Open access echocardiography A primary care view

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Open access echocardiographyA primary care view

• Dr Amrit Takhar
• General Practitioner
• Wansford surgery

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A primary care view

• Practice based Audit of heart failure patients
• Changes 1996-8
• Case histories

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Audit Method

• January 1996 Computer search of all patients
  having prescriptions for diuretics
• Records examined for coding of major diagnoses
  including heart failure and hypertension

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1996 Audit criteria

• Use of ECG CXR and ECHO at diagnosis
• BP, FBC U/E in past 13 months
• Whether patients on diuretics for HF were also on
  an ACE inhibitor

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1996 Results
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Changes since 1996

• Interpretative ECG used routinely in all
  suspected cases
• Open access ECHO - launched Spring 1997 allowing
  improved investigation facilities
• Greater confidence in appropriate use of ACE
  inhibitors

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1998 Audit criteria

• Use of ECG and ECHO at diagnosis
• Whether patients on diuretics for HF were also on
  an ACE inhibitor
• New cases since Jan 1997

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1998 audit Results
15 new cases at Wansford 1997-8
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Case 1

• 71 year old man
• Longstanding severe COAD / Asthma
• April 97 episode of severe chest pain - attended
  3 weeks later
• ECG showed signs inferior MI
• July 97 Exercise ECG limited by SOB

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Case 1

• Standard chest X-ray The heart is not enlarged
  CTR 15 to 34.5. The lung fields are a little
  hyperexpanded but no focal lung lesion is seen.
  The appearance is consistent with COAD
• Sept 97 C/0 SOB, bubbling sensation in chest.
  Scattered rhonchi

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Case 1

• Nov 1997 Echocardiogram abnormal Mild to mod left
  ventricular impairment,
• Rx Frusemide and lisinopril
• Symptoms improved

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Case 2

• (1994) 64 year old lady with soboe, worse in
  mornings, occ tightness in chest, ankle swelling
• FH
• Pulse 80 SR, Bilateral basal creps
• ECG CXR Cholesterol 6.1
• Rx Bendrofluazide

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Case 2

• 1997 Referred for ECHO
• Normal echocardiogram
• Diuretic stopped
• No recurrence of SOB, tendency to URTI

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