 beats per minute. Extrasystoles are extra heartbeats that disrupt the normal rhythm of the heart and can originate from either the atria or ventricles. Sinus arrhythmia is a common occurrence in children and young adults and involves cyclic changes in heart rate during breathing. Sinus tachycardia is a physiological response to various stimuli such as fever, anxiety, pain, exercise, and hyperthyroidism, and is characterized by a regular heart rate of over 100 beats per minute.
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This question is part of the following fields:
- Cardiovascular Health
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Question 21
Incorrect
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A 60-year-old woman with suspected heart failure undergoes open-access Doppler echocardiography and is diagnosed with heart failure with reduced ejection fraction. She has experienced increased shortness of breath since the diagnosis and now requires four pillows to sleep comfortably. Which medication is most likely to provide the quickest relief of symptoms for this patient?
Your Answer:
Correct Answer: Furosemide
Explanation:Medications for Heart Failure: Understanding the Recommendations
Heart failure is a serious condition that requires careful management. When it comes to medication, it’s important to understand which drugs are recommended and when they should be prescribed. Here’s a breakdown of some common medications and their appropriate use in heart failure treatment:
Furosemide: This loop diuretic is recommended by the National Institute for Health and Care Excellence (NICE) for patients with symptoms of fluid overload. The dose should be adjusted based on symptoms and reviewed regularly.
Spironolactone: While this aldosterone antagonist can be considered for all patients, NICE advises that it should only be added if symptoms persist despite optimal treatment with an ACE inhibitor and beta-blocker. Referral to a specialist may be necessary.
Carvedilol: This beta-blocker is indicated for heart failure, but it won’t provide rapid symptom relief. It may even worsen symptoms if given while there are still signs of fluid overload.
Digoxin: This drug has a limited role in heart failure management and should not be routinely prescribed. It may be helpful for patients in normal sinus rhythm.
Ramipril: An ACE inhibitor should be prescribed routinely, but it should not be initiated in patients with suspected valve disease until a specialist has assessed the condition. An angiotensin-II receptor antagonist is an alternative if the ACE inhibitor is not tolerated.
Understanding the appropriate use of these medications can help improve outcomes for patients with heart failure.
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This question is part of the following fields:
- Cardiovascular Health
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Question 22
Incorrect
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A 60-year-old man with no medication history comes in with three high blood pressure readings of 155/95 mmHg, 160/100 mmHg, and 164/85 mmHg.
What is the probable diagnosis?Your Answer:
Correct Answer: Essential hypertension
Explanation:Understanding Hypertension
Ninety five percent of patients diagnosed with hypertension have essential or primary hypertension, while the remaining five percent have secondary hypertension. Essential hypertension is caused by a combination of genetic and environmental factors, resulting in high blood pressure. On the other hand, secondary hypertension is caused by a specific abnormality in one of the organs or systems of the body.
It is important to understand the type of hypertension a patient has in order to determine the appropriate treatment plan. While essential hypertension may be managed through lifestyle changes and medication, secondary hypertension requires addressing the underlying cause. Regular blood pressure monitoring and consultation with a healthcare professional can help manage hypertension and reduce the risk of complications.
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This question is part of the following fields:
- Cardiovascular Health
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Question 23
Incorrect
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A 72-year-old man visits his GP clinic with a history of hypertension. He reports experiencing progressive dyspnea on exertion and orthopnea for the past few months. Physical examination reveals no abnormalities. Laboratory tests including full blood count, urea and electrolytes, and CRP are within normal limits. Spirometry and chest x-ray results are also normal. The physician suspects heart failure. What is the most suitable follow-up test to conduct?
Your Answer:
Correct Answer: B-type natriuretic peptide
Explanation:According to NICE guidelines, the initial test for patients with suspected chronic heart failure should be an NT-proBNP test. This should be done in conjunction with obtaining an ECG, and is recommended for patients who have not previously experienced a myocardial infarction.
Diagnosis of Chronic Heart Failure
Chronic heart failure is a serious condition that requires prompt diagnosis and management. In 2018, the National Institute for Health and Care Excellence (NICE) updated its guidelines on the diagnosis and management of chronic heart failure. According to the new guidelines, all patients should undergo an N-terminal pro-B-type natriuretic peptide (NT‑proBNP) blood test as the first-line investigation, regardless of whether they have previously had a myocardial infarction or not.
Interpreting the NT-proBNP test is crucial in determining the severity of the condition. If the levels are high, specialist assessment, including transthoracic echocardiography, should be arranged within two weeks. If the levels are raised, specialist assessment, including echocardiogram, should be arranged within six weeks.
BNP is a hormone produced mainly by the left ventricular myocardium in response to strain. Very high levels of BNP are associated with a poor prognosis. The table above shows the different levels of BNP and NTproBNP and their corresponding interpretations.
It is important to note that certain factors can alter the BNP level. For instance, left ventricular hypertrophy, ischaemia, tachycardia, and right ventricular overload can increase BNP levels, while diuretics, ACE inhibitors, beta-blockers, angiotensin 2 receptor blockers, and aldosterone antagonists can decrease BNP levels. Therefore, it is crucial to consider these factors when interpreting the NT-proBNP test.
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This question is part of the following fields:
- Cardiovascular Health
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Question 24
Incorrect
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A 55-year-old man presents after experiencing a panic attack at work. He reports feeling extremely hot and unable to concentrate, with a sensation of the world closing in on him. Although his symptoms have mostly subsided, he seeks medical attention. Upon examination, his pulse is 78 beats per minute, blood pressure is 188/112 mmHg, and respiratory rate is 14 breaths per minute. Fundoscopy reveals small retinal hemorrhages, but cardiovascular examination is otherwise unremarkable. The patient's PHQ-9 score is 15 out of 27. What is the most appropriate course of action?
Your Answer:
Correct Answer: Admit for a same day assessment of his blood pressure
Explanation:This individual is experiencing severe hypertension, according to NICE guidelines, and is also exhibiting retinal haemorrhages. In such cases, NICE advises immediate referral and assessment. While the reported panic attack may be unrelated, it is important to rule out the possibility of an underlying phaeochromocytoma.
NICE released updated guidelines in 2019 for the management of hypertension, building on previous guidelines from 2011. These guidelines recommend classifying hypertension into stages and using ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension. This is because some patients experience white coat hypertension, where their blood pressure rises in a clinical setting, leading to potential overdiagnosis of hypertension. ABPM and HBPM provide a more accurate assessment of a patient’s overall blood pressure and can help prevent overdiagnosis.
To diagnose hypertension, NICE recommends measuring blood pressure in both arms and repeating the measurements if there is a difference of more than 20 mmHg. If the difference remains, subsequent blood pressures should be recorded from the arm with the higher reading. NICE also recommends taking a second reading during the consultation if the first reading is above 140/90 mmHg. ABPM or HBPM should be offered to any patient with a blood pressure above this level.
If the blood pressure is above 180/120 mmHg, NICE recommends admitting the patient for specialist assessment if there are signs of retinal haemorrhage or papilloedema or life-threatening symptoms such as new-onset confusion, chest pain, signs of heart failure, or acute kidney injury. Referral is also recommended if a phaeochromocytoma is suspected. If none of these apply, urgent investigations for end-organ damage should be arranged. If target organ damage is identified, antihypertensive drug treatment may be started immediately. If no target organ damage is identified, clinic blood pressure measurement should be repeated within 7 days.
ABPM should involve at least 2 measurements per hour during the person’s usual waking hours, with the average value of at least 14 measurements used. If ABPM is not tolerated or declined, HBPM should be offered. For HBPM, two consecutive measurements need to be taken for each blood pressure recording, at least 1 minute apart and with the person seated. Blood pressure should be recorded twice daily, ideally in the morning and evening, for at least 4 days, ideally for 7 days. The measurements taken on the first day should be discarded, and the average value of all the remaining measurements used.
Interpreting the results, ABPM/HBPM above 135/85 mmHg (stage 1 hypertension) should be
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This question is part of the following fields:
- Cardiovascular Health
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Question 25
Incorrect
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A 39-year-old man presents with gingival hypertrophy.
Which of his cardiac medications is likely to be responsible?Your Answer:
Correct Answer: Atenolol
Explanation:Gingival Hypertrophy and Medications
Gingival hypertrophy, or an overgrowth of gum tissue, can be caused by certain medications. Calcium channel blockers, such as amlodipine, as well as drugs like phenytoin and cyclosporin, have been associated with this side effect. It is important for patients taking these medications to maintain good oral hygiene and regularly visit their dentist to monitor any changes in their gum tissue. If gingival hypertrophy does occur, treatment options may include scaling and root planing, gingivectomy, or medication adjustments. Awareness of this potential side effect can help patients and healthcare providers make informed decisions about medication management.
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This question is part of the following fields:
- Cardiovascular Health
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Question 26
Incorrect
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A 48-year-old man comes to your GP clinic complaining of feeling generally unwell and lethargic. His wife notes that he has been eating less than usual and gets tired easily. He has a history of hypertension but no other significant medical history. He drinks alcohol socially and has a stressful job as a banker, which led him to start smoking 15 cigarettes a day for the past 13 years. He believes that work stress is the cause of his symptoms and asks for a recommendation for a counselor to help him manage it. What should be the next step?
Your Answer:
Correct Answer: Refer for an urgent Chest X-Ray
Explanation:If a person aged 40 or over has appetite loss and is a smoker, an urgent chest X-ray should be offered within two weeks, according to the updated 2015 NICE guidelines. This is because appetite loss is now considered a potential symptom of lung cancer. While counseling, smoking cessation, and a career change may be helpful, investigating the possibility of lung cancer is the most urgent action required. It is important to address each issue separately, as trying to tackle all three at once could be overwhelming for the patient.
Referral Guidelines for Lung Cancer
Lung cancer is a serious condition that requires prompt diagnosis and treatment. The 2015 NICE cancer referral guidelines provide clear advice on when to refer patients for suspected lung cancer. According to these guidelines, patients should be referred using a suspected cancer pathway referral for an appointment within 2 weeks if they have chest x-ray findings that suggest lung cancer or are aged 40 and over with unexplained haemoptysis.
For patients aged 40 and over who have 2 or more unexplained symptoms such as cough, fatigue, shortness of breath, chest pain, weight loss, or appetite loss, an urgent chest x-ray should be offered within 2 weeks to assess for lung cancer. This recommendation also applies to patients who have ever smoked and have 1 or more of these unexplained symptoms.
In addition, patients aged 40 and over with persistent or recurrent chest infection, finger clubbing, supraclavicular lymphadenopathy or persistent cervical lymphadenopathy, chest signs consistent with lung cancer, or thrombocytosis should be considered for an urgent chest x-ray within 2 weeks to assess for lung cancer.
Overall, these guidelines provide clear and specific recommendations for healthcare professionals to identify and refer patients with suspected lung cancer for prompt diagnosis and treatment.
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This question is part of the following fields:
- Cardiovascular Health
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Question 27
Incorrect
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You assess a 52-year-old patient with hypertension who has been taking 2.5mg of ramipril for a month. He reports experiencing a persistent tickly cough that is causing him to lose sleep at night. Despite this, his blood pressure is now under control.
What recommendations would you provide to him?Your Answer:
Correct Answer: Stop the ramipril and prescribe candesartan
Explanation:When patients are unable to tolerate ACE inhibitors due to the common side effect of a dry, persistent cough, angiotensin-receptor blockers (ARBs) should be considered as an alternative. For individuals under the age of 55 who experience intolerance to ACE inhibitors, prescribing medications such as candesartan, an ARB, may be the next appropriate step.
Hypertension, or high blood pressure, is a common condition that can lead to serious health problems if left untreated. The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the management of hypertension in 2019. Some of the key changes include lowering the threshold for treating stage 1 hypertension in patients under 80 years old, allowing the use of angiotensin receptor blockers instead of ACE inhibitors, and recommending the use of calcium channel blockers or thiazide-like diuretics in addition to ACE inhibitors or angiotensin receptor blockers.
Lifestyle changes are also important in managing hypertension. Patients should aim for a low salt diet, reduce caffeine intake, stop smoking, drink less alcohol, eat a balanced diet rich in fruits and vegetables, exercise more, and lose weight.
Treatment for hypertension depends on the patient’s blood pressure classification. For stage 1 hypertension with ABPM/HBPM readings of 135/85 mmHg or higher, treatment is recommended for patients under 80 years old with target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For stage 2 hypertension with ABPM/HBPM readings of 150/95 mmHg or higher, drug treatment is recommended regardless of age.
The first-line treatment for patients under 55 years old or with a background of type 2 diabetes mellitus is an ACE inhibitor or angiotensin receptor blocker. Calcium channel blockers are recommended for patients over 55 years old or of black African or African-Caribbean origin. If a patient is already taking an ACE inhibitor or angiotensin receptor blocker, a calcium channel blocker or thiazide-like diuretic can be added.
If blood pressure remains uncontrolled with the optimal or maximum tolerated doses of four drugs, NICE recommends seeking expert advice or adding a fourth drug. Blood pressure targets vary depending on age, with a target of 140/90 mmHg for patients under 80 years old and 150/90 mmHg for patients over 80 years old. Direct renin inhibitors, such as Aliskiren, may be used in patients who are intolerant of other antihypertensive drugs, but their role is currently limited.
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This question is part of the following fields:
- Cardiovascular Health
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Question 28
Incorrect
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A 60-year-old man who was active all his life develops sudden severe anterior chest pain that radiates to his back. Within minutes, he is unconscious.
He has a history of hypertension, but a recent treadmill test had revealed no evidence for cardiac disease.
What is the most probable diagnosis?Your Answer:
Correct Answer: Tear in the aortic intima
Explanation:Aortic Dissection: A Probable Cause of Sudden Collapse with Acute Chest Pain
The patient’s history is indicative of aortic dissection, which is a probable cause of sudden collapse accompanied by acute chest pain radiating to the back. Although other conditions may also lead to sudden collapse, they do not typically present with these symptoms in the presence of a recent normal exercise test. While acute myocardial infarction (MI) is a possibility, it is not the most likely explanation. For further information on the diagnosis and management of aortic dissection, please refer to the following references: BMJ Best Practice, BMJ Clinical Review, and eMedicine.
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This question is part of the following fields:
- Cardiovascular Health
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Question 29
Incorrect
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A 75-year-old man with a history of type 2 diabetes mellitus and hypertension is seen in clinic. There is no evidence of diabetic retinopathy, chronic kidney disease or cardiovascular disease in his records.
He is currently taking the following medications:
simvastatin 20 mg once daily
ramipril 10 mg once daily
amlodipine 5mg once daily
metformin 1g twice daily
Recent blood results are as follows:
Na+ 142 mmol/l
K+ 4.4 mmol/l
Urea 7.2 mmol/l
Creatinine 86 µmol/l
HbA1c 45 mmol/mol (6.3%)
The urine dipstick shows no proteinuria. His blood pressure in clinic today is 134/76 mmHg.
What is the most appropriate course of action?Your Answer:
Correct Answer: No changes to medication required
Explanation:Since there are no complications from her diabetes, the target blood pressure remains < 140/80 mmHg and her antihypertensive regime doesn't need to be altered. Hypertension, or high blood pressure, is a common condition that can lead to serious health problems if left untreated. The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the management of hypertension in 2019. Some of the key changes include lowering the threshold for treating stage 1 hypertension in patients under 80 years old, allowing the use of angiotensin receptor blockers instead of ACE inhibitors, and recommending the use of calcium channel blockers or thiazide-like diuretics in addition to ACE inhibitors or angiotensin receptor blockers. Lifestyle changes are also important in managing hypertension. Patients should aim for a low salt diet, reduce caffeine intake, stop smoking, drink less alcohol, eat a balanced diet rich in fruits and vegetables, exercise more, and lose weight. Treatment for hypertension depends on the patient’s blood pressure classification. For stage 1 hypertension with ABPM/HBPM readings of 135/85 mmHg or higher, treatment is recommended for patients under 80 years old with target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For stage 2 hypertension with ABPM/HBPM readings of 150/95 mmHg or higher, drug treatment is recommended regardless of age. The first-line treatment for patients under 55 years old or with a background of type 2 diabetes mellitus is an ACE inhibitor or angiotensin receptor blocker. Calcium channel blockers are recommended for patients over 55 years old or of black African or African-Caribbean origin. If a patient is already taking an ACE inhibitor or angiotensin receptor blocker, a calcium channel blocker or thiazide-like diuretic can be added. If blood pressure remains uncontrolled with the optimal or maximum tolerated doses of four drugs, NICE recommends seeking expert advice or adding a fourth drug. Blood pressure targets vary depending on age, with a target of 140/90 mmHg for patients under 80 years old and 150/90 mmHg for patients over 80 years old. Direct renin inhibitors, such as Aliskiren, may be used in patients who are intolerant of other antihypertensive drugs, but their role is currently limited.
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This question is part of the following fields:
- Cardiovascular Health
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Question 30
Incorrect
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You are conducting a medication review for a 65-year-old man who has a history of cerebrovascular disease (having suffered a stroke 2 years ago), depression, and knee osteoarthritis. He is currently taking the following medications:
- Clopidogrel 75 mg once daily
- Simvastatin 20 mg once daily
- Amlodipine 5mg once daily
- Ramipril 10 mg once daily
- Diclofenac 50 mg as needed
- Sertraline 50 mg once daily
What changes would you recommend to his medication regimen?Your Answer:
Correct Answer: Switch diclofenac for an alternative NSAID
Explanation:The use of diclofenac is now prohibited for individuals with any type of cardiovascular ailment.
Diclofenac and Cardiovascular Risk
The MHRA has updated its guidance on diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), due to a Europe-wide review of cardiovascular safety. While it has been known for some time that NSAIDs may increase the risk of cardiovascular events, the evidence base has become clearer. Diclofenac is associated with a significantly higher risk of cardiovascular events compared to other NSAIDs. Therefore, diclofenac is contraindicated in patients with ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, and congestive heart failure (New York Heart Association classification II-IV). Patients should switch from diclofenac to other NSAIDs, such as naproxen or ibuprofen, except for topical diclofenac. Studies have shown that naproxen and low-dose ibuprofen have the best cardiovascular risk profiles of the NSAIDs.
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This question is part of the following fields:
- Cardiovascular Health
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