Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Mhm. All right. Uh Life from my perspective. Great. Um Do you reckon we should give another minute to wait for people. Yeah, I think, I think maybe, um, like one or two minutes and then, yeah, there's no, there's no rush. Yeah. Now let's give it one or two minutes and we, we'll start shortly um, for those of you watching already, if you have a minute to spare, if you don't mind scanning that QR Code, um, it's similar later we're currently um collecting on some research on medical education. So that would be really, really beneficial to us if you just don't mind giving that a quick scan and it's quite, it's a brief survey basically. Right. All right. Should we make a start, Alex? Yeah. Sure. Sure. Um So hi everyone. Um, thanks for joining us. Um I hope, you know, some more people are going to trickle in but we might as well get some start. So my name is Mary. I'm one of the F one doctors. I currently work in London. Um, and I've got um, Alex with me, Alex if you want to introduce yourself as well. Uh Yes, I'm Alex. Um, I'm an F one currently working in Manchester and we're gonna be taking you through today's session, um, which is on cardiology, really stable, um, really basic stuff um, that we're gonna cover for. Um, so we're gonna cover over some chest pain, hypertension, heart failure, uh, some arrhythmias, including some um, ischemic heart disease and cardiac auscultation as well. Um, it's all kind of, um based on the curriculum of the UK MLA. Um, so it's some basic stuff that is really gonna give a good, um, some really good knowledge for your exams, hopefully. Um And yeah, let's get started. So we've got question one for you guys. So question one, I'll, I'll just read it out. So a 55 year old Caucasian man presents to the GP for his regular BP monitoring appointment in clinic. His BP is 100 and 51/97. His past medical history includes hypertension type two diabetes and CKD. His current medications include atorvastatin, Ramipril, amLODIPine and Tin. There's some blood tests there. What is the most appropriate next step in his treatment? I can see you've got some answers in the pool already. So do keep voting if you know the answer, I'm just gonna give you a few more seconds so people can get a vote in as well. Ok. All right. I'm gonna go to the next slide. Ok. So the answer was a indapamide. Um, and we get to why that was the correct answer. Um When we look through the algorithm for um medications and how you um sort of in sort of add medications on. So firstly, we'll look at um how to diagnose and then when to treat hypertension. Um So key things are if a patient presents to the GP, they have their BP taken and it's um over 1 40/90 then you offer ambulatory BP monitoring. Um If it's over 100 and 80/100 and 20 then that's an immediate referral to specialist care, um a specialist um assessment. So if they've got their, if they've gone and done their ambulatory BP monitoring and then they come back. Um and that's reported as over 100 and 35/85 then you start treatment. So this is, is it as simple as that? So you'd never start treatment off of just one BP monitor reading. So if we go to the next slide, so this is the algorithm for um which medications you start patients on and then which ones you add in uh really important to know this um at the back of your hand. Um So essentially it starts off with two groups, um less than 55 or over 55 if you're over 55 but have um type two diabetes, then you're put over onto the left side. Um However, if you're um under 55 but uh Black African or African Caribbean um ethnicity, then you go over to the right side. Um, so firstly, you're, you're adding an ace inhibitor, A RB or calcium channel blocker. Then after that, you're adding either a Thiazide like diuretic and depending on what you added first, either a calcium channel blocker or an ace inhibitor. And A B, then after that, if they're still not, um, sort of within the target range, which is um, less than, er, which is less than 100 and 35/85 then you'd consider adding another um a third agent. So it's all three of them. So, whichever one out of the previous um three that you haven't added, you have that in at this point. And then after that, you add 1/4 agent. Uh and this depends on the potassium level. So if the potassium is less than 4.5 then you had Spiro and if it's more than uh 4.5 because Spiro a duster antagonists and potassium sparing. If it's over 4.5 you add an alpha blocker or beta blocker instead. Um I'm really key to understand this slide. I know it really well. So this is the next question I won't read it out this time. I got one answer and two answers in the poll. So keep answering, you know. All right, I'm gonna go forward and we really answer in 321. Here you go. OK. So the answer is press you grow. Um So uh classic presentation of um Temi and actually, we uh we give you the fact that there was ST elevation. Um uh It, it's quite a difficult question actually. And I think it required some clinical judgment to actually rule out some of the answers um rather than just knowing straight away what the right answer might be. Um So, if we go to the next slide, um this is the algorithm for treating a stemi and hopefully.