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Historically, young people with genetic heart diseases were discouraged from active sport due to concerns about the increased risk of sudden cardiac death during competitive or intensive exercise. The shock resulting from the sudden death of a young athlete, an event often highly publicised, tends to generate concern in the general population, and fear of litigation in a low-evidence area: both influence decision-making by the medical profession when discussing ‘restrictions’, especially in patients with genetic heart diseases, who by definition, are at increased risk of sudden cardiac death. In recent years, however, we have moved to a point where many athletes with certain genetic heart diseases can, with optimal medical therapy, be considered for involvement in various sporting and athletic pursuits. We are cautiously moving away from the assumption that exercise is contraindicated; we are factoring in the wishes of the patient-athlete (shared decision-making), and we are encouraging optimal protection for these athletes during their sporting endeavours (easily available automated external defibrillators [AEDs], and club personnel trained in basic life support [BLS]), while ensuring regular medical assessment to identify alterations in risk status. With dedicated follow-up of all such patient-athletes, we can refine our understanding of how best to advise (and protect) them in terms of exercise for enhanced quality of life.

Immune checkpoint inhibitors (ICIs) have revolutionised cancer care, but can cause serious cardiac immune-related adverse events (irAEs), particularly myocarditis, which carries up to 50% mortality. This study explores patient pathways to improve early recognition and management of ICI myocarditis in acute settings.

This was a retrospective, single-centre case series from a UK tertiary hospital with a specialist cardio-oncology multi-disciplinary team (MDT). Ten patients referred to the cardio-oncology MDT between March and August 2024 were included if diagnosed with myocarditis, pericarditis, or arrhythmias linked to ICI treatment. Clinical pathways were described using structured vignettes.

Seven patients had myocarditis, two pericarditis, and one bradyarrhythmia. Fatigue (57%) was the most common presenting symptom in myocarditis. Echocardiography was unremarkable in 86% of cases, while cardiac magnetic resonance imaging (MRI) confirmed myocarditis in 57%. N-terminal pro-B-type natriuretic protein (NT-proBNP) rose 17-fold from baseline compared with a four-fold rise in troponin T. Early MDT referral facilitated prompt diagnosis and treatment, while delayed recognition was associated with worse outcomes.

This case series highlights the importance of early MDT involvement, and the utility of additional cardiac biomarkers, such as NT-proBNP. It provides practical guidance to improve the acute care pathway for patients developing ICI-associated cardiac toxicities.

Cardiovascular medicine is undergoing transformation driven by machine learning (ML) technologies.¹ Algorithms now assist in imaging interpretation, electrocardiogram (ECG) analysis, and outcome prediction, with increasing sophistication.^1,2 The adoption of ML-powered diagnostic tools in cardiology is growing, yet training programmes remain largely unchanged, creating a disconnect between skills taught and those required in contemporary practice.^1–4

Despite rigorous clinical preparation, many cardiology trainees complete their education with insufficient knowledge of the ML technologies increasingly present in clinical workflows.^5,6 As these applications become more prevalent, training programmes must integrate relevant ML education to ensure cardiologists can effectively evaluate, implement, and collaborate with artificial intelligence (AI) systems, rather than merely function as passive end-users of increasingly sophisticated technology.

We evaluated the usability of a novel 2-in-1 blood pressure (BP) and electrocardiogram (ECG) monitor (developed to facilitate earlier detection of hypertension and atrial fibrillation). Arrhythmia clinic patients and public volunteers were recruited. Key themes were generated from semi-structured interviews.

Patients (n=12) found the experience of measuring ECG and BP equally positive. Public volunteers (n=11) found BP measurement a more positive experience compared with ECG recording. Several key themes were generated: patient empowerment, investment in health, technical know-how, user requirements and ergonomics.

In conclusion, the 2-in-1 BP and ECG monitor received overall positive reviews, showcasing the device’s potential to enhance patient care in the management of hypertension and atrial fibrillation.

Syncope, as a symptom, remains poorly understood and handled in the UK. Personal involvement stemmed from successful abolition of syncope by cardiac pacing, initially in atrioventricular block then other bradycardias; UK facilities were sparse in the late 1970s. The aim was to broaden distribution and encourage understanding. To achieve this required abandoning the typical cardiology mindset and re-engaging with internal medicine. Syncope is poorly taught in medical schools, which implies that few physicians understand it and, therefore, cannot practise it to benefit patients. Syncope patients presenting in emergency departments (>1% of all) are frequently admitted to hospital to undergo numerous non-diagnostic tests, then discharged without diagnosis. Syncope has life-threatening causes in >1% of patients; given its prevalence, this represents a large number. Treatment is now possible.

Syncope science has notably advanced, offering valuable diagnostic and therapeutic strategies. Ubiquitous delivery in the UK requires a new approach, which has been applied in the Netherlands. Now, more than ever, is the time to take syncope seriously, with action now to address this critical situation.

Every week, patients present to emergency departments (EDs) following an episode of transient loss of consciousness (TLoC) due to syncope. It is common, affecting 40% of the population, and it constitutes 1–3% of ED visits and up to 6% of all hospital admissions.^1,2 The US Society for Academic Emergency Medicine – Guidelines for Reasonable and Appropriate Care in the Emergency Department (SAEM GRACE) review found that among ED patients, up to 50% remain undiagnosed after initial evaluation, that hospitalisation rates were highly variable, and approximately one-third of admitted patients are discharged without a definite diagnosis.³ Along with this, patients are subjected to unnecessary investigations, which contribute to escalating healthcare costs.⁴

Syncope is common, disabling, and, if mismanaged, potentially dangerous, both in terms of missed diagnoses or needless and harmful stays in hospital. Yet across health systems, it continues to fall between the cracks. It is time to build bridges: connecting emergency care, cardiology, neurology, geriatrics and acute medicine, through cohesive pathways that are early, equitable, efficient, and delivered by experts.

As Sutton and de Lange remind us, syncope is a symptom, not a diagnosis, and must be taken seriously.⁵ It should no longer be the orphan condition with no home. Despite not belonging in one specialty, a coordinated approach and collaboration should be forged between specialties.

This article won first prize in the recent British Junior Cardiologists’ Association (BJCA) essay competition.

Ischaemic heart disease remains the number one cause of mortality worldwide, with chest pain being one of the most common presentations to both primary care and cardiology services. Suspected angina referral pathways have become well established within NHS practice through rapid access chest pain clinics (RACPC), allowing prompt specialist assessment. While the expansion of access to noninvasive imaging has significantly enhanced risk stratification and management of patients with obstructive coronary artery disease (CAD), questions remain about the suitability of this rule-in/rule-out approach for all individuals referred to RACPC.

There is a high prevalence of frailty in people with heart failure, chronic kidney disease, type 2 diabetes, and multiple long-term conditions. These groups are eligible for treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i), with numerous large-scale trials demonstrating favourable clinical outcomes spanning disease states. There are now increasing data that the benefits of these agents are consistent across all frailty severities and are well tolerated. However, real-world data suggest a hesitancy in SGLT2i use in those with frailty. As a result, SGLT2i are either not initiated or discontinued inappropriately in people with frailty who are likely to derive benefit from these agents. This review critically evaluates current evidence and clinical guidelines for SGLT2i use in people with frailty, addressing safety concerns and offering practical recommendations for clinical practice.