831 e-Letters

  • A further case of left ventricular opacification with intracoronary echo contrast during PTSMA
    RAP Skyrme-Jones

    We read the case report by Elliott et al (1) with great interest and would like to add to their findings. In three of five consecutive patients undergoing percutaneous septal ablation (PTSMA) for hypertrophic cardiomyopathy (HCM) they observed left ventricular cavity opacification during selective injection of the first septal perforator with the contrast agent Optison.

    We treated a 61 year old man with a long hist...

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  • Pseudo Brugada or true Brugada revealed by tricyclic agents?
    De Roy

    Dear Editor

    We have read with great interest the short case in cardiology reported by E Zakynthinos et al (1) in the March 2000 edition of Heart. The ECG recordings after acute ingestion of amitriptyline are remarkable, especially the ST segment elevation in the precordial leads V1 - V3, 6 to 100 hours after admission in the intensive care unit.

    The ECG pattern resembles markedly the ones described in...

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  • Cardiocutaneous fistula following left ventricular aneurysmectomy
    Marco Pocar

    Dear Editor:

    We read with great interest the review "Cardiocutaneous fistula" published by Dr. Danias and co-workers. At our Institution, we encountered a similar case, concerning a 72-year-old female, who developed this complication eleven months after coronary bypass sugery and linear resection of an anteroapical left ventricular aneurysm; the postoperative course had been complicated by mediastinitis necessit...

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  • Magnetic resonance imaging of atherosclerosis
    Stephen G Worthley

    I would like to acknowledge the interesting work published by Coulden et al [1] in the February 2000 edition of the journal. The concept of noninvasive arterial wall imaging with MR is an exciting new field with numerous potential implications, including atherosclerotic plaque characterisation. However, I would like to raise a few questions about the selection of MR imaging parameters.

    Firstly, I was interested t...

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  • Survival of patients with a first hospital admission for heart failure
    Kate MacIntyre

    To the Editor;

    Cowie et al(1) reported high case fatality rates in a population-based cohort of patients with incident heart failure between 1995 and 1996. Survival was 81% at one month, 75% at 3 months, 70% at 6 months, 62% at 12 months and 57% at 18 months. There are few population data that describe the contemporary survival of patients with heart failure.

    The Linked Morbidity Record Database con...

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  • Natural History of Bicuspid Aortic Valve without Stenosis
    Jerome Liebman

    Dear Editor:

    The excellent review by Ward on the clinical significance of the bicuspid aortic valve (Heart 2000;83:81-85) is of great interest and value. The extensive reference list as well put a good bit of the pertinent bicuspid valve literature in one place. The paper adds greatly to our knowledge.

    However, without critiquing every issue in the paper, there are two areas in particular I would...

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  • Homocysteine, B vitamins and risk of cardiovascular disease
    J Y Jeremy
    We read with interest the editorial on homocysteine, B vitamins and the risk of cardiovascular disease.(1) The editorial highlighted that the B vitamins are being used to treat homocysteine - mediated vascular disease. However, this presupposes that the absolute levels of homocysteine are the only determinants of the pathological impact of the amino acid.

    We have recently proposed an alternative mechan...

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  • Skeletal chest pain
    Richard A Best

    While December's editorial on non-cardiac chest pain is thoughtful and thorough,(1) there is a strange lack of emphasis on skeletal chest pain. I am not sure if this is due to selection of patients, but I wonder if it is the lack of a diagnostic test for skeletal pain. Since this may involve up to 73% of patients referred with chest pain to cardiac clinics,(2) it would seem to be of paramount importance. The author...

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  • Aortic changes with bicuspid aortic valve
    John P Veinot

    To the Editor;

    We read with interest the review of congenitally bicuspid aortic valve by Ward.[1] The complications of congenitally bicuspid aortic valve, including aortic stenosis, aortic regurgitation and aortic dissection, are well documented in this review.

    It is interesting to note the association of congenitally bicuspid aortic valve with aortic medial disease (cystic medial necrosis), coarct...

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  • Risk assessment after myocardial infarction - response from author
    Adam D Timmis

    In my review on risk stratification in acute coronary syndromes, "diagnostic value" was used conventionally to refer to the ability of predischarge tests to predict future coronary events, particularly death and myocardial infarction.

    In response to the 3 additional points:

    1. Cost-effectiveness Underwood et al are correct to caution me on statements of cost-effectiveness. My contention was (...

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