Tag Archives: diagnosis

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

Introduction Figure 1. A large vegetation on the aortic valve from a patient with infective endocarditis Untreated infective endocarditis (IE) is fatal; even with appropriate treatment, IE is associated with high rates of morbidity and mortality worldwide.1 The annual incidence of IE over the past two decades has remained relatively constant, ranging between 1.7 and 6.2 cases/100,000 population. Neither advances in healthcare nor revisions made to the current diagnostic criteria have substantially altered this.1-3 The current definition for IE now incorporates infections of prosthetic heart valves (both bioprosthetic and mechanical), implante

Case report A 51-year-old Asian woman presented with intermittent presyncope and profound breathlessness. She had no significant past medical history of note and was not receiving any regular medication. A resting 12-lead electrocardiogram (ECG) revealed a second-degree atrioventricular block. She subsequently underwent insertion of a dual-chamber permanent pacemaker. Further investigations at that time revealed unobstructed coronary arteries on angiography and normal ventricular function on transthoracic echocardiography. Figure 1. 12-lead electrocardiogram (ECG) demonstrates ventricular tachycardia of varying morphology Her symptoms initial

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Figure 1. Computed tomography (CT) scan of the chest showing normal contrast filling of the right coronary artery (panel A), and absence of contrast within the left main coronary artery (panels B and C) A computed tomography (CT) scan of the chest excluded a pulmonary embolism and aortic dissection, and, although not a dedicated cardiac CT, suggested an occlusion of the left main coronary artery (LMCA) (figure 1). Echocardiography showed impaired left ventricular function with an akinetic anterior, inferior and lateral wall. An intra-aortic balloon pump (IABP) was inserted and coronary angiography was performed, which confirmed an occlusion o