section 3 (answers)

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2 years later despite good blood pressure control, Mr. Johnson is admitted to hospital with an acute myocardial infarction and receives thrombolytic therapy 6 hours after the onset of his chest pain. He makes a moderately good recovery. During his stay investigations conclude the following.

  • Acute Anterior MI

  • Controlled hypertensive

  • Type 2 diabetes mellitus

  • Normal ECHO – no evidence of heart failure

  • Hypercholesterolaemia – 8.8 mmol/L

He is discharged home on a variety of medications and advised to contact his GP.

  1. What post-MI patient plan might your practice currently operate?

    • Have a look at your system in your practice for reviewing post-MI patients.  There should be something in place in ALL practices.

  2. Who is involved?

    • GP?

    • Practice nurse?

    • Other professionals?

  3. What follow-up systems could be in place for a patient such as Mr. Johnson in your practice?

    • Diabetes clinic?

    • Hypertension clinic?

    • CHD clinic?

  4. What elements of continued care does the NSF expect to be carried out by practices for post-MI patients?

    • Risk factor advice about smoking cessation, exercise, diet, weight and diabetes

    • Give low dose aspirin

    • Give Beta-blockers for at least 1 year

    • Provide BP advice and treatment – get BP well-controlled

    • Give statins to lower cholesterol <5 mmol/L (LDL-chol <3 mmol/L) or by 30% reduction

    • Give ACE inhibitors for those with heart failure or ECHO LV dysfunction

    • Meticulous blood glucose and BP control in diabetics

  5. How do you think your practice compares with the expectations of the NSF?

  6. Should a diabetic screen have been done in primary care and at what stage prior to his MI?

    • Yes. British hypertension society advises – diagnosed hypertensives to be screened for diabetes (blood glucose)

Patient summary

57-year-old male with

  • Acute myocardial infarction

  • Type 2 Diabetes mellitus

  • Hypertension (controlled)

  • Overweight

  • High alcohol intake
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