Tag Archives: revascularisation

Introduction Peripheral artery disease (PAD) refers to all arterial disease outside of the coronary arteries and the aorta.1 It is estimated that over 200 million individuals are living with PAD globally.2,3 In the Western world, one in five adults over the age of 75 has PAD, including over 40 million Europeans.3-6 Though the prevalence of PAD is already at endemic levels worldwide, ageing populations and the increasing burden of chronic disease (i.e. hypertension, dyslipidaemia, diabetes mellitus, smoking) will contribute to further increases in the incidence and prevalence of PAD in the coming decades.2,3 As a consequence, PAD is the third

Introduction Computed tomography coronary angiography (CTCA) is an established and validated alternative to invasive coronary angiography (ICA).1 The extent to which CTCA can replace ICA is controversial.2 The low diagnostic yield from ICA suggest there is ample scope to select patients more efficiently for investigation.3 In 2010, in the UK, the National Institute for Health and Care Excellence (NICE)4 published new guidelines for the investigation of patients with suspected coronary artery disease (CAD), which incorporated CTCA as a first-line investigation.5 In keeping with these guidelines, we ceased to use exercise testing as a primary t

Introduction For many years coronary angiography (CA) has been used as the gold standard in the assessment of coronary artery disease (CAD), and even a normal result is considered a worthwhile outcome.1 However, concern has been raised about the use and overuse of what is an invasive and expensive procedure.2-4 We examined our cardiac catheter database to assess our diagnostic yield in terms of detecting CAD, and also in terms of subsequent referral for coronary revascularisation, whether this be by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG), in a population of patients being assessed for possible CAD.

Coronary heart disease is responsible for one sixth of UK deaths. Improvements in making an earlier diagnosis and more effective management have aided a reduction in mortality over the last two decades. Such improvements would not have been possible without well thought-out and carefully constructed guidance and teaching programmes. With the spread of internet technology, online medical education has seen an exponential growth in popularity. The British Journal of Cardiology (BJC) has recently launched its e-learning site BJC Learning and its first e-learning programme on angina (www.bjcardio.co.uk/learning). The angina e-learning programme

Yes, it’s true. After more than 20 years of accessing the arterial circulation almost consistently from the femoral approach, I have given in to the undeniable logic of the trans-radial enthusiasts. Was I among the last of a dwindling minority of dinosaurs, plodding on with traditional practice despite a changing – if not hostile – environment? Technology supporting the radial approach has undoubtedly advanced, and at the same time the interventional landscape has become less attractive to the use of a much larger vessel in which haemostatic control can never be guaranteed. I was wondering how this Damascene change in my practice came a

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The new guideline from the National Institute for Health and Clinical Excellence (NICE)1 covers adults who have been diagnosed with stable angina due to atherosclerotic disease, following on from clinical guideline 95,2 which advises on diagnosis of chest pain of recent onset. A key priority for implementation in the latest guidance is to ensure that people with stable angina receive balanced information and have the opportunity to discuss the benefits, limitations and risks of their treatment. Initial management of stable angina should be to offer optimal drug treatment, addressing both the angina itself and secondary prevention of cardiovas

Figure 1. A short-axis slice of the mid left ventricle illustrating contrast enhancement in the anterior segment (25% transmurality – viable), anterolateral segment (50–75% transmurality – non-viable), inferolateral segment (50% transmurality – potentially viable) Case 1 Mr K P is a 45-year-old man who presented to our hospital with symptoms of exertional breathlessness. His LV function was found to be severely impaired on echocardiography and it was initially thought that he had ‘dilated cardiomyopathy’. As he had a strong family history of coronary artery disease and was an ex-smoker, he underwent X-ray coronary angiography. He

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