Thanks for all the suggestions about this. The query was totally clinical
with no bean counting element intended.
The patient is a 47 y.o. non-smoker who presented with several episodes of
palpitations (almost certainly related to recent stress) over a period of a
few days. He is a non-smoker and has had a variable slightly raised BP for
sometime again mainly when stressed - rest of the time (upper limits of)
normal. (He is stressed a lot of the time). His father died of MI at 49 and
2 uncles in their 50s. All were very heavy smokers. The EGG was done mainly
because of the palpitations. There was no previous ECG for comparison.
Currently no medication except aspirin. Total Cholesterol 5.4 and HDL 1.4.
Ignoring the family history - adding all the factors into a cardiac risk
programme give a 6+% risk assuming that the borderline LVH is not
significant/absent. Assuming LVH IS present it is 17+% presumably because he
has or is developing target organ damage. I'm not sure that he would have
got an ECG had it been an incidental isolated finding of hypertension in
some of the practices that I work in. (I'm a locum). I'm probably
underestimating cardiac risk in lots of people by not looking for it
often/closely enough. Even using an ECG to screen - I will add to the 10/12
ECHO waiting list at the same ivory tower in Nottingham that Mike Leuty
refers to.
The patient is fully involved in deciding the future management and is
having 24 hour ambulatory BP monitoring done. He is also fully aware that
I'm discussing his case on GP-UK.
Thanks again for the help.
David
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David Tyers
Nottingham
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