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)
These are the common presenting complaints that should be covered for this topic:
- Calf pain (https://bit.ly/2FuVFSS)
- Chest pain in adults (https://bit.ly/2SWPslE) (BEACH)
- Dizziness/vertigo (https://bit.ly/2stf3H2)
- Dyspnoea, acute or chronic (https://bit.ly/2VOqgzs)
- Epigastric pain (https://bit.ly/2srqQFX)
- Facial pain (https://bit.ly/2FAmMuN)
- Fits, faints and funny turns (https://bit.ly/2QSg6dm)
- Leg and ankle swelling (https://bit.ly/2APBLOc)
- Leg ulcers (https://bit.ly/2VXUIHl)
- Palpitations (https://bit.ly/2SY7WCe)
These are the common conditions that should be reviewed for this topic:
|Ischaemic heart disease|
|Heart failure (NYHA classification) including valvular disease|
|Peripheral vascular disease/claudication – including varicose veins, thrombophlebitis|
|Acute aortic aneurysm|
|Arrhythmias – Atrial fibrillation|
|Cardiology investigations – including ECGs, echo, imaging|
These are the medications and doses that should be learned for the exam:
|Acute coronary syndrome|
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)
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:
- Cardiovascular examination playlist by GP Synergy: https://bit.ly/2CwLxoK
- ECG interpretation playlist by GP Synergy: https://bit.ly/2syKiAx
Copyright © 2021 Andrew Harris