Determining the most important parameters affecting exercise performance, particularly in relation to age, could have important implications for rehabilitation. Although a reduction in maximal heart rate is known to be important, previous studies have implied that left ventricular systolic function did not correlate with maximal exercise time. […]
Latest articles
Fractional Flow Reserve achieves FAME at last
Fractional flow reserve (FFR), calculated using a coronary presure wire, is an index of the physiological significance of a coronary stenosis and is defined as the ratio of maximal blood flow in a stenotic artery to normal maximal flow. FFR in a normal artery is 1.0 – a value <0.80 identifies ischaemia causing lesions with […]
NSAIDs in Chronic Heart Failure – Further Evidence of Harm
Current guidelines advise against the use of NSAIDs in patients with chronic heart failure (CHF) due to the increased risk of fluid retention. However, many NSAIDS are available over the counter (OTC), and patients obtaining them in this manner may be putting themselves at increased risk of myocardial infarction or worsening heart failure. […]
BNP guided therapy for heart failure
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. […]
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). […]
Genetic polymorphisms and response to clopidogrel and risk of cardiovascular events
Across the whole spectrum of acute coronary syndromes and in patients undergoing PCI and stenting, dual anti-platelet therapy with aspirin and clopidogrel is the current recognised standard of care. However, significant variation in response to clopidogrel is observed between patients, with those with lesser degrees of platelet inhibition being at higher risk of adverse cardiovascular […]
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 […]