case 15 - well man check Flashcards
what is the NHS Health Check?
a free check-up of your overall health
what does the NHS health check involve?
tell you whether you’re at higher risk of getting certain health problems over the next 10 years and how to reduce your risk of them
- heart disease
- diabetes
- kidney disease
- stroke
- dementia (above 65)
what is calculated in the NHS health check and why is that useful?
your individual cardiovascular risk calculated and explained
given advice on how to prevent cardiovascular conditions (tailored, personalised advice)
what happens at an NHS health check?
takes approx 20-30 mins
healthcare professional (nurse/HCA) will
- ask you questions about your lifestyle and family history
- measure height and weight
- take blood pressure
- do a blood test (to assess risk of CVD, stroke, kidney disease, diabetes etc)
- give you personalised advice to improve your risk
what personalised advice is given to improve your risk at an NHS health check?
- how to improve your diet and the amount of physical activity you do
- taking medicines to lower your blood pressure or cholesterol
- how to lose weight or stop smoking
where do NHS health checks take place?
at a GP surgery or local pharmacy
how are NHS health checks arranged?
usually invited every 5 years if you’re between 40 and 74 years of age and do not already have a pre-existing condition
local authority can send appointment letters to invite you as well
do NHS health checks work?
for every 30 to 40 people having an NHS Health Check, 1 person is diagnosed with high blood pressure
for every 80 to 200 people having a Health Check, 1 person is diagnosed with type 2 diabetes
for every 6 to 10 people having an NHS Health Check, 1 person is identified as being at high risk of cardiovascular disease
= have prevented around 2500 heart attacks or strokes in the first five years
how can hypertension affect the brain?
give two possible effects
transient ischaemic attack
stroke
how can hypertension affect the eyes?
give two possible effects
hypertensive retinopathy
optic neuropathy
(glaucoma)
how can hypertension affect the heart?
give two possible effects
left ventricular hypertrophy
angina
how can hypertension affect the kidneys?
give two possible effects
glomerulosclerosis
kidney failure
(chronic kidney disease)
how can hypertension affect the peripheral vasculature?
give two possible effects
atherosclerosis
aneurysm
(peripheral vascular disease)
how is hypertension managed?
(according to the NICE guidelines)
recheck BP
24 hour ambulatory BP monitoring
lifestyle advice
recheck BP
start medication
what is 24-hour ambulatory blood pressure monitoring (ABPM)?
a method to measure blood pressure on a continuous basis
= gives a more accurate picture of your blood pressure
when is 24hr ABPM carried out?
to identify untreated patients who have high BP readings in the clinic but normal readings during usual daily activities outside of this setting (‘white coat hypertension’)
how is 24hr ABPM carried out?
small digital blood pressure monitor is attached to a belt around your waist and connected to a cuff around your upper arm
blood pressure is measured as you move around, living your normal daily life
in which scenarios is ABPM most useful?
in scenarios where white coat hypertension is suspected
what lifestyle recommendations are made for patients with hypertension?
weight loss
increased physical activity
dietary modifications
reduced salt intake
what is salt-sensitive hypertension and how common is it?
changes in blood pressure levels parallel to change in salt intake
= around 30-50% of hypertensive patients
what is white coat hypertension?
when the blood pressure readings at your doctor’s office are higher than they are in other settings
= when readings are over 140/90mmHg in clinic and under this threshold normally at home
what do the NICE guidelines suggest for all people diagnosed with hypertension?
- test for proteinuria, estimated ACR (albumin:creatinine ratio), haematuria
- blood test for HbA1c. electrolytes, eGFR, total cholesterol and HDL cholesterol
- 12-lead ECG

what is the P wave of an ECG linked to?
atrial depolarisation (triggered by the SAN)

what is the P-R segment of an ECG linked to?
the delay caused when the electrical impulse slows down as it travels from the SAN to the AVN to allow time for ventricular filling




































