eLetters

197 e-Letters

published between 2002 and 2005

  • In-stent restenosis: To stent or not to stent
    Peter Barlis

    Dear Editor,

    We read with interest the paper by Iofina et al.[1] highlighting the superior outcomes observed using sirolimus eluting stents (SES) versus intra-coronary radiation therapy (IRT) for patients with in-stent restenosis (ISR). This condition remains a significant source of morbidity and need for repeat procedures and, up until recently, IRT has remained the most proven treatment for ISR, with reported...

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  • Clopidogrel and atrial shunt closure for migraine: why is migraine aggravated immediately?
    Vinod K Gupta

    Dear Editor,

    Old medical theories, like myths, never die. In every era, long after the initial excitement evaporates, scientific theories that have not gathered logical strength through increasing clinical associations are recycled to address current perceptions. Such theories, like myths, offer a vicarious resolution of the ignorances that lies between our insecurities and our expectations.[1,2] Wilmshurst et al....

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  • The return of silent ischemia? Not really
    Sakir Uen

    Dear Editor,

    Mulcahy's article is an interesting update on the subject of silent myocardial ischemia.[1] He postulates that ambulatory ST segment monitoring does not add significantly to the finding of exercise testing, because it would occur almost exclusively in patients with a positive result in the ischemia exercise test.

    In a German multicentre study, we have analyzed both exercise test and ambulat...

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  • Treatment of ST elevation myocardial infarction with primary angioplasty
    Dr Shamsul A Bhuiyan

    Dear Editor,

    We have read the article[1] with great interest. Selection of the 23 patients is not clearly mentioned here. There is a lack of some other information too. Once the chest pain started, after what time those patients were selected for angioplasty? What was the percentage of lumen narrowing or stenosis? Was the stenosis complicated or not? What was the material used for primary angioplasty?

    Rap...

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  • Time to treatment of acute ST elevation myocardial infarction
    Dr Shamsul A Bhuiyan

    Dear Editor,

    Intra-country variation versus inter-country variation in pre-hospital care management of acute MI with ST elevation is worrisome matter. Thanks to R C Welsh et al. for wring the article. ST elevation acute MI needs early treatment with fibrinolysis therapy as early possible.

    Study[1] shows that time management is the key of ST elevation MI. Rapid time to treatment with thrombolytic therapy...

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  • Representative of UK practice?
    Tom Quinn

    Dear Editor,

    The data presented in Welsh et al.'s paper assessing variations in practice across the 12 countries in the ASSENT 3 PLUS trial may not be representative of UK practice since each of the four constituent countries of the UK have distinct health systems.

    In England and Wales, both of which have national standards for the care of STEMI patients -National Service Frameworks- and in which all 130...

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  • Saving lives
    Jill F Pattenden

    Dear Editor,

    Norris[1] reports that most out of hospital cardiac arrest occurs in the home, but that as patients usually have premonitory symptoms, there is an opening for education about these symptoms and how to act to avoid delay and subsequent mortality. Although there is clearly a need to educate the public at large to call an ambulance if they witness what could be a heart attack or cardiac arrest, less is k...

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  • Intra-country variation in pre-hospital STEMI care
    Robert C. Welsh

    Dear Editor,

    We thank Dr Tom Quinn for his interest in this manuscript. His letter addresses the realities of intra-country variation versus inter-country variation in pre-hospital care. Dr Quinn appropriately points out in his letter to the editor that the United Kingdom is made up of distinct nations with distinct health systems. We have recognized this issue in the manuscripts limitations section, “Because our stu...

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  • New definition of an abnormal Q wave – is it clinically useful?
    Jesper Khédri Jensen

    Dear Editor

    Since myocardial infarction (MI) was redefined five years ago(1), focus has been on troponins. However, with the consensus document the presence of an abnormal Q wave has also been redefined, but this change appears to have created only little controversy. Abnormal Q waves are still considered a definite objective sign of an established MI, and in this connection, the history of the patient is often in...

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  • Glyceryl trinitrate, headache and coronary artery disease: mechanistic and therapeutic uncertainties
    Vinod K Gupta

    Dear Ediutor

    Hsi et al. propose absence or presence of gyceryl trinitrate (GTN)- induced headache as a possibly useful clinical tool to assist in the initial risk stratification of patients with chest pain [1]. Several issues merit attention:

    1. The mechanism of action of GTN in precipitation of headache in patients – regardless of status of the coronary circulation – is unknown.

    2. Exc...

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