Tag Archives: coronary artery disease

Introduction Computed tomography coronary angiography (CTCA) is an established and validated alternative to invasive coronary angiography (ICA).1 The extent to which CTCA can replace ICA is controversial.2 The low diagnostic yield from ICA suggest there is ample scope to select patients more efficiently for investigation.3 In 2010, in the UK, the National Institute for Health and Care Excellence (NICE)4 published new guidelines for the investigation of patients with suspected coronary artery disease (CAD), which incorporated CTCA as a first-line investigation.5 In keeping with these guidelines, we ceased to use exercise testing as a primary t

Introduction Coronary heart disease (CHD) is the leading cause of death worldwide. Chronic subclinical inflammation is a key recognised process in the pathogenesis of CHD, and may play an important role in atherogenesis. Figure 1. Atherosclerotic plaque rupture Atherosclerosis is a complex multi-factorial disease process, which is initiated at the endothelium in response to various forms of injurious stimuli (shear stress, oxidative stress, arterial pressure changes) including inflammation. These factors appear to alter the endothelial cell’s capacity to maintain homeostasis and vascular tone and leads to the so-called endothelial ‘dysfun

Dr Mike Norell I was asked recently to speak at a fringe meeting that was juxtaposed to a major interventional gathering in London. My brief, ‘Gender differences in PCI outcomes’, was not a subject with which I was immediately familiar, and nor was it one upon which I was known to be authoritative, so my initial reaction was along the lines of “why me?”. The four other speakers were all women with both well-established and well-deserved reputations as acknowledged experts in this area. Thus for a number of reasons – some more obvious than others – I was clearly going to be the odd man out.  On the face of it my work was not going

Introduction It is accepted that coronary revascularisation with coronary artery bypass graft surgery (CABG) provides both symptomatic and prognostic benefit in patients with multi-vessel coronary artery disease (mvCAD).1,2 Both percutaneous coronary intervention (PCI) and CABG provide better relief of angina symptoms than medical therapy alone.1,3 Large, randomised-controlled trials (RCTs), in recent years, have demonstrated that CABG offers an improved outcome in patients with complex three-vessel coronary artery disease (CAD), especially in those with co-existing diabetes mellitus.4,5 However, in patients with one- or two-vessel CAD, PCI o

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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Introduction For many years coronary angiography (CA) has been used as the gold standard in the assessment of coronary artery disease (CAD), and even a normal result is considered a worthwhile outcome.1 However, concern has been raised about the use and overuse of what is an invasive and expensive procedure.2-4 We examined our cardiac catheter database to assess our diagnostic yield in terms of detecting CAD, and also in terms of subsequent referral for coronary revascularisation, whether this be by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG), in a population of patients being assessed for possible CAD.

Introduction For many years, the exercise tolerance test (ETT) has been the first-line investigation in patients presenting with stable chest pain. However, equivocal and false-positive results often lead to additional investigations. In recent years, computed tomography (CT) coronary angiography (CTCA) has been demonstrated to have excellent negative predictive value, making it a useful test to rule out obstructive coronary artery disease (CAD).1-3 In 2010, the UK National Institute for Health and Care Excellence (NICE) published clinical guideline 95: ‘Chest pain of recent onset’. This guideline advocates the use of a new risk estimatio

Introduction The use of cardiac computerised tomography (CT) in the UK is changing. National Institute for Health and Clinical Excellence (NICE) clinical guideline 95 (CG95) defined its role in the assessment of stable chest pain patients.1 Further, recent NICE diagnostics guidance 3 (DG3) has recommended the use of newer scanners for difficult patients and specifically addressed the concerns about the effective radiation dose (ED) of earlier CT platforms.2 However, the commercial availability of the latest CT scanners is not yet widespread within the National Health Service (NHS). The 64-detector CT is presently the workhorse of the NHS and

Introduction Left pleuropericardial agenesis is a developmental abnormality that results in the heart and the left lung sharing a common coelomic cavity. This abnormality manifests due to failure of mesodermal ingrowth from the lateral body wall to close off the left pleuropericardial canal and also the failure of development of the left pleuropericardial membrane. Although pre-operative diagnosis is very unusual, partial agenesis can precipitate catastrophic complications of chamber or appendage incarceration. Complete agenesis results in incompletely understood effects on the right ventricular geometry due to luxation of heart into an extre