Transcript Document

Name
RACPC: Clinical Assessment
DoB
Date __________ / Dr __________
Hosp #
History
Classify the pain
Drug History
TYPICAL ANGINA
ATYPICAL ANGINA
NON ANGINAL
Typical features of angina
Constricting pain of chest / jaws / arm
Precipitated by physical exertion
Relieved by rest / GTN spray
Bloods
NICE classification of angina
Typical angina has all three factors
Atypical angina has two features
Non-anginal chest pain has none
Non-anginal features
Pain very prolonged
Unrelated to activity
Related to respoiration
Related to dizziness
Related to palpitations
Related to tingling
Related to meals
ECG
Is the patient low or
high risk?
Examination
HR
BP
SaO2
RR
Important
aspects to
cover
Signs of
cardiovascular
disease
Signs of
cardiac risk
factors
Exclude aortic
stenosis
Exclude
cardiomyopat
hy clinically
Exclude non
cardiac chest
pain
Smoking
Cholesterol
Lipids
HDL
Diabetic
BMI
LDL
FH
TG
HTN
Glu / A1C
HIGH RISK
LOW RISK
Name
RACPC: Diagnostic Testing
DoB
Date __________ / Dr __________
Hosp #
Percentage of people estimated to have coronary artery diseas, based on gender / age / risk profile
Low risk patients have none of smoking, diabetes and high cholesterol as risk factors
Resting Q waves increase risk
Non-anginal chest pain
Age
Male
Low
35
45
55
65
3
9
23
49
35
47
59
69
LOW RISK
NICE
Guidance
Atypical angina
Female
High Low
1
2
4
9
Male
High Low
19
22
25
29
High Low
8
21
45
71
Preferred test CT calcium score
Alternative test CT coronary angiogram
Other
Exercsie tolerance test
Typical angina
Female
59
70
79
86
MEDIUM RISK
10-30%
Anatomical assessment
NICE Risk Stratification
Male
High Low
2
5
10
20
39
43
47
51
30
51
80
93
HIGH RISK
Estimated risk
30-60%
Functional assessment
Female
High Low
88
92
95
97
High
10
20
38
56
78
79
82
84
ESTIMATED
RISK ____%
60-90%
Invasive assessment
Stress echo
Coronary angiogram at Harlow
Angiogram ± PCI at CTC
Myocardial perfusion scan at UCLH Admission for workup
Impression
Plan
Sign _________ Bleep _____