2. Cardiovascular

2. Cardiovascular
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2. Cardiovascular

By Andrew Harris
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Hi Everyone!

I hope you’ve taken a moment today to stop and breathe. If not, do it now. Feel the cool air touch the back of your throat, and fill your lungs deeply. Imagine the oxygen  nourishing your cells as they carry your mind into a world of study once more. You’ve got this!

This article is about Cardiovascular medicine.

The bulk of our daily medicine really pivots around prevention of cardiovascular disease. We do all we can to help minimise the cardiovascular risk factors for our patients by encouraging smoking cessation, reducing lipid levels, monitoring blood pressure and counselling about daily exercise. A true understanding of cardiovascular risk minimisation needs to be ingrained within us so that we can provided snippets of advice at every opportune moment. Learn by heart the targets for lipids, blood pressure, exercise and diet!

One of the most valuable documents I read when starting GP training was the “Guidelines for the management of absolute cardiovascular disease risk” (see the newsletter for details). This guideline was pivotal in my journey to being able to make the clear decisions about when to start a patient on a lipid lowering medication or a blood pressure tablet. It helped guide my counselling to being evidence-based and focused on a clear goal. These guidelines, along with the “Australian absolute cardiovascular disease risk calculator”(again see newsletter for details) are vital tools for any GP. Take a look if you haven’t already!

Hone your clinical skills when taking the time to focus on cardiovascular disease medicine this week. Listen to everyone’s heart; feel every pulse; weigh everyone; measure everyone’s waist circumference; record everyone’s smoking and alcohol status; check that fasting lipids/BSLs and urine ACRs have been done for relevant patients; and rationalise medication use with special focus on de-prescribing aspirin where it is not indicated. Remember, It is our job to choose the right medication and offer the right advice, but it is ultimately the patient’s responsibility to take this advice and to choose health.

Be kind to yourself, and don’t forget to take the time to breath!

Dr Andrew Harris

Director of Amadeus Education.

Did you know?

According to BEACH data, 7.9% of all encounters in General Practice were specifically related to the circulatory system. Consider this as you are preparing for your exams. (Source: General practice activity in Australia: 2015-16. https://bit.ly/2c4d8Em)

Presenting complaints:

These are the common presenting complaints that should be covered for this topic:

Common conditions:

These are the common conditions that should be reviewed for this topic:

Topics

Important reading

Ischaemic heart disease– Australian absolute cardiovascular disease risk calculator. (https://bit.ly/2eDVyYw)
– Guidelines for the management of Absolute cardiovascular disease risk. (https://bit.ly/3RpY4zp)
– Dual antiplatelet therapy: Management in general practice. AFP, October 2013. (https://bit.ly/2Ek3EjF)
– Coronary heart disease: The benefits of exercise. AFP, March 2010. (https://bit.ly/2TWstYm)
Hypertension– Guideline for the diagnosis and management of hypertension in adults. Heart foundation, 2016. (https://bit.ly/3RsxgOO)
– ACEIs for cardiovascular risk reduction: Have we taken our eye off the ball? AFP, September 2013 (https://bit.ly/2BD4Ah9)
– Hypertension: The difficult decisions. AFP, June 2013. (https://bit.ly/2S9lycI)
– Ambulatory blood pressure monitoring. AFP, November 2011. (https://bit.ly/2Eg4vSk)
Hyperlipidaemia– Detecting familial hypercholesterolaemia in general practice. AFP, December 2012. (https://bit.ly/2tqWZ0P)
– The metabolic syndrome. AFP, August 2013. (https://bit.ly/2SheRp6)
Heart failure (NYHA classification) including valvular disease– Guidelines for the prevention/detection and management of chronic heart failure (https://bit.ly/3Rre8AW)
– Chronic heart failure: Improving life with modern therapies. AFP, December 2010. (https://bit.ly/2IlwDYl)
– End stage heart failure patients: Palliative care in general practice. AFP, December 2010. (https://bit.ly/2Se2Iks)
– Heart failure management: A team based approach. (https://bit.ly/2SWF40x)
Peripheral vascular disease/claudication – including varicose veins, thrombophlebitis– Exercise for intermittent claudication and peripheral arterial disease. AFP, December 2014. (https://bit.ly/2SJDGyN)
– Non-aortic aneurysms: Natural history and recommendations for referral and treatment. AFP, June 2013. (https://bit.ly/2SJa2d5)
– Peripheral arterial disease: Diagnosis and management in general practice. AFP, June 13. (https://bit.ly/2HGGSFj)
Acute aortic aneurysm– Aortic aneurysms: Screening, surveillance and referral. AFP, June 2013. (https://bit.ly/2Iqc2Ci)
Arrhythmias – Atrial fibrillation– Anticoagulation: A GP primer on the new oral anticoagulants. AFP, May 2014. (https://bit.ly/2V8dJ98)
– Initial management of cardiac arrhythmias. AFP, July 2008. (https://bit.ly/2SWFEvf)
– New oral anticoagulants and perioperative management of anticoagulants/antiplatelet agents. AFP, December 2014. (https://bit.ly/2GQAvhR)
– Emergency management acute cardiac arrhythmias. AFP, July 2007. (https://bit.ly/2EiN3Nd)
Cardiology investigations – including ECGs, echo, imaging– Imaging for cardiac disease: a practical guide for general practitioners. AFP, May 2014. (https://bit.ly/2GQXf1g)
– Transthoracic echocardiography findings: Implications for clinical management. AFP, December 2012. (https://bit.ly/2IqceS2)
– Cardiac stress testing: Stress electrocardiography and stress echocardiography. AFP, March 2012. (https://bit.ly/2NaXfdx)
– Echocardiography in heart failure: A guide for general practice. AFP, December 2010. (https://bit.ly/2TVntDf)
Pericarditis/Endocarditis– Pericarditis: Clinical features and management. AFP, October 2011. (https://bit.ly/2T4wXPe)

Medication doses:

These are the medications and doses that should be learned for the exam:

Condition

Medication

Hypertension
  • ACE-inhibitor – perindopril arginine 2.5mg PO daily
  • ARB – candesartan 4mg daily
  • HCT – 12.5mg PO daily
  • CCB – amlodipine 2.5-5mg PO daily
Hyperlipidaemia
  • Rosuvastatin 10mg PO daily
  • Fenofibrate 145mg PO daily
Heart failure
  • ACE-inhibitor – perindopril arginine 2.5mg PO daily
  • BB – bisoprolol/carvedilol/metoprolol SR
  • Frusemide 20-40mg mane PO
  • Spironolactone 12.5mg daily PO
Acute coronary syndrome
  • Aspirin 300mg PO stat
Post-MI treatment
    Aspirin 100mg PO daily Clopidogrel 75mg PO daily Metoprolol 25-100mg BD Perindopril arginine 2.5-10mg daily Rosuvastatin 10mg PO daily

Mnemonics:

These are some important mnemonics relevant to this topic:

  • CAGE (alcohol use)
  • CHADS2 score (atrial fibrillation stroke risk)
  • CHA2DS2-VASc score (atrial fibrillation stroke risk)
  • HAS-BLED (major bleeding risk)
  • Framingham (heart failure diagnostic criteria)
  • Jones criteria (acute rheumatic fever diagnosis)

Checks:

Here are the list of recommended Checks that would be useful in your study for GP exams (accessed via subscription from http://gplearning.racgp.org.au):

  • Cardiology, December 2016
  • Heart health, March 2014
  • Ischaemic heart disease, March 2012

Focus on clinical skills:

Here is a brief focus on some OSCE preparation materials related to this topic:

Copyright © 2021 Andrew Harris