2025, Volume 32, Issue 2, pages 41–80

You are a cardiology trainee (or you want to be one) and you’re contemplating your future career development. You’ve just noticed that cardiology is on the competitive side, and you want to maximise your chances of getting ahead. You light on the idea that you might do some research, get some publications, and that this might stand you in good stead for the future. Well …

From the outside, it might seem that research is quite glamorous – flying to conferences in exotic places, wining and dining with the great and the good, delivering lectures to rapt audiences in large halls … sadly, the reality is quite different, particularly at an early stage in research.

The sixteenth-century French surgeon Ambroise Paré remarked, “aneurysms which happen in the internal parts are incurable”,^1,2 underscoring the historical challenges of managing aortic disease. Frank Nicholls’ autopsy report of King George II of England (1760) was the first to describe aortic arch dissection.³ It was not until 1944 that Crafoord and Nylin reported the first end-to-end aortic anastomosis for coarctation resection,⁴ and shortly after, Gross set the stage for rapid aortic repair advancements by replacing a coarctation segment with an arterial homograft.⁵

In 1952, Cooley and DeBakey utilised homografts for thoraco-abdominal aortic aneurysm repair,⁶ and by 1954 they introduced aortic dissection surgery. In 1957, homografts had been used to replace ascending aorta⁷ and arch.⁸

During the 1970s, Crawford pioneered thoraco-abdominal aneurysm repair, employing an anatomic endovascular graft-inclusion technique. His innovations improved early survival rates, achieving a remarkable 92%.⁹ Rather than fully resecting the aneurysm, the retained aneurysmal wall was wrapped around the replacement graft. In contemporary practice, open aortic repair remains the standard of care for the majority of patients.

For more than 30 years, Cardiac Risk in the Young (CRY) has been at the forefront of efforts to prevent sudden cardiac deaths in young people. Established in 1995, CRY has transformed the landscape of cardiac screening, research, and bereavement support in the UK and beyond. Through pioneering research, large-scale screening initiatives, and raising awareness, CRY has saved lives, supported affected families, and driven critical policy changes. This article explores CRY’s impact over the past three decades and its continuing efforts to prevent young sudden cardiac death (YSCD).

Cardiac rehabilitation (ExCR) is an essential, evidence-based part of the management of people with chronic heart failure (CHF), but research indicates it is underused. This retrospective audit explores the eligibility of heart failure inpatients for ExCR, according to the European Society of Cardiology (ESC) consensus statement, and the impact of frailty on referral rates.

The first 100 patients admitted with a diagnosis of CHF from 1 February 2020 within one hospital trust were included in the audit. Only 54% of patients were eligible for ExCR at discharge and, of them, 43% were referred. Most patients (69%) admitted to cardiology wards were eligible for ExCR compared with 14% of those admitted to non-specialist care. Frail patients were less likely to be admitted to cardiology wards (43%) than their non-frail counterparts (93%).

Not all patients admitted to hospital with heart failure are eligible for ExCR, and assessing eligibility is important in identifying the true referral rate to allow national benchmarking. Interventions to improve referral are still important, but focus also needs to be directed to developing interventions for those individuals currently not eligible for standard ExCR programmes.

Myocardial fibrosis is a common pathological process associated with various cardiovascular diseases, contributing to adverse cardiac remodelling and increased morbidity. Angiotensin-converting enzyme inhibitors (ACEi) have been widely used for myocardial protection in high-risk patients. However, there are no clear recommendations for their use for the prevention of fibrosis after myocardial injury. On the other hand, procollagen type III amino-terminal propeptide (PIIIP) and procollagen type I propeptide (PIP) have been identified as effective biomarkers for predicting fibrotic change in the myocardium. It is important to evaluate the effects of ACEi by PIIIP and PIP levels to provide insights into the potential antifibrotic effects of ACEi.

We assessed the effects of ACEi on the process of fibrosis in the myocardium through serum levels of PIIIP and PIP. Four databases were searched to identify relevant studies investigating the association between the use of ACEi and myocardial fibrosis marked by PIIIP and PIP levels. Animal and non-original research articles were excluded.

Six studies with a total of 706 participants met the inclusion criteria. Three studies assessed the change of PIIIP and PIP levels in patients with hypertension, while the other three were in patients with heart failure, myocardial infarction and congenital heart diseases. The included studies demonstrated a significant reduction in PIIIP and PIP serum levels with ACEi therapy (p<0.05), except in patients with post-myocardial infarction. The mean reduction in serum PIIIP levels in all patients treated by ACEi was 20.8%.

These results suggest that ACEi can effectively inhibit collagen synthesis and deposition in the myocardium, potentially preventing, or even reversing, the progression of myocardial fibrosis. This supports the idea that ACEi have potent antifibrotic effects and can contribute to improved clinical outcomes in cardiac conditions that are not currently indicated, including myocarditis.

This case report describes a young man in his early thirties with insulin-dependent diabetes mellitus and ulcerative colitis, who developed acute myocardial infarction (AMI) during an acute flare-up of ulcerative colitis. The case highlights the diagnostic and therapeutic challenges involved in managing AMI in patients with systemic inflammatory diseases and metabolic conditions. The patient was successfully treated with a combination of thrombectomy and a drug-eluting balloon procedure for coronary occlusion, along with pharmacotherapy consisting of intravenous steroids, intravenous glycoprotein IIb/IIIa inhibitor and the involvement of a multi-disciplinary team of cardiologists and gastroenterology specialists. This case underscores the need for an integrated care approach, aggressive cardiovascular risk management, and interdisciplinary collaboration to optimise outcomes in complex clinical scenarios where systemic inflammation intersects with cardiovascular events.

Severe mitral regurgitation (MR), when complicated by a co-existing lung abscess, is a management challenge, as both conventional cardiac and thoracic surgical interventions may be contraindicated. In the case described below, transcatheter edge-to-edge mitral valve repair (TEER) was utilised to achieve haemodynamic stability, permitting subsequent thoracic surgical lung abscess resection.

We report the case of a 60-year-old man with torrential MR secondary to chordal rupture presenting with recurrent pulmonary oedema, complicated by lung sepsis and abscess formation resistant to antibiotic therapy and precluding open valvular repair. The presence of a lung abscess contraindicated open mitral valve repair, and the severity of MR precluded thoracic surgical treatment of the lung abscess, precluding any form of surgical intervention.

A successful TEER procedure resulted in a reduction of MR from severe to no more than mild-to-moderate, enabling haemodynamic stabilisation and permitting subsequent thoracic surgical treatment of the lung abscess.

Our case demonstrates the possibility of treating severe MR with TEER in the presence of a lung sepsis and abscess, when both conventional cardiac and thoracic surgical interventions were considered contraindicated. This later enabled thoracic surgery and treatment of the lung abscess.

A 79-year-old woman presents to the hospital with dyspnoea, fever, and hypotension, and is diagnosed with community-acquired pneumonia and septic shock. Resuscitation is initiated with fluids and vasopressors, and a central venous catheter is placed. However, during the procedure, the guide experiences resistance and cannot be removed, becoming trapped. This is confirmed with tomography and reconstruction, demonstrating intravascular position. The patient is then sent to interventional cardiology for extraction, which is successfully performed using the EN Snare (Merit Medical). The significance of this case lies in the complications of not guiding procedures with ultrasound and how to resolve them, such as the guide being trapped in this patient.

Sudden cardiac death (SCD) is a devastating and tragic occurrence that may affect individuals of all ages. It is defined as an unexpected death occurring within one hour of the onset of symptoms, if witnessed, or within 24 hours of last being seen alive and well, if unwitnessed. Athletes are considered to be the healthiest of all the population, and exercise is known to reduce the risk of atherosclerotic coronary artery disease. However, both amateur and highly trained athletes do die suddenly and unexpectedly, and this gets widespread media attention as it is so shocking and unexpected. This brings SCD, its frequency and causes into the spotlight. This review focuses on the epidemiology and aetiology of SCD in athletes from a pathological perspective.

We performed a cross-sectional study to determine the frequency of use of proton-pump inhibitors (PPIs) in acute coronary syndrome (ACS) patients on dual antiplatelet therapy (DAPT) within 24 hours of hospital admission, and their effectiveness in reducing bleeding complications.

This cross-sectional study included a total of 83 patients admitted via the medical take to Queen Elizabeth Hospital, Lewisham and Greenwich Trust (LGT), London, with ACS from May 2022 to June 2022. The data of these patients were analysed to see whether ACS patients on DAPT were given PPIs within 24 hours of their hospital admission. These patients were further assessed for any bleeding event during their hospital admission and its association with the prescription of PPIs.

A significant number of ACS patients (26, 32.1%) were not prescribed PPIs within 24 hours of hospital admission. However, 55 (67.9%) patients were prescribed PPIs within 24 hours of their hospital admission. Of the 26 ACS patients not given PPIs within 24 hours of their hospital admission, three patients developed bleeding complications during their admission. Two out of the three patients developed gastrointestinal (GI) bleeding (melena) with a significant drop in their haemoglobin levels, while one patient developed haematuria.

In conclusion, a large number of patients admitted with ACS and started on DAPT did not receive a concomitant PPI within 24 hours of admission to the hospital in accordance with European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines, and, as such, were at significant risk of bleeding events.

National Institute for Health and Care Excellence (NICE) guidance recommends routine early inpatient invasive coronary angiography (ICA) for patients presenting with non-ST-elevation acute myocardial infarction acute coronary syndrome (NSTEMI-ACS) within 72 hours of hospital admission. For patients admitted to hospitals without invasive cardiac facilities, completing interhospital transfer and investigation within this timeframe is challenging. This retrospective cohort study evaluated factors influencing time to ICA, diagnosis and treatment allocation decisions in 4,087 NSTEMI-ACS patients referred from five district general hospitals to the Royal Infirmary of Edinburgh over four years. The mean time from admission to coronary angiography was 5.0 ± 3.0 days, with the majority waiting longer than the 72-hour NICE target. Admission towards the end of the week, defined as Wednesday to Saturday, was associated with longer delay. Coronary revascularisation was not required in 34% of patients. The presence of obstructive coronary disease and use of coronary revascularisation varied with age and sex, with younger female patients more likely to have normal coronary arteries or mild non-obstructive plaque disease. Use of percutaneous coronary intervention (PCI) varied with supervising consultant operator. These findings highlight disparity between clinical practice and NICE guideline recommendations for NSTEMI-ACS patients admitted to hospitals without invasive cardiac facilities, and highlight the need for the development of treatment pathways that reduce delay and better identify patients who will benefit from coronary revascularisation.

A 24-year-old male bodybuilder presented with cardiac symptoms following long-term performance-enhancing drug (PED) use. He was diagnosed with heart failure with reduced ejection fraction and body dysmorphic disorder. Treatment included cardiac medical therapy and psychiatric support. After PED discontinuation and ongoing psychological care, symptoms improved and relapse was prevented. This case highlights the potential severe cardiovascular consequences of PED abuse in young, healthy individuals. It emphasises the importance of early recognition, multidisciplinary intervention addressing both physical and psychological aspects, and increased awareness about PED risks, particularly among those with body image disorders.

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.