IHD, AF and HF + Asthma and COPD presentations

Question 1

What is offered in Leicester for someone with chest pain that is not ACS but suspect cardio?

Answer 1

• Rapid access chest pain clinic
• Nurse led
• Baseline and then exercise ECG following Bruce protocol
• Further tests inc angiogram, stress MRI test if symptoms but ECG fine

Question 2

4 A’s of managing stable angina?

Answer 2

• Aspirin 75mg
• ACEi- consider if diabetic
• Atrovastatin
• Already on BB

Question 3

Aim for ACEi and BB dosing for HF

Answer 3

• ACEi and BB aim for 10mg
• But people often do not get to this due to hypotension or bradycardic symptoms

Question 4

MDT and HF

Answer 4

• HF nurses in community - bridge the gap between GP and secondary specialist care
• Can titrate up meds etc

Question 5

Atypical MI presenters

Answer 5

• Women
• Diabetics
• Elderly

Question 6

Bloods for those with IHD/stable angina presentation

Answer 6

• FBC - rule out anaemia
• U&E - baseline if commencing ACEi
• Lipids - check for familial hyperlipidaemia
• LFTs - baseline for statin
• Normal ECG does not exclude SA

Question 7

Risk of using ICS inappropriately in COPD

Answer 7

• Pneumonia

Question 8

Grading COPD

Answer 8

• Mild if FEV1 still 80%
• Moderate 50-79%
• Severe 30-49%
• Very severe if <30% or <50% with resp failure

FEV1/FVC <70% at all stages
All have annual review apart from very severe which has every 6 months

Question 9

Indications for surgery in COPD (lung volume reduction, bullectomy or transplant)

Answer 9

• Severe COPD FEV1 <50% despite optimal treatment
• They do not smoke
• They can complete a 6 minute walk distance of 140m
• Completed pulmonary rehab
• Localised emphysema `

Question 10

How often is pulmonary rehab and what is it?

Answer 10

• Exercise and breathing technique course
• Healthcare professional led
• Recommended to do every 3 years
• 6-8 weeks
• 2 sessions /week so about 2 hrs

Question 11

Asthma vs COPD

Answer 11

• Asthma - younger, non smoker, diurnal variation, triggered then recover
• COPD - older, smoking history, progressive breathlessness

Question 12

Most beneficial treatments for COPD

Answer 12

• Smoking cessation
• Pulmonary rehab

Question 13

Common cause mortalilty in young asthmatics

Answer 13

• Lack of use of ICS
• Overuse of SABA
• Then get severe asthma attack as inflammation has not been controlled

Question 14

Common concerns with asthmatic patients

Answer 14

• Lack compliance
• Poor inhaler technique - inhale too fast
• Lie about PEFR ocassionally if asked to complete diary - be aware of this
• When treating with nebuliser for severe exacerbations can appear to stabilise but could have attack later on - safety netting essential

Question 15

How to check compliance of using ICS?

Answer 15

FeNO - should be lower if using ICS