Tag Archives: arrhythmias

Introduction Coronary artery spasm (CAS), or Prinzmetal angina, is an increasingly recognised cause of myocardial ischaemia in non-obstructed coronary arteries. It typically presents with anginal chest pain.1 It is rarely associated with myocardial infarction and symptomatic arrythmias.2 It occurs primarily at rest, most commonly in the morning,1,3 and is mostly observed in 40–70-year-old males.4 Prevalence varies by ethnicity, with Japanese ethnicity most strongly linked.5 Atherosclerotic coronary stenosis is an independent risk factor for CAS; more diseased vessels have a higher tendency to spasm in ergonovine provocation testing.6 We des

25in25 The meeting began with an update on the 25in25 initiative from BSH Chair-Elect Dr Lisa Anderson (St George’s University Hospital, London). This national quality improvement initiative, led by the BSH in collaboration with over 54 national and international healthcare organisations, has the goal of reducing heart failure deaths by 25% over the next 25 years. With already over one million people in the UK living with heart failure, a number which is expected to double by 2040, the ambitious initiative is eagerly awaited. In the UK alone this could translate to over 10,000 lives saved per year. A population health approach underpins th

Dr Fang Qin Goh Introduction With semi-professional sporting events becoming more accessible,1 the effect of endurance training on the body is increasingly relevant, not just in elite athletes, but also fitness enthusiasts. Exercise prevents and aids treatment of coronary heart disease (CHD), hypertension, heart failure, diabetes mellitus, obesity and depression,2,3 reduces cardiac events,1 and improves survival.4,5 However, there is concern excessive exercise could have adverse cardiac effects.2 This article aims to address whether an upper limit to mortality benefits of exercise exists, consider physiological and potentially pathological ch

Introduction Implantable cardiac monitors (ICMs) are becoming more commonly recommended during the investigation of a patient with transient loss of consciousness.1,2 The original first-generation devices were implanted by a surgical procedure, usually by a cardiologist in a cardiac catheterisation theatre on a day-case basis, lasting up to 30–45 minutes per procedure. This process is inherently resource heavy for theatre time, staff (implanting physician, catheter lab nurses, cardiac radiographer and cardiac physiologist), in addition to pre-admission assessment, surgical equipment and patient recovery in a day-case facility. The developme

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New data on intensive glucose lowering in type 2 diabetes The results of three large trials investigating the clinical effects of intensive glucose lowering in patients with type II diabetes were presented at the recent American Diabetes Association meeting in San Francisco, USA, and have shown somewhat conflicting results. The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial was stopped earlier this year because of an increased mortality in the intensive glucose lowering group. The two other trials – ADVANCE (Action in Diabetes and Vascular Disease – Preterax and Diamicron MR Controlled Evaluation) and VADT (Veteran’s A

Prevention In the opening session on prevention strategies, Dr Brendan Lloyd, Medical Director, Cardiff Local Health Board commented that these must be carefully chosen based on the evidence and focused towards those most likely to show the most benefit, ie. higher risk patients. However, as Dr Phil Webb, All Wales Specialist Commissioner of Cardiothoracic Services pointed out, without an appreciation of the spectrum of decisions that influence healthcare managers, clinicians cannot begin to understand their reasoning. Dr Terry McCormack, a Whitby GP and PCCS Chairman, showed that, according to national statistics, coronary heart disease (CHD

Introduction The basis of modern cardiac pacing can be traced to the early nineteenth century, which saw the first hesitant development of cardiac electrostimulation.1,2 The nineteenth century concluded with a flurry of publications3 confirming that the heart could be reliably stimulated both directly, in open-chest dogs and, indirectly, in humans, via large electrodes placed over the praecordial area and on the back. In 1869 external electrical energy applied to the praecordium of a patient with tachycardia resulted in a slowing and regularising of the rhythm, probably the first reported case of external cardioversion.4,5 1871 saw the first

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