2022, Volume 29, (online first)

April 2022 Br J Cardiol 2022;29:77–8 doi:10.5837/bjc.2022.014

Iatrogenic aortic dissection of the descending aorta after percutaneous coronary intervention

Kristen Westenfield, Shannon Mackey-Bojack, Yale L Wang, Kevin M Harris

Content

Aortic dissection is a rare and potentially fatal complication of coronary angiography. We report a case of a woman in her late 80s who underwent a left femoral approach coronary angiogram for evaluation of a transcatheter aortic valve replacement (TAVR). Following the procedure, she had a cardiac arrest and was found to have a descending aortic dissection on transoesophageal echocardiogram. Autopsy showed an acute intimal tear of the descending aorta, most likely related to catheter manipulation. Patients undergoing evaluation for TAVR, who tend to be elderly with concomitant atherosclerosis, are at risk for complications following cardiac catheterisation including aortic dissection....

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April 2022 Br J Cardiol 2022;29:67–72 doi:10.5837/bjc.2022.013

Angina with coronary microvascular dysfunction and its physiological assessment: a review with cases

Pitt O Lim

Content

Imagine that it is possible to know, the actual coronary blood flow. Would this not remove any doubt, if a chest pain is the heart’s fault?...

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April 2022 Br J Cardiol 2022;29:52–4 doi:10.5837/bjc.2022.012

Drive-by collection and self-fitting of ambulatory electrocardiogram monitoring

Mark T Mills, Sarah Ritzmann, Maisie Danson, Gillian E Payne, David R Warriner

Content

Ambulatory electrocardiogram (AECG) monitoring is a common cardiovascular investigation. Traditionally, this requires a face-to-face appointment. In order to reduce contact during the COVID-19 pandemic, we investigated whether drive-by collection and self-fitting of the device by the patient represents an acceptable alternative. A prospective, observational study of consecutive patients requiring AECG monitoring over a period of one month at three hospitals was performed. Half underwent standard (face-to-face) fitting, and half attended a drive-by service to collect their monitor, fitting their device at home. Outcome measures were quality of the recordings (determined as good, acceptable or poor), and patient satisfaction. A total of 375 patients were included (192 face-to-face, 183 drive-by). Mean patient age was similar between the two groups. The quality of the AECG recordings was similar in both groups (52.6% good in face-to-face vs. 53.0% in drive-by; 34.9% acceptable in face-to-face vs. 32.2% in drive-by; 12.5% poor in face-to-face vs. 14.8% in drive-by; Chi-square statistic 0.55, p=0.76). Patient satisfaction rates were high, with all patients in both groups satisfied with the care they received. In conclusion, drive-by collection and self-fitting of AECG monitoring yields similar AECG quality to conventional face-to-face fitting, with high levels of patient satisfaction....

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April 2022 Br J Cardiol 2022;29:55–9 doi:10.5837/bjc.2022.011

Marijuana: cardiovascular effects and legal considerations. A clinical case-based review

Saad Ahmad, Shwe Win Hlaing, Muhammad Haris, Nadeem Attar

Content

Though coronary artery disease primarily occurs in those over the age of 40 years, younger individuals who use recreational drugs may be afflicted with coronary events. Cannabis is one such perilous agent that can cause myocardial infarction (MI) and is one of the most common psychoactive drugs used worldwide. Cannabis (also known as marijuana, weed, pot, dope or grass) is the most widely used illegal drug in the UK. The desired euphoric effects are immediate, as are life-threatening hazardous ones. In this article, we briefly describe a case series of two unique but similar cases of cannabis-induced ST-elevation MI witnessed at our hospital in quick succession. We will analyse the composite pathophysiology in acute coronary syndromes provoked by cannabis and discuss the evolving legality around the use of the drug....

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May 2022 Br J Cardiol 2022;29(2)

BSH position statement on heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) is an increasingly recognised form of heart failure that has been described as an emerging epidemic. It presents many challenges to patients, ...

June 2022 Br J Cardiol 2022;29(3) doi:10.5837/bjc.2022.022

The protracted path to untethered mechanical circulatory support: always the future or reality soon?

Jignesh K Patel

Content

Significant pharmacologic, interventional and surgical strategies in the management of coronary syndromes, together with evolving surgical and non-surgical innovations for valvular disease and improved care of congenital heart disease, have ensured that patients live longer and better lives. With these advancing therapies for cardiac disease, the number of patients surviving to develop end-stage heart failure continues to increase exponentially. While the heart as an organ has evolved to demonstrate remarkable resilience in the setting of disease, death from cardiovascular causes remains the most common cause of death in many parts of the world. Given the significant morbidity and mortality associated with end-stage heart failure, the last half century has been notable for a concentrated effort on developing therapies for the failing heart. In this issue, Professor Stephen Westaby (see https://doi.org/10.5837/bjc.2022.021) provides an insightful personal perspective on a laudable life-long pursuit in the development of mechanical circulatory support with the ultimate goal of a fully implantable device. His long career has been punctuated by a number of seminal achievements, which have led to incremental improvements in a challenging area....

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June 2022 Br J Cardiol 2022;29(3) doi:10.5837/bjc.2022.021

Evolution of a circulatory support system with full implantability: personal perspectives on a long journey

Stephen Westaby

Content

Implantable mechanical circulatory support systems have evolved dramatically over the last 50 years. The objective has been to replace or support the failing left ventricle with a device that pumps six litres of blood each minute, a massive 8,640 litres per day. Noisy cumbersome pulsatile devices have been replaced by smaller silent rotary blood pumps that are much more patient friendly. Nonetheless, the tethering to external components, together with the risks of power line infection, pump thrombosis and stroke, must be addressed before widespread acceptance. Infection predisposes to thromboembolism, so elimination of the percutaneous electric cable has the capacity to transform outcomes, reduce costs and improve quality of life. Developed in the UK, the Calon miniVAD is powered by an innovative coplanar energy transfer system. As such, we consider it can achieve those ambitious objectives....

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July 2022 Br J Cardiol 2022;29(3) doi:10.5837/bjc.2022.026

High-output heart failure due to arteriovenous malformation treated by endovascular embolisation

Federico Liberman, Roberto Cooke, María J Cabrera, Santiago Vigo, Guillermo Allende, Luciana Auad, Juan P Ricarte-Bratti

Content

High-output heart failure (HF) is an uncommon condition. This occurs when HF syndrome patients have a cardiac output higher than eight litres per minute. Shunts, such as fistulas and arteriovenous malformations are an important reversible cause. We present the case of a 30-year-old man who presented to the emergency department due to decompensated HF. Echocardiogram showed dilated myocardiopathy with high cardiac output (19.5 L/min calculated on long-axis view). He was diagnosed with arteriovenous malformation by computed tomography (CT) and subsequent angiography, and a multi-disciplinary team decided to perform endovascular embolisation with ethylene vinyl alcohol/dimethyl sulfoxide at different times. The transthoracic echocardiogram showed a significant decrease in cardiac output (9.8 L/min) and his general condition improved significantly....

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July 2022 Br J Cardiol 2022;29(3) doi:10.5837/bjc.2022.025

Infective endocarditis: acne to zoonoses on the valve, an A to Z perspective

Mark Boyle, Charlene Tennyson, Achyut Guleri, Antony Walker

Content

Cutibacterium acnes (C. acnes), previously known as Propionibacterium acnes, is a rare cause of infective endocarditis (IE). We provide a review of the literature and describe two recent cases from a single centre to provide insight into the various clinical presentations, progression and management of patients with this infection. The primary objective of our review is to highlight the difficulty in the initial assessment of these patients with an aim to improve the time and accuracy of diagnosis and expedite subsequent treatment. There are currently no guidelines in the literature specific to the management of IE caused by C. acnes. Our secondary objectives are to disseminate information about the indolent course of the disease and add to the growing body of evidence around this rare, yet complex, cause of IE....

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July 2022 Br J Cardiol 2022;29(3) doi:10.5837/bjc.2022.024

Pain after pacemaker/ICD implants

Selwyn Brendon Goldthorpe

Content

A retrospective study of 322 patient experiences of post-operative pain, short term and long term, following a cardiac implantable electronic device (CIED) procedure. Pain from pacemaker and ICD (implantable cardioverter-defibrillator) implant surgery remains a problem both in terms of severity and longevity. There is a subset of patients receiving implants that have severe pain that may be of a long duration. Patient advice needs to be appropriate to these findings. This study illustrates a need for better pain management by physicians, support, and realistic communication with their patients....

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July 2022 Br J Cardiol 2022;29(3) doi:10.5837/bjc.2022.023

Age and the power of zero CAC in cardiac risk assessment: overview of the literature and a cautionary case

John P Sheppard, Suvasini Lakshmanan, Seth J Lichtenstein, Matthew J Budoff, Sion K Roy

Content

The coronary artery calcium (CAC) score is a marker of advanced coronary atherosclerosis. Numerous prospective cohorts have validated CAC as an independent marker that improves prognostication in atherosclerotic cardiovascular disease (ASCVD) beyond traditional risk factors. Accordingly, CAC is now incorporated into international cardiovascular guidelines as a tool to inform medical decision-making. Particular interest concerns the significance of zero CAC score (CAC=0). While many studies report CAC=0 to virtually exclude obstructive coronary artery disease (CAD), non-negligible rates of obstructive CAD despite CAC=0 are reported in certain populations. Overall, the current literature supports the power of zero CAC as a strong downward risk classifier in older patients, whose CAD burden predominantly involves calcified plaque. However, with their higher burden of non-calcified plaque, CAC=0 does not reliably exclude obstructive CAD in patients under 40 years. Illustrating this point, we present a cautionary case of a 31-year-old patient found to have severe two-vessel CAD despite CAC=0. We highlight the value of coronary computed tomography angiography (CCTA) as the gold-standard non-invasive imaging modality when the diagnosis of obstructive CAD is in question....

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