Tag Archives: chest pain

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

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

Amiodarone for the treatment of stable ventricular tachycardia – has the Resuscitation Council got it wrong? Dear Sirs, Amiodarone has been the UK Resuscitation Council’s recommendation for the treatment of haemodynamically stable ventricular tachycardia (VT) since 2000.1  It is my opinion that the evidence in support of amiodarone in this setting is poor and that superior agents may exist. In the last six years, three retrospective studies have been published showing a dismal success rate when amiodarone is used to treat patients with stable VT. Marill et al reported that eight out of 28 (29%) patients cardioverted using a dose of 150 m

PARTNER: transcatheter valves just as good as surgery for high risk aortic stenosis Transcatheter aortic valve implantation (TAVI) is just as effective at reducing mortality as surgery for severe aortic stenosis in elderly patients whose age and overall health posed high risks for conventional surgery, according to the results of the PARTNER (Placement of AoRTic TraNscathetER Valve trial). However, stroke rates were higher in the trancatheter group. The transcatheter approach involves delivering a bioprosthetic valve to its target location with a catheter using either transfemoral access or trans-apical access (through the ribs) if peripheral

Chest pain – troponin and athletes Dear Sirs. We recently admitted two young men with chest discomfort suggestive of an acute coronary syndrome, who were troponin I positive. One was a 26-year-old Caucasian with left-sided chest heaviness engaging in regular triathlons. While serial resting electrocardiograms were unremarkable, troponin I on admission and one month later were elevated at 0.1 and 0.09 mg/L, respectively (normal range 0-0.04). An echocardiogram was entirely normal. An exercise treadmill stress test (ETT) was performed to 13 minutes (99% target heart rate achieved) of a Bruce protocol without symptoms or changes in the E

The guideline, jointly developed with the National Clinical Guidelines Centre for Acute and Chronic Conditions, represents a significant change in practice in some key areas of diagnosing acute coronary sydromes (ACS) and angina. The focus of the new guideline is on the diagnosis of chest pain which is suspected to be of cardiac origin, so that appropriate treatment can be provided. It notes that chest pain is experienced by some 20–40% of the general population at some time during their lives, and accounts for up to 1% of visits to GPs, approximately 700,000 visits (5%) to emergency departments and up to 25% of emergency admissions to hosp

1. Take a detailed history Table 1. Clinical classification of chest pain (more…)

Introduction The National Health Service (NHS) Improvement Plan stated that by 2008 no one would wait longer than 18 weeks from GP referral to hospital treatment.1 This is, therefore, currently a key area of focus for the Department of Health and a major challenge for hospital trusts that provide cardiac services. ‘Chest pain’ is the most common indication for out-patient referral to cardiology. The delay between referral and out-patient review has been successfully reduced in our institution and across the UK by the rapid-access chest pain clinics (RACPC), with 96% of referrals nationwide being seen within two weeks.2 In this centre, up

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