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Compared with other diseases, cardiovascular diseases (CVD) are responsible for the greatest burden of disease both globally¹ and in the UK.² Drugs for CVD and its risk factors have always been represented in the list of international blockbuster drugs. Important research innovations, such as ‘learning health systems’, ‘precision medicine’ and electronic health record (EHR)-based trials, have been led by professionals in the field of cardiology. Cardiovascular scientists from the UK have a long and strong history of research contributions with international impact. Training in cardiology is critical, not only in preparing and mentoring the clinical and academic cardiologists of the future, but also in shaping how the specialty is perceived from inside and outside. Global health and data science are overarching themes that offer new lenses through which to view CVD and cardiology. However, cardiology training in the UK barely pays lip service to either of these issues, when their implications have never been greater or more acute on our specialty. 

The ability to perform invasive diagnostic coronary angiography is a core requirement for cardiologists and fellows in training programmes. However, although key to their independence is the ability to obtain high-quality images that allow visualisation of the entire coronary vasculature, there exists no formal systematic method or teaching aid. This article provides an overview of the radiological equipment used in the catheter laboratory, details the naming of the different angiographic projections, and gives key tips and tricks to improve image quality. In addition, the coronary vasculature is broken down into segments, with descriptions provided of the essential views required to image each one. Using this approach, it aims to provide an essential aid to trainees and other healthcare professionals at the start of their careers. 

There is variable adoption in same-day discharge for pacing procedures across Europe. We compared length of hospital stay and complication rates in two cohorts, using a same-day and next-day discharge protocol. Case notes were reviewed for 229 consecutive patients attending our tertiary centre for device implantation to establish the rate of hospital readmission and complications. These comprised 106 patients in the next-day discharge cohort, and 123 from the same-day cohort. All pacing procedures, including cardiac resynchronisation therapy (CRT) and implantable cardioverter-defibrillators (ICDs), were included.  

No significant differences were observed between cohorts in age, gender, device indication, device type, procedure urgency or venous access route. Median length of stay post-implant significantly reduced from 1.2 days in the next-day cohort (25^th–75^th centile 1.06–3.24) to 0.99 days in the same day cohort (0.3–1.3) and from 1.08 days (0.94–1.2) to 0.36 (0.27–0.97), respectively, for the subgroup of elective patients (n=95). Death, complication, and readmission rates were similar between the two cohorts. Morning procedures were associated with shorter hospitalisation. No same-day cohort CRT recipients (n=28) suffered complications.

In conclusion, same-day discharge for pacing (including CRT and ICDs) results in decreased length of stay without increasing complications.  

A 22-year-old man was admitted to a general district hospital with a three-day history of epigastric pain and shoulder discomfort. He reported shortness of breath on exertion, but denied any chest pain or flu-like symptoms. He had no past medical history of note. Vital signs assessment confirmed low blood pressure of 90 mmHg systolic, and tachycardia of 130 beats per minute. Physical examination of the abdomen revealed mild epigastric tenderness. A computerised tomography (CT) scan for suspected cholecystitis showed a normal gall bladder, but revealed a large rim of pericardial effusion measuring 2.8 cm. He was then urgently transferred to a tertiary cardiac centre for assessment and consideration of pericardiocentesis.