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Tag Archives: chest pain

Opinions on the expanding role of CTCA in patients with stable chest pain and beyond: a UK survey

July 2018 Br J Cardiol 2018;25:107–9 doi:10.5837/bjc.2018.019 Online First

Opinions on the expanding role of CTCA in patients with stable chest pain and beyond: a UK survey

Saad Fyyaz, Alexandros Papachristidis, Jonathan Byrne, Khaled Alfakih

Abstract

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,

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Implementation of a modified version of NICE CG95 on chest pain of recent onset: experience in a DGH

November 2016 Br J Cardiol 2016;23:151–4 doi:10.5837/bjc.2016.039

Implementation of a modified version of NICE CG95 on chest pain of recent onset: experience in a DGH

Peregrine Green, Stephanie Jordan, Julian O M Ormerod, Douglas Haynes, Iwan Harries, Steve Ramcharitar, Paul Foley, William McCrea, Andy Beale, Badri Chandrasekaran, Edward Barnes

Abstract

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

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Anomalous origin of the left coronary artery from the pulmonary artery: case report and review

June 2016 Br J Cardiol 2016;23:79–81 doi:10.5837/bjc.2016.022

Anomalous origin of the left coronary artery from the pulmonary artery: case report and review

Kully Sandhu, David Barron, Hefin Jones, Paul Clift, Sara Thorne, Rob Butler

Abstract

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

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March 2016 Br J Cardiol 2016;23:37 doi:10.5837/bjc.2016.011

The clinical and cost impact of implementing NICE guidance on chest pain of recent onset in a DGH

Boyang Liu, Regina Mammen, Waleed Arshad, Paivi Kylli, Arvinder S Kurbaan, Han B Xiao

Abstract

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

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A survey on the implementation of the NICE guidelines on chest pain of recent onset 

July 2014 Br J Cardiol 2014;21:116 doi:10.5837/bjc.2014.025

A survey on the implementation of the NICE guidelines on chest pain of recent onset 

John Whitaker, Andrew Wragg, Khaled Alfakih

Abstract

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

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Do NICE tables overestimate the prevalence of significant CAD?

June 2014 Br J Cardiol 2014;21:75 doi:10.5837/bjc.2014.017

Do NICE tables overestimate the prevalence of significant CAD?

Jaffar M Khan, Rowena Harrison, Clare Schnaar, Christopher Dugan, Vuyyuru Ramabala, Edward Langford

Abstract

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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High-sensitivity troponin: six lessons and a reading

September 2013 Br J Cardiol 2013;20:109–12 doi:10.5837/bjc.2013.026

High-sensitivity troponin: six lessons and a reading

James H P Gamble, Edward Carlton, William Orr, Kim Greaves

Abstract

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July 2013 Br J Cardiol 2013;20:88-9 doi:10.5837/bjc.2013.023 Online First

Cardiac magnetic resonance imaging in the UK – an end to status anxiety but no room for complacency

Charlotte Manisty, James C Moon

Abstract

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

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Feasibility of using CTCA in patients with acute low-to-intermediate likelihood chest pain in a DGH

February 2013 Br J Cardiol 2013;20:39 doi:10.5837/bjc.2013.002 Online First

Feasibility of using CTCA in patients with acute low-to-intermediate likelihood chest pain in a DGH

Michael Michail, Shubra Sinha, Mohamed Albarjas, Kate Gramsma, Toby Rogers, Jonathan Hill, Khaled Alfakih

Abstract

Introduction Multi-detector computed tomography coronary angiography (CTCA) is becoming increasingly available in UK Hospitals. The National Institute for Health and Clinical Excellence (NICE) clinical guideline 95, released in 2010, recommended the use of calcium score ± CTCA in patients with low likelihood chest pain of recent onset.1 American College of Cardiology (ACC)/American Heart Association (AHA) appropriateness criteria for CTCA recommend its use in patients with low or intermediate likelihood chest pain.2 The rationale for the recommendations of CTCA is its excellent negative-predictive value.3 A further important point is that fu

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March 2012 Br J Cardiol 2012;19:15

Correspondence: Chest pain

Drs Rebecca Cooper, Emma Eade and Andrew RJ Mitchell

Abstract

Do the NICE guidelines for chest pain add up? Dear Sirs, The recent articles by Purvis and Hughes1 and Kelly et al.2 question the issued guidance from the National Institute of Health and Clinical Excellence (NICE) on the investigation of patients with recent onset chest pain.3 Purvis and Hughes focused on the investigation of patients in the low risk category for coronary artery disease (CAD), who under the NICE guidelines would be referred directly for computed tomography (CT) calcium scores (CTC) rather than exercise tolerance tests (ETTs), as is current practice in many hospitals. Their results were inconclusive, indicating that there may

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