2003, Volume 10, Issue 03, pages 161-240

Anonymised data collected from 24 participating localities in England have been aggregated for this report. The data are taken from general practice computer records using a validated extraction tool Morbidity Information Query and Export SynTax (MIQUEST). The number of patients with heart disease, a cholesterol measure, whether they had been prescribed a statin, their quality of control, and its implications are reported. In the population studied of 2.4 million, 89,422 patients had a diagnosis of ischaemic heart disease; a prevalence rate of 3.7%. Cholesterol measurement was available for half (48.3%) of these patients, of whom half (55.2%) were taking a statin. As a result of this treatment gap, 118 excess myocardial infarctions annually are predicted, equivalent to around 7,150 events nationally. Compared to previous audits carried out in UK general practice, considerable progress has been made towards the achievement of treatment goals. The treatment gap is represented by a combination of lack of measurement and recording of data as well as poor quality of control.

Patients with Dressler syndrome generally present with malaise, fever, chest pain, leukocytosis, an elevated erythrocyte sedimentation rate and pericardial effusion.1 To the best of our knowledge, presentation of Dressler syndrome with pericardial tamponade is very rare. An investigation on Medline revealed that no cases had been reported in the last 10 years. We reported this case because of its rare presentation pattern and its successful treatment with percutaneous catheter drainage.

Statins are prescribed worldwide for patients with coronary heart disease (CHD) and also for those at risk of developing atherosclerotic vascular disease. This article looks at the prescribing of statins in the UK demonstrating how they are underprescribed in this country, how ineffective doses of statins are used due to many doctors not understanding how to implement guidelines, and how the greatest reductions in CHD risk are achieved by the greatest reductions in cholesterol.

Routledge et al. have addressed an increasingly topical issue. They demonstrate in a small cohort of patients with aortic stenosis (AS) that the use of angiotensin- converting enzyme (ACE) inhibitors may be safe, particularly with some degree of systemic hypertension.1 This adds to the evidence that the use of ACE inhibitors in this patient population should not be strictly contraindicated. However, the more searching question of whether they should be used remains unanswered.

Aortic valve stenosis is a common cause of left ventricular hypertrophy (LVH). Severe LVH in association with aortic stenosis does not always regress following valve replacement surgery and is associated with a poor prognosis. The importance of angiotensin II in the hypertrophic process is increasingly recognised and the benefits of angiotensin-converting enzyme (ACE) inhibition in reducing LVH associated with hypertension are well established. Although ACE inhibitors are currently contraindicated in aortic stenosis (AS) on theoretical grounds there are very few data to support this. We have audited the current use of ACE inhibitors in a group of patients with AS and found that 27% of this group are currently taking an ACE inhibitor with no documented adverse effects. Trials to investigate the therapeutic benefit of ACE inhibition in preventing adverse left ventricular remodelling are merited but must be preceded by safety and tolerability studies.

Persistent left superior vena cava (PLSVC) is the most common anomaly involving central venous return in thorax. Anatomically it is a mirror image of the right superior vena cava and is usually asymptomatic but can cause difficulties during Swan-Ganz catheterisation and insertion of pacing systems. This article presents a comprehensive review of this anomaly and clinical scenarios in which it can prove problematic, illustrated by an example.

Thrombolytic therapy for acute ischaemic stroke improves outcome in a highly selected group of patients. It will shortly be licensed in the UK for this indication. Implementation of this treatment will be difficult as current stroke services are ill-equipped to meet the challenges associated with aggressive management of hyperacute stroke.
This article evaluates the published literature concerning thrombolytic therapy in the context of ischaemic stroke and briefly discuss the obstacles which prevent more widespread use of this treatment in the UK. It also considers the effect of age on efficacy and tolerability of thrombolytic therapy.

Echocardiography is a commonly used diagnostic tool in assessing cardiac disease. The advent of hand-held ultrasound devices means useful information on cardiac cavity size, ventricular wall thickness and function, or apparent valvular pathology can now be obtained by general practitioners after adequate training. This will be particularly useful in the care of patients with suspected heart failure, left ventricular hypertrophy, a cardiac murmur or atrial fibrillation. It will reduce the number of patients needing referrals and the waiting times for hospital echocardiography services. It is limited by the technical specifications of the equipment and operators expertise.

A survey on cardiovascular education was sent out to over 1,800 general practitioners by the Primary Care Cardiovascular Society. This generated 304 replies. Of those responding, the majority indicated they would be interested in post-graduate education in cardiovascular medicine. Most would prefer a simple distance-learning course covering the 30 compulsory hours of postgraduate education required every year. Some would be interested in a more demanding course to achieve GPSI status. The majority did not like the current option of clinical assistant work in a hospital out-patients’ department but would attend such a department for education. There were differing views on who should pay for the course.

A systematic approach to the identification and treatment of high-risk coronary heart disease (CHD) patients has been adopted in the UK health care system.