218 e-Letters

published between 2003 and 2006

  • Myocardial entropy.
    Richard G Fiddian-Green

    Dear Editor,

    Living beings violate the second law of thermodynamics, one definition of which is progression always occurs towards an higher entropy state or more accurately never occurs to a lower entropy state. The violation is known as the entropy paradox, entropy being loosely defined as the amount of disorder within a system.

    In his book, "The Road to Reality", Sir Roger Penrose, interprets the entro...

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  • Is subclinical myocardial affection in Duchenne muscular dystrophy detectable?
    josef finsterer

    Dear Editor,

    With interest we read the article by Giatrakos et al. on tissue velocity (TV) and radial strain rate (RSR) imaging in 56 Duchenne muscular dystrophy (DMD) patients. The authors found that TV and RSR were reduced in systole and early diastole in DMD boys as compared to controls and predicted an adverse outcome of these patients [1]. The findings raise the following concerns:

    How to explain the d...

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  • Hospital discharge codes greatly underestimate the burden of AF
    Aleem Khand

    Dear Editor,

    We read with interest the paper by Currie et al [1]. However we wish to highlight our concerns about the use of hospital discharge coding as a means of capturing the hospitalised population of atrial fibrillation (AF). We have previously estimated that 31% of total admissions with AF do not possess a code for AF. [2] The absence of a code does not indicate co- incidental AF. In approximately 10% of the...

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  • England and Wales have different health systems
    Tom Quinn

    Dear Editor,

    This is an interesting paper and I agree with the general thrust, but is it fair to assess England and wales together when, post-devolution, each has a different health system? The NSF for CHD cited applies only to England. the Welsh policy is not cited. It would be helpful to have separate analyses in an attempt to assess the impact of each country's system/policies, surely.

  • Response to Dr Okreglicki

    Dear Editor,

    Dr Okreglicki correctly identifies an error in the placement of the decimal point in relation to the maximum P wave amplitude in lead 2. As he says the upper limit of normal for P wave amplitude in lead 2 is 0.25mV. Amplitudes in all tables are in millivolts. Apologies for the omission of this information from table 1.

  • ECG wave amplitudes and measurements
    Andrzej M Okreglicki

    Dear Editor,

    Measurements of amplitude and duration of waves or complexes on the electrocardiogram are frequently bedevilled by issues of scale, calibration and paper-speed of recordings.1 The potential for non- standard recordings strengthens the case for using units of measurement unaltered by the scale i.e. millivolts (mV) and seconds instead of millimetres (mm) of amplitude or duration respectively. We have...

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  • Role of digoxin in chronic heart failure in the developing nation
    Ali Ahmed

    Dear Editors,

    The recent editorial review of the 2005 European Society of Cardiology (ESC) chronic heart failure guidelines by Brady and Poole- Wilson commented that “digoxin is rightly consigned to be used only in patients with heart failure and atrial fibrillation (AF), and should be combined with a ß blocker.”1

    However, the ESC guidelines also state that while digoxin has no effect on mortality, it...

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  • Takotsubo cardiomyopathy
    Yoshihiro J. AKASHI

    Dear Editor,

    Haghi, et al. recently reported that variant form of the acute apical ballooning syndrome (takotsubo cardiomyopathy; TC). Although the age of these cases was relatively younger than the previous report, this scientific letter is indeed intriguing, and the authors are understandably speculative about the possible mechanisms underlying this disease.

    We previously suggested that TC was related...

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  • Low-intensity vitamin K antagonists in preference to aspirin for low risk patients with NVAF
    Oscar, M Jolobe

    Dear Editor,

    Given the fact that abnormalities of coagulation rather than platelet abnormalities are the one which predominate in atrial fibrillation (AF)(1)(2), it seems more plausible to rely on low-intensity anticoagulation along the lines of BAATAF(3) and SPINAF(4) rather than on aspirin(1) when managing patients with non valvar atrial fibrillation (NVAF) deemed to be at low risk of thromboembolism. The princ...

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  • Risk stratification undersold; risk modification oversold
    Michael P Grocott

    Dear Editor,

    We welcome the viewpoint expressed by Karthikeyan and Bhargava [1] in an important area where cardiologists, anaesthetists, surgeons and intensivists need to work together to improve patients outcomes. We do however contest two of their conclusions.

    Firstly the authors assert that the results of non-invasive stress testing have a poor predictive value for major cardiovascular events or deat...

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