Troponin T as a first-line test: the Royal Liverpool and Broadgreen University Hospital experience.

Many hospital laboratories are unable to offer a cardiac troponin service because of the cost of providing this assay in addition to existing cardiac enzyme profiles: we circumvented this problem by withdrawing the conventional cardiac enzyme service and substituting cardiac troponin T. By ensuring that only one specimen for cTnT is analysed per episode of chest pain. substantial financial savings have been achieved.

Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test.

Objective: To examine the utility of the six-minute walk test (6'WT), in assessing the effectiveness of a six-week cardiac rehabilitation programme, of which exercise training was an integral part.

Setting: Royal Liverpool and Broad Green Hospitals Rehabilitation Unit.

Design: Two hundred and thirty-nine consecutive patients referred for cardiac rehabilitation were allocated to one of two groups.

The management of acute myocardial infarction.

Greater understanding of the underlying pathophysiology of acute myocardial infarction (AMI) has led to more aggressive management and lower mortality, both in-hospital and long term. AMI results mainly from thrombotic occlusion of the infarct-related coronary artery. The ensuing necrosis evolves over a 6-12 h period providing a time window for interventions designed to reduce eventual infarct size.

Prognostic value of ambulatory ST segment monitoring compared with exercise testing at 1-3 months after acute myocardial infarction.

The relative value of ambulatory ST segment monitoring for assessing prognosis following acute myocardial infarction is currently uncertain. Ambulatory monitoring was performed in 177 patients at a mean of 38 days (range 22-93) post-myocardial infarction and its prognostic value was compared with exercise treadmill testing (n = 170). Cardiac events (myocardial infarction, cardiac death or coronary revascularisation) were noted during at least 1 year of follow-up.

Electrocardiogram interpretation in general practice: relevance to prehospital thrombolysis.

Objective: To assess, in the context of their possible role in prehospital thrombolysis, the ability of general practitioners to recognise acute transmural myocardial ischaemia/infarction on an electrocardiogram.

Design: 150 doctors (every fifth name) were selected from the alphabetical list of 750 on Merseyside general practitioner register and without prior warning were asked to interpret a series of six 12 lead electrocardiograms. Three of these showed acute transmural ischaemia/infarction, one was normal, and two showed non-acute abnormalities.

Transient myocardial ischaemia after acute myocardial infarction does not induce ventricular arrhythmias.

Objective: To see whether transient myocardial ischaemia on ambulatory monitoring after myocardial infarction is associated with ventricular arrhythmias.

Design: A prospective study.

Setting: The coronary care unit, general medical wards, and cardiorespiratory department of a major teaching hospital.

Prognostic significance of transient myocardial ischemia on ambulatory monitoring after acute myocardial infarction.

The prognostic value of ambulatory ST-segment monitoring after myocardial infarction was prospectively assessed in 203 patients both early (mean 6 days, n = 201) and late (38 days, n = 177). During at least 1 year of follow-up there were 21 cardiac deaths and 44 cardiac events (death, reinfarction or coronary revascularization). ST depression was seen less often during early than late monitoring (29 of 201 [14%] vs 56 of 177 [32%]).

Significance of ST-segment elevation during ambulatory monitoring after acute myocardial infarction.

The significance of ST segment elevation during ambulatory monitoring after acute myocardial infarction was examined in 203 patients. Ambulatory monitoring was performed both early (mean 6.4 days [range 3 to 15]; N = 201) and late (38 days [range 22 to 93]; N = 177), and 174 patients underwent exercise treadmill testing (38 days [range 22 to 93]).

Isradipine therapy in chronic stable angina pectoris--comparison with nifedipine.

Current available calcium antagonists, although useful in angina pectoris, are often poorly tolerated. We therefore compared isradipine, a new calcium antagonist, with nifedipine in 18 patients with angina. Patients sequentially received incremental doses of either isradipine (IS) 2.

Domiciliary investigation of sleep-related hypoxaemia in Duchenne muscular dystrophy.

In Duchenne muscular dystrophy (DMD) nocturnal oxygen desaturation occurs during rapid eye movement (REM) sleep. Polysomnography, which requires hospital admission, will detect sleep-related breathing abnormalities. In order to avoid the inconvenience of hospital admission for the disabled patient, we investigated overnight oxygenation in ten boys with DMD by domiciliary oximetry.

Transient ischaemia after acute myocardial infarction: relationship to exercise ischaemia.

To study the implications of transient myocardial ischaemia following acute myocardial infarction we compared ambulatory ST segment monitoring with exercise treadmill testing in 170 patients (mean age 58 years) at 4-8 weeks after admission. Ambulatory monitoring detected transient ischaemia (265 episodes; 249 (94%) silent) in 53/170 patients (31%) which was less frequent than ischaemia during exercise testing (90 patients; 53%) (P less than 0.0001).

Transient myocardial ischaemia after acute myocardial infarction.

The prevalence and characteristics of transient myocardial ischaemia were studied in 203 patients with recent acute myocardial infarction by both early (6.4 days) and late (38 days) ambulatory monitoring of the ST segment. Transient ST segment depression was much commoner during late (32% patients) than early (14%) monitoring.

Cardiac arrhythmias during acute exacerbations of chronic airflow limitation: effect of fall in plasma potassium concentration induced by nebulised beta 2-agonist therapy.

The effect on cardiac rhythm of the fall in plasma potassium concentration induced by nebulised beta2-agonist therapy was studied in 20 patients admitted to hospital with an acute exacerbation of their reversible chronic airflow limitation. Arrhythmias considered serious or potentially life-threatening were recorded in 13 patients (65%). However, there was no significant increase in these arrhythmias in the hour following administration of nebulised beta2-agonist despite a significant fall in plasma potassium concentration during this period.

Primary cardiac amyloidosis in a young man presenting with angina pectoris.

A 32 year old man presenting with typical angina pectoris was found to have primary cardiac amyloidosis. Myocardial infiltration was strongly suggested by echocardiography, and a histological diagnosis was confirmed by renal biopsy. Nevertheless, technetium pyrophosphate myocardial scanning, recently proposed as a sensitive non-invasive test, showed negative results despite widespread cardiac involvement confirmed at necropsy after unexpected sudden death.

The effects of oral digoxin therapy in primary mitral leaflet prolapse.

The effects of oral digoxin on symptoms, arrhythmias, exercise tolerance and echocardiographic function in primary mitral leaflet prolapse were studied in 23 patients using a double-blind crossover protocol. Digoxin reduced the incidence and severity of chest pain compared with both the control (P = 0.0002) and placebo (P = 0.

Effect of beta adrenergic blockade on thallium-201 myocardial perfusion imaging.

Nine patients with stable angina (group 1) underwent maximal treadmill stress testing and thallium-201 (201T1) myocardial scintigraphy after intravenous propranolol hydrochloride, and after placebo. Though seven of the nine patients exercised longer after propranolol than after placebo, this difference did not reach statistical significance. Propranolol, however, significantly reduced the mean maximum rate pressure product.