Tag Archives: diagnosis

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%

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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

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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This supplement is a report from the inaugural meeting of the Cardiometabolic Forum, jointly organised by the British Journal of Cardiology and HEART UK – The Cholesterol Charity. The meeting was held at the Royal Pharmaceutical Society, London, on 24th November 2011. Meeting chairs were Dr Dermot Neely (Royal Victoria Infirmary, Newcastle upon Tyne) for HEART UK, and Dr Henry Purcell (Royal Brompton Hospital, London, and Editor) for BJC. We hope this supplement will provide readers with an independent overview on recent developments in our knowledge of cholesterol metabolism and its implications for clinical practice. Speakers Dermot Neely

Abnormalities in plasma lipoprotein concentrations are found in seven of out every 10 patients with premature coronary disease, with a familial disorder in more than half of these cases, highlighting the importance of accurate diagnosis and scope for early treatment of affected families.1 Clinical assessment, incorporating review of phenotypic features, personal and family history, physical signs and laboratory tests, is fundamental to diagnosis. Table 1. Key tests to exclude secondary causes of dyslipidaemia In the first instance, it is important to exclude secondary causes of dyslipidaemia. Diabetes mellitus, untreated hypothyroidism, neph

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Two recent, but completely separate instances, prompted me to produce the paragraphs below. The first was National Institute for Health and Clinical Excellence (NICE) guidance covering the management of patients with recent onset chest pain. As a cardiologist with more years of experience than I would wish to count, this will, of course, prove to be most helpful in the interpretation of the symptom complex with which our patients present. The second, and probably more pertinent, was a tutorial I was delivering (sic) to a small group of medical students about the clerking of cardiac patients. It dawned on me that the ease with which we chat to