ISCHAEMIC HEART DISEASE

How long to wait before a plane journey after AMI ▸Aircrafts are pressurised to achieve cabin pressures equivalent to 5000–8000 feet altitude. At this cabin pressure, PIo₂ falls from 150 to 107 mm Hg and Pao₂ falls from 98 to 55 mm Hg. Although in healthy individuals this results in only a small drop in Sao₂, if Sao₂ is low to start with, the fall may be clinically significant. Short distance helicopter transport of patients with acute myocardial infarction (AMI) for emergency medical care has been assessed in a number of small studies and appears safe, with the most frequent side effects being hypotension (~10%), bradycardia (~10%), and tachycardia (atrial fibrillation/flutter or ventricular tachycardia ~5%). There is some discordance in current guidelines for unescorted patients travelling after AMI. After an uncomplicated AMI, travel should be deferred for at least two weeks (American College of Cardiology/American Heart Association, two weeks; Aerospace Medical Association, three weeks; and American Medical Association, four weeks).

Atorvastatin induced neuropathy ▸ A case report of a 57 year old man in good health, excluding hyperlipidaemia, with progressive numbness and burning in both feet, particularly the dorsal aspect, for six months is described. His medications included atorvastatin, 5 mg, and one aspirin daily. The patient did not report muscle tenderness, weakness, or paralysis, and had no difficulty walking. Punch biopsy of the proximal thigh, distal thigh, and distal leg revealed a neuropathic process affecting small calibre sensory nerve fibres. Three months after treatment with atorvastatin was discontinued, the burning resolved. There is a four- to 14-fold increased risk for idiopathic polyneuropathy, the mechanism for which is unclear.

When to start statins ▸ Should statins be started predischarge after acute coronary syndrome (ACS)? There are no conclusive data to …