David Tyers wrote:
> The presence or absence of LVH makes a big difference when calculating
> a cardiac risk score. How do the list members handle "borderline LVH"
> on ECG? Presumably it has an effect on risk but to
> what degree? Should it influence when we intervene with treatment?
>
> Any thoughts appreciated.
Radiology registrars who have recently passed their membership write
long spiels on perfectly normal chest x-rays musing over the possibility
of upper lobe blood diversion etc. etc. Don't they understand that GPs
who code only work in absolutes!?
The voltage criteria for LVH vary from text to text. Unless there are
corroborative clinical or radiological signs, or a history of poorly
controlled hypertension I take borderline LVH not to be a diagnosis of
LVH and I do not code it as such. They get clobbered when applying for
insurance and I suspect that in many cases there is nothing wrong with
them. I suppose it might be a vote swinger if I was not sure whether to
start statins. I've seen a normal echocardiogram in a man who turned out
to have a benign murmur and I'm sure the ECG report of borderline LVH
was guided more by the clinical history than the ECG itself which was
equivocal at best. In the same way I assume that heart size at the ULN
on a CXR is not cardiomegaly.
Of course, if our prevalence figures do not make the national average we
may take a view on this!!
Laurie
---
Outgoing mail is certified Virus Free.
Checked by AVG anti-virus system (http://www.grisoft.com).
Version: 6.0.688 / Virus Database: 449 - Release Date: 18/05/2004
|