Tag Archives: acute coronary syndrome

Definition of ACS Acute coronary syndromes (ACS) include unstable angina and acute myocardial infarction (AMI). AMI is classified according to those patients with electrocardiographic ST-segment elevation, ST-elevation myocardial infarction (STEMI) and those without electrocardiographic ST-segment elevation, non-ST-elevation myocardial infarction (NSTEMI).1 The requirement for a diagnosis of AMI in the universal definition is the detection of troponin release from injured cardiac myocytes with at least one value >99th centile of the upper reference limit.1 Diagnosis is confirmed only if this is associated with at least one of: symptoms of

Figure 1. Patient chest X-ray showing a ‘full metal jacket’ Her physical examination and vital signs were unremarkable. Routine blood tests had been requested. Resting 12-lead electrocardiogram (ECG) showed left bundle branch block; no previous ECGs were available for comparison. A chest X-ray was performed, which gave another clue to the diagnosis… The chest radiograph (figure 1) shows clear lung fields, normal cardiac contour and, more importantly, a radio-opaque structure across the anterior surface of her heart. This is sometimes termed a ‘full metal jacket’, implying extensive stenting of a coronary artery in its entirety f

Introduction Current evidence suggests there has been a marked proliferation of troponin testing within medical units as the troponin assay has become the cornerstone biomarker in the diagnosis of an acute myocardial infarction (AMI).1,2 Both troponin T (TnT) and troponin I (TnI) are cardio-specific structural subunits and highly sensitive and specific markers of myocardial injury.3,4 Newer generation high-sensitivity troponin (hs-Tn) assays can detect increasingly lower troponin concentrations within an earlier time window of up to three hours.5 Early implementation of first-generation assays were accompanied with poor patient selection; ava

Introduction For patients with acute coronary syndrome (ACS) who survive to reach hospital, the majority of mortality and morbidity over the following five years occurs after discharge.1 Of all complications, development of acute heart failure (AHF) and left ventricular systolic dysfunction (LVSD) are key determinants of adverse outcome. Approximately half of patients with ACS are readmitted to hospital, constituting a profound burden on healthcare resources.1 In several healthcare systems there are financial penalties when ACS patients are readmitted within 30 days.2 Prediction of the development of AHF and hospital readmission following ACS

Introduction Approximately 4.2 million people (7.5% of population), whose racial origins are from South Asia, live in the UK. High rates of coronary disease in Asians,1-4 seem likely to be influenced by genetic factors.5 We have previously reported differences in the presentation of coronary syndromes between British South Asians, as a whole, and white Europeans.6 The term ‘South Asian’ describes around 1.5 billion people (22.5% of the world’s population), occupying regions as diverse as Sri Lanka to Nepal. A wide variety of genotypes, cultures, diets, belief systems, educational attainment, socioeconomic status and risk factors are enc

*citation from Havelock Ellis ‘Impressions and Comments’ Introduction Rivaroxaban is an oral direct factor Xa inhibitor belonging to the novel oral anticoagulants (NOACs) class. Concerning efficacy and tolerability, it has been reported to be more effective than enoxaparin in preventing venous thromboembolism in patients undergoing orthopaedic surgery,1,2 and was non-inferior to enoxaparin followed by warfarin in a study involving patients with established venous thrombosis.3 Its good bioavailability, rapid-action and a half-life of 5–13 h,4 associated with a highly reproducible anticoagulant activity and the same rate of bleeding compl

Summary Oral anticoagulation has been restricted to vitamin K antagonists (VKAs) for more than 50 years. Starting in the last decade of the past century, central coagulation factors such as thrombin and factor Xa were explored as potential targets for the development of novel oral anticoagulants (NOACs). This led to the successful development and approval of a novel class of direct oral anticoagulants targeting factor Xa. Rivaroxaban was the first of the novel class of agents named ‘xabans’ that are direct oral factor Xa inhibitors. Since its initial approval for thromboembolic prophylaxis after hip and knee surgery in 2008, rivaroxaban a

The National Institute for Health and Care Excellence (NICE) has said that thousands of people with atrial fibrillation (AF) could be prevented from having strokes, disability or death if its new guidance is followed. It says many patients with AF are not being appropriately anticoagulated and highlights how there has not been widespread uptake of novel oral anticoagulant drugs (NOACs) which were approved by NICE in 2012. Clinical guideline 180 published in June 2014 updates and replaces the 2006 NICE clinical guideline 36. The full guidance can be found at http://www.nice.org.uk/guidance/CG180 NICE Chair, Professor David Haslam writes on the

Introduction Following observations that smokers experience decreased mortality following acute myocardial infarction (acute MI [AMI]) in comparison with non-smokers,1 the term ‘smoker’s paradox’ was introduced into scientific discourse more than 25 years ago.2 The ‘smoker’s paradox’ following various reperfusion strategies, however, is argued not to be due to any benefit from smoking itself but simply due to smokers being likely to undergo such procedures at a much younger age, and, hence, having, on average, lower comorbidity. In a recent systematic review (with a search by September 2010)2 of 17 studies presenting adjusted tota

(more…)