Tag Archives: myocardial infarction

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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Presented in a hotline session by Dr Martin Landray (University of Oxford), the trial’s co-principal investigator, and simultaneously published in the New England Journal of Medicine (https://doi.org/10.1056/NEJMoa1706444), this large-scale, placebo-controlled study was carried out on 30,449 patients with cardiovascular disease, who were all receiving lipid-lowering treatment with atorvastatin. Those patients also receiving anacetrapib (100 mg once daily) showed a significant reduction in the primary outcome, the risk of major coronary events (coronary death, myocardial infarction or coronary re-vascularisation) by 9% relative to those pati

The DETO2X-AMI study questioned the current practice of routine oxygen therapy for all patients with suspected myocardial infarction (MI), said Dr Robin Hofmann (Karolinska Institutet at Södersjukhuset, Stockholm, Sweden) who presented the study at the meeting. This prospective, randomised, open label trial enrolled 6,229 patients with suspected heart attack from 35 hospitals across Sweden. Half of the patients were assigned to oxygen given through an open face mask and the other half to room air without a mask. The study – using a registry-based randomised clinical trial protocol – was representative of real world practice and used nati