patient cases Flashcards
what 4 diagnosis jump to mind for chest pain
acute coronary syndrome
stable angina
gastroesophageal reflux
pectoral muscle injury
analytical diagnosis
when you have little idea what the problem might be slow effortful for uncommon conditions use google and NICE
intuitive diagnosis
illness script - see it more often
common patterns link to diagnosis
fast
more prone to bias/error
symptoms of aortic stenosis
breathlessness, chest pain, lethargy, balance issues, decreased activity
how do you form a diagnosis
data is applied to hypothesis
do physical examination
process of diagnosis
look at presenting symptoms
look at history - beware of distractions
look at examinations
common cause of chest pain in primary care
musculoskeletal
common cause of chest pain in A and E
cardiac
normally more serious than in primary care
chest pain aggravated by breathing
musculoskeletal
chest pain worsened by exercise
cardiac
chest pain from eating
cardiac (could be GI too)
sharp stabbing pain
musculoskeletal
pain from fall
maybe musculoskeletal
chest pain and diabetes
cardiac/GI
dull chest pain
cardiac
smoker, and stress in job causing chest pain
cardiac
chest pain causing nausea and sweat
cardiac
common for MI
pathway of diagnosis for musculoskeletal problem
percussion of lungs to see if PE
see if there has been a spontaneous fright, anxiety, palatations, dyspnoea or fainting (MSK no)
see if pain reproducible by palpation (for MSK it is)
chest wall pain
(if not reproducible by palpation = heart failure/GI pathology)
pathway of diagnosis for angina
have typical/atypical anginal pattern, pain radiation, diaphoresis or cardiac risk factors
ECG normal - no ST elevation
troponin levels - slightly abnormal - should still be outpatient because don’t want to bring people in every time that they have an angina attack to decide look at ECG while they are exercising
with moderate risk and abnormal ECG - stress test with perfusion scan
high risk - perform angiography
pathway of diagnosis for acute coronary syndrome
ECG normal
troponin marker for CV damage - high
MI/heart attack
evaluate as an inpatient
continuum of cardiac problems
few atherosclerotic symptoms might have anginal attack then low level MI cause heart abnormalities eg arrhythmia mean each MI is more severe
main lifestyle recommendations for cardiac
control diet
problem with diet advice
delivery is not proof of receipt
concept that it is less important that a drug
good fats
monosaturated fatty acids (plant), polyunsaturated fatty acids (fish)
liquid at room temp
HDL
cardio protection
Mediterranean diet
epidemiology - Mediterranean countries disease trend not raise same as uk
bad fats
LDL
unhealthy diet
change little things and incorporate into daily life
salt
intake should be reduced
associated with increased bp - increase water retention - increased pressure - increased hypertension
SBP - increases the most - for target to be reached - need to change ingrained behaviour
hypertension CVD that can cause other CVD eg kidney, eye, liver damage
fruit and veg
need more fruit and veg based diet
better than processed food
increase of 1 portion a day reduce risk CHD 4% and stroke 6%
extra 1.4 portion a day reduce SBP by 4mmHg
alcohol
small amount - cardioprotective effects
as consumption increase - risk increase incrementally
J shaped curve between mortality and ethanol
reporting alcohol
self report unreliable
they don’t want to feel judged/or they don’t realise how much they drink
recommendation for alcohol
reduce
recommendation for diet
fat - <10% saturated energy salt <6g/d fruit and veg >5 portions day alcohol <21units/w male <14units/w (female)
