You are working in a general cardiology clinic and are just finishing a consultation with a 69-year-old man who had been admitted with an NSTEMI 6 weeks previously. He has recovered well and has good LV function on a recent echocardiogram. His medications include aspirin, clopidogrel, bisoprolol, ramipril, and simvastatin. On the way out of the door he mentions some concerns about sexual dysfunction.
Which one of the following statements is incorrect?
Whilst the rest of the advice given in the options in the question is correct, phosphodiesterase type 5 inhibitors may be considered in stable patients who have had an MI more than 6 months earlier.
When advising patients about the DVLA regulations governing the entitlement to drive a private car or motorcycle, which one of the following statements is incorrect?
As with standard bradycardia pacemakers, patients who have received a CRT-P device should not drive for 1 week after implantation. Patients with an ICD implanted for a ventricular arrhythmia associated with incapacity should not drive for 6 months after the first implant, for 6 months after any shock therapy and/or symptomatic anti-tachycardia pacing, and for 2 years after any therapy accompanied by incapacity. If the shocks were due to an inappropriate cause, patients can resume driving 1 month after these problems have been resolved. If the shocks were appropriate, and appropriate steps have been taken to prevent recurrence, patients can resume driving after 6 months. Patients with an ICD implanted for a ventricular arrhythmia which did not cause incapacity can drive 1 month after ICD implantation, provided that their LVEF is >35%, no fast VT is induced on an electrophysiological study, and that any induced VT could be pace-terminated by the ICD twice, without acceleration, during the post-implantation study. Patients with an ICD should stop driving for 1 month following any revision electrodes or alteration of anti-arrhythmic drug, and for 1 week after a defibrillator box change.
When advising patients about the DVLA regulations governing Group 2 entitlement to drive an HGV, which one of the following statements is incorrect?
Patients who have undergone an elective PCI procedure are disqualified from their Group 2 entitlement for 6 weeks, and are required to meet the functional requirements in options A and B prior to relicensing. Following a CABG, patients are disqualified from their Group 2 entitlement for 3 months and may be considered for relicensing provided that their LVEF is >40% and the functional test requirements are met.
You have been looking after an obese 55-year-old man with a history of hypertension, who was admitted with an NSTEMI. Apart from optimizing his antihypertensive medication,
which one of the following would be appropriate lifestyle advice measures for improving his blood pressure?
Following an MI, patients should aim for a target blood pressure of 140/90 mmHg (or 130/80 mmHg in patients with diabetes or renal disease). Lifestyle advice for hypertensive patients should include smoking cessation, weight loss and healthy diet regimes, reduction in salt intake, regular exercise, stress management, and keeping alcohol intake within recommended limits.
You are reviewing a 45-year-old man in clinic who suffered an NSTEMI 6 months previously. He has always led a healthy lifestyle, but when he was admitted he was found to have a cholesterol of 8.4 mmol/L. He is very concerned about his elevated cholesterol and is asking if there is anything he can do to help lower it.
You emphasize the importance of continuing with his statin medication, but which one of the following lifestyle measures would also be appropriate?
Following a cardiac event patients should aim for a total cholesterol of <4 mmol/L and LDL cholesterol <2 mmol/L (<1.8 mmol/L according to ESC) or a reduction of LDL-C by 30%, whichever is greater. In addition to continuing any prescribed medications, patients with elevated cholesterol can be advised to stop smoking, take regular exercise, keep alcohol intake within recommended limits (<21 units/week for men and <14 units/ week for women), lose weight/reduce waist circumference, and maintain a diet low in saturated fat. It is important for diabetic patients to maintain their target HbA1c.
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