March 2018 doi: 10.5837/bjc.2018.006
Anthony D Dimarco, Eunice N Onwordi, Conrad F Murphy, Emma J Walters, Lorraine Willis, Nicola J Mullan, Nicholas S Peters, Mark A Tanner
Palpitations are a common symptom leading to primary care consultation. Establishing a symptom-rhythm correlation is important for providing a diagnosis. The Kardia Mobile personalised smartphone electrocardiogram (ECG) can provide patient-driven real-time ECG recording over extended periods. We investigated if this device might provide an effective alternative to conventional ECG recorders as the first-line investigation of low-risk palpitations.
Patients referred to our institution for investigation of intermittent palpitations but without syncope were supplied with a Kardia Mobile device if they had access to a compatible smartphone. Patients were asked to record an ECG when symptomatic.
Between March 2015 and June 2016, 148 patients were issued with a Kardia Mobile: 113 (76.4%) patients made symptomatic recordings during this period. A symptom-rhythm correlation was possible for all patients who submitted downloads. Median time to diagnosis was nine days (1–287 days). Diagnoses were: sinus rhythm n=47 (41.6%), sinus tachycardia n=21 (18.6%), supraventricular/ventricular ectopics n=31 (27.4%), atrial fibrillation n=8 (7.1%), and supraventricular tachycardia n=6 (5.3%).
In conclusion, the Kardia Mobile diagnosed the cause of intermittent palpitations in the majority of patients referred for specialist evaluation. Use of the Kardia Mobile may permit patients with palpitations to be evaluated in primary care.
March 2018 doi: 10.5837/bjc.2018.007
Emma Johns, Gerry McKay, Miles Fisher
In this article we review the latest cardiovascular outcomes trials performed using older diabetes drugs.
March 2018 doi: 10.5837/bjc.2018.008
Wala Mattar, Christopher Walker, Shelley Rahman Haley, Andre Simon, Charles Ilsley
We present a patient with progressive aortic regurgitation that developed following successful implantation of a left ventricular assist device (LVAD). We were able to correct this known complication of LVAD by occluding the aortic valve percutaneously with an AmplatzerTM multi-fenestrated septal occluder – Cribriform. This is the first such case to be reported in the UK.
January 2018 doi: 10.5837/bjc.2018.001 Online First
Jonathan Bennett, Alexander R Lyon, Chris Plummer, Stuart D Rosen, Kai-Keen Shiu
This review aims to summarise the cardiovascular complications from cancer treatments and the methods used to prevent, identify, and treat them.
While the field of cardio-oncology is relatively new, it is developing rapidly in the UK. There is a need to develop services to care for the patients with current cardiac problems, to undertake research and education to identify those patients at higher risk of complications, and to apply modern imaging methods and biomarkers to detect problems early and implement prevention strategies. An evidence-based approach is required to enhance delivery of care and prevent cardiovascular toxicity in this patient population.
January 2018 doi: 10.5837/bjc.2018.002 Online First
Alison Carr, Fosca De Iorio, Martin R Cowie
Despite guidelines on the treatment of acute heart failure (AHF), treatment remains heterogeneous, particularly regarding intravenous (IV) nitrate use. This clinical decision-making study assessed the use of IV nitrates and diuretics by 40 UK hospital physicians, each ‘treating’ the same 10 virtual patients. Semi-structured interviews were performed to investigate participants’ decision-making rationale.
IV nitrates were prescribed in 37% of clinical decisions. Considerable variability was seen in the administration of IV nitrates among physicians. Interview data revealed polarised opinions regarding the efficacy of IV nitrates and the evidence base supporting their use. Physicians’ treatment decisions were more heavily influenced by their perceptions and beliefs regarding IV nitrates than by consideration of the evidence. In contrast, diuretics were prescribed more frequently (78%) and more consistently.
In conclusion, where there is a limited evidence base and no strong recommendation from clinical guidelines, prescribing behaviour for AHF therapies such as IV nitrates are likely to reflect variability in physicians’ beliefs, experiences, and decision-making styles.
MEETING REPORT Online First