Screening for secondary causes of hypertension is important, though often not thought of. Primary aldosteronism is the most common endocrine cause. The screening test is the aldosterone-renin ratio (ARR).Read More
Chest pain presentations are common, but management can be variable and difficult to understand. Here is my approach:Read More
Murmur is common, but picking out the significant ones could be hard. Here is my approach.Read More
Terminology can sometimes be confusing in heart failure care.
Here is a summary:
NYHA Class, HF stages, HFpEF vs. HFrEFRead More
Heart failure medications save lives.
Dosages are important though, and many patients may not be on sufficient dosages.
Here are a number of tables useful for references, adapted from ACC/AHA guidelines 2013.Read More
HFpEF stands for heart failure with preserved ejection fraction. Commonly, it is defined as those with an LV ejection fraction of more than 50%, though varying definitions do exist.
This condition is poorly understood and is difficult to diagnose, because it is largely one of excluding other potential non cardiac causes of symptoms suggestive of HF.Read More
ECG interpretation could be difficult, but a simplified approach would serve us well 95% of the time. Here is my approach:Read More
NTproBNP is a very useful test in heart failure. However, often it is overused, as the diagnosis of heart failure should be a clinical one.
Here are the scenarios where it may be useful:
First line agents for hypertension are one of three classes:
- ACE inhibitors or Angiotensin receptor blockers
- Calcium channel blockers
Drug preference is mainly influenced by co-morbidities and contraindications, rather than a simple age cut-off.Read More
70-year-old asymptomatic man with hypertension but not cardiovascular disease presented for a routine check. His pulse rate was 40bpm. His son, aged 45, recently had an MI in Australia.
His medications include
Doxazosin 8mg OD
Metoprolol 95mg CR OD – since 2006
Cilazapril 5mg / Hydrochlorothiazide 12.5mg OD
ECG shows sinus bradycardia, with normal PR interval, QRS duration.Read More
65M with Type 2 diabetes on oral hypoglycaemics but no proven coronary artery disease, BP 150/95mmHg despite 3 months of intensive lifestyle modifications, not currently on anti-hypertensives. Would you?
- Introduce low dose ACE inhibitors, with gradual up-titration
- Introduce combination ACE inhibitor / thiazide, with up-titration later onRead More
Antibiotic prophylaxis is suggested for patients with cardiac conditions that confer the highest risk of adverse outcome from infective endocarditis.Read More
GPs often receive echocardiogram reports and are asked to interpret them. Here is a grossly simplified version of how.Read More
Daily supplementation with marine-derived omega-3 fatty acids has been promoted for its potential health benefits in cardiovascular diseases. We blogged about this last year with a meta-analysis from Oxford. Here is the update.
The promised randomized controlled trial has now come out after the European Society of Cardiology Congress in Munich last week.Read More
Despite apparent “benefit” for heart attacks, increasing levels of alcohol consumption increase the risk of all-cause mortality and of cancers specifically, meaning that the level of consumption that minimises health loss is probably zero. At most, 100g per week is the absolute maximum before which risk increases significantly.Read More
64F presented with chest pain, consistent with non-ST elevation myocardial infarction with preserved systolic function. At invasive angiogram, right coronary artery was successfully stented with a drug eluting stent. On hospital discharge, she was given Aspirin, Ticagrelor as dual anti-platelet agents. How long should the dual antiplatelet therapy be continued for?Read More
65M presented for a general health check, asymptomatic on systems enquiries. BP was 150/90mmHg with no other abnormalities. You decided to send him for an ambulatory blood pressure monitor to establish if more aggressive intervention is necessary. The report states that he is not a nocturnal dipper. His average diurnal BP was 145/85mmHg. Would medications be necessary? Is there anything else we should consider?Read More
In general practice (and in secondary care), we discuss at length lifestyle modifications that aid blood pressure lowering. But exactly how effective are the various strategies?
There are 5 things we could do to reduce our blood pressure, without medications.Read More
55M presented with first episode of paroxysmal atrial fibrillation proven on resting ECG in the GP practice. Echocardiogram showed structurally normal heart. The cardiologist decided to manage conservatively without starting anti-arrhythmics right now. Which of the following risk factor management should be part of his AF treatment and prevention?Read More
The ACC/AHA Hypertension Guidelines 2017 was released in the AHA meeting in Anaheim, Californiain November 2017.
While there were a lot of changes, I think it has simplified a lot of the complexities surrounding treatment threshold and goal.Read More