Tag Archives: echocardiography

Introduction Fabry disease is a rare X-chromosome-linked disorder that results from alpha-galactosidase A enzyme deficiency. It is broadly divided into classical (earlier onset, low enzyme activity) and non-classical (milder, later-onset and some residual activity). It is underdiagnosed despite the availability of diagnostic tests, such as blood (plasma or leucocyte alpha-galactosidase A enzyme) and genetic testing. Due to its heterogeneous nature as a multi-system disorder, Fabry disease (FD) is rarely considered. Patients often present with non-specific symptoms, such as fatigue and gastrointestinal symptoms akin to irritable bowel, taking

Introduction In the financial year 2022–23 there were 185 heart transplants performed in the National Health Service (NHS) of the UK.1 These were performed across six adult centres: Queen Elizabeth Birmingham, Golden Jubilee Glasgow, Harefield London, Wythenshawe Manchester, Royal Papworth Cambridge, Freeman Newcastle upon Tyne; and two paediatric centres: Great Ormond Street London and Freeman Newcastle. Each hospital has an allocation zone, which encompasses 336 referring hospitals across the UK.2 The heart donations are classified as either donation after brainstem death (DBD) or donation after circulatory death (DCD). The donation proc

Introduction The tricuspid valve (TV) is involved in 90% of patients with right-sided endocarditis and is most common in people with intravenous drug use (IVDU). Septic pulmonary emboli occur in >50% of patients with TV involvement and manifests with various respiratory symptoms.1 Case report A 38-year-old man presented with a prodrome of flu-like illness along with night sweats, pleuritic chest pain and cough for two weeks unresponsive to the usual first- and second-line oral antibiotics (amoxicillin 1 g 8 hourly for five days, and doxycycline 100 mg 12 hourly for five days, respectively). There was no history of illicit IVDU or any condi

Introduction The World Health Organisation (WHO) defines obesity as “abnormal or excessive fat accumulation that may impair health” and classifies obesity based on body mass index (BMI), with those with a BMI of 25–30 kg/m2 termed as overweight and those with BMI over 30 kg/m2 defined as obese.1,2 Obesity has reached pandemic levels in the last 50 years.3 One and a half billion people over the age of 20 in the world are thought to be overweight or obese.4 Obesity is associated with low-grade chronic inflammation leading to insulin resistance, which may progress to diabetes mellitus.5 Moreover, fatty liver disease, systemic hypertension

Introduction Timely corrective surgery for severe mitral regurgitation (MR) reduces the risk of limiting symptoms and irreversible left ventricular dysfunction.1,2 Left untreated, severe MR carries a poor prognosis. In asymptomatic patients, the estimated five-year rates of death from any cause, death from cardiac causes and adverse cardiac events (death, heart failure or new atrial fibrillation), are 22%, 14% and 33%, respectively.2 The prognosis for symptomatic patients is significantly worse, and further adversely affected by older age and comorbidities, including atrial fibrillation, pulmonary hypertension, left atrial dilatation, and re

Introduction In recent years heart failure with preserved ejection fraction (HFpEF) has become a research priority, since despite having a preserved ejection fraction (EF), it is still associated with mortality and survival rates similar to heart failure with a reduced ejection fraction (HFrEF).1 Historically, the interest in HFpEF stems from the collaboration of two areas of research. Studies found that diastolic left ventricular (LV) dysfunction contributed to myocardial hypertrophy.2,3 Shortly after, HFpEF was found to be an adjunct in heart failure (HF) trials, examining the usefulness of angiotensin-converting enzyme (ACE) inhibitors in

The problems First: we are leaking highly skilled workforce Dr Claire Colebourn, President of the British Society of Echocardiography The experienced Band 7 echocardiographer is the lynch-pin of every UK NHS echo service, acting as trainers, on-the-ground supervisors and quality assurers. Our data show that, far from recruitment being our major issue, there is a steady drip of senior workforce leaking from the profession. Departments with a high proportion of newly qualified echocardiographers risk a gradual decline in quality without adequate senior presence, the ‘rookie factor’ is simply too high. Second: echocardiography is an advanced

Table 1. Clinical features and complications First author Symptoms / complications Pur Jn Spl SCH Os Valve Culprit pathogen Cecarelli1 Meningitis, SMA, SE Y N N N N Mitral Staph. aureus Deonarine2 Cirrhosis, CHF, spondylitis Y N N N N Quadrivalve Strep. mutans El Chami3 CHF, respiratory failure Y N N N N Aortic Enterococcus faecalis Yokota4 Mesenteric abscess Y N N N N Mitral MSSA Miridjanian5 Fever, myalgia, headache Y N Y Y N Aortic Moraxella kingae Mahmoud6 Cirrhosis, CHF, ICE Y N N N N Mitral Pasteurella multocida Tiliakes7 Polyarthralgia, ANCA+ve, splenomegaly Y N N N N Aortic Strep. viridans Messiaen8 CHF, Gln, ANC

Dr Garbi (President, British Heart Valve Society, and Consultant Cardiologist) Capacity increase is imminently needed to meet the current demand. An immediate increase in workforce to increase capacity is not realistic, because of the national shortage of cardiac physiologists and the time needed to appropriately train them in echocardiography. Thus, the BHVS proposed an increase in capacity by reducing the time used for echocardiography when a comprehensive study is not needed. The complete description of the proposal is available on the BHVS website (https://bhvs.org/bhvs-management-of-echocardiography-requests/). The BHVS proposes the use

Discussion Biomarkers have not been used routinely in clinical AS management, but recent advances look set to change this. The PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) study identified that a higher ratio of apolipoprotein B/apolipoprotein A‐I was associated with a 3.4-fold increase in haemodynamic progression in the younger (<70 years) AS cohort. The balance of atherogenic and anti-atherogenic lipid factors appears to play a crucial role in pathogenesis in younger patients,4 presenting a screening target. Regardless of symptom status, biomarkers have application in risk stratification. Systematic review