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Hyperbaric oxygen therapy (HBOT) is successfully implemented for the treatment of several disorders. HBOT is a promising treatment modality for coronary artery disease (CAD), where outcomes are frequently poor despite early revascularisation. The aim of this study is to investigate the effect of HBOT on the left ventricular function of patients with CAD after reperfusion.

Electronic journal searching was performed in PubMed, ScienceDirect, and Cochrane to find studies that investigate the effect of HBOT on the myocardial function of patients with CAD. The primary outcomes were left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF). Meta-analyses were performed on included studies and mean differences (MD) and 95% confidence intervals (CI) were estimated using Review Manager v5.4.

A total of three observational studies enrolling 195 participants were included in our analysis. HBOT significantly increased LVEF by 4.16% in patients with CAD after revascularisation compared with non-HBOT (MD=4.16, 95%CI 0.97 to 7.34, p=0.01). There was no statistical significance observed in the HBOT versus non-HBOT comparison on LVEDV (MD=–1.63, 95%CI –6.52 to 3.26, p=0.51) and LVESV (MD=–1.58, 95%CI –4.06 to 0.90, p=0.21).

In general, this meta-analysis shows HBOT significantly increased LVEF in patients with CAD after revascularisation compared with non-HBOT. There were no significant changes in LVEDV and LVESV in the HBOT group and non-HBOT group.

Heart failure (HF) is a highly prevalent long-term condition, with variation in services and resources across the UK. This report provides findings from a cross-sectional survey of community HF services in the UK between September 2021 and February 2022.

Eighty-five responses describing community HF services were received. Community services were primarily led by a HF specialist nurse (HFSN), with a median of 1.25 cardiology consultants with HF training, and a variety of other nurses and support workers. All services reviewed patients with HF with reduced ejection fraction (HFrEF), only 58% reviewed patients with HF with preserved ejection fraction (HFpEF). Median wait time was 20 days, with substantially longer waits in many areas. All services accepted referrals from multiple sources. Most services provided admission avoidance (96.5%), post-discharge checks (87%), pharmacological optimisation (99%), ongoing monitoring (82%) and palliative care (87%).

In conclusion, UK community-based HF teams provide many services, however, there is significant geographical variation. Studies are needed to determine if they are adequately resourced to meet population needs and improve patient outcomes.

Acute coronary syndromes (ACS) are common in patients with end-stage renal disease (ESRD). Diagnosis may be challenging given diverse symptomatology, absence of classical symptoms on presentation, and difficulties in the interpretation of biomarkers. Morbidity and mortality in this patient population remain high compared with patients with normal renal function, partly due to a lack of evidence for optimal management. This review presents a summary of the diagnostic features and early management of ACS in patients with ESRD on haemodialysis.

Acute coronary syndrome (ACS) events in people receiving long-term haemodialysis (HD) are common, present atypically and are associated with poor outcomes.^1–3 Diagnosis is challenging, and treatment even more so. The complexity of this population drives their exclusion from clinical trials, resulting in a scarcity of evidence supporting any ‘optimal’ treatment strategy.⁴ Guidelines are, as a result, vague and, to a degree, contradictory.^5–7 These are some of the reasons that the combination of cardiac and renal disease strike fear into even the most seasoned clinicians. Is it this fear that underlies the observed conservatism in treatment of those with advanced chronic kidney disease (CKD), and are we, therefore, contributing inadvertently to the adverse outcomes we are simultaneously striving to avoid? I commend Muhammad Haider and colleagues for tackling this challenging area, and attempting to summarise our knowledge in their review: “Diagnosis and management of ACS in patients with ESRD on haemodialysis: a comprehensive review”.⁸

This review provides information about the current evidence-base for screening for atrial fibrillation (AF). The current burden of AF and recommendations related to AF screening are discussed, and randomised-controlled trial evidence for AF detection, clinical outcomes, harms and cost-effectiveness of population-based AF screening are reviewed. Finally, novel methods to refine the population to whom AF screening should be offered, which may improve clinical and cost-effectiveness, are considered.

Coronary artery spasm (CAS), or Prinzmetal angina, is a recognised cause of myocardial ischaemia in non-obstructed coronary arteries which typically presents with anginal chest pain. This case report describes an atypical presentation of CAS in a 68-year-old white British male with cardiovascular risk factors. The patient presented with recurrent palpitations and pre-syncope, with no chest pain. Ambulatory electrocardiography (ECG) monitoring revealed recurrent polymorphic ventricular tachycardia (PMVT). Coronary angiography identified moderate stenosis of the right coronary artery (RCA), without significant flow restriction by invasive pressure wire interrogation.

Inpatient monitoring revealed episodes of recurrent PMVT coinciding with transient inferior ST elevation and a distinct ‘shark fin’ waveform, indicating dynamic RCA occlusion. The arrhythmias persisted despite initial medical management, including calcium channel blockers and intravenous glyceryl trinitrate. Percutaneous coronary intervention to the moderate RCA lesion was performed, which definitively treated the arrhythmias.

This case emphasises the importance of recognising plaque-associated CAS as a potential trigger for life-threatening arrhythmias, even in the absence of chest pain. While medical therapy remains first-line treatment, life-threatening presentations may necessitate invasive interventions to stabilise the patient and prevent recurrence.

Pericardial cyst is a rare diagnosis, mainly considered a congenital condition. Most patients with pericardial cysts present without symptoms. Symptomatic presentation often relates to the size and location of the pericardial cyst. We report a case of a 49-year-old man who presented with subacute breathlessness in which the diagnosis of a pericardial cyst was made following various investigations – from transthoracic echocardiography and computed tomography scan to video-assisted thoracoscopic surgery biopsy, upon which a histological diagnosis was made. This case report reviews and discusses the available literature on the epidemiology and potential presenting features of a pericardial cyst, and the current recommended assessment and management strategies thereof. This case highlights the importance of effective multidisciplinary communication and joint input towards clinical decision-making, particularly in complex scenarios, to achieve optimal patient outcomes.

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

Though a rare condition, acute type A aortic dissection (ATAAD) is associated with high morbidity and mortality; hence, timely diagnosis and surgery are important to reduce the risk of mortality. If the dissection extends into the aortic arch branches, ensuring adequate cerebral perfusion during surgery is crucial to preventing stroke.

A 50-year-old man presented to the emergency department with symptoms of acute chest pain, dizziness, and headache. His blood pressure was 180/110 mmHg and heart rate was 100 bpm. He had a high blood pressure and heart rate and was initially treated with glyceryl trinitrate. Initial investigations ruled out acute coronary syndrome. Further investigations revealed ATAAD with the involvement of arch branches, an incomplete (open) circle of Willis and cerebral malperfusion. He was prepared for a branch-first total aortic arch replacement. Due to the high risk of stroke in this patient, off-pump axillo-axillary bypass (adaptive perfusion technique) was used to ensure bihemispheric cerebral perfusion throughout the surgery. The surgery was uneventful, and the patient was discharged 12 days later. Postoperative follow-up at six months was normal.

In conclusion, ATAAD is a surgical emergency that can mimic other acute thoracic conditions, such as pulmonary embolism and acute coronary syndrome; therefore, a judicious approach should be applied in the diagnosis and early management of symptoms. The reconstruction technique should be tailored to the patient’s needs; as this patient had a poorly functioning circle of Willis and cerebral hypoperfusion, continuous bilateral cerebral perfusion was essential to prevent irreversible cerebral ischaemic insult. The adaptive technique is easy to learn for surgeons who are already proficient in aortic dissection procedures, it is reproducible and requires only minor changes to the surgical setup without any substantial increase in operative time. Adoption of this technique in other surgical centres could be beneficial in increasing the success rate for the treatment of ATAAD.