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Social distancing/isolation is vital for infection control but can adversely impact on mental health. As the spread of COVID-19 is contained, mental health issues will surface with particular concerns for elderly, isolated populations. We present a case of Takotsubo cardiomyopathy related to lockdown anxiety.

We describe a case of pneumopericardium following emergency pericardiocentesis in a patient with coronavirus disease 2019 (COVID-19).

The European Society of Cardiology (ESC) updated their guidelines on stable chest pain in 2019,¹ and recommended the use of either imaging stress tests or computed tomography (CT) coronary angiography (CTCA). They emphasised the importance of imaging stress tests or CT fractional flow reserve (CT-FFR) as a second test, to assess any coronary stenoses found on CTCA. The National Institute for Health and Care Excellence (NICE) 2016 guidelines, on stable chest pain,² recommend CTCA for all patients with new-onset chest pain and, in a separate guideline in 2017,³ recommended CT-FFR to assess coronary stenoses. This need for a second test for the assessment of the significance of coronary stenoses is to reduce the need for invasive coronary angiography (ICA), because CTCA can be associated with false-positive results, as it can overestimate the degree of coronary stenosis, compared with ICA.⁴

Atrial fibrillation (AF) increases cardio-embolic stroke risk, yet AF diagnosis and subsequent prophylactic anticoagulant prescription rates are suboptimal globally. This project aimed to increase AF diagnosis and subsequent anticoagulation prescription rates in East Midlands Clinical Commissioning Groups (CCGs).

This service improvement evaluation of the East Midlands AF Advance programme investigated the implementation of mobile AF detection devices (Kardia, AliveCor) into primary-care practices within East Midlands CCGs, along with audit tools and clinician upskilling workshops designed to increase AF diagnosis and anticoagulation prescription rates. AF prevalence and prescription data were collected quarterly from July to September (Q3) 2017/18 to April to June/July to September (Q2/3) 2018/19.

AF prevalence increased from 1.9% (22,975 diagnoses) in Q3 2017/18 to 2.4% (24,246 diagnoses) in Q2 2018/19 (p=0.026), while the percentage of high-risk AF patients receiving anticoagulants increased from 80.5% in Q3 2017/18 to 86.9% in Q3 2018/19 (p=0.57), surpassing the Public Health England 2019 target of 85%.

The East Midlands AF Advance programme increased AF diagnosis and anticoagulation rates, which is expected to be of significant clinical benefit. The mobile AF detection devices provide a more practical alternative to traditional 12-lead electrocardiograms (ECGs) and should be incorporated into routine clinical practice for opportunistic AF detection, in combination with medication reviews to increase anticoagulant prescription.

Regular physical activity for secondary prevention in cardiovascular disease has many well-recognised benefits, with declines in physical activity being associated with worsening cardiovascular disease, suboptimal treatment or worsening comorbidities that might be rectified by early intervention. Most cardiovascular implantable electronic devices (CIED) now have the ability to detect, analyse and interpret physical activity data through an inbuilt accelerometer. Currently, these data are not being utilised to their full potential. We present three cases that demonstrate some of the possible uses of CIED-collected physical-activity data. These data have the potential to detect a deteriorating patient, to monitor the effects of an intervention, and/or provide motivational feedback to a patient. However, for the data to be used in this manner in the future, greater transparency from manufacturers and robust validation studies will be needed.