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Clinical articles

June 2002 Br J Cardiol 2002;9:356-7

Serious interaction between digoxin and warfarin

Arpandev Bhattacharyya, Manju Bhavnani, David James Tymms

Abstract

Drug interaction with warfarin is a common cause of loss of anticoagulant control. An interaction between warfarin and digoxin has not previously been documented in the British National Formulary or datasheet. We report a case of digoxin toxicity responsible for prolongation of the INR to more than 10.

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June 2002 Br J Cardiol 2002;9:355

On-call seen as a pathophysiologic state

Johan EP Waktare, Alex Stewart, John P Lyons

Abstract

On-call seen as a pathophysiologic state Johan EP Waktare, Alex Stewart, John P Lyons Recently, one of us (AS) underwent 24-hour Holter (ambulatory ECG) monitoring for investigation of minor cardiac symptoms. The recording was performed during a night as medical registrar on-call. We feel the result provides some interesting insights into the pathophysiology of life as a modern junior doctor.

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June 2002 Br J Cardiol 2002;9:351-4

Patients of Southern Asian descent treated with valsartan (POSATIV) study

Jatin KV Patel and Richard Leaback, on behalf of the POSATIV investigators

Abstract

Southern Asians in the UK have a substantially increased (50%) risk of coronary heart disease compared with the general population, in part due to a high prevalence of hypertension and diabetes. This patient group has not been specifically studied in a clinical trial using modern antihypertensive therapy such as the angiotensin II receptor antagonists (AIIRAs). A multi-centre, double-blind, randomised, parallel-group study compared the effects of treatment with valsartan 80 mg once daily (o.d.) with control therapy (bendrofluazide 2.5 mg o.d.) in 116 patients with mild hypertension (diastolic blood pressure [DBP] ≥ 90 mmHg and ≤ 105 mmHg) after a four-week run-in period. Sitting blood pressure was measured at baseline (end of run-in) and after four and eight weeks of treatment using the OMRON automatic oscillometric blood pressure monitor. The study medication dosage was doubled if patients had < 4 mmHg decrease in DBP after four weeks. Compared with the control group (n=62), the addition of valsartan 80/160 mg o.d. (n=51) resulted in a significantly greater reduction in blood pressure at eight weeks (mean change in blood pressure -15.6 mmHg [95% CI -19.9 to -11.2 mmHg] for systolic blood pressure [SBP] and -9.3 mmHg [95% CI -11.8 to -6.8 mmHg] for DBP; p<0.001). Both treatments were well tolerated. Valsartan is effective and well tolerated, and would be an appropriate treatment option in Southern Asian hypertensive patients.

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June 2002 Br J Cardiol 2002;9:343-50

Efficacy of micronised fenofibrate in patients with primary hyperlipidaemia: a comparison with pravastatin

Jean Ducobu, Luc Van Haelst, Herva Salomon

Abstract

This randomised, double-blind, six-month trial assessed the efficacy and tolerability of micronised fenofibrate and pravastatin in 265 patients (18–75 years of age) with primary hyperlipidaemia (pure hypercholesterolaemia, type IIa; and mixed dyslipidaemia, type IIb) recruited from 28 European centres. After a first three-month phase in which patients received once daily either micronised fenofibrate 200 mg or pravastatin 20 mg, type IIa patients attaining low density lipoprotein cholesterol (LDL) < 4.14 mmol/L and type IIb patients attaining LDL < 4.14 mmol/L and triglycerides < 2.26 mmol/L continued with the same dose in a three-month extension phase. Patients not meeting these criteria received a double dose of drug in this extension phase.

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June 2002 Br J Cardiol 2002;9:339-42

Complications associated with 64 temporary pacing wires implanted at a district general hospital – should this procedure be reserved for specialist centres?

Adam Brown, Barnaby Thwaites

Abstract

This study assessed complication rates in 64 emergency temporary pacing procedures, of which atrioventricular block formed the largest group (72%). Of the in-hospital deaths, most (76%) were due to myocardial infarction, and none due to the procedure. Immediate complications occurred in 22%: arrhythmia or arterial puncture, and one hemiparesis. Late complications occurred in 34%: loss of capture, infection including one instance of staphylococcal septicaemia. No complications occurred in 59%. Involvement of a consultant in the procedure did not reduce complication rates. In such potentially unstable patients, the risks of not pacing or delaying pacing probably far outweigh those of immediate intervention.

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June 2002 Br J Cardiol 2002;9:337-8

Primary pulmonary hypertension: a GP comment

Ross Price

Abstract

General practitioners (GPs) are subject to bombardments of medical information from many sources – local pharmaceutical formularies, local and national guidelines, national service frameworks, medical newspapers, peer-reviewed national journals and special interest publications.

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June 2002 Br J Cardiol 2002;9:330-6

Management of primary pulmonary hypertension

Ghada W Mikhail, J Simon R Gibbs, Magdi H Yacoub

Abstract

The onset of symptoms in primary pulmonary hypertension (PPH) is usually insidious with several years elapsing before the diagnosis is actually made. It is important that general physicians should be made aware of this fact and that they should have a high rate of suspicion of the subtle nature of the clinical presentation in this group of patients. Patients with a suspected diagnosis of PPH should be referred to specialised centres where early diagnosis and treatment can be initiated. We review the salient features of PPH and provide an insight into the various therapeutic options that are now available for this disease.

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May 2002 Br J Cardiol 2002;9:303-4

NICE announce audit of secondary prevention guidance

Tom Quinn

Abstract

NICE announce audit of secondary prevention guidance Tom Quinn The National Institute for Clinical Excellence (NICE) has ann-ounced plans to commission the development of an audit tool to support the primary care management of patients who have survived myocardial infarction (MI). The audit will focus on aspects of treatment and support highlighted in the National Service Framework (NSF) for Coronary Heart Disease1 and NICE’s own guideline Prophylaxis for patients who have experienced a myocardial infarction,2 inherited from the Department of Health in 1998 and published in early 2001.

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May 2002 Br J Cardiol 2002;9:297-02

Optimising management of patients with hypertension and diabetes

George Kassianos

Abstract

Optimal management of hypertension and diabetes is essential if the cardiovascular and renal mortality and morbidity associated with this condition is to be reduced. Recent guidelines from the National Service Framework for Diabetes and the Scottish Intercollegiate Guidelines Network are discussed. Recent studies (UKPDS, RENAAL and PRIME) looking at the contribution tight blood pressure control and angiotensin II receptor antagonists can make to the management of this hypertension in diabetics are also covered. Finally, the author advises how primary care can implement guidelines in practice to give the best possible care to patients with diabetes.

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May 2002 Br J Cardiol 2002;9:294-6

Extensive multiple coronary artery to left ventricular fistulas – a 10-year case history

Matthew J Banks, Jane Flint, Peter R Forsey, George D Kitas

Abstract

Extensive multiple coronary artery to left ventricular fistulas – a 10-year case history We report the 10-year case history of a 50-year-old woman who presented with angina due to extensive, bilateral, multiple coronary artery to left ventricular fistulas (MCALVF). 201Thallium myocardial scintigraphy revealed reversible ischaemia due to coronary ‘steal’. Cardiac catheterisation showed left ventricular dilatation due to high cardiac output from significant coronary to left ventricular shunt.

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