Cardiology

e-learning | New treatments for hyperkalaemia

There have been two recent new guidelines from NICE on managing hyperkalaemia. The first deals with the snappily named sodium zirconium cyclosilicate. The second deals with patiromer. These are both oral drugs, binding potassium in the GI tract and, as they are not absorbed, it is then excreted. Who can have these drugs? Both drugs…
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e-learning | Hypertension in adults

This is an updated guideline from NICE on managing hypertension in adults. It was published in Aug 2019. So what is new? The meat and bones of management is the same. There are a few small differences, which I'll list below. The biggest difference is that they encourage us to have much more of a…
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e-Learning | Chronic Heart Failure in adults

This is an updated guideline on heart failure from NICE published in September 2018. Most of this is what we are currently doing. They have pulled several different guidelines together to make this more comprehensive. There are a few new things which I'll lay out, then I'll give a brief summary of management: Terminology They…
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Evolocumab and Alirocumab for treating dyslipidaemia

There are two new guidelines from NICE on the use of Evolocumab and Alirocumab for treating primary hypercholesterolaemia (both familial and non-familial) and mixed dyslipidaemia. What are these drugs? Both Evolocumab and Alirocumab are monoclonal antibodies that inhibit an enzyme that down-regulates LDL receptors. This therefore increases the number of LDL receptors and so increases…
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Sacubitril valsartan for chronic heart failure

This is a new guideline from NICE on when sacubitril valsartan should be used. Sacubitril valsartan is a combination drug. It includes the angiotensin 2 receptor blocker (ARB), valsartan. It also includes the neprilysin inhibitor, sacubitril. Neprilysin inhibition leads to increased levels of vasoactive proteins, which leads to vasodilation. This then allows increased sodium excretion…
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Routine pre-operative tests and blood pressure

These are two guidelines, but both on the topic of pre-operative testing, so they fit nicely together. I am just pulling out the points useful for us GPs. Pre-operative tests This is a new guideline from NICE on what tests are required pre-operatively. Most of it is obviously for secondary care, but there are a…
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Nice | Apixaban for the treatment of DVT and PE

This is a new guideline from Nice on apixaban. It has now been approved for the treatment of and secondary prevention of DVT and VTE. Now dabigatran, rivaroxaban and apixaban can all be used in AF, for the prevention of VTE after hip surgery and for treatment and secondary prevention of DVT and PE. Louise…
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Nice | Rivaroxaban in Acute Coronary Syndrome (ACS)

This new guideline from Nice states that rivaroxaban can now be used after ACS with elevated cardiac enzymes. It should be used either with aspirin, or with aspirin and clopidogrel together. It decreases the combined end points of MI, CVA or deaths from cardiovascular events by 20%. There is a 3 x increased risk of…
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Nice | Acute heart failure

This is a new guideline from NICE on Acute Heart Failure. This is really aimed at secondary care and does not add anything to what we would routinely do in general practice. One thing to remember is the possibility of using BNP testing if you are not certain if someone may be presenting with new onset acute…
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