CPRS Case 7: Heart Failure Flashcards Preview

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Flashcards in CPRS Case 7: Heart Failure Deck (12)
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***Confidentiality and consent for information disclosure

Obtain consent before disclosure of medical information to third party

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


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

See CPRS lecture 18


Describe structure of cardiac muscle

See IASM lecture 31


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


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

See CPRS lecture 44


Actions of ACE inhibitors and diuretics

See CPRS lecture 45


How to examine cardiovascular system

- 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



Signs of pulmonary oedema

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

- 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


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


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

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

- Security (generally safe)

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


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


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