Editorial articles

The current specialist registrar (SpR) training system in the UK is necessarily built on the foundation of general training in cardiology. The acquisition of skills in subspecialties such as intervention, electrophysiology and echocardiography is arranged informally and locally.

Doctors are encouraged to follow evidence-based
guidelines in the assessment and management of
chest pain. Sometimes following these guidelines
conflicts with clinical experience and even common sense,
as is shown by the contrasting approaches (and outcomes)
to this case .

Every day we are bombarded with media headlines and
news stories about obesity, physical inactivity, faddy
diets and ‘miracle’ foods.But how far do we need to go
before we adopt a balanced approach to eating? And what
is our current nutritional status: is it possible to be overweight
yet still have suboptimal nutritional status, particularly with
respect to vitamins and minerals?

Statin therapy is established as the basis of lipid-lowering
therapy in all patients with established atherosclerotic
disease.1 However, statin trials show that 50–70% of
cardiovascular events cannot be prevented by statins alone.2,3
This raises the question about the next step that should be
taken to prevent further events in high-risk patients already
on a statin.ITED

Statins are prescribed worldwide for patients with coronary heart disease (CHD) and also for those at risk of developing atherosclerotic vascular disease. They represent a valuable treatment option for managing lipid levels. However, the well-publicised withdrawal of cerivastatin (Baycol®, Bayer) in 2001 led to concern and much subsequent discussion over the safety of statins. This review looks at the evidence in relation to the benefits and risks of statins and demonstrates that the benefits of statins far outweigh the risks.

Over the last decade improvements in the anaesthetic,
medical and surgical management of patients
undergoing coronary artery bypass grafting
(CABG), along with refinements in cardiopulmonary bypass,
have resulted in better clinical outcomes.

A recent report in the British Medical Journal has
suggested that the incidence of myocardial infarctions
has only plateaued with the rise in statin prescriptions (BMJ 2004;329:645).
Although this observation does need to be interpreted with caution,
there may be several reasons for this.

Recombinant factor VIIa (rFVIIa, Novoseven®, Novo
Nordisk®, Denmark) is established for the management
of bleeding episodes in haemophiliac patients with inhibitors.
Interest has been growing in the use of this drug
for the management of severe intractable bleeding following
major trauma and surgery.

Implementation of new evidence-based guidelines is one of
the most daunting tasks facing healthcare professionals
today, and in order to meet this challenge we need to be
well informed and to inform our patients.

Although studies from two decades ago documented
the association of low haemoglobin with chronic
heart failure (CHF), the potential for an important
pathophysiological link has largely been ignored until recently.
In 2000 Silverberg and colleagues reported on a cohort of
patients (n=142) attending a specialist nephro-cardiology clinic.
1 Anaemia (haemoglobin < 12 g/dL) was present in over half the patients and was associated with symptom severity.