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April 2022 Br J Cardiol 2022;29:52–4 doi: 10.5837/bjc.2022.012

Drive-by collection and self-fitting of ambulatory electrocardiogram monitoring

Mark T Mills, Sarah Ritzmann, Maisie Danson, Gillian E Payne, David R Warriner

Abstract

Ambulatory electrocardiogram (AECG) monitoring is a common cardiovascular investigation. Traditionally, this requires a face-to-face appointment. In order to reduce contact during the COVID-19 pandemic, we investigated whether drive-by collection and self-fitting of the device by the patient represents an acceptable alternative.

A prospective, observational study of consecutive patients requiring AECG monitoring over a period of one month at three hospitals was performed. Half underwent standard (face-to-face) fitting, and half attended a drive-by service to collect their monitor, fitting their device at home. Outcome measures were quality of the recordings (determined as good, acceptable or poor), and patient satisfaction.

A total of 375 patients were included (192 face-to-face, 183 drive-by). Mean patient age was similar between the two groups. The quality of the AECG recordings was similar in both groups (52.6% good in face-to-face vs. 53.0% in drive-by; 34.9% acceptable in face-to-face vs. 32.2% in drive-by; 12.5% poor in face-to-face vs. 14.8% in drive-by; Chi-square statistic 0.55, p=0.76). Patient satisfaction rates were high, with all patients in both groups satisfied with the care they received.

In conclusion, drive-by collection and self-fitting of AECG monitoring yields similar AECG quality to conventional face-to-face fitting, with high levels of patient satisfaction.

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April 2022 Br J Cardiol 2022;29:67–72 doi: 10.5837/bjc.2022.013

Angina with coronary microvascular dysfunction and its physiological assessment: a review with cases

Pitt O Lim

Abstract

Imagine that it is possible to know, the actual coronary blood flow. Would this not remove any doubt, if a chest pain is the heart’s fault?

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April 2022 Br J Cardiol 2022;29:77–8 doi: 10.5837/bjc.2022.014

Iatrogenic aortic dissection of the descending aorta after percutaneous coronary intervention

Kristen Westenfield, Shannon Mackey-Bojack, Yale L Wang, Kevin M Harris

Abstract

Aortic dissection is a rare and potentially fatal complication of coronary angiography. We report a case of a woman in her late 80s who underwent a left femoral approach coronary angiogram for evaluation of a transcatheter aortic valve replacement (TAVR). Following the procedure, she had a cardiac arrest and was found to have a descending aortic dissection on transoesophageal echocardiogram. Autopsy showed an acute intimal tear of the descending aorta, most likely related to catheter manipulation. Patients undergoing evaluation for TAVR, who tend to be elderly with concomitant atherosclerosis, are at risk for complications following cardiac catheterisation including aortic dissection.

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March 2022 Br J Cardiol 2022;29:21–5 doi: 10.5837/bjc.2022.008

Atrial fibrillation prevalence and predictors in patients with diabetes: a cross-sectional screening study

Angela Hall, Andrew Robert John Mitchell, Lisa Ashmore, Carol Holland

Abstract

Prevalence of atrial fibrillation (AF) and diabetes is increasing worldwide. Diabetes is a risk factor for AF and both increase stroke risk. Previous AF screening studies have recruited high-risk patient groups, but not with diabetes as the target group. This study aims to determine whether people with diabetes have a higher prevalence of AF than the general population and investigate whether determinants, such as diabetes duration or diabetes control, add to AF risk.

In a cross-sectional screening study, patients with diabetes were recruited via their GP surgeries or a diabetes centre. A 30-second single-lead electrocardiogram (ECG) was recorded using the Kardia® device, along with physiological measurements and details relating to risk factor variables.

There were 300 participants recruited and 16 patients identified with AF (5.3% prevalence). This demonstrated a significantly greater likelihood of AF than the background population (p=0.043). People with diabetes and AF were significantly older than those who only had diabetes. More people with type 2 diabetes had AF than people with type 1. Prediction of AF diagnosis by age, sex, diabetes type, diabetes duration and level of control revealed only age as a significant predictor.

In conclusion, these findings add to existing data around the association of these chronic conditions, supporting AF screening in this high-risk group, particularly in those of older age. This can contribute to appropriate management of both conditions in combination, not least with regards to stroke prevention.

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March 2022 Br J Cardiol 2022;29:5–7 doi: 10.5837/bjc.2022.007

Pipedreams, the pandemic and PoTS: is the post-COVID-19 era a turning point for PoTS services?

Morwenna Opie, Michaela Nuttall

Abstract

The paper by Gall et al., published in this issue (see https://doi.org/10.5837/bjc.2022.003), is timely and important; the largest case series from the UK, and among the largest globally detailing the clinical characteristics of patients affected with postural tachycardia syndrome (PoTS) developing after a COVID-19 infection. It brings empirical stature to the anecdotal reports of PoTS developing post-COVID-19. It articulates that this presents in a form indistinguishable from PoTS precipitated by other events.

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