Ischaemic heart disease

Only about 6% of episodes of cocaine induced chest pain are caused by MI ▸

Chest pain may be caused by ischaemia without infarction, or it may be extracardiac (for example, pleuritic) in nature. Weber and associates report on a prospective study in which they validated the hypothesis that such an approach is safe. They evaluated 344 patients with cocaine related chest discomfort. Forty two of these patients (12%) were admitted to the hospital with acute myocardial infarction (MI), unstable angina, or another cardiac condition. Among the remaining 302 patients, those who had no new electrocardiographic changes indicative of ischaemia, as well as normal concentrations of cardiac troponin I, a negative exercise test, and no cardiovascular complications during a 9–12 hour period in an observation unit, were discharged. Thirty day follow up in this cohort revealed that none of the patients died of a cardiovascular event. Four patients sustained a non-fatal MI; however, these patients had continued to use cocaine. So, many patients can be sent home from the emergency room, if all the standard tests are available all night.

Fish oils enhance plaque stability ▸

One hundred and eighty eight patients awaiting carotid endarterectomy were enrolled and randomised to sunflower oil, placebo, n-3 PUFA (polyunsaturated fatty acid) or n-6 PUFA; 18 withdrew and eight were excluded. Duration of oil treatment was 7–189 days (median 42 days) and did not differ between groups. Sunflower oil had little effect on the fatty acid composition of lipid fractions. Fewer carotid plaques from patients being treated with fish oil had thin fibrous caps and signs of inflammation and more plaques had thick fibrous caps and no signs of inflammation, compared with plaques in patients in the control and sunflower oil groups (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.24 to 0.89, and OR 1.19, 95% CI 1.02 to 1.57, v control; OR 0.49, 95% CI 0.23 to 0.90, and OR 1.16, 95% CI …