CPRS Case 7: Heart Failure Flashcards
***Confidentiality and consent for information disclosure
Obtain consent before disclosure of medical information to third party
Exception:
- disclosure in public interest
- disclosure in individual’s interest (because failing to disclose would exposure the patient / someone else to risk of deaths / serious harm)
- when required by law
Personal data ordinance: patient’s right of access / correction of information in medical record and circumstances in which right may be refused
Explain balance of forces controlling filtration/reabsorption at capillaries (Starling’s hypothesis)
See CPRS lecture 18
Describe structure of cardiac muscle
See IASM lecture 31
Explain effect of preload and afterload on force of cardiac contraction (Starling’s law of the heart) and length tension relationship for cardiac muscle
See CPRS lecture 25
Roles of RAAS system in control of blood volume and blood pressure
See CPRS lecture 44
Actions of ACE inhibitors and diuretics
See CPRS lecture 45
How to examine cardiovascular system
General:
- eyes: pallor
- lips and tongues: central cyanosis
- hands: clubbing, tar stain, peripheral cyanosis, infective endocarditis (Janeway lesion, Osler nodes, Splinter haemorrhage)
- pulse rate
- legs: posterior tibial pulse (behind and slightly below Medial Malleolus)
Inspection and palpation:
- scar
- apex beat
- left parasternal heaves
- thrills at sites of auscultation
Auscultation
Signs of pulmonary oedema
Acute:
- extreme SOB worsen when lying down
- feeling of suffocation when lying down
- wheezing
- rapid irregular beat
- cold clammy skin
Chronic:
- more SOB than normal when physically active
- difficulty breathing with exertion
- difficulty breathing when lying flat
- awakening at nighty with cough / breathless feeling relieved by sitting up
- weight gain
- swelling in lower limb
- fatigue
Appropriate investigations for patient with suspected heart failure
- **- Chest X-ray: enlarged, lung congestion
- **- ECG: ischaemic changes, hypertrophy
- **- Echocardiogram: SV, EF, ventricular muscle movement
- CT: chronic condition
- MRI: extent of damage
- Lung function test
- Catheterisation
- Biochemistry
- Heart scans with injected dye
Pros and cons of different methods of storage and retrieval of patient records
Electronic:
Pros:
- Improved quality of care (easier to read than handwriting)
- Convenience and efficiency
- Saving space
- Patient access
- Financial incentive
Cons:
- Privacy and security issues
- Inaccurate information if not updated frequently
- Frightening patients (if patient can access)
- Malpractice liability (deleted on purpose)
Paper-based:
Pros:
- Security (generally safe)
Cons:
- Inconvenient to access
- Susceptible to natural disaster
- Poor legibility
- Storage problem
Incidence of heart failure among survivors of myocardial infarction
5.8 per 100 person-years
Prior to thrombolysis: incidence of HF after STEMI: 40%
After thrombolysis: incidence of HF: 3% at presentation, 17% during admission
Issues of data managment
Doctors have due regard to responsibilities and liabilities under Personal Data Ordinance
- patient’s right of access / correction of information in medical record and circumstances in which right may be refused
Improper for doctors to accept money / gifts from commercial firms for collection of clinical data
