Chronic cases

Question 1

Summarise you case of ischaemia heart disease in 30 second?

Answer 1

Mr Smith is a 68 year old male who has suffered from two MIs. He recieved percutaneous stenting for both. He is an ex smorker of 20 pack years and has an increased BMI. Following his first heart attack he made an effort to alter his risk factors but found this to be very difficult. Following his second MI he has noticed increased shortness of breath and chest pain affecting his day to day activities.

Question 2

How was Mr smith diagnosed?

Answer 2

He was Diagnosed following percutaneous angiogram and stenting. Troponins done adn found to be raised.

Question 3

What are the nice guidelines on management of STEMI?

Answer 3

ECG and bloods (inc troponin)
MONAC - should recieve reperfusion therapy within 120 mins in available
Or fibrinolysis if this is not available

Question 4

What are the side effects of asprin?

Answer 4

Vomiting.
Stomach pain.
Heartburn.
Drowsiness.
Nausea.

Question 5

What are the side effects of bisoprolol?

Answer 5

Dizziness
Weakness
Headache
dry eyes

Question 6

What are the side effects of clopidogrel?

Answer 6

Abdo pain
Bleeding disorders
diarrhoea
dyspepsia

Question 7

What are the side effects of ramipril?

Answer 7

Dry cough
Dizziness
Hyperkalaemia
Hyponatraemia

Question 8

What are the side effects of simvastatin?

Answer 8

Headache
Difficulty sleeping
Muscle aches

Question 9

What are the side effects of tamsulosin?

Answer 9

Drowsiness
Weakness
Head ache
Decreased semen on ejaculation

Question 10

What are the nice guidelines for drug treatment after stemi?

Answer 10

ACE inhibitors
Antiplatelets
Beta blockers
Statins

Question 11

What monitoring is required for ACE inhibitors?

Answer 11

For ACE inhibitors should have renal function and serum electrolytes and BP monitored 1-2 weeks after starting treatment. Also after any dose increases

Question 12

What monitoring is required for statins?

Answer 12

Measure ALT and AST at 12 months, ask patient if they are experiencing any muscle symptoms (pain, tenderness, weakness) if so measure creatine kinase.
Non fasting measurement of non-HDL can be done to see if statins are working

Question 13

How is Mr Smiths care organised?

Answer 13

He has annual cardiovascular and medication checks with GP

Cardiology review around 2 weeks after his MI

Question 14

What have you learnt form Mr Smiths case?

Answer 14

How hard it is for people to change their diet/Increase excercise etc

Question 15

Please summarise Mrs George’s case?

Answer 15

Mrs George is a 53 year old lady who was diagnosed with multiple sclerosis in 1999. Since her initial diagnosis her disease has followed a relapsing remitting course and she feels she has recieved very little support. It effects her in her day to day activites and feels she has been let down by the healthcare service.

Question 16

How was Mrs George diagnosed?

Answer 16

Went to GP with recurrent trigeminal neuralgia and gp noticed pupil defects.
Referred to neurologist who made the clinical diagnosis also had MRI that showed lesions

Question 17

How is MS diagnosed now?

Answer 17

McDonald criteria 2010 is on clinical findings and number of relapses the patient has experienced.

Question 18

What is the management of MS for Mrs george?

Answer 18

gabapentin is for her spasticity
Carbamezipine for trigeminal neuralgia
Oxybutanin to rela bladder
co dydramol for pain relief
Prednisolone for flares