Heart Murmurs

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

Always follow-up asymptomatic LBBB with a good LV?

I expect you are the same, I find it quite reassuring when there is no clear agreement amongst my Consultant colleagues to a clinical question because it’s then most likely that there is no scientific right or wrong. Last month, I mentioned asymptomatic left bundle branch block (LBBB) with a good LV, and as my colleagues gave

Anomalous coursing LCA: always go into the valley of death?

“Which way round do you think it goes, anterior or posterior to the aorta?”, said the interventional fellow. My staff replied: “Well, you could do more views whilst I consult the textbook…then you could do more views with a PA catheter in-situ…then take a few more views….but really you need to stop, and request a

Takotsubo cardiomyopathy: more stress, or better detection?

“The 401 highway running through the centre of Toronto is said to be the busiest road in the world,” said my wife reading from our Canadian travel guide that we bought to prepare us for our time in Canada for my interventional fellowship. Not long off the plane, and driving ‘on the wrong side of