Prof. Samuel Okoye Flashcards
What does the patient tell the doctor in the case video cover?
Doesn’t smoke
Occasionally drinks alcohol - special events e.g. birthdays
Difficulty at night to sleep - nocturia
Weight increase - 89kg, waist = 38 inches, 1.76m
BMI = 29 (overweight)
Typical day’s food or drink = variety of foods, more meat, lots of salt
Not much exercise - occasional walk in the park
Not been abroad for the last couple years
Not suffering from stress
Wants to be a grandfather - one daughter comes visits on the weekend
Just him and Daisy (wife?) at home
Brother was diagnosed with Chronic Myelogenous Leukemia (CML) recently
What does the doctor recommend for the patient in the case video?
Keep a food diary Blood test - FBC, kidney function, liver function Prostate examination Check BP Take an ECG
What can the health check identify what you are at risk of?
Heart disease Diabetes Kidney disease Stroke Dementia
What happens at a health check?
20-30 mins Lifestyle Family history Height Weight Blood pressure Blood test
Where can you have a health check?
GP Surgery
Local Pharmacy
Local Library or Leisure centre
How can you arrange for a health check?
Every 5 years if between 40-74
Call up and ask for an appointment
Patient’s BP comes back as 162/84.
Name 2 effects / conditions that can be caused by the hypertension on the following organs:
Brain Eyes Heart Kidneys Peripheral Vasculature
Brain - stroke, transient ischaemic attack
Eyes - retinopathy, optic neuropathy
Heart - coronary heart disease, left ventricular hypertrophy
Kidney - glomerulosclerosis, kidney failure
Peripheral Vasculature - atherosclerosis, aneurysm
What are the next steps for the patient’s management?
Recheck BP - in case first reading was due to other causes e.g. exercise, anxiety, etc.
24 hr ambulatory monitoring - takes their own BP 2x per hour for 24hrs
Lifestyle advice
Recheck BP
Start medication
It was confirmed that the patient has hypertension
A 12-lead ECG was performed.
What are the electrical events of a typical ECG?
Electrical activity begins in SA node, to AV node, then via bundle of His, then up the left and right purkinje fibres
P wave = atrial depolarisation
QRS segment = depolarisation of the ventricles
Amplitude = amount of voltage / depolarisation
ST segment = isoelectric (neutral) time between ventricular depolarisation to ventricular repolarisation
T = ventricular repolarisation
Where do the different leads on the ECG go on a patient?
look up a pic
RA = right shoulder LA = left should V1 and V2 = 4th intercostal space V3 = 5th intercostal space V4, V5, AND V6 = 6th intercostal space? straight line RL = right lumbar area on abdomen LL = left lumbar area on abdomen
How does the patient’s ECG differ from a normal ECG?
What does the patient have?
Height of QRS complex = taller in patient’s ECG than in the normal one
Height = amount of depolarisation in the ventricles
Suggests there is more electrical activity during ventricular depolarisation, in the left ventricle due to hypertension
He has left ventricular hypertrophy - i.e. more muscle on the left ventricular wall so more depolarisation for all the muscle fibres to contract
ST segment is sloping down and not at the isoelectric point - ST depression suggests something to do with repolrisation (Ask Anouk)
Some inverted T waves - ventricular repolarisation is abnormal due to the increased amount of muscle in the heart
What causes ventricular hypertrophy?
Sympathetic nervous system activation
High BP increases the afterload
Leads to increased pressure
Leads to changes / remodeling of the left ventricular
Leads to stiffness of the left ventricular - heart cannot relax as it normally does
Volume overload in the left ventricle leading to either dilation or hypertrophy of the left ventricle
Leads to changes in the systolic function too
How do calcium channel blockers (CCBs) work?
What is the difference between rate limiting and non-rate limiting CCBs?
Recommended to over 55s and/or of Afro-Caribbean descent
Rate limiting = greater impact on the heart (slow the heart / decrease contractility)
Non-rate limiting = greater impact on blood vessels (vasodilation)
The patient was prescribed Amlodipine, 5mg.
In 3 months time, at his check-up, his BP reads 150/75.
Why does he still have hypertension?
Non-adherence Side effects - CCBs = constipation, ACE inhibitors = cough Multiple drugs required Ethnicity White-coat syndrome
