2021, Volume 28, (online first)

February 2021

News from the BSH 23rd Annual Autumn Meeting: 2020 vision for heart failure

New perspectives in heart failure management and the development of the multidisciplinary workforce was the focus of the 23rd Annual Autumn Meeting of The British Society for Heart Failure (BSH) ‘2...

August 2021

BJC and HaemSTAR announce new partnership

We are delighted to announce a media partnership between the British Journal of Cardiology (BJC) and HaemSTAR, which is a UK-wide network of passionate UK Clinical Haematology registrars.

September 2021 Br J Cardiol 2021;28(4) doi:10.5837/bjc.2021.041

Post-stenting angiographically silent coronary dissection: OCT comes to the rescue

Roopali Khanna, Anindya Ghosh, Ankit Kumar Sahu, Pravin K Goel


Stent edge dissection is one of the procedural complications concerning percutaneous coronary intervention (PCI). We present a clinical case of multi-vessel PCI where the patient had to return with recurring symptoms within two weeks of a seemingly successful PCI, only to teach us a valuable lesson in the more frequent and judicious use of intracoronary imaging....

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October 2021 Br J Cardiol 2021;28(4) doi:10.5837/bjc.2021.046

Loperamide-induced ventricular tachycardia storm

Mohamed Daoub, Philippa Cawley, Jonathan Sahu


Loperamide is an over-the-counter, peripherally-acting, µ-opioid receptor agonist commonly used in the treatment of diarrhoea. It has increasingly been recognised as a potential drug of misuse, having previously been thought to have low potential for abuse owing to its low bioavailability and poor penetration of the central nervous system. High doses can result in life-threatening cardiac-toxicity. We present a case of a young woman who had been self-treating her depression with high doses of loperamide for one year, who then presented to hospital with syncope secondary to ventricular tachycardia (VT). While in the emergency department (ED) the patient had monomorphic pulseless VT requiring electrical cardioversion multiple times. Transfer to a tertiary cardiac centre was immediately arranged after she was stabilised and intubated. This complicated the diagnostic process as a thorough history could not be obtained on arrival to the tertiary centre, which meant the loperamide misuse only came to light multiple days into admission, after the patient was extubated. The final diagnosis of loperamide-induced secondary long-QT syndrome was made and the patient made a full recovery....

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October 2021 Br J Cardiol 2021;28(4) doi:10.5837/bjc.2021.045

Correspondence: Burden of coronary heart disease in Nepal – current status

Arun Kadel, Binay Kumar Rauniyar, Neeti Bhat


Burden of coronary heart disease in Nepal: current status Dear Sirs, As a part of an epidemiological shift from communicable to non-communicable diseases (NCDs), Nepal is facing a major burden of coronary heart disease (CHD).1,2 By 2025, the Government of Nepal (GoN) has pledged to reduce cardiovascular disease (CVD)-related mortality by 25% and manage 50% of eligible patients for ischaemic heart disease (IHD)-related treatment. A multi-sectoral action plan was developed in 2014, targeting behavioural and physiological risk factors to reduce “preventable morbidity, avoidable disability and premature death”.3 The sluggish progress of the dilapidated health system of Nepal puts it off course to achieve this....

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October 2021 Br J Cardiol 2021;28(4) doi:10.5837/bjc.2021.044

Analysis of the trend in community prescribing of RAAS inhibitors during the COVID-19 pandemic

Layla Guscoth, Sam Hodgson


The coronavirus disease 2019 (COVID-19) pandemic has sparked novel research and insights, but also concerns and anxiety regarding established practices. Early into the pandemic, public and scientific concern was raised regarding the role of renin–angiotensin–aldosterone system (RAAS) inhibitors on the susceptibility to COVID-19 given their effect on angiotensin-converting enzyme 2 (ACE-2), the host receptor for the virus. This gathered media attention globally, despite several health boards encouraging the ongoing use of these medications. We aimed to investigate whether, despite advice supporting continued use of these medications, there was a change in prescribing practices for RAAS inhibitors in general practice. Data were collated from the NHS digital platform, which provides monthly practice-level prescribing information for all primary care practices in England. We performed an interrupted time-series analysis on national-level prescribing data comparing time-series coefficients pre- and post-March 2020 with metformin used as a control. We find that from March to December 2020, prescribing rates of RAAS inhibitors were reduced relative to the previous time-series trend. This finding persisted after adjustment for rates of metformin prescription. This suggests that there was a change in prescribing behaviour during the COVID-19 pandemic, which may be linked to the public and scientific concerns during this time....

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October 2021 Br J Cardiol 2021;28(4) doi:10.5837/bjc.2021.043

Pain during cardiac implantable electronic device implantation

David G Wilson, Nicki Brewster, Robin J Taylor, Amelia Trevelyan, Michail Apostolakis, Deepak Goyal, Will Foster, Elaine Walklet, Eleanor Bradley


In order to evaluate the extent and causes of pain during cardiac implantable electronic device (CIED) implantation in our hospital, a prospective audit over a 23-month period using a patient self-reporting questionnaire was undertaken. In total, 599 procedures were reported, 52.9% for de novo pacemaker implantation and 23.4% for high-energy devices (cardiac resynchronisation therapy defibrillator [CRT-D], implantable cardiac defibrillator [ICD], subcutaneous ICD). Overall, the median pain score was 2/10 (interquartile range 2–4). In total, 61.6% (367/599) reported no pain or mild pain (pain scores 0–3/10), 27.7% (165/599) reported moderate pain (pain score of 4–6/10) and 10.7% (64/599) reported severe pain (pain score of 7–10/10) during the procedure. Significant pre-implant worry (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.22 to 3.73) and higher lidocaine doses (OR 1.06, 95%CI 1.00 to 1.11) were associated with severe patient-reported pain. In conclusion, most patients underwent CIED implantation with minimum stress and maximum comfort. An important minority reported severe pain during the procedure. Optimising surgical technique and interventions targeted at reducing pre- and peri-implant worry, particularly in women, and especially in those receiving ICDs, warrants further investigation to reduce patient-reported pain during CIED implantation....

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October 2021 Br J Cardiol 2021;28(4) doi:10.5837/bjc.2021.042

Quality of life among people with atrial fibrillation with and without diabetes: a comparison study

Angela Hall, Andrew Robert John Mitchell, Lisa Ashmore, Carol Holland


Quality of life (QoL) is an essential consideration when managing the wellbeing of patients and assists in interpretation of symptoms, functional status and perceptions. Atrial fibrillation (AF) and diabetes demand significant healthcare resources. Existing data demonstrate a negative impact on QoL as individual conditions, but there is less evidence relating to the impact of these disease groups in combination. This study therefore explores QoL in patients with AF and diabetes. This cross-sectional, observational study required participants to complete the short form (SF)-36 survey via an online platform and was offered to people affected by AF alone and people with AF and diabetes in combination. The SF-36 provides a prevalidated tool with eight domains relating to physical and psychological health. A total of 306 surveys were completed (231 AF group, 75 AF and diabetes group). The mean and standard deviation (SD) were calculated for each QoL domain, after re-coding in accordance with SF-36 guidance. Multi-variate analysis of variance (MANOVA) demonstrated an overall significant difference between the groups when considered jointly across all domains. There were significant differences between AF and AF with diabetes QoL responses in physical functioning, energy fatigue, emotional wellbeing, social functioning and pain. In these domains, the mean was highest in the AF group. There were no significant differences in the role physical, role emotional and general health domains. In conclusion, this study demonstrates that diabetes and AF has a more detrimental effect on QoL than AF alone, in the majority of domains. Further research into the general AF population and where chronic conditions co-exist is important to comprehend the true impact this disease combination has on QoL....

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