Heart : official journal of the British Cardiac Society
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Cardiovascular disease (CVD) mortality in the UK is declining; however, CVD burden comes not only from deaths, but also from those living with the disease. This review uses national datasets with multiple years of data to present secular trends in mortality, morbidity, and treatment for all CVD and specific subtypes within the UK. We produced all-ages and premature age-standardised mortality rates by gender, standardised to the 2013 European Standard Population, using data from the national statistics agencies of the UK. ⋯ CVD mortality has declined notably for both men and women while hospital admissions have increased. CVD prevalence shows little evidence of change. This review highlights that improvements in the burden of CVD have not occurred equally between the four constituent countries of the UK, or between men and women.
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A 75-year-old patient with hypertension and severe aortic stenosis underwent elective coronary angiography that showed mild non-obstructive disease in the mid left anterior descending artery (LAD). A left ventriculogram, however, demonstrated segmental systolic dysfunction with dilated akinetic apex (figure 1A, see online supplementary video 1). There was no history of prior myocardial infarction and the patient had not experienced any chest pain recently. A 12-lead ECG showed widespread deep symmetrical inverted T-waves with the exception of leads I, aVL and V1 (see online supplementary figure S1). Cardiac MRI (CMR) was performed to further delineate the morphology of the left ventricle (LV) and a representative frame in late gadolinium phase is shown (figure 1B). ⋯ Above information is most likely consistent with: Takotsubo cardiomyopathyLeft ventricular pseudoaneurysmApical variant of hypertrophic cardiomyopathy (HCM) with aneurysm formationA sequel of prior myocardial infarction in the setting of aortic stenosisLeft ventricular non-compaction.
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Observational Study
Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery.
Due to their unique pathophysiological profile, patients with hypertrophic cardiomyopathy (HCM) undergoing non-cardiac surgery require additional attention to perioperative management. We sought to compare perioperative outcomes of patients with HCM undergoing non-cardiac surgery with a matched group patients without HCM. ⋯ Patients with HCM undergoing high-risk and intermediate-risk non-cardiac surgeries have a low perioperative event rate, at an experienced centre. However, they have a higher risk of composite events versus matched patients without HCM.
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Case Reports Multicenter Study
ECG features and proarrhythmic potentials of therapeutic hypothermia.
Hypothermia can induce ECG J waves. Recent studies suggest that J waves may be associated with ventricular fibrillation (VF) in patients with structurally normal hearts. However, little is known about the ECG features, clinical significance or arrhythmogenic potentials of therapeutic hypothermia (TH)-induced J waves. ⋯ J waves were recorded in about 40% of the patients who received TH. They were most frequently observed in the inferior limb leads or lateral precordial leads. Life-threatening VF occurred only rarely (1.7%) during TH and were mainly observed in patients with primary arrhythmic disorder. Although a causal relationship between TH-induced J waves and VF remains unknown, administering TH to this potentially susceptible, high-risk population may require careful attention.
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Progression of aortic regurgitation after subpulmonic infundibular ventricular septal defect repair.
In patients with subpulmonic infundibular ventricular septal defect (VSD), postoperative progression of aortic regurgitation (AR) sometimes occurs despite early operation before the development of AR. The present study was aimed to identify the occurrence rate and predictors of late AR progression after VSD repair alone. ⋯ Among patients with subpulmonic infundibular VSD, the incidence of late AR progression after VSD repair alone was unexpectedly high (7.7%). Postoperative VSD leakage may be a significant risk factor for late AR progression. Long-term follow-up of postoperative AR is needed even for patients who undergo VSD repair alone.