Hyperkalaemia is a common electrolyte disorder which, when severe, can cause lifethreatening cardiac arrhythmias and paralysis of the respiratory muscles. It is therefore crucial for clinicians to have a clear understanding of its management. Hyperkalaemia is usually caused by a combination of factors, but renal impairment and drugs are often implicated. The rising prevalence of chronic kidney disease and increasing use of medications that interact with the renin-angiotensin-aldosterone system have resulted in a sharp rise in the prevalence of hyperkalaemia.
Improving the management of cardiovascular disease during pregnancy
It is exceedingly uncommon for a woman in the UK to die during pregnancy, with maternal mortality in the region of one death per 10,000 maternities1. Although there have been very significant improvements in antenatal care, such as a marked reduction in the number of deaths due to thromboembolic disease, other areas are trailing behind. One such area is cardiac disease – now the leading cause of maternal death in the UK. These relatively rare deaths also mask the much larger issues of maternal, fetal and perinatal morbidity. The most recent Confidential Enquiries into Maternal Death and the new European Society of Cardiology guidelines summarised in this issue of the PCCJ highlight the major clinical issues and attempt to provide consensus opinion regarding optimal care in what is a relatively evidence-sparse field.
Choosing the NTproBNP cut off for use as part of a community heart failure care pathway
Echocardiography (ECHO) is the “gold standard” test in the diagnosis of heart failure. Brain natriuretic peptide (BNP) can be helpful to rule outpatients who do not require ECHO. This study used an elevated level of Nterminal prohormone BNP (NT-proBNP) as a criterion for referral to a new community heart failure clinic. Results showed that NT-proBNP could be a useful test in the management of heart failure. The researchers propose to institute age- and sex-related cut-offs to refine its place in the patient care pathway.
How can we avoid a stroke crisis?
A report from a multidisciplinary alliance has made a compelling case for a coordinated planin Europe to reduce the health, social and economic burdens of stroke related to atrialfibrillation (AF). The group comprises eminent cardiologists, neurologists, a healtheconomists, hospital pharmacists, a haematologist and representatives from patientorganisations.How Can We Avoid a Stroke Crisis? has been endorsed by 17 medical and patientorganisations, including the European Primary Care Cardiovascular Society. Its aim is tohighlight to European policy makers the need to achieve earlier diagnosis and bettermanagement of AF across Europe, with the ultimate goal of reducing the risk of stroke inpatients with AF. The key points summarised in the report are shown in table 1.
Atrial Fibrillation In Primary care: Bringing practice closer to guidelines – a tool for primary care physicians
In the last few years we have witnessed a number of advances in the management of atrial fibrillation (AF). While these have created valuable opportunities to improve patient outcomes, we need to ensure physicians have the right support to deliver the most appropriate care. The AF AWARE (Atrial Fibrillation AWareness And Risk Education) campaign, working with a panel of AF experts, has developed the Atrial Fibrillation in Primary care (AFIP) tool – a ‘go to’ resource for primary care physicians, to help with the identification and management of AF, in line with the latest published guidelines. This article provides some background to the need for such a tool, and an outline of its content.
CT coronary calcium scoring: improving cardiac risk stratification
We describe the technique, application, risks and benefits of computed tomography (CT) coronary calcium scoring in relation to how it could be used in primary care to help produce an individualised cardiac risk assessment.
Give me sunshine: vitamin D and cardiovascular health
Vitamin D deficiency is a prevalent and important health issue that warrants vigilant systematic screening and appropriate treatment and follow-up on the part of physicians,especially those in the primary care and cardiovascular fields. In this article we review the sources and metabolism of vitamin D, the epidemiology of vitamin D deficiency, and the available evidence linking vitamin D deficiency to cardiovascular disease; and we suggest an approach to systematic screening and to treatment of vitamin D deficiency.
Current evidence for the management and early treatment of transient ischaemic attack
Transient ischaemic attack (TIA) is an important risk factor for stroke. Early recognition of symptoms and timely secondary prevention significantly reduce stroke risk. We review current evidence and guidelines for early management and treatment of TIA, including early antiplatelet therapy, specialist review, and recognition and treatment of other risk factors. The roles of carotid artery and brain imaging are also considered.
Screening for asymptomatic atrial fibrillation at seasonal influenza vaccination
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Its incidence rises with age: in the over-65s the prevalence is 4% but this rises to 8.8% in the over-80s. The prevalence of AF is on the rise due, in part, to an ageing general population and to increased longevity resulting from improved medical care. AF is clinically important because it contributes to the incidence of heart failure, stroke and overall cardiovascular mortality. In addition, when strokes occur in association with AF, patients suffer substantial mortality, disability and longer hospital stays compared to stroke patients without AF, leading to an increased financial and resource burden on the NHS.
Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management
The prevalence of many physical illnesses is increased in people with severe mental illness and accounts for around three quarters of all deaths; cardiovascular disease is the commonest cause of death. The level of screening for and management of diabetes and cardiovascular risk factors remains low but a straightforward yet systematic care pathway should go a long way towards reducing the health inequalities experienced by people with severe mental illness.
Key clinical points for the management of erectile dysfunction
Erectile dysfunction (ED) is a marker for cardiovascular disease, and it represents an opportunity for the clinician to intervene and reduce the patient’s cardiovascular risk. This article provides guidance on taking a history, investigations and treatments, all timely now that ED has been added to the Quality and Outcomes Framework (QOF) for 2013.
Recognition of post-stroke depression: a chance to improve outcomes
Depression is common after a stroke. All stroke patients should have their mood assessed. A range of evidence-based interventions may be used, and guidelines should be implemented since failure to treat depression leads to poorer outcomes in rehabilitation and recovery.
