My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I look at Chat GPT generated case of heart failure with co-morbidities to see how the NICE guidelines could apply to it. I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement. There is a YouTube version of this and other videos that you can access here: · The NICE GP YouTube Channel: NICE GP - YouTube You can download my summary of the guideline with additional information here: · https://1drv.ms/b/s!AiVFJ_Uoigq0l3uRYZ7-U3R808gA?e=2LT5XI Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through TranscriptHello everyone and welcome. My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I look at the journey from diagnosis to treatment of a ChatGPT generated patient with heart failure and other co-morbidities to see how the NICE guidelines could be applied. Make sure that you stay for the whole episode because at the end, I am going to give you the pathophysiological reasons why ACEIs, ARBs, betablockers and MRA are so beneficial in heart failure, and I am sure that once you have understood it, you will never forget. By the way, I am not giving medical advice; this is for health care professionals and it is only my interpretation of the guidelines so you must use your own clinical judgement. If you want to download a copy of my summary of the NICE guidelines on Chronic heart failure, the link is in the episode description.Remember that there is also a Youtube version of these episodes so have a look in the episode description. Right, so let’s have a look at our fictitious patient: - His Name is: John Smith- His Age: 68- Ethnicity: Caucasian- Past Medical History includes: Obesity, Hypertension, Type 2 Diabetes, and Hyperlipidaemia His Current Symptoms are:- Shortness of breath on exertion and lying down- a Persistent cough- Fatigue and weakness- Bilateral ankle swelling- And The symptoms have been developing gradually over the last 4-6 months but recently he has noticed more rapid weight gain which could be from fluid retention His usual medication is:- Amlodipine 5 mg OD for hypertension- Lisinopril 2.5 mg OD for hypertension- Metformin 500 mg BD for type 2 diabetes and- Atorvastatin 20 mg OD for hyperlipidaemia So, we have a 65-year-old Caucasian male who presents with shortness of breath, fatigue, ankle swelling, and a persistent cough. On examination we find the following: His BMI is 34, so he is obese.His Weight is 97 and John says that this is 4Kg more than his usual weightHis BP is 151/92 mmHg andOn auscultation, he has lung crackles. His heart sounds are regular with no murmurs, and his heart rate is 96 bpm. Palpation of the chest reveals a laterally displaced point of maximum impulse consistent with an enlarged ventricle. His Oxygen saturation is 98%And his Peak Flow is: 450 L/min (which is normal for his age and sex)Abdomen showed no hepatomegaly and there is no raised JVP He has Slight bilateral pitting ankle oedema His Urinalysis and His Temperature are normal Right, we have someone with lung crackles and a normal temperature and no other sings of infection, so it would be reasonable to suspect HF rather than bronchopneumonia. His main symptoms are suggestive of left sided heart failure although he also has some ankle oedema which is a possible symptom of right sided heart failure. However, he is also on amlodipine and at this stage we cannot be 100% sure of whether this is a side effect of his medication or secondary to heart failure. Let’s remember that typical symptoms of left-sided heart failure include cool clammy skin, cyanosis, a laterally displaced point of maximum impulse consistent with an enlarged ventricle, lung crackles and a gallop rhythm. On the other hand, signs in right sided heart failure include an elevated JVP, ankle of leg oedema, ascites, hepatomegaly, and hepatojugular reflux. Signs of both left and right sided heart failure can be present at the same time. In order to confirm the diagnosis of heart failure, we will need to measure the levels of the N-terminal pro-B-type natriuretic peptide, or BNP levels. In addition, and in order to exclude other diagnoses, NICE says that we should also arrange an ECG, a chest X-ray, especially as he has a persistent cough, other blood tests including full blood count, renal, liver, thyroid function, lipid profile, and HbA1c. Peak flow was normal for John but if we are in any doubt about a respiratory condition, we should also request spirometry testing. Right, so we are going to send him off to have some tests. Should we be doing anything else in the meantime? Well, if we feel that...
