Cardiovascular

Cardiovascular

Lisa Freeman (Consultant Cardiologist)Atrial Fibrillation
Leisa Freeman (Consultant Cardiologist)

Leisa Freeman is a Consultant Cardiologist, Norfolk and Norwich University NHS Hospital Trust, Honorary Senior Lecturer UEA School of Medicine Health Policy and Practice and Honorary Consultant Cardiologist (GUCH) Papworth Hospital

Leisa specialises in General adult cardiology, Cardiac catheterization (coronary angiography), and has a Sub specialist interest in Congenital heart disease in the adult including inherited heart muscle and rhythm problems.
This talk by Leisa Freeman will explain all you need to know about atrial fibrillation. This is an important lecture, as AF is a common pathology amongst our patients, and a major risk factor for stroke. The emphasis here is on understanding how it is managed medically, and the treatment options available across the range of problems that can present.

This is a comprehensive account and will cover all a GP will encounter, and give an understanding of the way in which patients can be managed in secondary care.

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Paul Guyler (Lead Consultant for Stroke)A GP Guide to Atrial Fibrillation
Paul Guyler (Lead Consultant for Stroke)

Dr Paul Guyler is the Lead Consultant Stroke Physician at Southend University Hospital. He also works as an Associate for the Stroke Improvement Programme, particularly in the areas of hyperacute stroke and atrial fibrillation, and has been Lead for Acute Stroke in Essex Cardiac and Stroke Network; now leading on research and innovation.
His lecture recorded here is a comprehensive update on atrial fibrillation that will refresh your knowledge and review the evidence base for management

Atrial fibrillation is common and highly variable in its clinical presentation and evolution; it causes substantial morbidity and mortality, including impaired quality of life, heart failure, systemic emboli, and stroke.
Atrial fibrillation is the commonest sustained arrhythmia encountered in clinical practice. Its prevalence increases with age, rising from 0.7% in people aged 55-59 years to 18% in those older than 85 years. Consequently, the public health burden associated with atrial fibrillation is increasing. The therapeutics of atrial fibrillation is evolving. In recent years, publication of several randomised controlled trials and meta-analyses have improved our understanding.
The first priority is to control heart rate (if tachycardia is present) and provide adequate antithrombotic treatment for preventing complications of embolism.
Patients with moderate to high risk of stroke require warfarin long term for preventing embol.

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Liam Hughes (Interventional Cardiologist)Coronary Heart Disease
Liam Hughes (Interventional Cardiologist)

As a Norfolk based interventional cardiologist, Dr Hughes has spent the 11 years since appointment to the Norfolk and Norwich University Hospitals NHS Foundation Trust developing cardiac interventional treatments. He now has considerable experience in all the major interventional techniques, especially stenting for multivessel coronary disease and acute coronary syndrome.

His talk is an important review of angina and a reminder of how much stenting has transformed the management of acute coronary syndrome. There are some insightful points made about the definition of angina and he describes common pitfalls in diagnosis in stable angina and useful markers of ischaemic disease. The accuracy of exercise tolerance testing and other functional methods of diagnosis is discussed and there is a graphic demonstration of the importance of angiography and stent insertion in management.

You will enjoy this lecture.

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Kneale Metcalf (Consultant Physician)How do I diagnose a TIA?
Kneale Metcalf (Consultant Physician)

Dr Kneale Metcalf is a Consultant Physician and Stroke Physician in Norwich. He spends the majority of his time working with patients who have had a stroke. His experience working with patients shows throughout this lecture as he discusses how important TIAs are. Kneale thinks of them as emergencies, and his enthusiasm for their appropriate and timely management shows through.

After discussing what TIAs are he talks about how they present. His insights into how they present are illuminating. TIA mimics, scenarios where the diagnosis can be made erroneously are dealt with at length. He then discusses investigations, including the Diffusion Weighted Imaging MRI, the predicted effect of treatment, and the management of risk factors.

The message of his talk is that A TIA is an index event signifying high risk. Urgent response is essential.

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Anne White (BHF Cardiac Genetics Specialist Nurse)Inherited Cardiac Conditions & Sudden Death
Anne White (BHF Cardiac Genetics Specialist Nurse)

Anne White is a cardiac genetics specialist nurse working at Papworth hospital. Her talk here is a review of the inherited cardiac diseases, the cardiomyopathies and diseases of abnormal conduction, and sudden adult death syndrome.

There are several very important disease entities here that will interest GPs. Anne concludes with the subject of screening and the needs of families that are affected by these inherited diseases.

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Anne White (BHF Cardiac Genetics Specialist Nurse)Cardiac and genetic testing
Anne White (BHF Cardiac Genetics Specialist Nurse)

Anne White is a cardiac genetics specialist nurse working at Papworth hospital.
This is actually Part 4 of her talk on inherited cardiac conditions and sudden death. Here Anne discusses family screening and genetic testing.

As GPs we are all aware that this subject comes up at irregular intervals in our clinical lives, usually when we are asked about patient risk arising from a clinical finding or event in one of their relatives. This lecture will prime your knowledge and prepare you for the next occasion you are asked.

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Ian Williams (Consultant Cardiologist)Pacemakers
Ian Williams (Consultant Cardiologist)

Ian Williams is a Consultant Cardiologist who specialises in electrophysiology and the assessment of arrhythmais and syncope. He has a special interest in the Device management of heart failure
After discussing the technology of pacemakers and their indications, Ian talks about biventricular pacemakers and their indication of severe heart failure. Ian talks about the indications for referal, which will be of interest to us all.
Biventricular pacing therapy is recommended for patients in sinus rhythm with a widened QRS interval (>=120 ms) and severe LV systolic dysfunction LVEF (<=35%) who have persistent, moderate to severe HF (NYHA III) despite optimal medical therapy.
Finally this lecture deals with implantable defibrillators, their technology and indications.
The important lesson from this lecture is that the UK, when compared with the rest of Europe, lags well behind in the International league tables.
A lecture that should stimulate interest amongst GPs for a review of our referal policies for patients with heart failure, as well as a general update on implantable cardiac support devices.

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