what do you think of doxazosin?
I saw a gentleman yesterday who has Ischaemic heart disease and hypertension and normally takes ramipril 10mg and amlodipine 10mg for hypertension. He was seen in the renal clinic last week as he now has stage 3 CKD and had a bp recorded at 220 / 90 (don't know if this was a one-off measurement or rechecked by the doctor) and was prescribed doxazosin 4mg. His BP yesterday was about 80 systolic and he has been feeling dizzy funnily enough. What do you think of this clinical hisotry?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - February 26, 2014 Category: Cardiology Authors: sadian Source Type: forums
Can I please get guidance with these ECGs?
A case Study
Dear Fellow medical students,
I would like some help reading these ECG: they are for a 62 yrs old male patient with high blood pressure, high choletrol and COPD. he gets chest pain and pain down his left shoulder when he does activities and the pain stops when he stops exertion.
the first one is resting ecg:
the second ecg is recorded during exercise testing . the patient had central chest pain and had to stop.
what are key feature can you pick from the resting ECG?
for the exercise ECg, i am suspecting acute lateral myocardial ischemia.Can you please confirm ?
Thank you
&n...
Source: Doc2Doc BMJ Cardiology - January 23, 2014 Category: Cardiology Authors: nazek Source Type: forums
My first ECGs to interpret!HELP ME!:)
Dear Fellow medical students,
I would like some help reading these ECGs: they are for a 62 yrs old male patient with high blood pressure, high choletrol and COPD. he gets chest pain and pain down his left shoulder when he does activities and the pain stops when he stops exertion.
the first one is resting ecg:
the second ecg is recorded during exercise testing . the patient had central chest pain and had to stop.
what are key feature can you pick from the resting ECG?it shows leads I, II, III, aVR, aVL and aVF.
for the exercise ECg, i am suspecting acute lateral myocardial ischemia.Can you please confirm ?
Th...
Source: Doc2Doc BMJ Cardiology - January 23, 2014 Category: Cardiology Authors: nazek Source Type: forums
22 year old female patient with mysterious symptoms
Hello all.
I have a 22 year old female european patient with mysterious symptoms. Just over a year she underwent coronary angiography, but no diagnosis. She became seriously ill at age 16 and complaints of heart problems. The female patient with childhood lagging behind in physical development (155 cm, 35 kg). With 11 years of she has supraventricular tachycardia.
Symptoms:
High blood pressure (high diastolic BP or systolic and diastolic): 110/90 - 160/100.
Chest pain (left side and sternum)
Pain in lower left jaw and sometimes in right lower jaw (Provocative factors: cold and...
Source: Doc2Doc BMJ Cardiology - December 20, 2013 Category: Cardiology Authors: Gisela Krause Source Type: forums
top cardiology discussions of 2013
As clinical champion in cardiology it is my pleasure to kick off the review of the cardiology forum in 2013.
Here are my top picks
What would you do for this diabetic with these ABPM results- who would have thought that the treatment of hypertension could get so complicated this year? It gets my number one slot as it's a very wide ranging discussion questioning what we really know, what we believe and what the evidence tells us. Strikes a chord with the 'too much medicine' theme of the year
My number two slot goes to can you diagnose aortic stenosis - this must be the commonest valve lesion we see i...
Source: Doc2Doc BMJ Cardiology - December 17, 2013 Category: Cardiology Authors: sadian Source Type: forums
have you seen PRES syndrome?
I saw a lady on the ward round on Friday who is mid 70's, has a long history of hypertension that is poorly controlled (BP 180 / 90 -100) and has presented with poor gait, headache and poor memory. A CT head was unremarkable and on discussing it with the neurologist the possibility of PRES came up. She is booked for an MRI but I'm not sure I have ever diagnosed this syndrome and if I have seen it I have failed to diagnose it. How common is this?
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - November 10, 2013 Category: Cardiology Authors: sadian Source Type: forums
a 27 year old male with hypertension
I'm interested to know what you would do for this man
27 male
recently diagnosed with hypertension by gp on basis of abpm (not aviailable in clinic)
clinic pressure 160/95 (repeated )
normal cv exam
ecg meets voltage criteria for lvh
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - October 26, 2013 Category: Cardiology Authors: sadian Source Type: forums
What Would You Do For This Diabetic With These ABPM Results?
A 76 years old man, type 2 diabetic for 10 years, on 1.0 gram of Metformin, HBA1C of 8%, BMI of 28.5, No Microalbuminuria, small right carotid intima thickness but no plaques. He has a healthy Life Style with regular exercises and Diet, taking also 10 mg Atorvastatin, and on Amlodipine 5 mg/day had a 24 hour Arterial Blood Pressure Monitoring requested by his GP because of his Hypertension. These are the Main Results Report:
- Mean 24 hours Systolic BP: 144 mmHg.
- Mean 24 hours Diastolic BP : 84 mmHg.
- Mean Systolic Daytime BP: 146 mmHg.
- Mean Night time Systolic BP 142 mmHg.
- Mean Day...
Source: Doc2Doc BMJ Cardiology - October 13, 2013 Category: Cardiology Authors: Joey Rio Source Type: forums
What Would You Do For This Diabetic With This ABPM Results?
A 76 years old man, type 2 diabetic for 10 years, on 1.0 gram of Metformin, HBA1C of 8%, BMI of 28.5, No Microalbuminuria, small right carotid intima thickness but no plaques. He has a healthy Life Style with regular exercises and Diet, takink also 10 mg Atorvastatin, and on Amlodipine 5 mg/day had a 24 hour Arterial Blood Pressure Monitoring requested by his GP because of his Hypertension. This are the Main Results Report:
- Mean 24 hours Systolic BP: 144 mmHg.
- Mean 24 hours Diastolic BP : 84 mmHg.
- Mean Systolic Daytime BP: 146 mmHg.
- Mean Night time Systolic BP 142 mmHg.
- Mean Dayt...
Source: Doc2Doc BMJ Cardiology - October 11, 2013 Category: Cardiology Authors: Joey Rio Source Type: forums
more data on salt
the large PURE study (100 000 people or so) has just reported at the ESC that population based sodium restriction makes very little sense in most countries and only really is effective in those people with hypertension , a sodium intake of more than 5 g /day and in older adults. For most countries in the study the average intake was less than 5g /day. They did however confirm the linear relationship between salt intake and blood pressure though. Ah well, back to the crisps!
sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - September 16, 2013 Category: Cardiology Authors: sadian Source Type: forums
Help: How can left-sided hypertrophy coexist with hypertension?
Can someone explain how a patient can have left-sided hypertrophy of the heart along with hypertension?
I thought: left ventricular hypertrophy --> reduced ventricular filling --> reduced stroke volume --> reduced cardiac output --> decreased blood pressure --> no hypertension.
In some of the cases I read, they don't mention heart rate or peripheral resistance, yet they say the patient has left ventricular hypertrophy and hypertension. So, do I have to assume that the heart rate and peripheral resistance are high for that patient? Even if heart rate and peripheral resistance are high, if the ven...
Source: Student Doctor Network Forums - September 8, 2013 Category: Universities & Medical Training Authors: pizza100 Tags: Allopathic Source Type: forums
ECG for discussion
Hi there.I wonder if you would help me with an ECG I took recently. The patient a 42 y/old male, c/o central chest pain for 30 minutes radiating through to his back, "aching", sweaty, anxious. Hx of hypertension. It looks to me like acute anterior MI with ST elevation in V2-V4, but it is not as obvious as most that I have seen and there are no reciprocal changes, perhaps because it is quite new onset? He was treated as ACS and taken for PCI but I do not know the results. Perhaps you would give me you impression?Many thanksUKDave (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - July 11, 2013 Category: Cardiology Authors: UKdave Source Type: forums
Are there any surprises in the European Hypertension guidelines?
The ESC have just launched a new European guideline for the treatment of hypertension. The recommendation is to aim for 140 mmHg systolic for most patients and to target treatment based on CV risk and patient characteristics? Do you find a single target surprising or just a practical approach to a difficult problem?sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - June 17, 2013 Category: Cardiology Authors: sadian Source Type: forums
Does QOF make you overtreat hypertension?
A former president of the RCGP says that a 'side effect' from QOF is that healthy people with borderline blood pressure get overtreated.http://www.pulsetoday.co.uk/20003013.articleDo you agree that this happens. From my perspective in secondary care most people will get treated as they have another cardiovascular indication and I am glad that my targets are largely around access!sadian (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 20, 2013 Category: Cardiology Authors: sadian Source Type: forums
Ignorant doctors and blood pressure
Richard Smith says in his blog that blood pressure is everyone's responsibility and that patients need to reclaim it from their ignorant doctors. He also makes an interesting point as to whether high blood pressure is a 'disease' or a risk factor for CV disease. I personally favour the latter approach but I am asking the doc2doc community for their thoughts.http://blogs.bmj.com/bmj/2013/05/16/richard-smith-reclaiming-blood-pressure-from-doctors/ (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - May 17, 2013 Category: Cardiology Authors: sadian Source Type: forums
