Although a number of studies have previously investigated the utility of N-terminal brain natriuretic peptide (BNP) to guide treatment for heart failure, these studies were limited by their small size and limited follow-up. The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) aimed to overcome these limitations. […]
Category: General cardiology
Interaction between clopidogrel and PPI can lead to increased mortality
Emerging evidence indicates that proton-pump inhibitors (PPI) may inhibit cytochrome P450 2C19, an enzyme that plays a critical role in influencing the anti-platelet effect of clopidogrel. This paper sought to characterize whether the use of clopidogrel and PPI concomitantly was associated with adverse outcomes following hospital discharge for myocardial infarction (MI). […]
Exercise caution when using treadmill ECGs for angina assessment
Prompt assessment and risk stratification is fundamental to the early management of patients presenting for the first time with suspected angina. Within the setting of rapid access chest pain clinics (RACPC), risk stratification is traditionally achieved by history taking, examination, resting ECG and exercise ECG (ex-ECG). However, it remains unclear whether the inclusion of resting […]
Gender differences in the treatment of mitral valve prolapse
Mitral regurgitation (MR) may occur secondary to mitral value prolapsed (MVP), the latter having an estimated prevalence of 2.5% in the population. Severity of MR has been shown to be the main driver of outcome and also left ventricular and atrial changes, so surgical intervention remains the treatment of choice for MVP with severe MR. […]
The importance of ambulatory blood pressure monitoring
Among patients with resistant hypertension (RH) – defined as the failure to control blood pressure (BP) despite optimal treatment with at least 3 antihypertensive drugs in full dosages – controversy exists regarding the additive prognostic value of ambulatory blood pressure monitoring (ABPM) over clinic blood pressure readings (CBPR). The prevalence of RH ranges from 10% […]
Improving CPR outcomes – querying the role of a “rapid response” team
Following cardiac arrest, delays in treatment are associated with poor neurological outcomes and lower survival rates. A rapid response team – also known as a medical emergency team – is a multidisciplinary team designed to diagnose, evaluate and treat non intensive-care patients showing signs of clinical deterioration, the aim being to decrease the chances of […]
New MI diagnosis criteria, same old risk
The traditional diagnosis of myocardial infarction (MI) used the World Health Organization definition and required the concentration of a cardiac biomarker to be above twice the upper limit of normal. However, more recent guidelines have defined a troponin level above the 99th percentile of normal as being diagnostic of MI. […]
No role for intermittent amiodarone in AF
Although amiodarone maintains sinus rhythm in 45% to 70% of patients during 12 to 54 months follow-up, it is also associated with many serious non-cardiac side effects. To investigate if episodic treatment with amiodarone could still be effective in preventing atrial fibrillation (AF), but without causing significant side-effects, Ahmed et al. randomised 209 patients with […]
Lp-PLA2 Inhibiton Decreases Complex Plaque Development
Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme that is produced by inflammatory cells in atherosclerotic lesions. It has previously been shown to be present at higher levels in the core of ruptured atherosclerotic plaques, although it was unclear whether this was merely an association or whether the enzyme played a key role in plaque vulnerability. […]
UKPDS – 10 year Follow-Up Data Reported
The United Kingdom Prospective Diabetes Study (UKPDS) was a randomised multi-centre trial which demonstrated that intensive glucose therapy in patients with newly diagnosed type 2 diabetes mellitus resulted in a decreased risk of clinically evident microvascular complications and a non-significant reduction in the relative risk of myocardial infarction (p=0.052). The results of 10 year follow […]