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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.
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Acute Anterior MI
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Controlled hypertensive
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Type 2 diabetes mellitus
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Normal ECHO – no evidence of heart failure
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Hypercholesterolaemia – 8.8 mmol/L
He is discharged home on a variety of medications and advised to contact his GP.
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What post-MI patient plan might your practice currently operate?
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Have a look at your system in your practice for reviewing post-MI patients. There should be something in place in ALL practices.
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Who is involved?
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GP?
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Practice nurse?
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Other professionals?
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What follow-up systems could be in place for a patient such as Mr. Johnson in your practice?
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Diabetes clinic?
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Hypertension clinic?
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CHD clinic?
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What elements of continued care does the NSF expect to be carried out by practices for post-MI patients?
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Risk factor advice about smoking cessation, exercise, diet, weight and diabetes
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Give low dose aspirin
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Give Beta-blockers for at least 1 year
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Provide BP advice and treatment – get BP well-controlled
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Give statins to lower cholesterol <5 mmol/L (LDL-chol <3 mmol/L) or by 30% reduction
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Give ACE inhibitors for those with heart failure or ECHO LV dysfunction
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Meticulous blood glucose and BP control in diabetics
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How do you think your practice compares with the expectations of the NSF?
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Should a diabetic screen have been done in primary care and at what stage prior to his MI?
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Yes. British hypertension society advises – diagnosed hypertensives to be screened for diabetes (blood glucose)
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Patient summary
57-year-old male with
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Acute myocardial infarction
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Type 2 Diabetes mellitus
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Hypertension (controlled)
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Overweight
- High alcohol intake