Clinical articles

This case describes the unfortunate consequence of hepatic abscess, initially discovered following abnormal liver function tests.

The aims of treatment in chronic heart failure are to reduce symptoms, improve function and prolong life. Currently there is no patient-centred health-related quality of life measure in chronic heart failure. The aim of this study was to explore health-related quality of life from the perspective of patients with chronic heart failure and to identify themes for inclusion in a patient-generated instrument. 

Semi-structured interviewing of patients with an objective diagnosis of chronic heart failure was undertaken. Analysis of the transcripts identified seven themes on health-related quality of life. These were: changes in physical ability, emotional state, self-awareness and self-perception, changes in relationships, symptoms, maintaining social/lifestyle status and cognitive aspects. 

Findings from this study will contribute to the development of a patient-led health-related quality of life measure for use in everyday practical care in a chronic heart failure population.

Atherothrombosis is a leading cause of global mortality. It represents a significant public health issue in the UK and, as such, the UK Government has made it a healthcare priority. The global REduction of Atherothrombosis for Continued Health (REACH) Registry aims to evaluate the long-term risk of atherothrombotic events in an at-risk population, to assess the importance of cross-risk and to define predictors of atherothrombotic events. REACH has recruited over 68,000 people in over 5,000 centres in 44 countries, of which 618 were from the UK.

Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease and in February 2006 was added to the Quality and Outcomes Framework (QOF) for primary care in the UK. The QOF indicators apply to all patients with stage 3–5 CKD and include the production of a register of such patients, appropriate monitoring and treatment of hypertension and the prescription of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

Over the last few years, there has been a gradual increase in the use of intensive statin therapy, ostensibly atorvastatin 80 mg for high-risk individuals, such as those who suffered a myocardial infarction or underwent revascularisation. First-World economies, such as the UK, with a significant state contribution healthcare funding, had mounting anxiety because of the expanding indications and therefore cost of intensive statin therapy. The perceived relative expense of this strategy provoked a swift, often unilateral, withdrawal of such regimens by commissioners.

Stent thrombosis (ST) is an uncommon but serious complication of percutaneous coronary intervention (PCI), and is associated with the discontinuation of antiplatlet therapy. In a retrospective study of ST cases during a two-year period of the Wessex Regional Cardiac Unit, 3,004 (1,661 emergency and 1,343 elective) patients underwent PCI between November 2003 and October 2005. There were 25 episodes of ST occurring in 22 patients (overall incidence of ST is 0.83%). There were two (8%) cases of acute ST, eight (32%) of sub-acute ST and 15 (60%) of late or very late ST (five cases between six and 12 months and one case more than one year post-procedure). In the late and very late ST group only one patient was taking dual antiplatelet therapy.

The demand for non-invasive diagnostic imaging in cardiology increases with the advancing age of the population. Whilst exercise testing and myocardial perfusion scintigraphy have provided non-invasive functional assessment of coronary artery disease there has been little alternative to invasive coronary angiography for anatomical assessment of the coronary tree.

Rhabdomyolysis is an uncommon but potentially serious adverse reaction associated with the use of statins. Simvastatin is metabolised by cytochrome P450 CYP3A4 and amiodarone is an inhibitor of this enzyme. Concomitant use of these drugs, especially with high doses of simvastatinm may result in myopathy. Acute renal failure as a result of rhabdomyolysis due to this aetiology is rare with only a few cases reported previously. Here, we report a case of rhabdomyolysis and acute renal failure secondary to concomitant use of simvastatin and amiodarone.

The presence of severe vessel tortuosity, extreme angulation of side-branch ostia, stent jail, or lack of control at the interface of chronic total occlusions can result in percutaneous coronary intervention failure or complications. The Venture™ wire control catheter is a new catheter system designed to facilitate tip direction of a standard 0.014” guidewire. The properties of this system are discussed in this article along with an example of its use in practice.

The demand for non-invasive diagnostic imaging in cardiology increases with the advancing age of the population. Whilst exercise testing and myocardial perfusion scintigraphy have provided non-invasive functional assessment of coronary artery disease there has been little alternative to invasive coronary angiography for anatomical assessment of the coronary tree. In recent years technological advances have enabled improvements in both temporal and spatial resolution such that multi-detector computed tomography (MDCT) is now able to reproducibly evaluate cardiac disease. The combination of this improved resolution with more advanced post-processing techniques now means that MDCT has the ability to perform both anatomical and functional assessment from a single study. This technique, therefore, not only provides a non-invasive alternative to conventional angiography but the same dataset allows concurrent assessment of cardiac function, assessment of aberrant vessels, graft patency studies and assessment of the coronary artery wall.

Cardiac CT has the potential to provide a much more complete assessment than conventional coronary angiography. It is likely to become the non-invasive imaging modality of choice to exclude significant coronary artery disease in those with intermediate risk of coronary artery disease.

This first part of a two-part article considers ECG-gated image reconstruction, image resolution, radiation dose, and post-processing protocols and limitations. The second part considers clinical applications and future developments.