You are evaluating an 80-year-old patient who has recently been diagnosed with heart failure. Her left ventricular ejection fraction is 55%. She has been experiencing orthopnoea and ankle swelling. The cardiology team has referred her to you for medication initiation.
During the assessment, her vital signs are blood pressure 120/80 mmHg and heart rate 82/min.
What should be the initial consideration in her management?
A 14-year-old girl comes to the clinic complaining of repeated episodes of collapsing. She reports that these episodes happen suddenly while she is playing sports. The patient has no significant medical history or family history. During the physical examination, an ejection systolic murmur is detected. Her blood pressure is 106/70 mmHg, and her pulse is 78 beats per minute. What is the probable cause of her symptoms?
A 56-year-old man comes in for a follow-up on his angina. Despite taking the maximum dose of atenolol, he still experiences chest discomfort during physical activity, which is hindering his daily routine. He wishes to explore other treatment options. He reports no chest pain at rest and his vital signs are within normal limits.
What would be the most suitable course of action for managing his condition?
A 50-year-old man comes in for a check-up. He is of Afro-Caribbean heritage and has been on a daily dose of amlodipine 10 mg. Upon reviewing his blood pressure readings, it has been found that he has an average of 154/93 mmHg over the past 2 months. Today, his blood pressure is at 161/96 mmHg. The patient is eager to bring his blood pressure under control. What is the most effective treatment to initiate in this scenario?
A 75-year-old male comes to the Emergency Department complaining of increased swelling in his right leg. He has a medical history of right-sided heart failure. During the examination, his right calf is found to be 3 cm larger than his left and he has bilateral pitting oedema up to the knee. A positive D-dimer result prompts the initiation of apixaban. However, an ultrasound scan of his leg comes back negative.
What would be the most suitable course of action?
You have been asked to review the blood pressure of a 67-year-old woman. She was recently seen by the practice nurse for her annual health review and her blood pressure measured at the time was 148/90 mmHg. There is no history of headache, visual changes or symptoms suggestive of heart failure. Her past medical history includes hypertension, osteoporosis and type 2 diabetes. The medications she is currently on include amlodipine, alendronate, metformin, and lisinopril.
On examination, her blood pressure is 152/88 mmHg. Cardiovascular exam is unremarkable. Fundoscopy shows a normal fundi. The results of the blood test from two days ago are as follow:
Na+ 140 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Bicarbonate 26 mmol/L (22 – 29)
Urea 5.5 mmol/L (2.0 – 7.0)
Creatinine 98 µmol/L (55 – 120)
What is the most appropriate next step in managing her blood pressure?
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?