eLetters

182 e-Letters

published between 2008 and 2011

  • Unmeasured socioeconomic variables - hallmark to various cardiovascular risk in asian cohort
    Pankaj Garg

    Dear Editor

    I read with great interest the editorial written by Zaman et al. The paper has also highlighted that it is very difficult in any ethnic group to understand all unmeasured socioeconomic variables which affect overall cardiovascular risk.

    Some unmeasured variable potentially could be:

    1) Level of education of parents in the family. 2) Profession of father and mother. 3) Financial...

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  • A Miscarriage of Justice in the RATPAC Trial ?
    Robert Wardrop
    Having read the three papers published around the RATPAC Trial (1,2,3), I have come to the conclusion there has been a major miscarriage of justice. That miscarriage of justice relates to diagnostic equipment used in the standard treatment protocols for the hospitals involved in the RATPAC Trial (Beckman Access, Centaur CP and Roche E170). Point of Care Testing (POCT) was not convincingly vindicated in this trial but the o...
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  • No additional information with Computed Tomography Coronary Angiography prior to alcohol septal ablation.
    Robbert C Steggerda

    to the editor: Spratt and colleagues describe two cases in which they state that performing a Computed Tomography coronary angiography (CTCA) prior to alcohol septal ablation (ASA) may aid in the selection of the appropriate septal branch for ablation and patients suitable for ASA (1). Visualisation of a dominant septal perforator and its course in the myocardium with CTCA has been described previously (2). Importantly,...

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  • Death following "pill-in-the-pocket" treatment with propafenone and verapamil in a CYP2D6 poor metaboliser
    Victoria Rollason Gumprecht

    To the Editor Daniell [1] reports a case of syncope after "pill-in-the-pocket" treatment with propafenone. He mentions the CYP2D6 metabolism of propafenone and the possible interaction with CYP2D6 inhibitors. We would like to further illustrate the potential risks of propafenone in CYP2D6 poor metabolisers with the case of a 70 year-old woman who died from sudden cardiac arrest after taking 600 mg of propafenone orally for...

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  • The neglected role of blood pressure in acute heart failure syndrome
    sripurna basu

    I read with interest Harinstein et al's review of clinical assessment in acute heart failure syndromes (AHFS) . Initial assessment of AHFS included evaluation of important prognostic factors which influence treatment such as the presence of atrial fibrillation, acute pulmonary oedema and renal function. This is in accordance with the 6 axis model described by Professor Gheorghiade. An important factor in the 6 axis model...

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  • Re:CT or MRI for post-procedural aortic stenting?
    Eric Rosenthal

    Further to Kenny et al's response to our editorial view (1) of their original paper (2), we completely agree that long-term surveillance after coarctation stenting is required to detect complications but would re- iterate that this must also apply to balloon dilation and surgical repairs too. Given that these patients will need life-long follow up and continued imaging it is important that such imaging carries a low risk to...

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  • Screening for 22q11.2 microdeletion in adults with tetralogy of Fallot
    M.Cristina Digilio

    To the Editor: We read with interest the paper by van Engelen et al.,1 analysing the prevalence of 22q11.2 deletion syndrome (22q11.2DS) in adults with tetralogy of Fallot (TOF) and with pulmonary atresia(PA)/ventricular septal defect (VSD). We agree with the experience that many adult patients with TOF have not been tested for 22q11.2DS in the past, so that awareness of the syndrome is needed among clinicians who care ad...

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  • Involving primary care and cardiac rehabilitation in a reorganized service could improve outcomes
    Hasnain M Dalal

    The full National Heart Failure Audit report[1] and a recent editorial in the Lancet endorse the report's conclusion that it 'provides a powerful incentive to reorganize heart failure care in the UK'.[1,2] The suggested solution is to provide specialist care similar to that given to people after heart attacks citing that such specialized units 'could do for heart failure what coronary care units have done for myocardial...

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  • chest radiography for validation of heart failure diagnosis
    oscar,m jolobe

    Remarkably, chest radiography was notable by its absence from the "mandatory fields for completion" in the 2008-2009 national heart failure audit(1) notwithstanding the documentation that clinical markers of congestion have high positive predictive value(PPV) for validation of acute heart failure(2). According to one review, pulmonary vascular redistribution is associated with a PPV of 75% and a negative predictive valu...

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  • Overnight dehydration increases the risk of a morning infarct
    Simon N. Thornton

    Dear Sir, It was with great interest that I read the recent article by A. Suarez- Barrientos and colleagues (1). However, I think there is one very important aspect left out of this very good clinical investigation and that is blood volume. One of the principal problems of heart pumping is having enough blood volume to do this with. If there is insufficient volume then the heart has to alter its rate of contraction, which...

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