eLetters

856 e-Letters

  • The sensitivity of the risk assessment tool should be the most important parameter
    Erica J Wallis
    Dear Editor

    The comparison of the mathematical accuracy of paper-based tables or charts for estimating coronary (CHD) or cardiovascular (CVD) risk by Jones et al[1] is extremely valuable, but their conclusion that the revised Joint British Societies chart has the best combination of sensitivity and specificity is surprising. When the SMAC guidance[2] based on the original Sheffield table[3] was issued in 1997 the recom...

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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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  • Redefinition of myocardial infarction
    David Hildick-Smith
    Dear Editor,

    The Guideline for the management of patients with acute coronary syndromes without persistent ECG ST segment elevation[1] gives excellent and timely advice, but there is one area which continues to cause confusion, and that concerns the diagnosis of "myocardial infarction".

    The International Redefinition of Myocardial Infarction[2] states that an infarct has occurred when there has been a typical rise...

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  • Redefinition of myocardial infarction - Authors' response
    David Hackett
    Dear Editor,

    Thank you for sending us the letter from Hildick-Smith and Glennon and inviting a response. The Guideline for the management of patients with acute coronary syndromes without persistent ECG ST segment elevation (Heart 2001;85:133-142) was based on the deliberations of a working party which met in October 1999, and on a review of the literature up to December 1999. The paper referred to by Hildick-Smith a...

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  • Re: Cost-effective investigation of chest pain - Authors' response
    IA Simpson

    Dear Editor,

    We thank Underwood for his kind comment about our study[1] which demonstrated an absence of gender bias in the investigation and management of patients referred to our open access chest pain clinic. We can reassure him that this study relied on routinely collected data and clinical staff were not aware that they would be under scrutiny with regard to gender bias. Also, primary physicians had guide...

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  • Cost-effective investigation of chest pain
    SR Underwood
    Dear Editor,

    Wong and colleagues very nicely demonstrate the absence of gender bias in investigation and management of 1522 patients referred by primary care physicians to an open access chest pain clinic.[1] This is very reassuring but their results raise an important issue concerning the strategies of investigation used in their clinic. To summarise their data:

    Table: Investigations in Southampton...

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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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  • 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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  • Myocardial perfusion defects visualized by MCE in hypertrophic cardiomyopathy
    Gustavo Camarano
    Dear Editor:

    I read with interest this case report from Hirooka and colleagues.[1] Myocardial contrast echocardiography (MCE) allows the assessment of myocardial perfusion, however, several technical issues remain unresolved and artifacts are quite common.

    It is highly debatable whether the perfusion defect shown represents myocardial ischemia due to systolic compression of the LAD septal branches. If that w...

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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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