Tag Archives: chest pain

Introduction Coronary artery disease (CAD) is a significant cause of morbidity and mortality in the UK, and anginal chest pain is the most common manifestation.1,2 Chest pain, however, is one of the most common presenting symptoms in both emergency, primary and secondary care, and can be secondary to a myriad of pathologies. Therefore, the diagnosis of CAD from symptoms alone can prove challenging. Despite developments in both invasive and non-invasive CAD imaging, these investigations are not without risks and cost to the health service. Reduction of unnecessary investigations, while identifying patients most at risk, has been a major motiv

Introduction Refractory angina (RA) is an increasingly common clinical problem due to improved survival from coronary artery disease (CAD) and an ageing population. It is defined as chronic angina-type chest pain (≥3 months in duration) due to myocardial ischaemia in the setting of CAD that persists despite optimal medical therapy, angioplasty or bypass surgery. In the US, between 600,000 and 1.8 million people are living with RA.1,2 Annually, it is estimated that 75,000 new cases are diagnosed in the US and 30,000 to 50,000 in Europe. Long-term outcomes are better than previously estimated (nine-year life expectancy is 71.6%).3 With persis

Introduction The National Institute for Health and Care Excellence (NICE) released an updated guideline on stable chest pain in 2016.1 It marked a radical departure from the 2010 NICE and European Society of Cardiology (ESC) guidelines.2 They recommended that the pre-test probability risk score should not be used as it over-estimated the likelihood of coronary artery disease (CAD) and that all patients with chest pain, typical or atypical, should be investigated with computed tomography (CT) coronary angiography (CTCA) in the first instance. Functional imaging tests were reserved for the assessment of patients with chest pain and known CAD,

Introduction The National Institute for Health and Care Excellence (NICE) clinical guideline 95 (CG95) was published in March 2010 and offers guidance to National Health Service (NHS) institutions on the further investigation of possible diagnoses of stable angina, based on pretest probability of coronary artery disease (CAD).1 Some recommendations were controversial, however, including the recommendation that patients with a very high risk of CAD (>90%) could be treated without further routine investigation with invasive coronary angiography. In addition, use of computed tomography (CT) calcium scoring or CT coronary angiography (CTCA) is

Introduction Figure 1. Diagnostic coronary angiogram via right femoral artery illustrating the presence of a large tortuous right coronary artery (RCA) with collaterals filling the left coronary arterial system (LCA) and retrograde flow of contrast within the main pulmonary artery (PA) Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital condition that often proves fatal in infants. However, we present a case of a young patient presenting with angina-like chest pains since childhood, who subsequently underwent successful surgical correction resulting in alleviation of symptoms. Case report A 25-year-old

Introduction There are 2.3 million people living with coronary heart disease in the UK, which results in a healthcare burden of 1% of all GP and 40% of all accident and emergency (A&E) visits.1 It is estimated that 20–40% of the general population will experience chest pain during their life. Chest pain caused by coronary artery disease has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence, the need for the development of the National Institute for Health and Care Excellence (NICE) guidelines for the diagnosis of chest pain.1 NI

Introduction In 2010, the National Institute of Health and Care Excellence (NICE) published a new guideline for the investigation of patients with chest pain of recent onset. This guideline reflected the importance of assessing the pre-test probability (PTP) of finding coronary artery disease (CAD) in patients, prior to selecting further investigations. NICE advocated a modified Duke Clinical Score method to calculate pre-test probability of CAD. They recommended the use of cardiac computed tomography (CT) in the investigation of patients with low PTP of having CAD, alongside clearly defined roles for functional imaging tests, in patients wit

Introduction There is no universal definition for stable angina, as there is for acute coronary syndrome.1 The diagnosis may be based on clinical history alone or on clinical history supplemented by functional testing, or angiography, or both. Angina pectoris is most often due to obstruction to flow in the epicardial coronary arteries, and the ‘gold-standard’ investigation, to date, to detect this, has been invasive coronary angiography.2 A small proportion of patients may have angina with unobstructed coronary arteries secondary to either microvascular coronary disease or coronary spasm.3 Functional ischaemia is not routinely tested for

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That CMR is the gold standard for heart size and function, and for congenital and inherited heart disease is little disputed. The additional benefit of CMR for tissue characterisation has gained widespread acceptance, particularly now with convincing prognostic data across a wide variety of disorders,1 and the large EuroCMR registry (27,000 patients, 15 countries),2 showing that CMR entirely changed diagnosis in nearly 10% of subjects. CMR adoption as a ‘workhorse’ for ischaemia and viability testing has, however, been slower, with continued calls for cost-effectiveness and head-to-head comparison data with other modalities. These data ar