2010, Volume 17, Issue 06, pages 250-296

Following recent publication of the 2010 European Society of Cardiology (ESC) guidelines for atrial fibrillation (AF) it is timely the BJC publish an article by Gunawardena et al. (see pages 271-6) describing a single centre cohort analysis of their AF ablation procedures.¹

The outcome and complications of atrial fibrillation (AF) ablation in a UK patient cohort were investigated by offering symptomatic, drug-refractory patients ablation. Treatment goals were to disconnect all pulmonary veins electrically and improve symptoms using a state-of-the-art ablation method. Outcomes were defined as: 'success' (no symptoms or Holter AF); 'partial success' (substantially reduced AF symptoms); 'clinical success' ('success' and 'partial success'); 'failure' (no symptom improvement).

Sulphonylureas are well established in the treatment of type 2 diabetes mellitus. They are effective in improving glycaemic control and preventing microvascular complications. Side effects that can restrict use include hypoglycaemia and weight gain. Although there is no clear evidence for reduction of cardiovascular disease from randomised-controlled trials, follow-up data from the United Kingdom Prospective Diabetes Study (UKPDS) shows reduced cardiovascular risk. Concerns about sulphonylureas causing inhibition of ischaemic preconditioning are relevant in primary angioplasty, but there is a lack of clear evidence, with a need for randomised-controlled trials to investigate this further.

Cardiac auscultation is a critical part of the clinical examination. In this review we discuss the conventional approach to teaching and using the skill of cardiac auscultation. We then consider how recent technological advances may improve the teaching and implementation of this essential clinical skill.

The number of patients with aortic stenosis (AS) in the UK is increasing. Patients with non-significant AS can be safely reviewed in technician-led clinics. The potential impact of this on healthcare services is unreported. The aim of this study was to describe the impact of establishing an AS surveillance clinic in a district general hospital setting and consider the potential impact of widespread implementation.

In recent years a large amount of research has focused on developing both invasive and non-invasive methods of assessing atherosclerosis. In this regard, magnetic resonance imaging (MRI) is safe, non-invasive, requires no ionising radiation, and is capable of giving high-resolution images of atherosclerotic plaque. As a result, MRI has been extensively applied to imaging of the vascular system – in particular, the carotid arteries – where it has been shown to have the ability to not only accurately quantify the extent of atherosclerotic plaque disease, but also to identify several compositional features suggestive of plaque vulnerability. Imaging of the relatively small coronary arteries has, until now, been limited by the problems of cardiac and respiratory motion, however, more recently, technological advancements have allowed more detailed plaque information to be acquired. This article will review the origins of MRI imaging of atherosclerotic disease, its current status, and its potential future applications.

A 66-year-old male presented with increasing dyspnoea. He was an ex-smoker and had been diagnosed with stage IV undifferentiated large cell carcinoma of the left lung two months previously. Clinical examination revealed signs consistent with cardiac tamponade. Cardiac tamponade, a life-threatening condition, is a continuum of haemodynamic compromise, initiated by a collection of fluid in the pericardial space causing an increase in intra-pericardial pressure and cardiac compression. Transthoracic echocardiography confirmed the presence of a large global pericardial effusion with echocardiographic signs of cardiac tamponade (figure 1A and 1B).