Tag Archives: coronary artery disease

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

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Introduction Coronary artery disease (CAD) forms the bulk of adult cardiology. Spectacular advances have been made in the diagnosis and treatment of CAD, but the diagnostic terminology has not kept pace with these developments. The babel of terms like Q-wave infarction, non-Q infarction, ST elevation infarction, non-ST elevation infarction, etc. does not reflect the present-day realities. The term ‘acute coronary syndrome’ is too vague. A case of acute myocardial infarction successfully reperfused is no longer an ‘infarction’. There is a need to describe these cases of ‘aborted infarctions’ and ‘threatened infarctions’.1 A pro

Introduction Renal artery stenosis (RAS), traditionally the preserve of the nephrologist, is a condition of increasing interest to the cardiologist. Ninety per cent of RAS is caused by atherosclerosis and the risk factors for renal atherosclerosis and coronary atherosclerosis are the same. Furthermore, the presence of RAS alters the prognosis of co-existent cardiac disease, most notably cardiac failure and ischaemic heart disease, both directly1–3 and via its sequelae of renal failure and hypertension. Finally, the treatments for the disease, both medical and interventional, are familiar to the cardiologist, who can employ much of the knowl

Introduction The use of ionising radiation within cardiology is widespread with both myocardial perfusion scintigraphy (MPS) and conventional invasive coronary angiography (CA) being common diagnostic investigations for coronary artery disease. In the UK, some 70,000 MPS were performed in 20001 and over 205,000 CA in 2005.2 The use of ionising radiation is likely to increase further with the advent of cardiac multi-detector X-ray computed tomography (MDCT) and X-ray computed tomographic angiography (CTA). Furthermore, all these investigations are deemed to involve moderate- or high-dose radiation.3 Previous studies have shown poor knowledge o

In recent years technological advances have enabled improvements in both temporal and spatial resolution such that multi-detector computed tomography (MDCT) is now able to reproducibly evaluate cardiac disease. The combination of this improved resolution with more advanced post-processing techniques now means that MDCT has the ability to perform both anatomical and functional assessment from the single study. This technique therefore not only provides a non-invasive alternative to conventional angiography but the same data-set allows concurrent assessment of cardiac function, assessment of aberrant vessels, graft patency studies and assessmen

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