1. Pearls from Hawaii
Some fun Q&A from Mayo Clinic’s “Selected Topics in Internal Medicine 2017”

3. Hypertension
According to a 2005 study of >5000 patients with hypertension, how much does the five year risk of cardiovascular death increase from a normotensive (<140 systolic) versus a systolic of 220 based on office BP measurements?
<1% 3% 5%
10%

4. Hypertension
According to a 2005 study of >5000 patients with hypertension, how much does the five year risk of cardiovascular death increase from a normotensive (<140 systolic) versus a systolic of 220 based on office BP measurements?
<1% (absolute increase from 0.7% to 1.4%) 3% 5%
10%

5. Hypertension
According to the same study, how much does the 5 year risk of CV death increase if ambulatory blood pressure measurements show nocturnal systolic pressures of 180mmHg?
1.5% 2% 3%

6. Hypertension
According to the same study, how much does the 5 year risk of CV death increase if ambulatory blood pressure measurements show nocturnal systolic pressures of 170mmHg?
1.5% 2% 3%

7. Hypertension

8. Hypertension
Discussion: Would ambulatory BP monitors be worth obtaining for our sites?

10. Atrial Fibrillation
According to the CHA2DS2VASc stroke risk scoring system, (0-9), at what score does the annual stroke risk exceed 5%? 2 3 4 5 6

11. Atrial Fibrillation
According to the CHA2DS2VASc stroke risk scoring system, (0-9), at what score does the annual stroke risk exceed 5%? 2 3 4 5 6

12. Atrial Fibrillation
At what CHA2DS2VASc score is warfarin or NOAC usually recommended, and what is the annual stroke risk at that score?

13. Atrial Fibrillation
At what CHA2DS2VASc score is warfarin or NOAC strongly recommended, and what is the annual stroke risk at that score?
Answer: 2 and about 2% (score of 1 is ‘optional’ for anticoagulation)

17. Atrial Fibrillation
BONUS QUESTION: What are the little subscript 2’s in CHA2DS2VASc representing?

18. Atrial Fibrillation
BONUS QUESTION: What are the little subscript 2’s in CHA2DS2VASc representing? Score of 2 for Age >75 and for prior stroke/TIA

19. Atrial Fibrillation
Discussion: How do you communicate this information clearly to (often elderly, hard of hearing) patients in a meaningful way for shared decision-making?

21. Gastroenterology
A 40 year old patient presents with episodic increasing epigastric pain without alarm symptoms. Urea breath testing for H. pylori is positive. What next?
Refer for upper endoscopy
Treat with PPI, amoxicillin and clarithryomycin x 14 days
Treat with PPI, bismuth, metronidazole and tetracycline x 10 days
Treat with PPI, amoxicillin, metronidazole and clarithromycin x 14 days

22. Gastroenterology
A 40 year old patient presents with episodic increasing epigastric pain without alarm symptoms. Urea breath testing for H. pylori is positive. What next?
Refer for upper endoscopy
Treat with PPI, amoxicillin and clarithryomycin x 14 days
Treat with PPI, bismuth, metronidazole and tetracycline x 10 days
Treat with PPI, amoxicillin, metronidazole and clarithromycin x 14 days

23. Thanks for Paying Attention