Medicine
There have been recent changes in the field of mitral valve disease, particularly regarding epidemiology, the continuing development of Doppler echocardiography and advances in interventional therapy.
Heart failure is a syndrome rather than a specific diagnosis. It is the final result of many diseases affecting the heart. Heart failure is usually viewed in terms of heart muscle disease, but other causes of the syndrome include valvular heart disease and chronic arrhythmias. In industrialized societies, the most common cause of heart failure is coronary artery disease. A substantial minority of...
Surgical practice for valvular heart disease varies around the world, depending on the predominant pathology encountered. Where rheumatic valvular heart disease remains prevalent, patients are often young. In these populations valve repair is frequently short-lasting, and the accelerated calcific degeneration of bioprostheses, together with the practical problems and hazards of life-long anticoagulation...
Recent advances in cardiovascular medicine include further evidence supporting the role of primary angioplasty, advances in stent technology, and new pharmacological approaches to the treatment of ischaemic heart disease.
Infective endocarditis is an endovascular infection of cardiovascular structures or intracardiac foreign bodies. The incidence is about 7/100,000 population/year and is increasing. Previously undamaged endocardium is resistant to colonization by micro-organisms, so platelet/fibrin deposits are a prerequisite for development of an infection. Early diagnosis and adequate treatment is required to reduce...
Investigations have several aims in heart failure: • to help establish the diagnosis • to find a treatable underlying cause • to estimate the severity and give prognostic information • to guide treatment (and monitor for potential adverse effects of treatment).
Heart failure affects 1-2% of the adult population and accounts for 5% of all acute hospital admissions. It carries a greater health economic resource burden than myocardial infarction. Despite the advent of medical therapies that improve survival in heart failure of any severity, the reported 2-year survival of patients with NYHA class III/IV symptoms remains about 40%. Selected patients may derive...
Acute rheumatic fever is initiated by group A streptococcal pharyngitis. This is followed by a latent period of 2-6 weeks, after which the clinical syndrome of acute rheumatic fever evolves, characterized by polyarthritis, carditis, chorea, erythema marginatum and subcutaneous nodules. These features may occur singly or in any combination.
Supraventricular arrhythmias can be divided into those that arise above the atrioventricular (AV) node (atrial arrhythmias) and those involving the AV junction and usually the AV node (supraventricular tachycardias (SVTs) or, more accurately, junctional tachycardias). (Many of these tachycardias involve the ventricle in the reentrant ciruit, so cannot be accurately termed – supraventricular'.) Diagnosis...
Chronic heart failure continues to be an exciting field of clinical research. Up to 5% of the population have heart failure or symptoms suggestive of the condition, and the mortality is high (up to 30% within 3 months of diagnosis and 10% per year thereafter), but current therapy approximately doubles life expectancy. The National Institute for Clinical Excellence (NICE) has published guidance on...
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder. Although many patients present with symptoms related to the haemodynamic disturbance conferred by the arrhythmia (e.g. heart failure, reduced exercise tolerance, impaired quality of life), AF is also a major risk factor for stroke and thromboembolism. In patients aged 80–89 years, it is the single most important independent...
Neonatal data collection gives an incidence of significant congenital heart disease of 8/1000 live births. This does not include minor defects, which often present later in childhood or even in adult life (e.g. bicuspid aortic valves occur in 1/100 of the population). Congenital heart disease is more common antenatally than post-natally; the discrepancy is explained by the greater incidence of spontaneous...
Ventricular arrhythmias are common and are usually benign, at least in those with a structurally normal heart. In patients with structural heart disease (usually coronary heart disease), however, ventricular arrhythmia is an adverse prognostic factor associated with cardiac arrest and cardiac mortality. Ventricular arrhythmias range from asymptomatic ventricular ectopy to sustained ventricular tachycardia...
Dizziness affects about one-third of individuals over the age of 65 years, and is one of the most common reasons for the elderly to consult their general practitioner. Syncope affects at least 20% of the population at some time and accounts for about 6% of general medical admissions in the UK. Recurrent symptoms are particularly disabling because they affect an individual's ability to work and to...
The investigation and management of bradycardia is an increasingly complex topic, but with the development of pacemakers there are few areas of medicine that offer such substantial improvements in patients' quality of life. About 400,000 pacemakers are implanted worldwide per year; about 270 are implanted per million population in the UK, 370 per million in Europe as a whole and 434 per million in...
Cardiopulmonary resuscitation (CPR) is the rescue of a collapsed patient from impending death from a potentially reversible cause. Unheralded ventricular fibrillation (VF) has received most attention, because of its prevalence in the older population and because of the success of treatment by CPR with rapid defibrillation. Other forms of cardiac standstill (asystole and electromechanical dissociation...
Heart disease in pregnancy is uncommon, affecting less than 1% of pregnant women. However, it is an important cause of maternal death; in the last triennial Report on Confidential Enquiries into Maternal Deaths (1997–1999), it accounted for 12 deaths per year in the UK. The prevalence varies between populations (Figure 1), depending largely on the prevalence of rheumatic heart disease. In addition,...
Doctors undertaking potentially dangerous procedures have a duty to be both well informed about the indications and potential complications of the procedure, and competent in the practical aspects. Invasive monitoring and therapeutic procedures are increasingly used in cardiology, and decisions to undertake them at the appropriate time can have fundamental consequences on patient outcome. This contribution...
Venous thromboembolism (VTE) is a spectrum of disease that includes both pulmonary embolism (PE) and deep venous thrombosis (DVT). In the USA, there are about 650,000 symptomatic cases of pulmonary embolism each year, causing 50,000 deaths and contributing to the death of a further 200,000. In the UK, 65,000 patients per year are hospitalized and about 20,000 die as a consequence of PE. DVT and PE...
There is firm evidence from prospective clinical trials that cardiovascular morbidity and mortality can be reduced significantly by blood pressure reduction. Thus, there are clear indications for the detection of elevated blood pressure and institution of safe and effective long-term antihypertensive treatment.