Systematic hand-held echocardiography in patients hospitalized with acute coronary syndrome.

Aims: Transthoracic echocardiography is recommended in all patients with acute coronary syndrome but is time-consuming and lacks an evidence base. We aimed to assess the feasibility, diagnostic accuracy, and time efficiency of hand-held echocardiography in patients with acute coronary syndrome and describe the impact of echocardiography on clinical management in this setting.

Methods And Results: Patients with acute coronary syndrome underwent both hand-held and transthoracic echocardiographies with agreement between key imaging parameters assessed using kappa statistics.

Multi-centre Randomised Controlled Trial of a Smartphone-based Event Recorder Alongside Standard Care Versus Standard Care for Patients Presenting to the Emergency Department with Palpitations and Pre-syncope: The IPED (Investigation of Palpitations in the ED) study.

Background: Patients with palpitations and pre-syncope commonly present to Emergency Departments (EDs) but underlying rhythm diagnosis is often not possible during the initial presentation. This trial compares the symptomatic rhythm detection rate of a smartphone-based event recorder (AliveCor) alongside standard care versus standard care alone, for participants presenting to the ED with palpitations and pre-syncope with no obvious cause evident at initial consultation.

Methods: Multi-centre open label, randomised controlled trial.

Atrial fibrillation case finding in over 65 s with cardiovascular risk factors - Results of initial Scottish clinical experience.

Background: Atrial fibrillation (AF) is a major preventable risk factor for stroke and may be silent in elderly individuals who are at especially high risk. This paper describes the first phase of implementation of a clinical AF detection programme in a community setting. Objectives were (i) to determine the feasibility of using a handheld ECG recording system for AF detection among individuals aged 65 years or more, who have cardiovascular risk factors.

Complications and prognosis of patients undergoing apical or septal right ventricular pacing.

Objectives: Optimal right ventricular lead placement remains controversial. Large studies investigating the safety and long-term prognosis of apical and septal right ventricular lead placement have been lacking.

Methods: Consecutive patients undergoing pacemaker insertion for high-degree atrioventricular block at Edinburgh Heart Centre were investigated.

Multi-centre randomised controlled trial of a smart phone-based event recorder alongside standard care versus standard care for patients presenting to the Emergency Department with palpitations and pre-syncope - the IPED (Investigation of Palpitations in the ED) study: study protocol for a randomised controlled trial.

Background: Palpitations and pre-syncope are together responsible for 300,000 annual Emergency Department (ED) attendances in the United Kingdom (UK). Diagnosis of the underlying rhythm is difficult as many patients are fully recovered on ED arrival; and examination and presenting electrocardiogram (ECG) are commonly normal. The only way to establish the underlying heart rhythm is to capture an ECG during symptoms.

Diagnostic yield of an ambulatory patch monitor in patients with unexplained syncope after initial evaluation in the emergency department: the PATCH-ED study.

Objectives: Diagnosing underlying arrhythmia in ED syncope patients remains problematic. This study investigates diagnostic yield, event prevalence, patient satisfaction and compliance, and influence on resource utilisation of an ambulatory patch monitor in unexplained ED syncope patients.

Methods: Prospective pilot study conducted in a single tertiary ED in Scotland between 17 November 2015 and 16 June 2017 with a historical unmatched comparator group.

Type D personality and three-month psychosocial outcomes among patients post-myocardial infarction.

Objective: Type D personality has been proposed as a risk factor for poor prognosis in cardiac patients. Recent studies which have adopted a dimensional approach to Type D (negative affectivity×social inhibition) found no effect of Type D on mortality, after controlling for its constituent elements. To-date, no study has determined if Type D is associated with psychosocial outcomes in post-myocardial infarction (MI) patients when conceptualised as a dimensional variable.

Type D personality and illness perceptions in myocardial infarction patients.

Objectives: To determine the relationship between Type D personality (the tendency to experience negative emotions and to be socially inhibited) and illness beliefs in postmyocardial infarction (MI) patients.

Methods: One hundred and ninety-two MI patients participated. Patients were assessed on demographic variables and completed the Type D Scale (DS14) and Brief Illness Perceptions Questionnaire one week post-MI.

T-wave alternans found in preventricular tachyarrhythmias in CCU patients using a wavelet transform-based methodology.

Ventricular tachyarrhythmias are potentially lethal cardiac pathologies and the commonest cause of sudden cardiac death. Efforts to predict the onset of such events are based on feature extraction from the surface ECG. T-wave alternans (TWAs) are considered a marker of abnormal ventricular function that may be associated with ventricular tachycardia (VT) and ventricular fibrillation.

Prediction of cognitive dysfunction after resuscitation from out-of-hospital cardiac arrest using serum neuron-specific enolase and protein S-100.

Background: More than 50% of patients initially resuscitated from out-of-hospital cardiac arrest die in hospital.

Objective: To investigate the prognostic value of serum protein S-100 and neuron-specific enolase (NSE) concentrations for predicting (a) memory impairment at discharge; (b) in-hospital death, after resuscitation from out-of-hospital cardiac arrest.

Methods: In a prospective study of 143 consecutive survivors of out-of-hospital cardiac arrest, serum samples were obtained within 12, 24-48 and 72-96 hours after the event.

A fully automated algorithm for the determination of respiratory rate from the photoplethysmogram.

Objective: To determine if an automatic algorithm using wavelet analysis techniques can be used to reliably determine respiratory rate from the photoplethysmogram (PPG).

Methods: Photoplethysmograms were obtained from 12 spontaneously breathing healthy adult volunteers. Three related wavelet transforms were automatically polled to obtain a measure of respiratory rate.

Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management.

Aims: To determine whether survival after discharge following pre-hospital cardiopulmonary arrest has improved.

Methods And Results: The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991-01 following pre-hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest.

Hybrid long-term temporary pacing.

Prolonged temporary pacing is associated with frequent complications. We describe a patient with aortic endocarditis and acquired tri-fascicular block in whom back-up pacing was indicated. Using a Seldinger technique via a subclavian approach, a permanent active-fixation lead was positioned in the right ventricle.

An algorithm for the detection of individual breaths from the pulse oximeter waveform.

Objectives: To determine if wavelet analysis techniques can be used to reliably identify individual breaths from the photoplethysmogram (PPG).

Methods: Photoplethysmograms were obtained from 22 healthy adult volunteers timing their respiration rate in synchronisation with a metronome. A secondary timing signal was obtained by asking the volunteers to actuate a small push button switch, held in their right hand, in synchronisation with their respiration.

Wavelet-based analysis of heart-rate-dependent ECG features.

Background: Wavelet-based methods of analyzing ECG signals have been used to identify specific features in cardiac arrhythmias. Since some of these features are rate dependent, it is a requirement that they are examined across a range of physiological heart rates. The wavelet transform is a signal analysis tool that can elucidate spectral and temporal information simultaneously from complex signals, including the ECG.

In-hospital cardiac arrest leads to chronic memory impairment.

Objective: To assess the prevalence and severity of memory deficits in a group of patients who survived an in-hospital cardiac arrest (IHCA) in comparison with patients resuscitated after cardiac arrest outside hospital (OHCA) and patients with acute myocardial infarction (MI).

Subjects: Thirty-five IHCA survivors, 35 OHCA survivors, and 35 patients who had suffered MI uncomplicated by cardiac arrest.

Procedure: Participants were assessed 8.