CPRS Case 7: Heart Failure Flashcards Preview

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Flashcards in CPRS Case 7: Heart Failure Deck (12)
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1

***Confidentiality and consent for information disclosure

Obtain consent before disclosure of medical information to third party

Exception:
1. disclosure in public interest
2. disclosure in individual’s interest (because failing to disclose would exposure the patient / someone else to risk of deaths / serious harm)
3. when required by law

Personal data ordinance: patient’s right of access / correction of information in medical record and circumstances in which right may be refused

2

Explain balance of forces controlling filtration/reabsorption at capillaries (Starling’s hypothesis)

See CPRS lecture 18

3

Describe structure of cardiac muscle

See IASM lecture 31

4

Explain effect of preload and afterload on force of cardiac contraction (Starling’s law of the heart) and length tension relationship for cardiac muscle

See CPRS lecture 25

5

Roles of RAAS system in control of blood volume and blood pressure

See CPRS lecture 44

6

Actions of ACE inhibitors and diuretics

See CPRS lecture 45

7

How to examine cardiovascular system

General:
- eyes: pallor
- lips and tongues: central cyanosis
- hands: clubbing, tar stain, peripheral cyanosis, infective endocarditis (Janeway lesion, Osler nodes, Splinter haemorrhage)
- pulse rate
- legs: posterior tibial pulse (behind and slightly below Medial Malleolus)

Inspection and palpation:
- scar
- apex beat
- left parasternal heaves
- thrills at sites of auscultation

Auscultation

8

Signs of pulmonary oedema

Acute:
- extreme SOB worsen when lying down
- feeling of suffocation when lying down
- wheezing
- rapid irregular beat
- cold clammy skin

Chronic:
- more SOB than normal when physically active
- difficulty breathing with exertion
- difficulty breathing when lying flat
- awakening at nighty with cough / breathless feeling relieved by sitting up
- weight gain
- swelling in lower limb
- fatigue

9

Appropriate investigations for patient with suspected heart failure

***- Chest X-ray: enlarged, lung congestion
***- ECG: ischaemic changes, hypertrophy
***- Echocardiogram: SV, EF, ventricular muscle movement
- CT: chronic condition
- MRI: extent of damage
- Lung function test
- Catheterisation
- Biochemistry
- Heart scans with injected dye

10

Pros and cons of different methods of storage and retrieval of patient records

Electronic:
Pros:
- Improved quality of care (easier to read than handwriting)
- Convenience and efficiency
- Saving space
- Patient access
- Financial incentive
Cons:
- Privacy and security issues
- Inaccurate information if not updated frequently
- Frightening patients (if patient can access)
- Malpractice liability (deleted on purpose)

Paper-based:
Pros:
- Security (generally safe)

Cons:
- Inconvenient to access
- Susceptible to natural disaster
- Poor legibility
- Storage problem

11

Incidence of heart failure among survivors of myocardial infarction

5.8 per 100 person-years

Prior to thrombolysis: incidence of HF after STEMI: 40%
After thrombolysis: incidence of HF: 3% at presentation, 17% during admission

12

Issues of data managment

Doctors have due regard to responsibilities and liabilities under Personal Data Ordinance
- patient’s right of access / correction of information in medical record and circumstances in which right may be refused

Improper for doctors to accept money / gifts from commercial firms for collection of clinical data