cardiology incorrects Flashcards
50 YO, atrial fibrillation picked up incidentally, pulse rate 80bpm, chadsvasc score is 0
what is the next step in management?
no medication!!
patient has non symptomatic AF. rate is controlled. no other RFs
A 63 year old woman has episodes of irregular palpitations, lasting several days and occurring once a month. She has ischaemic heart disease and type 2 diabetes.Her ECG confirms atrial fibrillation.
The patient wants to discuss the risks before starting anticoagulation (see image).
Which is her lifetime risk of having a stroke related to her atrial fibrillation?
A. 3%
B. 15%
C. 20%
D. 30%
E. 60%
UKMLA ppq!
Correct Answer(s): E
Justification for correct answer(s): 60% as the her CHADsVasc score is 3
From the table her adjusted stroke risk is 3.2
so 3% per year with life expectancy from 63 years to be about 20 years (83) (2020: life expectancy is 82 years). 3 x 20 is 60%. When discussing this with patients it puts it into perspective more if its lifetime rather than annual risk. Patients more likely to choose anticoagulation.
A 88 year old woman has 30 hours of severe abdominal pain. She was discharged from hospital 4 weeks ago following an aortobifemoral bypass graft.She has diffuse tenderness of the abdomen with absent bowel sounds. Plain X-ray of the abdomen is unremarkable.Investigations:Haemoglobin 114 g/L (115-160)
White cell count 18 × 109/L (3.8–10.0)Urea 16.4 mmol/L (2.5–7.8) Creatinine 158 μmol/L (60–120)CRP 110 mg/L (<5)Arterial blood gas breathing air
pH 7.28 (7.35–7.45)
PO2 13 kPa (11–15)
PCO2 4.6 kPa (4.6–6.4)
Bicarbonate 16 mmol/L(22–30)Lactate 4.5 mmol/L (1–2)
UKMLA ppq
Mesenteric ischemia
History of vascular disease and lactic acidosis
