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Clinical articles

December 2018 Br J Cardiol 2018;25:140–2 doi :10.5837/bjc.2018.031

Quality of life in postural orthostatic tachycardia syndrome (PoTS): before and after treatment

Toby Flack, Jamie Fulton

Abstract

Postural orthostatic tachycardia syndrome (PoTS) can be defined as tachycardia with or without hypotension in the upright posture, and more comprehensively as a manifestation of a wider dysautonomia. The scope of this article is to characterise patients with PoTS and look at patient-rated responses to treatment.

This research comprised a postal survey, sent to patients with diagnosed PoTS at a tertiary hospital in Southwest England. We collected data on the demographics of patients, time to diagnosis, methods of diagnosis, treatments and response to treatment.

PoTS has an impact on quality of life, with patients communicating a drop in quality of life from 7.5 to 3.75 on a 10-point scale. From 40 respondents, 29 patients describe their symptoms improving since diagnosis, with self-rated day-to-day function improving from 3.21 to 6.14 (on a 10-point scale) after initiating treatment.

Many patients experience a delay in receiving a diagnosis with PoTS, and present multiple times to a variety of healthcare professionals. With a simple bedside diagnostic test (sitting and standing heart rate), there is scope to improve the time taken from developing initial symptoms to diagnosis, treatment and an improvement in quality of life.

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December 2018 Br J Cardiol 2018;25:152–6 doi :10.5837/bjc.2018.032

Thrombus aspiration in primary percutaneous coronary intervention: to use or not to use?

Telal Mudawi, Mohamed Wasfi, Darar Al-Khdair, Muath Al-Anbaei, Assem Fathi, Nikolay Lilyanov, Mohammed Elsayed, Ahmed Amin, Dalia Besada, Waleed Alenezi, Waleed Shabanh

Abstract

Thrombus aspiration during primary percutaneous coronary intervention (PCI) has been extensively studied. Conflicting results have consistently emerged, hence, no clear guidance has been produced. The authors have examined several key clinical trials and meta-analyses, and discovered, arguably, major flaws within the designs of most trials, thus, accounting for the persistently discordant results. The authors conclude that there is some evidence to support the selective use of thrombectomy in primary PCI but a large-scale trial with the appropriate patient selection criteria is needed in order to substantiate or refute the argument.

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December 2018 Br J Cardiol 2018;25:159–60 doi :10.5837/bjc.2018.033

Percutaneous endovascular repair of congenital interruption of the thoracic aorta

Richard Armstrong, Kevin Walsh, David Mulcahy

Abstract

Presentation of an interrupted aortic arch in adulthood is rare, and, up until, recently the only treatment strategy was through surgical repair. Advances in percutaneous interventions for congenital heart disease have included the percutaneous repair of coarctation of the aorta – from straightforward luminal narrowing through to full aortic interruption.1-3 We present a case of a 28-year-old man who was diagnosed with a complete aortic interruption and successfully percutaneously treated.

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October 2018 Br J Cardiol 2018;25:147–9 doi :10.5837/bjc.2018.026 Online First

Transitions of an open-heart surgery support lab in a resource-limited setting: effect on turnaround time

Ijeoma Angela Meka, Williams Uchenna Agu, Martha Chidinma Ndubuisi, Chinenye Frances Onyemeh

Abstract

Open-heart surgery is a major surgical procedure that requires intensive patient monitoring. Clinicians require prompt laboratory test results to assist them in this monitoring. Timeliness of result delivery is of great importance in taking prompt clinical decisions. We set out to evaluate the performance of the support laboratory before and after domiciliation at the cardiac centre using turnaround time (TAT) of electrolytes and liver function tests as benchmarks.

This hospital-based descriptive study was carried out at the University of Nigeria Teaching Hospital (UNTH), Enugu. The authors conducted a desk review of laboratory records for electrolytes and liver function tests from March 2013 to July 2017. Relevant laboratory personnel were also interviewed to ascertain types of equipment used and possible causes of delay at different stages of transition during the period under review. The TAT was calculated as the time from sample reception to time of dispatch of results.

Between 2013 and 2014, TAT for electrolytes and liver function tests were ~2 and ~6 hours, respectively. In 2015, TAT reduced to ~1 hour for electrolytes and ~1½ hours for liver function tests. Between 2016 and July 2017, TAT further reduced to ~10 minutes for electrolytes and ~30 minutes for liver function tests.

In conclusion, we were able to demonstrate improvement in performance of the support laboratory as shown by a reduction in TAT following the transition from the main laboratory to being domiciled in the cardiac centre.

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October 2018 Br J Cardiol 2018;25:150–1 doi :10.5837/bjc.2018.027 Online First

Utility of MPS in AAA repair and prognostication of cardiovascular events and mortality

Mark G MacGregor, Neil Donald, Ayesha Rahim, Zara Kwan, Simon Wong, Hannah Sharp, Hannah Burkey, Mark Fellows, David Fluck, Pankaj Sharma, Vineet Prakash, Thang S Han

Abstract

Myocardial perfusion scintigraphy (MPS) is a non-invasive method that can be used to assess reversible left ventricular myocardial perfusion defect (<20% indicates limited and ≥20% indicates extensive ischaemia), and left ventricular ejection fraction (LVEF) at rest and at stress. Data on the utility of MPS used to stratify cardiac risk prior to abdominal aortic aneurysm (AAA) repairs are limited. We evaluated MPS as a stratification tool for patients scheduled for endovascular aneurysm repair (EVAR) or open repair, between 2013 and 2016 at Ashford and St Peter’s NHS Foundation Trust, and 4.9 years (median 2.8 years, interquartile range [IQR] 2.1–3.8) cardiovascular events (n=15, 17.9%) all-cause mortality (n=17, 22.6%). Of the 84 patients recruited (median age 75.7 years, IQR 69.4–79.6), 57 (67.9%) had limited and 27 (32.1%) extensive ischaemia, 62 (73.8%) underwent EVAR and 22 (26.2%) open repair. Compared with open repair patients, EVAR patients were older (median age 70.6 years vs. 76.4 years, p=0.015), had higher rates of extensive ischaemia (13.6% vs. 38.7%, p=0.025), and abnormal LVEF reserve (LVEF at stress minus LVEF at rest ≤0: 40.0% vs. 76.6%, p=0.011), while having lower rates of 30-day postoperative major adverse cardiac events (13.6% vs. 3.3%, p=0.040) but no difference for cardiovascular events (p=0.179) or 4.9 year all-cause mortality (22.7% vs. 22.6%, adjusted hazard ratio 0.80, 95% confidence interval [CI] 0.22 to 3.20, p=0.799). Our findings indicate that MPS provides valuable information for AAA repair procedure.

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October 2018 Br J Cardiol 2018;25:143–6 doi :10.5837/bjc.2018.028 Online First

New-onset giant T-wave inversion with prolonged QT interval: shared by multiple pathologies

Debjit Chatterjee, Priya Philip, Kay Teck Ling

Abstract

This is a case series of 10 patients who presented with the same electrocardiogram (ECG) manifestation of new-onset giant T-wave inversion and QT prolongation over a period of 24 months in a district general hospital. This unique ECG manifestation has been described with several cardiac and non-cardiac conditions.

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October 2018 Br J Cardiol 2018;25:157–8 doi :10.5837/bjc.2018.029 Online First

A case report of transient acute left ventricular dysfunction

Allam Harfoush

Abstract

Stunned myocardium is a rare, but serious, medical condition, and requires emergency intervention. Short periods of hypoperfusion may lead to a prolonged cardiac hypokinesia (hours to days), even though the perfusion is retained eventually. In other words, although the coronary circulation is retained, the hypokinesia remains. It might be considered as a case of prolonged post-ischaemic dysfunction.

In this case, a 60-year-old woman, visiting her siblings, presented with severe dyspnoea and cyanosis to the emergency department. Pulmonary oedema was diagnosed, and transthoracic echocardiography (TTE) showed general hypokinesia and reduced ejection fraction (15%), nevertheless, sequential TTE monitoring after the required medical intervention revealed a continuous improvement, with a 45% ejection fraction three days later and a specific anterior wall hypokinesia, solely.

In conclusion, rapid diagnosis and treatment are essential for stunned myocardium, as these could change the progress of the clinical condition.

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August 2018 Br J Cardiol 2018;25:86–7 doi :10.5837/bjc.2018.024

Artificial intelligence in cardiology: applications, benefits and challenges

Panos Constantinides, David A Fitzmaurice

Abstract

The introduction of such digital technologies as robotic implants, home monitoring devices, wearable sensors and mobile apps in healthcare have produced significant amounts of data, which need to be interpreted and operationalised by physicians and healthcare systems across disparate fields.1 Most often, such technologies are implemented at the patient level, with patients becoming their own producers and consumers of personal data, something which leads to them demanding more personalised care.2

This digital transformation has led to a move away from a ‘top-down’ data management strategy, “which entailed either manual entry of data with its inherent limitations of accuracy and completeness, followed by data analysis with relatively basic statistical tools… and often without definitive answers to the clinical questions posited”.3 We are now in an era of a ‘bottom-up’ data management strategy that involves real-time data extraction from various sources (including apps, wearables, hospital systems, etc.), transformation of that data into a uniform format, and loading of the data into an analytical system for final analysis.3

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August 2018 Br J Cardiol 2018;25:97–101 doi :10.5837/bjc.2018.025

Impact of hyperkalaemia in managing cardiorenal patients – a healthcare professional perspective

Navneet Kalsi, Sarah Birkhoelzer, Philip Kalra, Paul Kalra

Abstract

A recent survey of healthcare professionals confirms that hyperkalaemia is considered as a common and important clinical issue for patients receiving renin-angiotensin-aldosterone-system (RAAS) inhibitors in particular. Successful interventions to manage hyperkalaemia appear beneficial rather than avoidance or dose reduction of these RAAS inhibitors in patients with chronic heart failure, diabetic nephropathy or prior myocardial infarction.

Two newer potassium exchange resins, patiromer and sodium zirconium cyclosilicate (ZS-9), may offer improved predictability, tolerability, and efficacy for managing patients with hyperkalaemia.

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July 2018 Br J Cardiol 2018;25:115–7 doi :10.5837/bjc.2018.018 Online First

A pulmonary triad in a patient with a giant left atrial myxoma

Andrea Calo, Madeleine Openshaw, Timothy J Bowker, Han B Xiao

Abstract

A 55-year-old man with suspected community-acquired pneumonia and atrial fibrillation was found to have a very large left atrial myxoma complicated with a pulmonary triad – pulmonary hypertension, pulmonary infarction, and pulmonary lymphadenopathy. The myxoma was successfully removed and complete resolution of all three pulmonary complications followed. He re-presented two weeks post-surgery with atrial flutter, which was medically treated and considered for ablation. We have taken the opportunity to undergo a mini-literature review on myxoma and its pulmonary complications.

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