Heart Murmurs

Bleeding complications, are we too removed to appreciate the risks?

Have you had to use an antidote for one of the novel anticoagulants yet? I thankfully haven’t. I very rarely see bleeding complications bar those immediate or very close to our invasive procedures, and the vast majority are with antithrombotic and/or dual anti-platelet therapy. Any bleeding away from this time goes directly to someone else,

Should telling patients they can no longer drive be straightforward?

I find one of the more difficult conversations with patients about their cardiac disease is when we have to advise them to stop driving. This enforced change in lifestyle markedly affects everyone, especially the elderly. In my practice in a rural city, the impact is that bit greater as there are fewer avenues to maintain

Technological advances in everyday cardiology: friend or foe?

Technological advances in healthcare have been amazing in my lifetime. In cardiology, this year it’s the 40th anniversary of PCI and the 50th of heart transplant. These techniques have been progressively refined and were the launch pad for further advances. Medical progress continues exponentially. Now in-depth collaboration between medics and experts from other sciences is

Sports cardiology: questions from the heart

Just before I went off on summer break a now stable paroxysmal atrial fibrillation (PAF) patient shared that he was taking Dr John Mandrola’s The Haywire Heart to read on his cycling holiday. He’ll definitely find resonance in Dr John’s recount of his AF episode whilst cycling, which is almost the same as my patient

PCSK9 inhibitors may improve outcomes but can we afford them?

Last I week I got my first query from a GP about prescribing Repatha (Evolocumab by Amgen), the monoclonal antibody that inhibits PCSK9, for a patient with atherosclerotic cardiovascular disease (ASCVD). This new group of medications are a fantastic piece of translational science, but in our financially pressured healthcare system are they a therapeutic step too far for

Acute aortic dissection — the great mimicker: how can we improve patient outcomes?

Acute aortic dissection is one of a number of conditions in medicine that carries the moniker of “the great mimicker“. But there is no doubt that it is the one with the highest jeopardy. Acute aortic dissection (AAD) has a very high mortality, even with surgical intervention, and the time to diagnosis and then to

Cardiovascular disease in pregnancy: does it give you sleepless nights?

Even experienced general cardiologists find cardiovascular disease in pregnancy can give you sleepless nights. Most of the time we simply need to reassure, but a small percentage of cases need intense support, often with a complex clinical path. A good outcome is not guaranteed, which as always in young previously healthy individuals, raises your anxiety.  

Debate: “Should all coronary angiograms be done by interventionists?”

This is not a new debate I know, but further persuasive data on the use of pressure wires made me revisit the thought that diagnostic coronary angiograms should optimally only be done by interventionists; I would be interested to hear your views. For many years now we have known that an intra-coronary lumenogram often doesn’t give us

Too many normal coronaries in the cath lab

What’s your cath lab’s normal/non-actionable coronaries rate?  I don’t know what ours is, so we’ve sent a registrar to gather some of our data to discuss in the department. Are you like me, disappointed when you see an out-patient whose invasive angio finds minimal CAD, where even a pressure wire doesn’t seem justified?  It really isn’t the proceduralist that

The impact of adopting the new ESC guidelines on AF

In our department recently we have been discussing the issue of keeping up with contemporary practice guidelines to deliver best patient care. As I think with all NHS departments, with ever increasing workloads, high patient and referrer expectation (but slow or little progress with additional resource), how we achieve these goals in a sustainable way