115 e-Letters

published between 2015 and 2018

  • NICE guidance for the investigation of recent-onset chest pain
    Adam Timmis

    The paper by Patterson et al (1) illustrates why the NICE and ESC guidelines (2,3) recommend no non-invasive testing in patients presenting with undifferentiated chest pain in whom a non-cardiac cause is suspected or the probability of coronary artery disease (CAD) is judged to be very low (NICE <10%, ESC <15%). Table 5 shows there were 351 such patients, of whom 24 were subsequently diagnosed with CAD. Even if we...

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  • What about the actual history of the chest pain
    Justin Zaman

    I am rather surprised that the authors did not take into account more clinical features of the history in their model.(1) Pleuritic features and relief when sat up suggest pericarditis, whilst there are of course specific features that suggest reflux oesophagitis; timing is important, as pain lasting less than a minute is really not suggestive of ischaemic disease.

    The authors state 'we included consenting adults...

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  • what was the prevalence of concordant ST segment deviation in type 1 AMI with LBBB?
    oscar,m jolobe

    The 6.3% prevalence of left bundle branch block(LBBB) among 17,488 subjects with type 1 acute myocardial infarction(AMI) translates into 1101 subjects with this manifestation of AMI(1). This represents a golden opportunity to document the prevalence of concordant ST segment deviation in those 1101 subjects so as to enable a comparison to be made with the study which reported a low prevalence of acute coronary occlusion in...

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  • manchseter medical society
    oscar,m jolobe

    The documentation of a rising incidence of cardiac resynchronisation therapy(CRT)-related infection(1) calls for a reappraisal of the Class 1 level A recommendation for the use of this modality(2), given the fact that the recommendation antedated the ground breaking introduction of angiotensin-neprilysin inhibition in subjects with comparable severity of systolic heart failure(3). In that study a significant(p < 0.00...

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  • Physical Activity and Cardiorespiratory Fitness as Underappreciated Modulators of Obesity-Related Risk of Sudden Cardiac Death
    Jari A Laukkanen

    We read with great interest the recent report, published in Heart, entitled "Obesity related risk of sudden cardiac death in the Atherosclerosis Risk in Communities (ARIC) study" by Adabag et al.1 Among a large cohort of middle-aged adults (n = 14,491 African American and white men and women; 55% female), baseline measures of obesity, including body mass index (BMI), waist circumference (WC), and waist-to- hip ratio (W...

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