Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance.

Background: Coronary artery calcium (CAC) imaging by unenhanced computed X-ray tomography (CT) is recommended as an initial diagnostic test for patients with stable chest pain symptoms but a low likelihood (10-29%) of underlying obstructive coronary artery disease (CAD) after clinical assessment. The recommendation has not previously been tested prospectively in a rapid access chest pain clinic (RACPC).

Methods: We recruited 300 consecutive patients presenting with stable chest pain to the RACPC of three hospitals.

Therapies and nursing care of women with vulvar dermatologic disorders.

Vulvar dermatologic disorders are common among women, and prevalence increases with age. Treatment can provide women with symptomatic relief and can halt further progression of disease. Numerous therapies are available, and nurses who work with women across the life span should have an understanding of vulvar dermatologic disorders and therapeutic modalities.

Angioplasty of acquired pulmonary vein stenosis using covered stent.

One of the most serious complications post-catheter ablation of atrial fibrillation is the development of pulmonary vein stenosis. Controversy currently exists about the optimal treatment approach. The use of balloons and larger stents (~10 mm) results in more optimal outcome than just balloon angioplasty alone; however, even with stent implantation, recurrent restenosis may occur in 30 to 50% of patients.

Radiation dose of CT coronary angiography in clinical practice: objective evaluation of strategies for dose optimization.

Background: CT coronary angiography (CTCA) is an evolving modality for the diagnosis of coronary artery disease. Radiation burden associated with CTCA has been a major concern in the wider application of this technique. It is important to reduce the radiation dose without compromising the image quality.

Evaluation of graft patency by computed tomographic angiography in symptom-free post-coronary artery bypass surgery patients.

Background: Accelerated atherosclerosis occurs in aortocoronary saphenous vein grafts, contributing to increased morbidity and mortality rates. We estimated the prevalence of asymptomatic graft failure in patients 5 years or more after coronary artery bypass grafting (CABG) using electron-beam computed tomographic angiography (EBA).

Methods And Results: EBA was performed in 45 symptom-free patients (mean age, 66 +/- 9 years; 87% male; mean time interval after CABG, 8 +/- 5 years).

Determinants of progression of coronary artery calcification in type 2 diabetes role of glycemic control and inflammatory/vascular calcification markers.

Objectives: This study prospectively evaluated the relationship between cardiovascular risk factors, selected biomarkers (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-6, and osteoprotegerin [OPG]), and the progression of coronary artery calcification (CAC) in type 2 diabetic subjects.

Background: Coronary artery calcification is pathognomonic of coronary atherosclerosis. Osteoprotegerin is a signaling molecule involved in bone remodeling that has been implicated in the regulation of vascular calcification and atherogenesis.

Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy.

Aims: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome.

Methods And Results: Established risk factors and coronary artery calcium (CAC) scores were prospectively measured in 510 asymptomatic type 2 diabetic subjects (mean age 53+/-8 years, 61% males) without prior cardiovascular disease. Myocardial perfusion scintigraphy (MPS) was performed in all subjects with CAC > 100 Agatston units (AU) (n=127), and a random sample of the remaining patients with CAC < or = 100 AU (n=53).

Real-time myocardial contrast dobutamine stress echocardiography in coronary stenosis.

Background: Simultaneous wall motion and myocardial perfusion analysis could offer advantages over either method alone. Diagnostic utility of combining these parameters during dobutamine stress echocardiography is evaluated in this study.

Methods: Myocardial contrast dobutamine stress echocardiography was performed on thirty-eight patients with single or double vessel coronary artery stenosis of >50%.

Prevalence of silent myocardial ischemia in asymptomatic individuals with subclinical atherosclerosis detected by electron beam tomography.

Background: Electron beam tomography coronary calcium imaging is an evolving technique for the early detection of coronary atherosclerosis, and recent studies have established its prognostic value in asymptomatic individuals. The relationship of coronary artery calcium scores (CAC) to obstructive coronary artery disease (CAD) has been poorly studied but is clinically relevant because it determines which individuals are likely to benefit from revascularization procedures. Hence, we prospectively evaluated the prevalence of myocardial ischemia in asymptomatic patients with cardiovascular risk factors and subclinical atherosclerosis.

A case of spontaneous coronary artery disease regression.

Coronary angiographic trials have demonstrated that lowering cholesterol can slow the progression of atherosclerosis, limit the formation of new lesions and enhance atherosclerotic regression together with reducing the incidence of clinical events (Waters D, 1996). Spontaneous regression of coronary atherosclerotic lesions is rare. We report the case of a patient with a severe within-stent restenotic lesion whose coronary disease spontaneously regressed 12 months after initial diagnosis, allowing for medical treatment of symptoms rather than repeated intervention.

Treatment of iatrogenic aortic dissection by percutaneous stent placement.

During elective cardiac catheterization via the right femoral artery, difficulty was encountered advancing the guidewire beyond the aortic arch and the procedure abandoned. The patient later developed back pain and hypotension. A contrast-enhanced spiral computed tomography scan confirmed aortic dissection, extending from an entry point in the external iliac artery to the arch.

Prognostic value of stress echocardiography in women with high (> or = 80%) probability of coronary artery disease.

Objective: To assess the prognostic significance of stress echocardiography in women with a high probability of coronary artery disease (CAD).

Setting: Secondary and tertiary cardiology unit at a university teaching hospital.

Participants: A total of 135 women (mean (SD) age 63 (9) years) with pre-test probability of CAD > or = 80% were selected from a database of patients investigated by treadmill or dobutamine stress echocardiography between 1995 and 1998.

Prognostic value of negative dobutamine stress echo in women with intermediate probability of coronary artery disease.

Women with an intermediate pretest probability of coronary artery disease represent a significant proportion of patients referred for the investigation of chest pain. Dobutamine stress echocardiography can be used to restratify these patients into a low-risk group without resorting to cardiac catheterization.

Estimating the prevalence of chronic fatigue syndrome among nurses.

The present study assessed the prevalence of chronic fatigue syndrome (CFS) in a sample of nurses. There is a paucity of studies on the prevalence of CFS in healthcare professionals. Two samples of nurses were recruited through mailed questionnaires.

Computer-generated attenuation correction does not improve the accuracy of myocardial perfusion scintigraphy.

A short study was performed to determine if it is possible to increase the accuracy of thallium-201 (201T1) single photon emission tomographic myocardial perfusion imaging using computer-generated ('Chang') attenuation correction. The stress and rest myocardial perfusion studies from 22 patients with suspected or known ischaemic heart disease were reconstructed with and without "Chang' attenuation correction. For all patients, the scintigraphy results were compared with those of coronary angiography.

Anterior ST segment elevation due to isolated right ventricular infarction during right coronary angioplasty.

We describe the case of a 59-year-old man who developed anterior ST segment elevation and Q waves due to isolated right ventricular branch occlusion during right coronary angioplasty. Isolated right ventricular infarction was clearly demonstrated on echocardiography.

Estimating rates of chronic fatigue syndrome from a community-based sample: a pilot study.

Most of the Chronic Fatigue Syndrome (CFS) epidemiological studies have relied on physicians who refer patients having at least six months of chronic fatigue and other symptoms. However, there are a number of potential problems when using this method to derive prevalence statistics. For example, some individuals with CFS might not have the economic resources to access medical care.