A 65-year-old man comes in for a blood pressure check. His at-home readings have consistently been high at 155/94 mmHg. He reports feeling fine. He is currently on the maximum dose of amlodipine. An echocardiogram done recently showed moderate to severe aortic stenosis.
What is the most suitable course of action for management?
You are evaluating a 75-year-old patient who has just been diagnosed with heart failure after an echocardiogram revealed a left ventricular ejection fraction of 35%. He has been experiencing mild shortness of breath during physical activity and has no other known medical conditions. He is not currently taking any medications.
What is the most suitable recommendation to provide?
You are a GPST1 working in a general practice. A practice nurse seeks your guidance on a routine ECG performed on a 50-year-old man. Upon examining the ECG, you observe that the patient is in regular sinus rhythm with a rate of 70 beats per minute. However, the patient has a long QT interval and small T waves.
What could be the reason for this distinct ECG pattern?
Samantha is a 55-year-old female with hypertension which has been relatively well controlled with lisinopril for 5 years. Her past medical history includes hypercholesterolaemia and osteoporosis.
During a routine check with the nurse, Samantha’s blood pressure was 160/100 mmHg. As a result, she has scheduled an appointment to see you and has brought her home blood pressure readings recorded over 7 days.
The readings show an average blood pressure of 152/96 mmHg. What would be the most appropriate next step in managing Samantha’s condition?
A 47-year-old man has recently been prescribed apixaban by his haematologist after experiencing a pulmonary embolism. He is currently taking other medications for his co-existing conditions. Can you identify which of his medications may potentially interact with apixaban?
A 50-year-old man on your patient roster has been experiencing recurrent angina episodes for the past few weeks despite being prescribed bisoprolol at the highest dose. You are contemplating adding another medication to address his angina. His blood pressure is 140/80 mmHg, and his heart rate is 84 beats/min, which is regular. There is no other significant medical history.
What would be the most suitable supplementary treatment?
Barbara is a 57-year-old woman who has come to see you after high blood pressure readings during a routine check with the nurse.
You take two blood pressure readings, the lower of which is 190/126 mmHg.
Barbara has no headache or chest pain. On examination of her cardiovascular and neurological systems, there are no abnormalities. Fundoscopy is normal.
What is the most crucial next step to take?
Your next appointment is with a 48-year-old man. He has come for the results of his ambulatory blood pressure monitoring (ABPM). This was arranged as a clinic reading one month ago was noted to be 150/94 mmHg. The results of the ABPM show an average reading of 130/80 mmHg. What is the most suitable plan of action?
A 50-year-old man requests you to check his blood pressure after his colleague had a heart attack. Upon measurement, his blood pressure is 142/82 mmHg, and five minutes later, it is 134/74 mmHg in the same arm. According to NICE guidelines, what is the best next step to take?
A 65-year-old woman presents at the GP practice with increasing shortness of breath (SOB). She experiences SOB on exertion and when lying down at night. Her symptoms have been gradually worsening over the past few weeks. She is an ex-smoker and is not taking any regular medication. During examination, she appears comfortable at rest, heart sounds are normal, and there are bibasal crackles. She has pitting edema to the mid-calf bilaterally. Observations reveal a pulse of 89 bpm, oxygen saturations of 96%, respiratory rate of 12/min, and blood pressure of 192/128 mmHg.
What would be the most appropriate course of action?