Tag Archives: myocardial infarction

Introduction Acute coronary occlusions involving the diagonal or intermediate branches present diagnostic challenges, since classical patterns of ST-elevation in contiguous leads on electrocardiogram (ECG) are often not apparent. This leads to delays in catheter laboratory activation and delivery of reperfusion therapy, and, ultimately, worse clinical outcomes. Case report A 44-year-old man with a background of hypertension and paraplegia presented with acute chest pain radiating to the left arm, which woke him from sleep. He called for emergency medical assistance, and an ECG, performed by paramedics, showed ST-segment elevation in leads aVL

Introduction Clinical guidelines recommend routine early inpatient invasive coronary angiography (ICA) in patients presenting with non-ST-elevation acute myocardial infarction acute coronary syndrome (NSTEMI-ACS) who are considered at higher risk of future recurrent myocardial infarction (MI) and death. National Institute for Health and Care Excellence (NICE) guidance recommends early ICA in high-risk patients within three days of admission,1 and the European Society of Cardiology (ESC) recommends this investigation is completed within 24 hours.2 Most UK patients presenting with NSTEMI-ACS are admitted to hospitals that do not have invasive

Meeting patient needs Dr Rani Khatib Previously, individuals with CV disease and type 2 diabetes in our area were treated by two separate specialty teams. However, it is now well-established that there is significant interplay between CV and metabolic disease, as well as renal disorders.2,3 Thus, we have come to believe that the management of complex post-MI Cardio–Renal–Metabolic or ‘CaReMe’ cases requires a more holistic care model. In this way, we can ensure that patients gain easy access to all required risk and medicine optimisation, and other forms of care, in line with current treatment guidelines, and individually tailored to

Background and history In recent times, medical marijuana has been a popular topic that has necessitated legal regulation. Annual prevalence of marijuana consumption in 2017 was 147 million or roughly 2.5% worldwide,1 making it the most widely grown, distributed and consumed recreational drug. The cannabis plant as botanical product has 480 natural components, 66 of which are classified as cannabinoids. The most commonly studied component, delta-9-tetrahydrocannabinol (THC) interacts with internal cannabinoid (CB) receptors of the human body. This activates an intricate physiological cascade, i.e. the endocannabinoid system described by Raph

Introduction According to the British Heart Foundation (BHF), in the UK there are more than 100,000 hospital admissions each year due to ST-elevation myocardial infarction (STEMI), equating to 280 admissions each day, or one every five minutes.1 The Essex cardiothoracic centre (CTC) is a tertiary, state-of-the-art centre that is equipped to deal with these high-risk cases. There are five district hospitals covered by the Essex CTC to provide a primary percutaneous coronary intervention (PCI) service. The patient turnover is high and there are emergency and elective procedures undertaken every day. The discharge of patients needs to be timely

Introduction Primary percutaneous coronary intervention (pPCI) and stenting are considered first-line management of ST-elevation myocardial infarction (STEMI).1 There is a well-recognised inflammatory component to ischaemic heart disease (IHD), and, thus, C-reactive protein (CRP) has been implicated as a poor prognostic indicator for stent re-stenosis, cardiovascular mortality and all-cause mortality post-myocardial infarction (MI).1,2 Case An 87-year-old man presented to Accident and Emergency (A&E) for “a one day history of severe neck/parietal headache on background of recent discharge from hospital with an MI”. Past medical histor

The American Diabetes Association Scientific Sessions 2019 were held in San Francisco REWIND One of the highlights of the conference and, for many, the main event was the presentation of results from REWIND (Researching CV Events with a Weekly Incretin in Diabetes), a cardiovascular outcome trial (CVOT) for the GLP-1 receptor agonist (GLP-1RA) dulaglutide.1 Prior to this trial, the majority of CVOTs (and all prior CVOTs with GLP-1 RAs) were conducted in a predominantly secondary prevention population. Thus any positive cardiovascular (CV) outcomes were only shown in those with established atherosclerotic cardiovascular disease (ASCVD). The ba

Introduction Most patients presenting as an emergency with chest pain do not have myocardial infarction (MI),1 which must, nevertheless, be ruled out in order to reassure and discharge from hospital. High-sensitivity cardiac troponin T (hs-TnT) and troponin I (hs-TnI) have streamlined the assessment and management of chest pain, as a rapid rule out of MI is now possible, particularly if hs-TnT or hs-TnI are undetectable at presentation.2-8 Undetectable troponin cannot, however, be used to exclude unstable angina, which by definition is not associated with a troponin rise.9 It is for this reason that physicians and cardiologists may be reluct

Introduction Individuals with diabetes are at increased risk of vascular outcomes, and their prognosis following an event remains worse compared with those having normal glucose metabolism.1 The relationship between glycaemia and vascular disease is complex as it is affected by multiple glucose parameters, including chronic hyperglycaemia, hypoglycaemia and, potentially, glycaemic variability.2 To add to the complexity, the type of hypoglycaemic agent used may also alter predisposition to vascular events. Over a decade ago, one hypoglycaemic agent, rosiglitazone, was implicated in increasing the risk of vascular disease, which prompted the U

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