Archive for the ‘HEART ATTACKS’ Category

Clinical Review, BMJ  2007;335:929-932 (3 November).

Summary points

  • A favourable outcome depends on early, aggressive, treatment
  • Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
  • Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
  • Subtle signs of organ hypoperfusion should be sought in physically robust patients
  • The role of activated protein C and low dose steroids remains to be clarified

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BMJ 21 December 2007;

Organised marathons are not associated with an increased risk of sudden death, despite the media attention they attract. In fact, marathons lower the risk of fatal motor vehicle crashes that might otherwise have taken place if the roads had not been closed

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BMJ  2007;335:639 (29 September) NEWS:

Serum concentration of triglycerides is an independent risk factor for coronary heart disease.

Because triglycerides are so closely linked to obesity (p 425). Losing weight and taking more exercise is one of the best ways to keep triglycerides under control. In this study, lower concentrations were also associated with eating a decent breakfast.

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BMJ 2005;330 (11 June).

All drugs in the study were associated with an increased risk of myocardial infarction, which was statistically significant for rofecoxib, diclofenac, and ibuprofen; no protective effect was seen for naproxen.

If you want to read more JUST CLICK HERE.

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BY: Mike Clancy, ER consultant, BMJ 2007;335:623-624 (29 September)

Acute chest pain is responsible for one in four emergency medical admissions in the United Kingdom observation and investigation is not easy, especially when the consequences of misdiagnosis include infarction, arrhythmia, and death.

The strategy of evaluating such patients in a chest pain unit based within or near the emergency department is used in 30% of emergency departments in the United States.

In theory, a chest pain unit should improve outcomes—but does it?

The ESCAPE trial by Goodacre and colleagues tried to answer this question.

The introduction of a chest pain unit had no significant effect on the proportion of people attending the emergency department with chest pain, the proportion of people with chest pain who were admitted, or the number of people admitted over the next 30 days.

Setting up a chest pain unit led to more patients being tested, but no reduction in the proportion of patients admitted.

The trial showed no benefits of chest pain units.

If you want to find out more about the effectiveness of chest pain units, just CLICK HERE.

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Patients with cardiac chest pain should call emergency services 

BY: Will T Roberts, research fellow, Adam D Timmis, professor of clinical cardiology BMJ  2007;335:669 (29 September). 

In acute myocardial infarction, the risk of ventricular fibrillation is highest in the first 12 hours after onset of symptoms.

Key points

In acute myocardial infarction the most important means of saving life is to get the patient to a defibrillator and to start reperfusion therapy as soon as possible after the onset of symptoms

  • The time it takes patients with chest pain to seek help accounts for up to 75% of the total delay before treatment
  • Ambulance transport is the most effective means of accessing medical help, yet up to half of all patients with myocardial infarction do not use the emergency services
  • Healthcare professionals who deal with at-risk groups should educate them about how to recognise symptoms and the need to act quickly in the event of cardiac chest pain by calling for help from emergency services, rather than consulting general practitioners or medical helplines

If you want to find out more just CLICK HERE.

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