eLetters

179 e-Letters

published between 2020 and 2023

  • Decline in mortality from myocardial infarction and improved medical management in France
    Jean Ferrieres
    Dear Editor:

    The August 2000 issue of Heart contained our article entitled "Incidence, recurrence, and case fatality rates for myocardial infarction in southwestern France, 1985 to 1993".[1] This work was the last version of the presentation and the interpretation of data carefully collected for 10 years.

    The Editorial in the same issue written[2] by Simon Capewell and John McMurray concerning our article is...

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  • Neurobiology of fetal and infant markers of adult heart diseases
    Ernest H Friedman

    Dear Editor:

    Neurobiological features of fetal and infant markers of adult heart diseases are suggested by short-term laboratory experience demonstrating that adult female speech production is sufficient to influence infant speech production occurring in the silent intervals between the adult's vocalizations on the order of 3 s and is linked to increased coherence of EEG gamma-band activity associated with the...

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  • Improving door to needle time – time to train ALL staff
    Gideon Hirschfield

    Dear Editor:

    Wilmshurst et al published their experience of introducing nurse initiated thrombolysis.[1] They show that door to needle times (but not outcome) were reduced. Aside from this, the paper raises important issues about medical training. What the authors demonstrate, is that if you focus resources and training and follow strict protocol driven practice, then for a highly specific task you can improve...

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  • Re: Improving door to needle time – time to train ALL staff
    Peter Wilmshurst

    Dear Editor:

    We agree with Dr Hirschfield that training of doctors is important, but it must not take precedent over the interests of patients. We could not continue to delay thrombolysis to patients with myocardial infarction and thereby increase their mortality rate, so that junior doctors could have the experience of making a late decision. It may be embarassing for junior doctors for us to point out that th...

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  • Diagnosis of heart failure
    O M P Jolobe
    Dear Editor

    Chest radiography, to which not even a passing allusion was made in a recent report on misdiagnosis of heart failure,[1] has now been accorded its rightful status in the recognition of this syndrome.[2] Unlike some of the clinical stigmata of pulmonary disease, which have been accorded an importance, in the undergraduate curriculum, disproportionate to their relationship to evidence-based medicine,[3] the radiogra...

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  • The use of BNP in primary care
    Susan P Wright
    Dear Editor,

    The study by Hetmanski investigates the use of plasma BNP to detect low left ventricular ejection fraction in a cohort of patients in the community on frusemide.[1] The study showed a poor, albeit statistically significant, correlation between plasma BNP and left ventricular ejection fraction. The area under the receiver operating curve for BNP was only 0.587, and the authors conclude that the "accuracy o...

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  • Magnesium as therapy for aconitine poisoning
    Simon Conroy
    Dear Editor,

    We read with interest the ‘electronic’ case report posted recently by Yeih and colleagues on aconitine poisoning.[1] They describe in detail the mechanism by which aconitine is purported to cause severe cardiotoxicity. We recently encountered a patient who had taken aconite in an attempted suicide. A magnesium sulphate infusion was employed with apparent success.

    Case Report
    A 23 year o...

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  • Cystic media necrosis
    Conraads Viviane
    Dear Editor,

    I was surprised that Missouris and colleagues in their case report failed to mention cystic medial necrosis as a cause of spontaneous coronary artery dissection.[1] This disease requires histologic confirmation and is characterised by focal fragmentation of elastic fibers, loss of smooth muscle cells of the media and the accumulation of acid mucopolysaccharides. Mandatory exclusion of Marfan syndrome, his...

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  • Cystic media necrosis - Authors' response
    Constantinos G Missouris

    Dear Editor,

    We agree that cystic medial necrosis may in a small number of patients be the cause of spontaneous coronary artery dissection.[1] However, the pathogenesis of spontaneous coronary artery dissection remains poorly understood. Indeed, no uniform histological findings have been identified and it is improbable that a single mechanism operates in all these patients. Our patient had none of the featur...

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  • Marfan syndrome and pregnancy
    K Dhital
    Dear Editor:

    We read with interest Professor Treasure's recent paper on the cardiovascular surgical aspects of Marfan syndrome.[1] We wish to add to the discussion by raising the significant cardiovascular risks faced by Marfan patients during pregnancy, a problem that he touched on in a previous editorial.[2] This is an important and controversial issue in the management of adult cardiovascular manifestations of Marfa...

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