Although there was a higher event rate initially in the invasive group, associated with revascularisation, the event rate subsequently fell and the hazard curves crossed after 4 weeks. Exercise testing after myocardial infarction: how soon, what protocol, how should results be acted upon?. How do I start it and how should I monitor therapy?. N Engl J Med 1996;335: 1333—41. The author has also used them in rare patients with familial hypertriglyceridaemia during pregnancy to protect against pancreatitis. Vascular disease itself could impair nocturnal blood pressure fall through impairment of cardiovascular reflexes.
What lipid levels should I aim for? What are hibernating and stunned myocardium? Further work needs to be done to establish its role in coronary disease. Reduction in the response to coronary and iliac artery injury with photodynamic therapy using 5-amino-laevulinic acid. How soon before cardiac surgery should aspirin be stopped?. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study. Difficulties arise in those without end-organ damage or a previous cardiovascular event. Troponin T is released within 4—6 hours of injury peaking after 12 to 24 hours. J Am Coll Cardiol 1995;26: 1643—50.
Echocardiography can assess the presence of myocardial viability by looking at contractile reserve following inotropic stimulation with dobutamine dobutamine stress echocardiography. A few important topics defied our editorial culling and were given more space. Deciding on the optimal age of treatment in such individuals presents some difficulty and the correct strategy has yet to be determined. Design of appropriate delivery devices has taken a number of directions including double balloon catheters and perforated balloons allowing high pressure injection through radial pores. How do I assess suitability for transplantation? There are a number of reasons for this including the lack of correlation between animal models and the situation in man, the drug doses used or the power of some of the trials. Resins The resins are associated with a high frequency of gastrointestinal side effects which limit their use. Which cardiac patients should never get pregnant? When to repair the miral valve?.
What should I look for and how should they be managed?. Both studies were performed in large populations 3000 patients with probable coronary disease and had five year follow-up. Which patterns of response warrant referral for angiography?. While it is affected by disease prevalence, since diagnostic testing is usually only indicated when the pre-test probability is 50% i. What is the annual risk of bacterial endocarditis on these prosthetic valves?. Further reading Clement D, De Buyzere M, Duprez D.
N Engl J Med 1997; 337: 1648—53. They are first line treatment for severe hypertriglyceridaemia and in combination with statins in severe mixed lipaemia. Medical Research Council trial of treatment of hypertension in older adults: principal results. What other alternative monitoring devices are now available? Relationship between the level, pattern and variability of ambulatory blood pressure and target organ damage in hypertension. Vascular gene transfer; from bench to bedside.
When work up bias is removed by having all patients with chest pain undergo catheterisation different results are obtained though the predictive accuracy remains the same. Beta-adrenoceptor blockers are an important treatment in unstable angina, not only relieving symptoms but also reducing the likelihood of progression to infarction and cardiac death. Effects on stroke and coronary heart disease. Kieran Bhagat Innumerable editorials, reviews and letters have been written on the calcium channel blocker controversy that started with the publi-cation of the case-control study by Psaty et al in 19951 and the subse-quent meta-analysis of Furberg et al in the same year. Who should have a tilt test, and what do I do if it is positive?. How do I manage the patient with malignant hypertension?. How should such patients be managed to improve outcome and what are the results? Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina.
How should they be followed?. Renal angiography will identify renal artery stenosis. There is general consensus that short-acting dihydropyridines should not be given to patients with ischaemic heart disease. A patient is on life-long warfarin and wishes to become pregnant. Should I screen relatives, and how? By 6 months, 37% of the non-invasive group had crossed over to the invasive strategy.
Who should have a tilt test, and what do I do if it is positive? J Am Coll Cardiol 1995;25: 1286—92. However, a meta-analysis gave a 7. Do they need anticoagulation to cover the procedure?. The effect of aggressive lowering of low density lipoprotein cholesterol levels and low dose anticoagulation on obstructive changes in saphenous vein bypass grafts. In the latter study it could be argued that the low dose of vitamin E used did not prevent myocardial infarction but when one occurred it was more often fatal. Which patterns of response warrant referral for angiography? There is less experience with newer antihypertensive agents. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels.
Exercise standards: a statement for Healthcare Professionals from the American Heart Association Writing Group. Economics of myocardial perfusion imaging in Europe — The Empire Study. Myocardial viability on echocardiography predicts long-term survival after revascularisation in patients with ischaemic congestive heart failure. Joseph F Malouf Although exercise testing is generally considered a safe procedure, acute myocardial infarction and death have been reported up to 10 per 10,000 tests performed in some studies. Patients should be advised to eat diets rich in fruit and vegetables instead. Is there a role for digoxin? How do I treat them? Who should receive which one? The sensitivity ranges from a low of 40% for single vessel coronary artery disease to up to 90% for angiographically severe three vessel disease, with a mean sensitivity of 66%. Troponin T as a diagnostic tool Troponin T can be used both as a diagnostic and a prognostic tool in the Accident and Emergency Department.
Exercise capacity has been a consistent predictor of prognosis and disease severity. How do I assess suitability for transplantation?. Coronary artery bypass grafting: what is the case for total arterial revascularization?. They can be used in moderate renal impairment. What echocardiographic techniques are useful for detecting them? N Engl J Med; 1997;337: 447—52.