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Archive for the ‘HEART’ 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, 29 September 2007 (Vol 335).

“BEING UNWELL IS NOT JUST A NINE TO FIVE PROBLEM.”

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BMJ 2007;335:587 (22 September).

Diesel pollution promotes myocardial ischaemia.

It is already clear that air pollution is associated with an increased risk of cardiovascular events such as heart attack, arrythmias, and even death. To investigate why, researchers from Europe did a controlled experiment on 20 men with stable coronary heart disease.

The men exercised on a bicycle ergometer in clean air and in air containing diesel fumes at a concentration found in heavy traffic. As expected, the men had asymptomatic myocardial ischaemia during the exercise periods. But it was significantly worse when they were exposed to diesel.

Advise: don’t exercise in heavy traffic, surprise surprise.

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BMJ 2005;330 (11 June).
ANTI-INFLAMMATORY MEDICATION (NSAIDs) MAY BE BAD FOR YOUR HEART

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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