Clinical articles

Severe mitral regurgitation (MR), when complicated by a co-existing lung abscess, is a management challenge, as both conventional cardiac and thoracic surgical interventions may be contraindicated. In the case described below, transcatheter edge-to-edge mitral valve repair (TEER) was utilised to achieve haemodynamic stability, permitting subsequent thoracic surgical lung abscess resection.

We report the case of a 60-year-old man with torrential MR secondary to chordal rupture presenting with recurrent pulmonary oedema, complicated by lung sepsis and abscess formation resistant to antibiotic therapy and precluding open valvular repair. The presence of a lung abscess contraindicated open mitral valve repair, and the severity of MR precluded thoracic surgical treatment of the lung abscess, precluding any form of surgical intervention.

A successful TEER procedure resulted in a reduction of MR from severe to no more than mild-to-moderate, enabling haemodynamic stabilisation and permitting subsequent thoracic surgical treatment of the lung abscess.

Our case demonstrates the possibility of treating severe MR with TEER in the presence of a lung sepsis and abscess, when both conventional cardiac and thoracic surgical interventions were considered contraindicated. This later enabled thoracic surgery and treatment of the lung abscess.

A 79-year-old woman presents to the hospital with dyspnoea, fever, and hypotension, and is diagnosed with community-acquired pneumonia and septic shock. Resuscitation is initiated with fluids and vasopressors, and a central venous catheter is placed. However, during the procedure, the guide experiences resistance and cannot be removed, becoming trapped. This is confirmed with tomography and reconstruction, demonstrating intravascular position. The patient is then sent to interventional cardiology for extraction, which is successfully performed using the EN Snare (Merit Medical). The significance of this case lies in the complications of not guiding procedures with ultrasound and how to resolve them, such as the guide being trapped in this patient.

Sudden cardiac death (SCD) is a devastating and tragic occurrence that may affect individuals of all ages. It is defined as an unexpected death occurring within one hour of the onset of symptoms, if witnessed, or within 24 hours of last being seen alive and well, if unwitnessed. Athletes are considered to be the healthiest of all the population, and exercise is known to reduce the risk of atherosclerotic coronary artery disease. However, both amateur and highly trained athletes do die suddenly and unexpectedly, and this gets widespread media attention as it is so shocking and unexpected. This brings SCD, its frequency and causes into the spotlight. This review focuses on the epidemiology and aetiology of SCD in athletes from a pathological perspective.

We performed a cross-sectional study to determine the frequency of use of proton-pump inhibitors (PPIs) in acute coronary syndrome (ACS) patients on dual antiplatelet therapy (DAPT) within 24 hours of hospital admission, and their effectiveness in reducing bleeding complications.

This cross-sectional study included a total of 83 patients admitted via the medical take to Queen Elizabeth Hospital, Lewisham and Greenwich Trust (LGT), London, with ACS from May 2022 to June 2022. The data of these patients were analysed to see whether ACS patients on DAPT were given PPIs within 24 hours of their hospital admission. These patients were further assessed for any bleeding event during their hospital admission and its association with the prescription of PPIs.

A significant number of ACS patients (26, 32.1%) were not prescribed PPIs within 24 hours of hospital admission. However, 55 (67.9%) patients were prescribed PPIs within 24 hours of their hospital admission. Of the 26 ACS patients not given PPIs within 24 hours of their hospital admission, three patients developed bleeding complications during their admission. Two out of the three patients developed gastrointestinal (GI) bleeding (melena) with a significant drop in their haemoglobin levels, while one patient developed haematuria.

In conclusion, a large number of patients admitted with ACS and started on DAPT did not receive a concomitant PPI within 24 hours of admission to the hospital in accordance with European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines, and, as such, were at significant risk of bleeding events.

National Institute for Health and Care Excellence (NICE) guidance recommends routine early inpatient invasive coronary angiography (ICA) for patients presenting with non-ST-elevation acute myocardial infarction acute coronary syndrome (NSTEMI-ACS) within 72 hours of hospital admission. For patients admitted to hospitals without invasive cardiac facilities, completing interhospital transfer and investigation within this timeframe is challenging. This retrospective cohort study evaluated factors influencing time to ICA, diagnosis and treatment allocation decisions in 4,087 NSTEMI-ACS patients referred from five district general hospitals to the Royal Infirmary of Edinburgh over four years. The mean time from admission to coronary angiography was 5.0 ± 3.0 days, with the majority waiting longer than the 72-hour NICE target. Admission towards the end of the week, defined as Wednesday to Saturday, was associated with longer delay. Coronary revascularisation was not required in 34% of patients. The presence of obstructive coronary disease and use of coronary revascularisation varied with age and sex, with younger female patients more likely to have normal coronary arteries or mild non-obstructive plaque disease. Use of percutaneous coronary intervention (PCI) varied with supervising consultant operator. These findings highlight disparity between clinical practice and NICE guideline recommendations for NSTEMI-ACS patients admitted to hospitals without invasive cardiac facilities, and highlight the need for the development of treatment pathways that reduce delay and better identify patients who will benefit from coronary revascularisation.

A 24-year-old male bodybuilder presented with cardiac symptoms following long-term performance-enhancing drug (PED) use. He was diagnosed with heart failure with reduced ejection fraction and body dysmorphic disorder. Treatment included cardiac medical therapy and psychiatric support. After PED discontinuation and ongoing psychological care, symptoms improved and relapse was prevented. This case highlights the potential severe cardiovascular consequences of PED abuse in young, healthy individuals. It emphasises the importance of early recognition, multidisciplinary intervention addressing both physical and psychological aspects, and increased awareness about PED risks, particularly among those with body image disorders.

Hyperbaric oxygen therapy (HBOT) is successfully implemented for the treatment of several disorders. HBOT is a promising treatment modality for coronary artery disease (CAD), where outcomes are frequently poor despite early revascularisation. The aim of this study is to investigate the effect of HBOT on the left ventricular function of patients with CAD after reperfusion.

Electronic journal searching was performed in PubMed, ScienceDirect, and Cochrane to find studies that investigate the effect of HBOT on the myocardial function of patients with CAD. The primary outcomes were left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF). Meta-analyses were performed on included studies and mean differences (MD) and 95% confidence intervals (CI) were estimated using Review Manager v5.4.

A total of three observational studies enrolling 195 participants were included in our analysis. HBOT significantly increased LVEF by 4.16% in patients with CAD after revascularisation compared with non-HBOT (MD=4.16, 95%CI 0.97 to 7.34, p=0.01). There was no statistical significance observed in the HBOT versus non-HBOT comparison on LVEDV (MD=–1.63, 95%CI –6.52 to 3.26, p=0.51) and LVESV (MD=–1.58, 95%CI –4.06 to 0.90, p=0.21).

In general, this meta-analysis shows HBOT significantly increased LVEF in patients with CAD after revascularisation compared with non-HBOT. There were no significant changes in LVEDV and LVESV in the HBOT group and non-HBOT group.

Heart failure (HF) is a highly prevalent long-term condition, with variation in services and resources across the UK. This report provides findings from a cross-sectional survey of community HF services in the UK between September 2021 and February 2022.

Eighty-five responses describing community HF services were received. Community services were primarily led by a HF specialist nurse (HFSN), with a median of 1.25 cardiology consultants with HF training, and a variety of other nurses and support workers. All services reviewed patients with HF with reduced ejection fraction (HFrEF), only 58% reviewed patients with HF with preserved ejection fraction (HFpEF). Median wait time was 20 days, with substantially longer waits in many areas. All services accepted referrals from multiple sources. Most services provided admission avoidance (96.5%), post-discharge checks (87%), pharmacological optimisation (99%), ongoing monitoring (82%) and palliative care (87%).

In conclusion, UK community-based HF teams provide many services, however, there is significant geographical variation. Studies are needed to determine if they are adequately resourced to meet population needs and improve patient outcomes.

Acute coronary syndromes (ACS) are common in patients with end-stage renal disease (ESRD). Diagnosis may be challenging given diverse symptomatology, absence of classical symptoms on presentation, and difficulties in the interpretation of biomarkers. Morbidity and mortality in this patient population remain high compared with patients with normal renal function, partly due to a lack of evidence for optimal management. This review presents a summary of the diagnostic features and early management of ACS in patients with ESRD on haemodialysis.

This review provides information about the current evidence-base for screening for atrial fibrillation (AF). The current burden of AF and recommendations related to AF screening are discussed, and randomised-controlled trial evidence for AF detection, clinical outcomes, harms and cost-effectiveness of population-based AF screening are reviewed. Finally, novel methods to refine the population to whom AF screening should be offered, which may improve clinical and cost-effectiveness, are considered.