Health check Flashcards
The NHS Health Check can tell you whether you’re at higher risk of getting certain health problems such as what?
Heart Disease
Diabetes
Kidney Disease
Stroke
During the check-up you also discuss how to reduce the risk of these conditions and what other condition?
Dementia
If you are over what age will you be told the signs and symptoms of dementia to look out for?
65
Is everyone at risk of developing heart disease, stroke, type 2 diabetes, kidney disease and some types of dementia?
Yes
Is Cardiovascular risk the same for everyone?
No it varies from person to person
How long does the NHS Health Check take?
20-30 mins
What questions are asked by a health professional - often a nurse or healthcare assistant in an NHS Health Check?
Questions about your lifestyle
Questions about family history
What examinations are done by a health professional - often a nurse or healthcare assistant in an NHS Health Check?
Measurement of height and weight - calculate BMI
Take blood pressure
Do blood test - done either before or at the check
What can the personalised advice to improve your risk given in an NHS Health Check include?
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 you have an NHS Health Check?
Usually at GP surgery or local pharmacy
Could happen at local library or leisure centre
Some areas they are offered from mobile units to passers-by and in workplace
Why might NHS Health Checks be paused in some areas?
At the moment may be paused due to COVID-19
Local council should be contacted to find out if programme is available in area
If you are between what age are you invited to have a free NHS Health Check every 5 years?
40-74 and do not already have a pre-existing condition
What should a patient do if they are eligible for a check but have not had one in the last 5 years or if they are not sure if they are eligible?
Ask at a GP surgery for an appointment
Do NHS Health Checks work?
Health conditions picked up by NHS Health Check, when added together are the biggest cause of preventable deaths in the UK with about 7 million people affected by them
In its first 5 years, how many heart attacks or strokes has the NHS Health Check been estimated to have prevented?
2,500 As a result of people receiving treatment after their Health Check
For every how many people having an NHS Health check is one person diagnosed with High Blood Pressure?
30-40
For every how many people having a Health check is 1 person diagnosed with Type 2 Diabetes Mellitus?
80-200
For every 6 in how many people having an NHS Health Check is 1 person identified as being at high risk for CVD?
10
Who runs the NHS Health Check Programme in a patient’s area?
Their local authority
What test on the NHS website assesses your risk of getting heart disease or stroke?
online Heart Age test
How do you find out if you are a healthy weight on the NHS website?
Health Weight Calculator
What does the How Are You quiz on the NHS website show?
How healthy you are
Equation to calculate cardiac output
Cardiac output= stroke volume*heart rate
Why does arterial pressure lead to vascular function and structural changes?
arterial pressure–>peripheral vascular resistance–>vascular function and structural changes
Why is it important to recognise hypertension?
Important to recognise hypertension as it is usually silent
What are 10 effects of hypertension?
Cardiac- coronary artery disease, left ventricular hypertrophy
Systemic vascular- TIA, stroke
Microvascular- Atherosclerosis (could increase risk of aneurysm), aneurysm
Renal- glomerulosclerosis (microvascular effects in kidney, will lead to kidney failure if left untreated), kidney failure
Visual- retinopathy, optic neuropathy (optic nerve damage)
Why is first BP measurement usually higher than normal and how do you avoid this?
Can be due to stress- ‘white coat’ hypertension when they see a healthcare professional
Best out of 3 measurements taken
If BP still high even after best of 3, what is done?
24 hour ambulatory blood pressure monitoring in the comfort of the patients home, can help avoid the white coat effect
Usually goes off 2x in a day and once in night which can be scary and so if this happens you can use BP monitor yourself at home 2x in day and once in night
If you still have high BP after 24 hour ambulatory blood pressure monitoring, what is done next?
Lifestyle advice
exercise (circulation to skin and muscles for vasodilation and increased Renal function)
Diet
stop smoking
Give an example of lifestyle advice to do with diet
Usually hypertensive individual has high salt and vulnerable to renin so salt intake should be controlled
If BP still high after lifestyle changes, what should be done?
Give medication
What 4 things should be offered to all patients with hypertension?
Test for presence of protein in urine by sending a urine sample for estimation of albumin: creatinine ratio and test for haematuria using a reagent strip
Take a blood sample to measure glycated haemoglobin (HbA1c), electrolytes, creatinine, estimated glomerular filtration rate, total cholesterol and HDL cholesterol
Examine the fundi for the presence of hypertensive retinopathy
Arrange for a 12 lead ECG to be performed
((all test for end organ damage))
Describe the order of the 5 electrical events in the cardiac cycle
SA node signal
Atrial contraction
AV node signal
Ventricular depolarisation
Ventricular repolarisation
What is the name of the cell types in the SA node?
Autorhythmic myocytes
What is the name of the wave created by the SA node?
P-wave
How is the AVN signal represented on ECG and is this a slow or fast signal?
Isoelectric line
Slow transduction to allow ventricular filling before contraction
What wave does the depolarisation of the Bundle of His show on ECG and is this slow or fast signal?
Isoelectric line
Fast as it is insulated
What occurs in the Q wave?
Shows septal depolarisation via bundle branches
What does the R wave show?
Ventricular depolarisation by Purkinje fibres
What does the S wave show?
Late ventricular depolarisation and this is in opposite direction to lead II
What does the T wave show and why is this positive deflection on ECG?
Ventricular repolarisation which occurs in opposite direction to lead II but since it it is repolarisation in the opposite direction, it has positive deflection (depolarisation in opposite direction would have had negative depolarisation)
The part that depolarises first is what repolarises last
Summary diagram for ECG tracing
Where do each of the chest electrodes go?
V1- right sternal border in the 4th intercostal space
V2- left sternal border in the 4th intercostal space
V3- Halfway between V2 and V4
V4- Mid-clavicular line in the 5th intercostal space
V5- Anterior axillary line at the level of V4
V6- Mid axillary line at the level of V4
Which direction does electrical conduction travel from and to?
From negative electrode to positive electrode as depolarisation leads to a lower intracellular charge compared to extracellular charge
What direction do each of leads I-III go from in relation to the limbs?
What is the correct way to read an ECG?
- Check right patient, DOB, date and time
- Look at calibration and running speed to see how big each square is
- Rate - R-R interval (300/number of big square)
- Rhythm - equidistant R-R interval
- Axis - normal is -30 to 90 and see whether it is positive or negative deflection
- P-Wave - are they present in V1, are they normal morphology
- P-R interval - Within 3-5 small squares and if longer it is a type of heart block, is it regular without the lead
- QRS complex - height, amplitude and the width otherwise there is abnormality in ventricular depolarisation
- ST-Segment - Flat on isoelectric wave
- T-Wave - Morphology
- Q-T interval- abnormal or not
- Go through each lead systematically and see how to interpret it
What could large QRS complexes on the V leads suggest in the context of LV hypertrophy?
Large QRS complexes on the V leads - difference in ventricular depolarisation
Hypertrophied LV means more mass in LV so more muscle that needs to contract and so the QRS amplitude increases
What could ST segment depression suggest?
Abnormally electrical impulse goes through the muscle
What could t wave inversion mean?
Myocardial Ischaemia
What is diastolic dysfunction?
Stiffening of the heart’s ventricles
Explain the pathophysiology of diastolic dysfunction?
Increased peripheral vascular resistance so increased afterload
Adapts to this by pressure and volume related remodelling of the LV
Hypertrophy occurs and thicker muscle builds
LV remodels so much that it causes diastolic dysfunction
What is systolic dysfunction
Increased circulating volume leads to remodelled LV and so this leads to eccentric hypertrophy to allow the large volume which leads to systolic dysfunction
How does calcium channel blocker lead to reduction in blood pressure?
Inhibit L-type calcium channel, decreasing calcium influx in vascular smooth muscle leading to downstream inhibition of myosin-light chain and this prevents cross-bridge formation and smooth muscle contraction leading to dilation which reduces blood pressure
What effect does decreasing peripheral resistance have on vascular pressure?
Decreased peripheral resistance → decreases vascular pressure
What dose do you start with of CCBs?
Start with the lowest dose first and then you can move up
What is the difference between dihydropiridenes and non-dihydropiridenes?
Non-dihydropiridenes - more negative inotropic effects
Dihydropiridenes - more potent vasodilators
Choice of anti-hypertensive drug
Why are hypertensive patients less receptive to ACEi or ARB?
Less responsive to Renin and so are less receptive to ACEi or ARB as they have high salt
May be of black African or African-Caribbean family origin
Why is the blood pressure still high despite drug treatment?
- Non-Adherence (Intentional - they do not want to take the medication and are not engaging with the prescriptionUnintentional - may forget and not feel they are getting any benefit from it)
- Side effects
Ankle oedema - swelling of the ankles (most common)
Change in bowel habits - Calcium channels present in gut mucosa therefore affected gut motility and changes in these
Palpitations - decreasing blood pressure which is detected by baroreceptors and so the heart is pumped harder to increase pressure which the patient feels the heartbeat for
Headaches and flushings - Dilated blood vessels so more blood to head and this gives flushing and headaches - Multiple drugs required (70% patients fail to control hypertension on one medication
CCB with ACEi, ARB or Thiazide-like diuretic) - Ethnicity (Can increase risk of resistance to anti-hypertensives)
- White coat syndrome (Could still be stressed when coming in to see the doctor’s about the results of the blood pressure tests)
What is the function of pacemaker cells?
Set rate of heartbeat by sending out action potentials across cells
What percentage of cells are pacemaker cells?
1%
What is meant by the auto-rhythmicity of the pacemaker cells?
They are continually able to generate action potentials to send out to the rest of the heart
Every pacemaker cells has the ability to generate a new AP given a certain time
Where do skeletal muscle cells get their signal to send out APs from?
Neurons
What cells receive the AP from pacemaker cells?
Myocytes making up the myocardium
What is meant by polarisation?
More positive ions outside the cell than inside (negative membrane potential inside the cell compared to the outside)
What is meant by depolarisation?
Membrane potential is smaller and so it is more positive than in polarisation as the amount of positive ions on the outside is less than inside during depolarisation when compared with polarised state
What is a depolarisation wave?
When one cell after another is depolarised
What is the SA node?
Group of pacemaker cells in the upper right quadrant of the right atrium
What is the function of the SA node?
Generates signal for the atria to contract
Does the depolarisation wave move faster in myocytes or in pacemaker cells?
Faster in pacemaker cells
How does the depolarisation wave in the right atria reach the left atria?
Atrial internodal tracts - Bachmann’s bundle
Other than the atrial myocytes, what other structure does the SA node send signals to?
AV node
What causes the conduction to slow at the AV node?
Smaller diameter so higher resistance
Slower Ca2+ channels used rather than faster Na+ channels
Why is slowing of conduction at AV node useful?
Allows time for ventricular filling
Describe the path of the conduction after AV node?
AV node → Bundle of His → Bundle branches in interventricular septum → Purkinje Fibres
What is the significance of the His-Purkinje system being fast?
Heart contracts in a coordinated way to give a forceful push
If the SA node pacemaker cells fail to send out a signal to contract what happens?
Other atrial pacemaker cells send signal at 60-80 per minute
(Ectopic pacemakers - Not in SA node)
If these fail, AV node pacemaker cells send signal at 40-60 per minute
If these fail, ventricular pacemaker cells send signals at 20-40 per minute
What is meant by cardiac conduction velocity?
Velocity of depolarisation through myocardium (m/s)
Describe the action potential at a molecular level?
Calcium and sodium slip through gap junctions and trigger voltage gated sodium channels in adjacent cells to open leading to AP which causes next cell to allow sodium through its gap junction triggering another AP
Describe the conduction velocity at the atria, AV node, Bundle of His and Purkinje fibres and the Ventricles
In the t wave is there negative or positive deflection?
T wave shows repolarisation, however there is positive deflection as the last cells to depolarise (ventricular) are the first to repolarise and so the repolarisation wave which goes from negative to positive will travel in the opposite direction to the lead which then will show itself as positive deflection
What are the limb electrodes?
The limb electrodes are placed on the right arm, left arm, left leg and right leg
The right leg is used as a neutral and so the left leg is used to show the signal directions on ECG
Together they make leads I, II, III, aVF, aVL, aVR
What are the precordial electrodes?
They are the chest electrodes of V1-V6 placed across the chest
In which direction do each of the chest leads show deflection in?
Which are the inferior leads?
Leads II, III, AVF are inferior leads
What are the inferior leads supplied by?
Right coronary artery
Which are the lateral leads?
Leads I, aVL, V5, V6
What are the lateral leads supplied by?
Circumflex artery
Which are the septal leads?
V1, V2
What are the septal leads supplied by
Left anterior descending artery
Which are the anterior leads?
V3, V4
What are the anterior leads supplied by?
Right coronary artery
How many seconds and mV is one small box on an ECG?
0.04s in width
0.1mV in height
What does the P wave signify?
Atrial depolarisation via SA node
What is the isoelectric line after the P wave a show of?
AV node depolarisation and this shows the slow signal transduction which is protective of the ventricular filling
How is the PR interval measured and what does it show?
From beginning of P wave and end of isoelectric line
Time between start of atrial contraction and ventricular contraction
What is a normal PR interval?
0.12-0.20s
3-5 small boxes
What does the Q wave signify?
Signal passing through the bundle branches in which there is septal depolarisation
This is shown as negative deflection as the signal goes through all the myocytes in the thick intraventricular septum which shows it to be in opposite direction of lead II
What causes the R wave?
Signal conduction through large Purkinje fibre going through left ventricle
What causes the S wave?
Negative deflection caused by late ventricular depolarisation in the right ventricle via Purkinje fibres
What is the ST segment?
No change in electrical activity after hitting the J point (isoelectric line)
What causes the T wave?
Wave of negative charge due to repolarisation in the opposite direction to lead II shows positive deflection as opposed to S wave which was positive charge in opposite direction and so showed as a negative deflection
Why is the T wave more spread out?
Repolarisation is a slower process that takes place at slightly different times for each cardiomyocyte instead
Why does atrial repolarisation not show itself on ECG?
The small vectors this creates is lost by the larger vectors created by ventricular depolarisation
If there is an irritable atrial cell in left atrium which becomes an atrial extopic focus, is the PR interval going to be longer or shorter?
Longer as the atrial ectopic focus is farther away from the AV node
In first degree heart block is the PR interval longer or shorter than normal?
Longer as the conduction through AV node is slower
How does a ventricular ectopic focus alter the QRS complex?
Becomes wider as it takes longer to depolarise all the myocytes
How long is a normal QRS Complex?
0.10s
How do you define an intermediate and prolonged QRS Complex?
Intermediate - 0.10-0.12s
Prolonged - >0.12s
What does the QT interval show?
Ventricular systole from depolarisation through to repolarisation
How long is an abnormally long QT interval in men and women respectively?
Men - 440ms
Women - 460ms
At 60bpm
If a male has a QT interval of 400 at 90bpm is this normal?
Not necessarily as QT interval is supposed to change with rate
As Rate increases, QT interval should reduce
How do you calculate the adjusted QT interval for a ceratin rate?
:)
