eLetters

856 e-Letters

  • 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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  • 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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  • 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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  • We need more than genetics alone in Brugada syndrome
    Pedro Brugada

    Dear Editor:

    Dr Gavaliatsis points out the severe limitations that we still face in the exact diagnosis of monogenic diseases causing ventricular arrhythmias, like Brugada syndrome and the long QT syndrome. In Brugada syndrome it seems that we have a pharmacologic challenge (iv flecainide, ajmaline or procainamide) to unmask the phenotype. Unfortunately, that is not so in the long QT syndrome. But even with the ph...

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  • Challenged by "flecainide challenge"
    Isidoros P Gavaliatsis

    Dear Editor:

    In the July 2000 issue of Heart, in an Editorial by Brugada,[1] about a paper by Viskin et al,[2] it is stated:
    "The most important conclusion of the study by Viskin and colleagues is, however, that patients with syncope of unknown origin should be pharmacologically tested for Brugada syndrome, a suggestion made by the authors on the basis of their results."

    However, in th...

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  • Re: Use of the 12 lead ECG to predict lead position during RBBB morphology pacing
    Luc De Roy

    Dear Editor

    We have read the interesting comments of Dr Kapoor concerning left ventricular pacing and discriminating ECG patterns.

    In our short case report,[1] we could not, by lack of space, include the different ECG tracings nor discuss the complete differential diagnosis. The subject remains nevertheless extremely important with respect to the precise diagnosis and the therapeutic measures we have...

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  • Use of the 12 lead ECG to predict lead position during RBBB morphology pacing
    Aditya Kapoor

    Dear Editor

    The case described by Blommaert et al makes interesting reading. Inadvertent left ventricular (LV) pacing following attempted placement of a lead in the right ventricle (RV) is a known occurrence. It is vital to recognise the problem to institute appropriate therapeutic measures, realising however that often right bundle branch block (RBBB) pattern results from normal RV pacing. It would however be in...

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  • Re: National Service Framework – core data set
    J S Birkhead
    Dear Editor

    We thank Lawrance et al for their letter that raises several important points about the implementation of the national audit of myocardial infarction.[1] Until the numerator and denominator can be confidently stated there is little point in producing case fatality data either nationally or locally. The data that they quote in their letter strongly support this view. There is an urgent need to address thi...

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  • National Service Framework – core data set
    Richard A Lawrance

    Dear Editor:

    We read with interest the editorial by Birkhead,[1] concerning the implementation of the National Service Framework core data set for myocardial infarction, and would like to comment on several of the points raised.

    Birkhead emphasises a need for confidence in data collection and its subsequent analysis. The EMMACE study identified 2153 consecutive cases of AMI admitted to 20 adjacent hospita...

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