eLetters

215 e-Letters

published between 2004 and 2007

  • 'Safe than sorry'
    Pradeep Orakkan

    Dear Editor,

    Amiodarone is frequently used in the intensive care units. Very often it is used to treat atrial fibrillation in septic patients. As Russel and Saltissi mentioned in the case report we also give first a bolus of amiodarone followed by an maintainance infusion over 23 hours. It is advised in the BNF that amiodaorne has to be given through the central line. In the intensive Care Unit we follow this stri...

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  • Effect of remote ischaemic preconditioning on troponin release after PCI is yet to be established
    Stephen P Hoole

    Dear Editor,

    We read with interest the recent article published by Iliodromitis et. al.(1), but do not agree with the conclusions drawn by the authors. The study appears to be under-powered to draw meaningful conclusions as to the therapeutic value of remote ischaemic preconditioning, and certainly the size of the study precludes a subgroup analysis of the role of statins. The authors do not state the actual number...

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  • Risk scoring for percutaneous coronary intervention: we've done it!
    Antony D Grayson

    Dear Editor,

    We read with interest the recent editorial by Siotia and Gunn [1] which emphasised the need and growing enthusiasm for risk scoring for percutaneous coronary intervention (PCI). This editorial focuses on the recent publication by Wu and colleagues from New York of a risk model to predict in-hospital mortality following PCI [2]. This particular risk model was based on 46,090 patients undergoing PCI between 2...

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  • study does not dispute the need for clinical judgement
    A Conway Morris

    Dear Editor,

    We note Dorman et al's comments regarding our paper (1). We agree that risk scores should not be used in isolation to determine either the management or triage of patients. Although, in our study, no patient with a score of 0 experienced a major cardiac event within thirty days, the confidence interval includes a rate of up to 1.5%. A recent prospective evaluation of the TIMI score used in a simila...

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  • Caution in Heart Failure Stage Differentiation
    Christopher S Lee, RN, MSN, CCRN

    Dear Editor,

    I commend Azevedo and colleagues(1) for testing the ACC/AHA stages of heart failure.(2) Although these stages are theoretically appealing, they are challenging to use in practice. I am, however, concerned about the criteria used to differentiate asymptomatic and symptomatic structural abnormalities. The authors use a narrow definition of heart failure symptoms: shortness of breath and edema. Many heart...

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  • TIMI scoring fails to predict MACE rates in conventional high risk cases with low front door scores
    Stephen H Dorman

    Dear Editor,

    We read with interest the article by Conway Morris et al.(1) on the utility of the ‘front door’ TIMI risk score. The authors suggest that the TIMI score may be used to risk stratify patients with undifferentiated chest pain presenting to the emergency department and further state that patients with low scores (0 or 1) are at low risk of further cardiac events. Whilst the TACTICS-TIMI 18 investigators sugg...

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  • Valvar myxoid tissue is not a predisposition for rheumatic heart disease
    Pradeep Vaideeswar

    Dear Editor,

    We read with great interest the article by Nayar et al (1) on the concept of increased myxomatous tissue of the mitral valve serving as nidus for development of rheumatic heart disease. In developing countries, the morbidity and mortality related to rheumatic heart disease continues unabated. At our institution, we perform a large number of autopsies and many have rheumatic heart disease.(2)...

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  • Inter-atrial shunts in endurance-trained athletes: potential mechanism for EIAH during exercise.
    Darren E R Warburton

    Dear Editor,

    We were pleased to read the innovative and compelling work by Dr. Agnoletti and colleagues [1]. The authors have eloquently (via surgical procedures) revealed the importance of right-to-left shunting (through an inter-atrial communication) on arterial oxyhemoglobin saturation during resting and exercise conditions. They have also provided convincing evidence of the detrimental effects of an inter-atrial s...

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  • Therapeutic benefit might be attributable to effect on diastolic function
    Oscar M Jolobe

    Dear Editor,

    Given the fact that patients with subnormal left ventricular ejection fractions frequently have co-existing diastolic dysfunction(1)the therapeutic benefits resulting from blockade of the renin-angiotensin-aldosterone system(RAAS)in studies enrolling heart failure(HF) patients with subnormal left ventricular ejection fraction(LVEF)(2)(3)might, arguably, be attributable, at least in part, to amelioration of...

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  • What is 'high risk' PCI?
    Fraser N Witherow

    Dear Editor,

    In the April edition of Heart, the North West Quality Improvement Programme (NWQIP) produced a multivariate prediction model to assess the risk of major adverse cardiac events (MACE) in patients undergoing percutaneous coronary revascularisation.(1) The risk score was based on the outcomes of 9914 patients undergoing PCI in the four PCI centres in the northwest of England. From the data, a formula was pro...

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