Cardiorespiratory Flashcards
Patient pathway
First contact (GP) –> referral –> completion of treatment
What does secondary prevention for MI include
Advice and support for medications and rehabilitation (exercise and psych support)
Barriers to gaining help for MI
Personal: Expected and experienced Sx differ, interfere with life
Geographical: Transport
Socio-economic: Finances/time off work
Organisational: Long waiting times
Methods to overcome MI barriers
Public health Sx Efficient transport Interpreter Paid sick leave Reduce waiting times
What are performance indicators used for?
Made publicly available (e.g. mortality following surgery) to improve quality
4 benefits of performance indicators
Focusses attention on improving patient care
Public reassurance about effectiveness and safety
Competition will boost performance
Facilitate informed consumer choice
4 limitations of performance indicators
Negative impact on public trust
Case-mix: some areas only receive patients with poor prognosis, more complex cases have poorer prognoses.
Data manipulation: just treat healthier patients/ send them to other hospitals
Unmeasured performance will suffer
Which ethnicities are at a higher risk for IHD
South Asians - metabolic syndrome
African Caribbean - T2DM HTN
What is metabolic syndrome
HTN
High blood sugar
Excess body fat around the waist
Abnormal cholesterol
Differences in IHD between men and women
Develops later in women
Risk factors for IHD
- biggest
- non-modifiable and modifiable
BIGGEST: smoking
Non-modifiable: age, gender, FHx, ethnicity, socioeconomic
Modifiable: smoking, obesity, diet, alcohol, low exercise, high cholesterol
Scores to assess CVD risk
Framingham cohort charts
Q-Risk
10 year risk
How does smoking impact CVD
Increases risk by 50%, mortality is 60% higher
Passive smoking increases by 25%
% of CVD due to increased BMI
25-50%
Define central obesity
40 inch in men
35 inch in female
How much can exercise reduce CVD risk
30%
Exercise aim
150mins moderate/75 mins vigorous
Alcohol
14 units/week over 3 days
Primary prevention for MI
Don’t smoke, eat healthy foods, exercise, no alcohol, low bp
Secondary prevention for MI
already have CVD
Prevent MI/stroke (treat HTN, drug management)
Tertiary prevention for MI
After MI/stroke
CTPA, CABG, medications
Define strategy and give an example
Systematic plan for achieving a specific goal or result
e.g. reducing CVD
Target bp for male and female
male: 140/90
over 80: 150/90
DM: 140/80 (end organ damage 140/90)
Cause of asthma
Genetics, infections and environmental triggers
triggers of asthma
Allergen: smoke, dust mites, pollen
Occupational: paints, wood, grains, plastics
Medications that affect asthma
NSAIDs and Beta blockers
OTC and HRT before surgery
Stop 4 weeks before
Aspirin before surgery
Stop 1 week before
Low medium and high risk for DVT
Low: travel
Medium: PMHx, surgery over 30 min, pregnant, obese
High: Cancer, surgery
Prevention of DVT
Low: keep moving and hydrated
Medium: compression stockings
High: LMWH, fondaparinux)
Screen for latent TB
Mantoux test
How to increase TB compliance
Improve access to healthcare
DOT
Interpreter
Culture infection using PCR to find resistance
TB immunication
At risk areas of the country, family members from at risk countries, occupational risk
Is the BCG a good vaccine
Varies in efficacy
Screening for TB when new people enter the country
CXR
How many people in the country smoke
1/6
What are the benefits after stopping smoking
1 week: o2 levels improve
1 year: cvd risk halved
5 years: cancer risk halved
10 years: thrombosis risk same as non-smoker, lung cancer halved
3 approaches to stop smoking
Counselling and stop smoking groups
Nicotine replacement therapy
Bupropion
How does bupropion work
Reduces cravings and relieves withdrawal sx
What is varenicline
Nicotine replacement agonist that binds and blocks to remove desired effects