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Monday, 22 October 2012

#ECGclass Case 14

#ECGclass Case 14

This 84yr old lady attends to see your CHD nurse, for her annual BP/CHD review.

She mentions in passing, that hasn't been feeling too well recently with non-specific symptoms of malaise, intermittent palpitations and muscle weakness.

Her BP (on medication) is 142/74. Her pulse is regular.

In view of her mentioning palpitations, the CHD nurse decides to do an ECG:

What would you like to know?

Please hashtag (#ECGclass) any questions you'd like to ask .

This lady takes the following medication:
Lisinopril 20mg (for Hypertension)
Furosemide, Bisoprolol and Sprinolactone (for her mild-moderate LVSD).
She also takes Simvastatin, Calcium, and Alendronic acid.

The CHD nurse takes blood, as planned, for U&E's eGFR, LFTS, bone profile and FBC.
(Her last blood tests were almost a year ago, but were all in normal range, other than eGFR which was mildly reduced at 52).

It's 5pm and the duty GP is out on a late visit, so the CHD nurse asks your Nurse Practitioner to take a look.
The NP examines her thoroughly and finds no abnormalities of the CVS/RS/abdomen, but urinalysis reveals slightly cloudy urine, with leucocytes, protein and a trace of blood. There are no Nitrites  - but is is late in the day.
The NP decides her symptoms are consistent with a UTI, and prescribes her some empirical Trimethoprim. She sends the lady home and puts the ECG in the duty doctors paper tray to view on his return.

On his return at 5.30 pm the duty GP resumes surgery, which is now running late. He finally gets to his paperwork at 7pm. and notices the ECG with a brief explanatory note from the Nurse Practitioner.

He notes the slight tachycardia (which seems to fit with a possible infection), and tallish complexes - possibly compatible with her thin bony stature and hypertension.

But,  oh dear......the duty GP has not been attending #ECGclass on Twitter.  :(

He is not concerned, and continues with the rest of his paperwork.

Mid-morning the next day, the lady's daughter calls requesting to bring her mother straight down. She seems far more unwell today and the daughter is very worried about her. She has no chest pains, but more palpitations. On arrival, she doesn't look at all well, she's very pale and clammy.

What are you thinking now?

When you've had a go,  you'll find the full discussion on the next blog!

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