December 2018 Br J Cardiol 2018;25:140–2 doi: 10.5837/bjc.2018.031
Toby Flack, Jamie Fulton
Postural orthostatic tachycardia syndrome (PoTS) can be defined as tachycardia with or without hypotension in the upright posture, and more comprehensively as a manifestation of a wider dysautonomia. The scope of this article is to characterise patients with PoTS and look at patient-rated responses to treatment.
This research comprised a postal survey, sent to patients with diagnosed PoTS at a tertiary hospital in Southwest England. We collected data on the demographics of patients, time to diagnosis, methods of diagnosis, treatments and response to treatment.
PoTS has an impact on quality of life, with patients communicating a drop in quality of life from 7.5 to 3.75 on a 10-point scale. From 40 respondents, 29 patients describe their symptoms improving since diagnosis, with self-rated day-to-day function improving from 3.21 to 6.14 (on a 10-point scale) after initiating treatment.
Many patients experience a delay in receiving a diagnosis with PoTS, and present multiple times to a variety of healthcare professionals. With a simple bedside diagnostic test (sitting and standing heart rate), there is scope to improve the time taken from developing initial symptoms to diagnosis, treatment and an improvement in quality of life.
December 2018 Br J Cardiol 2018;25:152–6 doi: 10.5837/bjc.2018.032
Telal Mudawi, Mohamed Wasfi, Darar Al-Khdair, Muath Al-Anbaei, Assem Fathi, Nikolay Lilyanov, Mohammed Elsayed, Ahmed Amin, Dalia Besada, Waleed Alenezi, Waleed Shabanh
Thrombus aspiration during primary percutaneous coronary intervention (PCI) has been extensively studied. Conflicting results have consistently emerged, hence, no clear guidance has been produced. The authors have examined several key clinical trials and meta-analyses, and discovered, arguably, major flaws within the designs of most trials, thus, accounting for the persistently discordant results. The authors conclude that there is some evidence to support the selective use of thrombectomy in primary PCI but a large-scale trial with the appropriate patient selection criteria is needed in order to substantiate or refute the argument.
December 2018 Br J Cardiol 2018;25:159–60 doi: 10.5837/bjc.2018.033
Richard Armstrong, Kevin Walsh, David Mulcahy
Presentation of an interrupted aortic arch in adulthood is rare, and, up until, recently the only treatment strategy was through surgical repair. Advances in percutaneous interventions for congenital heart disease have included the percutaneous repair of coarctation of the aorta – from straightforward luminal narrowing through to full aortic interruption.1-3 We present a case of a 28-year-old man who was diagnosed with a complete aortic interruption and successfully percutaneously treated.
October 2018 Br J Cardiol 2018;25:147–9 doi: 10.5837/bjc.2018.026 Online First
Ijeoma Angela Meka, Williams Uchenna Agu, Martha Chidinma Ndubuisi, Chinenye Frances Onyemeh
Open-heart surgery is a major surgical procedure that requires intensive patient monitoring. Clinicians require prompt laboratory test results to assist them in this monitoring. Timeliness of result delivery is of great importance in taking prompt clinical decisions. We set out to evaluate the performance of the support laboratory before and after domiciliation at the cardiac centre using turnaround time (TAT) of electrolytes and liver function tests as benchmarks.
This hospital-based descriptive study was carried out at the University of Nigeria Teaching Hospital (UNTH), Enugu. The authors conducted a desk review of laboratory records for electrolytes and liver function tests from March 2013 to July 2017. Relevant laboratory personnel were also interviewed to ascertain types of equipment used and possible causes of delay at different stages of transition during the period under review. The TAT was calculated as the time from sample reception to time of dispatch of results.
Between 2013 and 2014, TAT for electrolytes and liver function tests were ~2 and ~6 hours, respectively. In 2015, TAT reduced to ~1 hour for electrolytes and ~1½ hours for liver function tests. Between 2016 and July 2017, TAT further reduced to ~10 minutes for electrolytes and ~30 minutes for liver function tests.
In conclusion, we were able to demonstrate improvement in performance of the support laboratory as shown by a reduction in TAT following the transition from the main laboratory to being domiciled in the cardiac centre.
October 2018 Br J Cardiol 2018;25:150–1 doi: 10.5837/bjc.2018.027 Online First
Mark G MacGregor, Neil Donald, Ayesha Rahim, Zara Kwan, Simon Wong, Hannah Sharp, Hannah Burkey, Mark Fellows, David Fluck, Pankaj Sharma, Vineet Prakash, Thang S Han
Myocardial perfusion scintigraphy (MPS) is a non-invasive method that can be used to assess reversible left ventricular myocardial perfusion defect (<20% indicates limited and ≥20% indicates extensive ischaemia), and left ventricular ejection fraction (LVEF) at rest and at stress. Data on the utility of MPS used to stratify cardiac risk prior to abdominal aortic aneurysm (AAA) repairs are limited. We evaluated MPS as a stratification tool for patients scheduled for endovascular aneurysm repair (EVAR) or open repair, between 2013 and 2016 at Ashford and St Peter’s NHS Foundation Trust, and 4.9 years (median 2.8 years, interquartile range [IQR] 2.1–3.8) cardiovascular events (n=15, 17.9%) all-cause mortality (n=17, 22.6%). Of the 84 patients recruited (median age 75.7 years, IQR 69.4–79.6), 57 (67.9%) had limited and 27 (32.1%) extensive ischaemia, 62 (73.8%) underwent EVAR and 22 (26.2%) open repair. Compared with open repair patients, EVAR patients were older (median age 70.6 years vs. 76.4 years, p=0.015), had higher rates of extensive ischaemia (13.6% vs. 38.7%, p=0.025), and abnormal LVEF reserve (LVEF at stress minus LVEF at rest ≤0: 40.0% vs. 76.6%, p=0.011), while having lower rates of 30-day postoperative major adverse cardiac events (13.6% vs. 3.3%, p=0.040) but no difference for cardiovascular events (p=0.179) or 4.9 year all-cause mortality (22.7% vs. 22.6%, adjusted hazard ratio 0.80, 95% confidence interval [CI] 0.22 to 3.20, p=0.799). Our findings indicate that MPS provides valuable information for AAA repair procedure.
MEETING REPORT Online First