http://heart.bmj.com This feed contains articles for Heart Subject Collection "Education in Heart" Heart http://heart.bmj.com http://heart.bmj.com/cgi/content/short/99/12/888?rss=1 Concomitant atrial fibrillation Concomitant atrial fibrillation Isolated AF FAST study Future in AF ablation References It has been 21 years since the first description of the maze procedure by James Cox.1 At that time the hypothesis of multiple independent wavelets propagating randomly through both atria was the most accepted dominant atrial fibrillation (AF) mechanism; there was no knowledge of the importance of focal triggers within the pulmonary veins, the influence of different local activation rates, frequency gradients, the autonomic nervous system, or genetics in the genesis of AF. The Cox maze procedure was designed basically with two aims: to reconduct the electrical impulse into dead-end paths, and to avoid its rotation on round structures like the mitral and tricuspid annuli, both venae ca ... Castella, M. 2013-06-15 doi:10.1136/heartjnl-2012-302044 Surgical ablation in atrial fibrillation: in which patients? British Cardiovascular Society 12 99 892 888 2013-06-15 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/99/11/811?rss=1 In the last decade three dimensional echocardiography (3DE) technology has evolved significantly, and the advance of matrix transducers has made its use commonplace in daily clinical practice.1 Currently, it is possible to acquire real-time 3DE images for appropriate visualisation of valvular anatomy and proper quantification of valvular heart disease (VHD). However, 3DE quality depends of a number of factors, including the intrinsic quality of the ultrasound images, the number of heart beats used to reconstruct each 3DE image, and the ability to limit motion artefacts with adequate electrocardiographic and respiratory gating.2 The latter is particularly challenging when using systems requiring electrocardiographically triggered multiple heartbeats for volume rendering analysis. The acquisition of 3DE images can be performed in most ultrasound systems using the live' mode, by one single ... Zamorano, J. L. Goncalves, A. 2013-06-01 doi:10.1136/heartjnl-2012-302046 Three dimensional echocardiography for quantification of valvular heart disease British Cardiovascular Society 11 99 818 811 2013-06-01 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/99/10/743?rss=1 Diabetic patients have an increased risk of cardiovascular disease (CVD), which is a major contributor to morbidity and mortality in the aging population, and have a more than twofold increase in the risk of dying from CVD.1 Even patients with pre-diabetes, as detected by abnormal glucose tolerance tests, have an increased risk of developing disabling stroke, peripheral artery disease, and myocardial infarction. Healthcare spending for people with diabetes is more than double the expenditure on those without diabetes, and a significant part of these costs is explained by CVD comorbidity. This article will focus on the effect of diabetes on the initiation and progression of arterial occlusive disease, preceded by a short outline of the enormous impact of this issue from a societal-economic perspective. Diabetes, a major healthcare issue Diabetes, a major healthcare... Dia ... Pasterkamp, G. 2013-05-15 doi:10.1136/heartjnl-2011-301172 Methods of accelerated atherosclerosis in diabetic patients British Cardiovascular Society 10 99 749 743 2013-05-15 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/heartjnl-2012-302064v1?rss=1 Physiological fundamentals of left ventricular torsion Physiological fundamentals of... Imaging techniques to assess... Influence of specific... Clinical applications of LV... Future directions References Left ventricular anatomy The normal left ventricular (LV) shape has been assimilated to a thick walled prolate ellipsoid with its long axis directed from apex to base.1 w1 The normal LV morphology is characterised by a high degree of regional heterogeneity. With the use of tagging magnetic resonance, a wide variation in circumferential and longitudinal radii of LV wall curvature has been shown, with a more oval shaped LV cavity in the short axis direction and more flattened LV wall towards the apex.2 In addition, ... Beladan, C. C. Calin, A. Rosca, M. Ginghina, C. Popescu, B. A. 2013-05-09 doi:10.1136/heartjnl-2012-302064 Left ventricular twist dynamics: principles and applications British Cardiovascular Society 2013-05-09 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/99/9/661?rss=1 Since the introduction of 64-detector row CT1 2 scanners in 2005, coronary CT angiography (CCTA) has developed into an accurate non-invasive method for direct visualisation of coronary arteries, coronary stenoses, and atherosclerotic plaque.3 These CT scanners have embodied a combination of favourable technological characteristics--including adequate volume coverage, high temporal resolution and reasonable spatial resolution--permitting the acquisition of images of the heart with reasonable breath holds, thus providing an advantage over prior generation 16-detector row scanners. Since its introduction, CCTA has experienced rapid adoption into daily clinical assessment of patients with suspected or known coronary artery disease (CAD), with resultant offerings of societal guidance documents such as the American College of Cardiology Appropriate Use Criteria, the American Heart Association Exp ... Min, J. K. Castellanos, J. Siegel, R. 2013-05-01 doi:10.1136/heartjnl-2012-302039 New frontiers in CT angiography: physiologic assessment of coronary artery disease by multidetector CT British Cardiovascular Society 9 99 668 661 2013-05-01 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/heartjnl-2011-301528v1?rss=1 In daily clinical practice, cardiologists frequently encounter patients demonstrating left ventricular hypertrophy (LVH) of initially unknown origin. The exact diagnosis and differentiation of pathological' LVH--which occurs in, for example, hypertensive heart disease (HHD), hypertrophic cardiomyopathy (HCM), myocardial storage/infiltrative disease, or systemic diseases such as mitochondrial myopathy--from physiological' LVH (which occurs in athletes) is of paramount therapeutic and prognostic value. However, determination of the underlying aetiology of LVH--which is frequently defined by a left ventricular (LV) wall thickness of at least 13 mmw1 w2--still constitutes a challenging and critical clinical problem. Hence, this article will focus on the current diagnosis of both common as well as rare (non-valvular) diseases that are associated with LVH. Diagnostic ... Yilmaz, A. Sechtem, U. 2013-04-30 doi:10.1136/heartjnl-2011-301528 Diagnostic approach and differential diagnosis in patients with hypertrophied left ventricles British Cardiovascular Society 2013-04-30 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/heartjnl-2012-302976v1?rss=1 The definition of myocardial infarction (MI) continues to evolve as refined ECG criteria, more advanced imaging, and more sensitive and specific biomarkers are developed. The acceptance globally of a clinically practical standard definition for everyday practice would allow for better comparisons across clinical experiences and further facilitate research in this critical area. Because of the evolution of better diagnostic tools and more information about the value and limitations of previous definitions, there was a need to update the Universal Definition of MI published in 20071 and this has recently been accomplished.2 Great efforts were made by the taskforce that developed these guidelines to establish clinical criteria which correspond to the contemporary management of patients suspected of having MI. Therefore, a combination of clinical symptoms, cardiac biomarkers, and ECG changes indicative of myocardial ischaemia are ce ... White, H. D. Thygesen, K. Alpert, J. S. Jaffe, A. S. 2013-04-27 doi:10.1136/heartjnl-2012-302976 Clinical implications of the Third Universal Definition of Myocardial Infarction British Cardiovascular Society 2013-04-27 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/heartjnl-2013-303884v1?rss=1 Atrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia in clinical practice, with a prevalence of 0.4-1% in the US population.w1 AF is a potent risk factor, increasing the risk of stroke fivefold and accounting for approximately 15% of all strokes in the USA.w2 AF also significantly increases the risk of mortality from heart failure.w3-7 Many therapies, including pharmacological approaches and direct current cardioversion, have been tried to treat this malignant arrhythmia, but were not found to be that effective.1 w8-w11 Catheter ablation of AF has provided better outcomes compared with other treatments, especially by applying pulmonary vein (PV) isolation in patients with paroxysmal AF.2 w12 However, other procedures modifying the substrate of AF, such as complex fractionated atrial electrogram ... Higuchi, K. Akkaya, M. Akoum, N. Marrouche, N. F. 2013-04-25 doi:10.1136/heartjnl-2013-303884 Cardiac MRI assessment of atrial fibrosis in atrial fibrillation: implications for diagnosis and therapy British Cardiovascular Society 2013-04-25 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/heartjnl-2012-303202v1?rss=1 Cardiac troponin (cTn) is a regulatory protein of the myofibrillar thin filament of striated muscle regulating excitation-contraction coupling in the heart.w1 Among the three subunits (T, I, and C), only cardiac troponin T (cTnT) and I (cTnI) are expressed in cardiac muscle and released into blood following myocardial cell death. Several distinct pathobiological mechanisms leading to elevated troponin values have been suggested, not all of which involve myocyte necrosis.w2 cTnT or cTnI are routinely used in emergency units as the preferred biomarkers for the diagnosis of acute myocardial infarction (MI). According to joint criteria for the diagnosis of acute MI by the European Society of Cardiology/American College of Cardiology/American Heart Association/World Heart Federation Task Force, an acute MI should be diagnosed in patients with symptoms of myocardial ischaemia and detection of a rise and/or fall of cardiac biomark ... Vafaie, M. Biener, M. Mueller, M. Schnabel, P. A. Andre, F. Steen, H. Zorn, M. Schueler, M. Blankenberg, S. Katus, H. A. Giannitsis, E. 2013-04-25 doi:10.1136/heartjnl-2012-303202 Analytically false or true positive elevations of high sensitivity cardiac troponin: a systematic approach British Cardiovascular Society 2013-04-25 EDUCATION IN HEART http://heart.bmj.com/cgi/content/short/heartjnl-2012-302034v1?rss=1 Acute coronary syndromes Acute coronary syndromes Evaluate the probability of... Invasive strategies in NSTE-ACS Timing of angiography in... Timing of PCI in... Influence between timing of... Influence between timing of... Trade-off between periprocedural... Future research Conclusions References Acute chest pain remains one of the most difficult challenges for the clinician. Nowadays, chest pain and its related complaints account for up to 10% of the adult emergency admissions and around 25% of all hospital admissions.w1 Notably, the number of patients presenting with complaints of chest pain is rising.w2 In a typical population of patients presented for the evaluation of acute chest pai ... Riezebos, R. K. Verheugt, F. W. A. 2013-04-20 doi:10.1136/heartjnl-2012-302034 Timing of angiography in non-ST elevation myocardial infarction British Cardiovascular Society 2013-04-20 EDUCATION IN HEART