Tag Archives: diagnosis

Introduction The acute aortic syndrome refers to a spectrum of potentially life-threatening emergencies encompassing intra-mural haematoma, penetrating aortic ulcer and acute aortic dissection, each with different pathophysiological mechanisms.1 Of these, acute dissections comprise 85–95% of acute aortic syndrome, with an annual incidence of 3–4 per 100,000 in the UK and US.2 According to the Stanford classification, type A aortic dissection (ATAD) involves the aorta proximal to the left subclavian artery origin, whereas type B dissections occur distal to this landmark. The disruption of aortic wall integrity in ATAD with proximal extensi

AS awareness and detection Low detection rates of valvular heart disease (VHD) and AS are widespread, as many patients are diagnosed only when symptoms occur.5,8 The OxVALVE study (https://academic.oup.com/eurheartj/article/37/47/3515/2844994) showed that 51% of the population aged 65 years and older have undiagnosed VHD, and 1.3% have undiagnosed AS.5 Among the general population, a lack of awareness exists of AS and its symptoms. In a European survey of over 12,000 people aged 60 years and over, only a fifth were aware of VHD, and less than 4% could provide an accurate description of AS.9 National campaigns are recommended to raise public

Epidemiology King George II “On 25 October 1760 George II, then 76, rose at his normal hour of 6 AM, called as usual for his chocolate, and repaired to the closet-stool. The German valet de chambre heard a noise, memorably described as ‘louder than the royal wind’, and then a groan; he ran in and found the King lying on the floor, having cut his face in falling. Mr Andrews, surgeon of the household, was called and bled his Majesty but in vain, as no sign of life was observed from the time of his fall. At necropsy the next day Dr Nicholls, physician to his late Majesty, found the pericardium distended with a pint of coagulated blood,

This supplement provides a user’s guide to what’s new in the guidelines for the diagnosis and treatment of heart failure. This primarily relates to recommendations provided in the updated (2021) European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure. The articles summarise the contemporary guidance with respect to the diagnosis and investigation of patients presenting with heart failure; drug therapy (including the early implementation of the ‘four pillars’ of drug treatment for heart failure with reduced ejection fraction); and recommendations on lifestyle, rehabilitation,

Introduction The heart failure (HF) community has seen huge advances in the care of HF, and we see a turning point in the narrative of doom and gloom, which has traditionally been associated with HF – we see cause for optimism. We recognise the urgency of putting these advances to prompt use, as demonstrated by the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic HF.1 The 2021 updated guidelines make it clear that we have the means to diagnose HF early, to classify it more accurately, the tools to change the HF trajectory, and the duty and ability to intervene – and to do so early. Diagnosis While the ESC diagnost

Case We present a 31-year-old professional golfer with no significant cardiac medical history, who presented to Aberdeen Royal Infirmary in the Summer of 2015. He described palpitations after drinking alcohol the night before. After further investigation he was found to be in atrial fibrillation (AF) with fast ventricular rate (figure 1), and underwent medical cardioversion with bisoprolol and flecainide. His blood results were normal and he was discharged with an outpatient echocardiogram follow-up. Figure 1. 12-lead electrocardiogram (ECG) showing atrial fibrillation, T-wave inversion II, III, aVf, V5, V6 Transthoracic echocardiogram in Aug

Professor John B Chambers Introduction Aortic stenosis (AS) is the most common type of primary heart valve disease in industrialised countries. Although echocardiography is key for its assessment, the need for surgery is most frequently dictated by symptoms.1 However, the history can be surprisingly elusive, and physicians without specialist competencies in valve disease may miss their onset.2 This is important because the risk of death is approximately 1% per annum without symptoms but 4% in the first three months after the onset of symptoms,3 usually before the patient has time to contact their physician (figure 1). It then rises up to 14%

(more…)

Figure 1. Suggested model for hypertension Clinical significance Controlled hypertension is likely clinically significant. Patients often receive prognostication or treatment upon the basis of a diagnosis of systemic hypertension. This is built upon the assumption that the patient risk profile is determined by a once proven diagnosis of systemic hypertension. However, if patients are successfully treated for their systemic hypertension they may in fact move from a higher risk group towards a lower risk group. This could result in some patients ultimately receiving inappropriate treatments. For example, consider a relatively young male patie

Introduction Electrocardiogram (ECG) is a common investigation carried out in the Emergency Department (ED) and provides important information for both diagnosis and prognosis. In the pre-primary coronary intervention era, ECG had been the key investigation for the prompt diagnosis and management of patients with acute myocardial infarction, particularly those with ST elevation.1-5 Since primary coronary angioplasty became widely available in the UK, patients with typical ST-elevation myocardial infarction are filtered directly to specialist centres by the ambulance service. Acute coronary syndrome (ACS) patients without typical ST elevation