GP and Consultant case study: Cardiology

Dr Patrick Davey, a consultant on the National Consultant Network, answers GP Telephone Advice & Guidance calls from around the UK. This includes calls from Southwark GPs.

“I am supportive of Consultant Connect, it is a very useful tool.” Dr Guallar

GP and Consultant case study: Cardiology

Dr Cristina Guallar is a GP at The New Mill Street Surgery in Southwark. She uses Telephone Advice & Guidance to speak to local and out-of-area consultants. She also has access to Photo Advice & Guidance through the Consultant Connect App.

Dr Guallar and Dr Davey have provided the case example below in which they discuss how immediate Telephone Advice & Guidance allowed them to organise the most effective care for a patient.

Dr Davey’s Perspective:

“An elderly woman was last seen by her local cardiology team about 18 months ago with some narrowing of the the aortic valve. She went to see her GP, Dr Guallar, as she was breathless. Dr Guallar found that she had fluid retention including swollen ankles and also discovered a heart rhythm disturbance which was atrial fibrillation. The first problem here is that atrial fibrillation in an elderly lady with heart problems creates a very high risk of blood clots in the heart, which can end up in the brain and cause a stroke. It is therefore very important to start powerful blood thinning drugs as soon as possible. Dr Guallar was aware of this but not certain of the interaction with the patient’s abdominal aortic aneurysm which could be life-threatening if it ruptured (particularly if the patient was on blood thinning therapy). I was able to reassure Dr Guallar that the benefit of blood thinners outweighed this risk and that this should be started today with a drug that would work immediately.

In addition, it seemed likely that her breathlessness was caused by a further narrowing of her aortic valve that had put pressure on the heart and resulted in the rhythm disturbance and inefficiency of the heart resulting in fluid retention. This is a condition known as heart failure and, when it is due to narrowing of the aortic valve, it is associated with a high early mortality risk. Accordingly, I was able to advise Dr Guallar that very early assessment by the local cardiology clinic was mandated. I suggested that she fax the local cardiology department requesting that the patient be seen within a week or 10 days to evaluate whether she was suitable for some form of operation on the aortic valve to relieve her symptoms and prolong life.”

How Telephone Advice & Guidance helped:

“The patient benefited from a phone conversation with a consultant in two ways. Firstly, she was able to immediately start blood thinning treatment which protected her against a stroke. Secondly, Dr Guallar could use my name to access early local cardiology services and assessment for aortic valve surgery which, if possible, would dramatically improve symptoms and life expectancy. Without this phone conversation it is likely that the referral would have been through the standard route and could have taken many months during which time she would have been at risk of stroke and may have died from her narrowed aortic valve.”

Dr Guallar’s Perspective:

“I was very grateful to Dr Davey as he listened to my patient’s case with reassuring interest.”

How Telephone Advice & Guidance helped:

“Dr Davey’s thorough advice was didactic and helped me a great deal in deciding a management plan and to expedite the referral to the anticoagulant clinic. I am supportive of Consultant Connect, it is a very useful tool.”

Click here to view and download PDF version of this case study.

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