NHS Health Check Flashcards
What is a NHS Health check and what type of diseases can it screen for
Free check-up of your overall health and can tell you whether you’re at a higher risk of getting conditions like:
- Heart disease
- Diabetes
- Kidney disease
- Stroke
You will be told how to reduce risk of getting these conditions and dementia
if you’re over 65, dementia will also be screened and oyu would be told what signs and symptoms to look out for.
How does the NHS Health Check help?
Your individual cardioV risk is calculated and explained to you.
Risk vary from person to person but everyone is at risk of developing heart disease, stroke, type 2 , kidney disease and some types of dementia
it gives advice on how to prevent them; can detect potential health problmes before they do damage
Desciribe what happens at the Health check
lasts 20-30 min
Health care professional (HCA or nurse) ask about:
- FH
- SH
- Height and weight- BMI
- take BP
- Blood test
Blood test can be done before the check (meeting) or at the meeting time.
It will show chances of getting the diseases
During the NHS health check, you will receive personalised advice to reduce your risk. what could they be?
- improving diet and exercise
- Taking meds to lower BP/ cholesterol
- Losing weight and stop smoking
Where can you have your NHS check?
Depends on where you live
i.e. could be GP, local pharamcy, local library or leisure centre
In some areas the Checks are offered from mobile units to passers-by and in workplaces
What are theways someone could arrange to have an NHS Health check
You’ll be invited for a check every 5 years if you’re between 40-74 with no pre-existing conditions
You’re GP practice will automatically send one if they offer the Health check.
Local authority could also tell you where to get one
if you’re not sure just ask a GP surgery
What impact does the NHS health check have on society.
the Health Check have prvent 2.5k heart attack or stroke in it’s first 5 years due to the treatments given.
- 1 in (30-40) ppl who have check is diagnosed with high BP
- 1 in (80-200) diagnosed with type 2 diabetes
- 1 in (6-10) identified as being high risk of cardiovascular disease (usng the calculator)
One of the management of hypertension is to discuss lifestyle interventions. Explain in detail what this entails
Inform them about any local initatives and supplement advice with leaflets or audiovisual information.
The interventions could include :
- Healthy Diet
- Stopping Smoking
- Encourage Exercise
- Reduce Salt intajke
What are the recommendations for healthy diet
Weight should be reduced and maintain BMI between 18.5 and 24.9
Use wholegrain food
Reduce saturated fat and increase mono-unsaturated fats (olive or rapseed oil and spreads)
Reduce sugar and refined sugar intake
Eat 5 fruit and veg a day
Eat 2 portions of fish per week (include a portion of oily fish)
Eat 4-5 portions of unsalted nuts,seeds and legumes per week
low salt
Discourage excessive coffee connsumption
keep alcohol levels low (14 units a week spread throughout the week with atleast 2 days alcohol free)
Ca, Mg and K not recommended to reduce bp
What specifc advice should you give regarding encouraging exercise?
Make physical activity part of everyday life (walk, cycle go up stairs) and build in enjoyable activities
Minimise sedentary activities like watching TV or playing video games
Join a local sporting group, take advantage of taster sessions and get used to exercising every week
What are the guidelines for salt reduction in diet
Salt reduction to 4.4g per day leads to a 4/2mmHg decrease in BP
No more than 5-6 grams of salt per day
Don’t add salt to food and avoid processed food. Look at food labelling to check salt content.
In Diagnosis of High bP, what are the stages of High BP
Stage 1 -
- BP in clinic is 140/90 mmHg to 159/99 mmHg AND
- ABPM or HBPM 135/85 mm Hg to 149/94 mm Hg.
Stage 2 -
- BP in clinic is1 60/100 mmHg to 179/119mmHg AND
- ABPM or HBPM >/= 150/95 mmhg
Stage3/ Severe hypertension -
- BP in clinic >180/120 mmHg
in what group of people should you measure standing as well as sitting BP
Those with hIgh BP AND ONE OF THE FOLLOWING;
- Type 2 diabetes
- Symptoms of postural hypotension
- Aged 80 or over
Treatment targets should be based on standing blood pressure in people with significant postural drop or symptoms of postural hypotension.
There are people who choose to monitor their own BP. What should you offer them?
Advise them to use HBPM
What should you provide for people who choose to use HBPM?
Training and advice on using home blood pressure monitors.
Advice on what to do if they are not achieving their target blood pressure
What should you consider for people with High BP and also have White coat/masked hypertension?
Consider ABPM or HBPM as well as clinic BP.
Note that the corresponding readings for ABPM and HBPM are 5mmHg lower than for clinic measurements.
For people with hypertension aged 80 or over, what BP level should you aim for?
reduce clinic BP to below 140/90 mmHg and maintain that level
what should you offer for people of any age with persistent stage 2 hypertension ?
Antihypertensive and lifestyle advice.
Use clinical judgement for people of any age who are frail or have multi-morbidity.
Discuss using anti-hypertensive treatment with people under 80 with persistent stage 1 high BP and one/more of the following disease? what are they?
Target organ damage.
Established cardiovascular disease.
Renal disease.
Diabetes.
An estimated 10-year risk of cardiovascular disease of 10% or more.
what other demographics of people should you offer anti-hypertensive treatment as well as lifestyle
Under 60, persistent stage 1 and 10yr cardiovascular risk below 10%.
People over 80 with a clinic BP above 150/90
(people of any age with persistent stage 2 hypertension)
what shoudl you consider for pts with stage 2 hypertension under 40
Consider specialist referral to rule out secondary cause
Also advise on risks and benefits of long-term antihypertensive meds
What are the intial antihypertensive choices for different demographics?
T2DM and hypertension: ARB/ACEi -> ARB/ACEi + CCB/thiazide like dieuretic -> ARB/ACEi + CCB + thiazide like dieuretic
Non-black under 55:
ARB/ACEi -> ARB/ACEi + CCB/thiazide like dieuretic -> ARB/ACEi + CCB + thiazide like dieuretic
OVER 55: CCB -> CCB + ACE/ARB/thiazide like dieuretic -> ARB/ACEi + CCB + thiazide like dieuretic
Black: CCB -> CCB + ACE/ARB/thiazide like dieuretic -> ARB/ACEi + CCB + thiazide like dieuretic
If no treatment works:
Confirm resistant hypertension
Consider seeking expert advice or adding a:
- low-dose spironolactone4 if blood potassium level is ≤4.5 mmol/l
- alpha-blocker or beta-blocker if blood potassium level is >4.5 mmol/l
Should you give ARB or ACE to an individual of african or carribian family origin? Why?
Consider ARB instead of ACEI
ACEi shown to have poor BP lowering affects
in what ways can the heart compensate for high BP
Left Ventricular hypertrophy- this can lead to ischeamia.
Increased blood pressure increases wall stress -> increased wall thickness to compensate
Heart failure syndrome- high blood pressure can lead to scarring of vessels which makes them stiffer and narrowers -> not enough blood pumped to heart -> heart faliure
What are the different organs high BP could affect?
Start from top to bottom
Brain:
- TIA
- Stroke
Eyes:
- Retinopathy
- Optic neuropathy
Heart
- Coronary heart disease
- Left Ventricular hypertrophy
Kidney
- Glomerulosclerosis
- Kidney Failure
Vasculature
- Atherosclerosis
- Aneurysm
Once you have a pt in the clinic, what are overall procedure to manage and monitor BP
lifestyle is very important, re-inforce it everytime you meet the pt
what does the NICE guidelines say you should measure/investigate for all people with hypertension?
- Urine sample test for proteinuria and haematuria
- HbA1c, U&Es, creatinine, eGFR, total cholesterol and HDL
- examine with fundoscopy for presence of retinopathy.
- perform 12 lead ECG
what different ECG leads look at different sides of the heart?
Lateral: I, avL, V5 and V6 = Left circumflex
Septal: V1 and V2 = Left anterior descending
Anterior: V3 and V4 = Left anterior descending
Inferior: II, III, avF = Right coronary artery
what was the pathology found in Dr OKoye ECG. There are other abnormalites, how can you differentiate it from an acute coronary syndrome?
Enlarged QRS- suggests left ventricular hypertrophy..
There are others like ST depression, however to distinguish it from ischeamia, look at history and previous ECGs.
What are the potential reasons for Left Ventricular Hypertrophy?
Pressure overload
Volume overload
Angiotensin 2, Aldosterone and Endothelin
Insulin, Insulin growth factors and lipids
According to the guidelines what were the drugs prescribed for Dr Okoye. Explain why
what about comorbidites of angina / diabetes
Amlodipine- 5mg orally per day. This is a non-rate limiting CCB as it affects blood vessels. it’s better it doesn’t affect the heart so it doesnt cause adverse effects
On second vist, Dr Okoye BP levels were still high, explain why.
What are the take home points?
Non-adherence : can be unintentional or intentional (side effects)
Side effects
Lifestyle changes (don’t take it seriously)
Multiple drugs required (maybe increase dose)
Ethincity- black individulas have low renin so we use CCB for them
White coat syndrome
The take home point is that even if BP levels or results don’t change, it doesn’t mean that your diagnosis is wrong.
Also meds don’t always reduce BP
What is electrical conduction in the heart?
Electrical signals that go from cell to cell in the heart.
This happens in the form of action potentials, which get sent out by the pacemaker cells in the heart.
What is a pacemaker cell?
also called conducting cells
they are autorhythmic- able to continually generate new action potentials that go out to the rest of the heart
What are myocytes?
Make up myocardium- muscle of the heart
Recieve APs
What is depolarisation?
the membrane potential gets smaller making a cell slightly more positive than it normally would be
If one cell after another depolarizes, then there’s a depolarization wave
How does the electrical signal travel through the heart?
- SA Node- in right atrium: During each heartbeat, one pacemaker cell out of the group will automatically depolarize first.
- Internodal tracts (Bachmann’s bundle): connect the SA node to spots in the right and left atria
- AV Node- between atria and ventricles
- Bundle of his -> left and right bundle branches -> purkinje fibres
- Depolarisation to rest of heart
What happens to conduction velocity at the AV node?
Slows down because:
- AV nodal cells have very small diameters which increases resistance to electrical flow
- AV nodal cells use the relatively slower opening calcium ion channels
This is important in making sure ventricles have enough tim to fill before they contract
What is the significance of the AV node?
only point where an electrical signal can go from the atria to the ventricles
What would happen if conduction thriugh AV node was quicker?
Less ventricular filling so:
- decreased stroke volume
- Dec. cardiac output
What is firing rate?
What is the firing rate of the SA node like?
The rate at which APs happen
Pacemaker cells in the SA node have short action potentials and short refractory periods, so right after depolarizing, they want to depolarize again.
What is cardiac depolarisation velocity?
the velocity at which a depolarization wave moves through the myocardium
Units: m/s
What determines cardiac velocity?
That rate at which ions (Na and Ca) pass through to the next cell and depolarise it
More Na channels and gap junction speed up depolarisation wave
How does conduction velocity change across the heart?
Fast at SA node: 1m/s
Slow at AV node: 0.01-0.05 m/s - allows atria time to contract
Very fast at Bundle of His and Purkinje fibres: 2-4m/s- allows ventricles to contract all at once
Slower at ventricular myocytes: 1m/s
Where are the limb electrodes located?
Left arrm (AVL): 30 deg from horizontal
Right arm (aVR): 30 deg from horizontal
Left leg (aVF): vertically down
^All detect positive charge
Right leg (neutral)
Where are the prechordial electrodes located? What is their charge?
V1-V6 (chest leads)
All positive
What are the bipolar limb leads?
Lead I, II and III
Use 2 electrodes
Lead I: RA to LA
Lead II: RA to LL
Lead III: LA to LL
^all neg to positive
What forms waves on an ECG?
P wave: SA node depolarisation to Bachmann’s bundle- atria contraction (same direction as lead II vector)- positive deflection
P-R interval: Delay at AV node (atria contract and fill venctricles) (no depolarisation towards or away from lead II)- Isoelectric line
Q wave: Small epolarisation to myocytoes in intraventricular septum (slight movement away from lead II)- small deflection
R wave: Depolarisation to purkinje fibres (depolarisation in direction of lead II )- large deflection
S wave: Depolarisation to top of ventricles (away from lead II)- slight deflection
J point:/S-T segment No change in electrical activity
T wave: Repolarisation (opposite direction to lead II but negative charge)- positive deflection
What is the PR interval?
How long is it?
What can change it?
Start of atrial depolarisation (contraction) to start of ventricular depolarisation (contraction)
Normalls 0.12-0.22s (3-5 boxes)
Can change:
- if atria depolarise by an atrial ectopic focus (irritable atrial cell outside SA node- if far from AV node, PR long)
- First degree heart block (long PR)
What is the QRS complex interval?
How long is it?
What can change it?
Depolaridation of ventricles
<0.12m/s (<3 boxes)
Can change due to:
Ectopic ventricualr focus (iritable ventricular cell fires- longer)
What is the QT interval?
How long is it?
What can change it?
Ventricualr systole
Use corrected QT interval to see if its too long
What can prolong it:
- Medications e.g. amiodarone
- Inhereted: matations
- Torsades de pointes
What is the corrected QT interval?
How would we work out if the QT interval is too long?
QT interval changes depending on heart rate
Bazett’s Formula:
QT (s)/ Sqr R-R(sec)
At 60bpm:
Abnormally long is
>440 ms in men
>460 ms in women
What blood pressure do we aim for in adults under 80?
140/90 mmHg
How can hypertension damage the kidneys?
Increased glomerular pressure
Increased glomerular filtration
Disruption of kidney BP regulation
Accelerated loss of nephrons
What would we see on an ECG for left ventricular hypertrophy?
Large QRS complexes on the lateral leads (increased voltage going through left ventricle so muscle must be larger)
Lateral/ left leads: v5, v6, aVL, lead I
Inversion of T waves in lateral leads
