Category: Uncategorized

Should telling patients they can no longer drive be straightforward?

05 Oct 2017 2 Comments

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...

Technological advances in everyday cardiology: friend or foe?

07 Sep 2017 5 Comments

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...

PCSK9 inhibitors may improve outcomes but can we afford them?

06 Jul 2017 4 Comments

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...

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

01 Jun 2017 8 Comments

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...

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

04 May 2017 36 Comments

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...

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

06 Apr 2017 20 Comments

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...

The impact of adopting the new ESC guidelines on AF

02 Feb 2017 127 Comments

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...

Always follow-up asymptomatic LBBB with a good LV?

05 Jan 2017 37 Comments

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...

Takotsubo cardiomyopathy: more stress, or better detection?

03 Nov 2016 1 Comments

“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...