Chronic conditions Flashcards
HASBLED score
HTN
Abnormal LFTs or U&Es ( up to 2 points)
Stroke
Bleeding
Labile INRs
Elderly >65
Drugs and alcohol (up to 2 points) - antiplatelts, NSAIDs, 8 or more alcohol/week
CHA2DS2VASc score and what points
CHD or LVEF <40% HTN AGE >75 - 2 points DM Stroke or TIA Hx - 2 points Vascular disease Age >65 Sex F
If male then anticoagulate if 1 point
If female then need 2 points
AF more common in males or females?
males
initial episode of AF definition
AF>/=30s diagnosed by ECG
paroxysmal AF
recurrent >/=2 episodes that terminate within 7 days (or <48hrs and terminated with cardioversion)
persistant AF
continuous >7 days or AF >48hrs in which decision made to perform cardioversion
long standing persistent AF
continuous AF of >12m
permanent AF
joint decision by pt and clinician to cease further attempts to restore or maintain sinus ryhthm
management of AF rate control
beta blocker or rate limiting CCB (eg diltiazem)
use digoxin in CHF
what is a rate limiting CCB contraindicated in
HF
definition of CKD
abnormality of kidney structure or function for >3 months that has implications for health
how to diagnose CKD
2x GFR <60 at least 3 months apart
definition of kidney failure
when GFR <15 or need for replacement
2 most common causes of CKD
diabetic nephropathy
glomerulonephritis
in a new finding of GFR <60 what do you do?
2nd sample within 2 weeks
3rd sample within 3 months
check ACR
what is defined by rapid progression of CKD
drop in GFR by 25% and in new category in <1yr
OR
drop in GFR by 15 in <1yr
definition of COPD in terms of spirometry
FEV1/FVC ratio <0.7
CXR in COPD signs
- hyperinflation (>6 ant ribs, flat hemidiaphragms, floating heart sign)
- large central pulmonary arteries (pulmonary HTN)
- reduced peripheral vascular markings
- bullae
what is the MRC dyspnoea scale used for
COPD
what is the BODE index used for and what are the components?
COPD
BMI
Airflow Obstruction
Dyspnoea
Exercise capacity
people who you should not use QRisk 2 for
>85yrs T1DM eGFR <60 prexisting CVD familial hypercholesterolaemia
when do you offer statin in T1DM
T1DM >40yrs, DM for >10yrs, established nephropathy or other CV risk factors
bloods in statins
basline LFTs + 3m +12m
lipids at start and at 3m (40% reduction wanted)
renal function at start
ask if persistent muscle pain if yes measure serum CK
interactions in statin
grapefruit
stable angina
occurs predictably with physical exertion or emotional stress. lasts <10mins and is relieved within mins of rest as well as GTN spray
unstable angina
new onset angina or abrupt deterioration in previously stable angina, often occuring at rest
diagnosis of angina (3 features)
- constricting discomfort at front of chest or in neck, shoulders, jaw or arms
- precipitated by physical exertion
- relieved by rest or GTN within 5 mins
angina management
GTN PRN beta blocker or CCB (both second line) consider 75mg aspirin consider ACEi if stable angina + DM statins Treat HTN
revascularisation - CABG or PCI
DVLA angina rules
cars/motorbikes: dont need to tell DVLA. might need to stop driving if angina at rest or while driving
lorries buses: must not drive and must notify DVLA
stage 1 HTN
> 140/90 clinic and ambulatory >130/85
stage 2 HTN
> 150/90 and ambulatory >150/95
severe HTN
> 180 systolic or >110 diastolic
who to offer pharmacological HTN treatment
< 80 yrs with:
- target organ damage, establised CVD, renal disease, DM, QRisk2>20%
offer to everyone with stage 2 HTN
what does beta blocker + thiazide incrrease risk of
DM
