Atrial fibrillation as a risk factor for myocardial infarction

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We all know that ischaemic heart disease is a risk factor for AF, through multiple mechanisms, however how about AF as a risk factor for having an MI?

Turns out AF doubles your risk (1.7 after adjustment for major risk factors). This association was stronger in women, and not significant in the older age group.

It’s not just strokes – AF is becoming a serious public health issue, and one we don’t know enough about. Read more at JAMA Internal Medicine.

 

image | Wikimedia Commons

source | JAMA Internal Medicine

 

guideline | heart failure

When it comes to cardiology, there are three major sets of guidelines: the ones from the US (ACCF/AHA), the ones from Europe (ESC), and the ones from Australia. You’ll be pleased to know that the AHA guidelines for heart failure have just been updated! Have a look at the Executive Summary (and links to the full thing) over here.

For more, the European guidelines are here, and the nicely designed Australian guidelines are here.

Continue reading

Reprogramming for heart repair

It’s one of the holy grails of cardiology, and indeed all of medicine – are we able to regenerate cardiac tissue? Cardiomyopathy of any type is difficult to manage, is the direct cause of a great deal of morbidity and mortality, and remains relatively poorly understood, regardless of aetiology. The potential to generate new cells or to reprogram existing ones could change the face of this disease.  Continue reading

Clopidogrel without aspirin in patients on warfarin undergoing percutaneous coronary intervention

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This is an article from a few months ago but one that needs to go in the archive – a patient already on warfarin (say for AF or a mechanical heart valve) comes to you and requires percutaneous coronary intervention. Do you put them on aspirin and clopidogrel, or just either agent on its own, in addition to the warfarin? The WOEST study looks at this.

Dewilde and colleagues performed an RCT across 15 centres in Belgium and the Netherlands, between the Novembers of 2008 and 2011.  These were all patients receiving PCI (with about a quarter being those with acute coronary syndromes), except those in cardiogenic shock, or with either a recent (within 6 months) peptic ulcer, major bleeding previously, or platelet count < 50. Anticoagulation was continued periprocedurally, with a target INR of 2. The majority of patents were done with femoral access, with around 25% using the radial approach. A mix of drug eluting and bare metal stents were also included.

Overall, there was significantly less bleeding in the triple therapy group, with no significant increased thrombotic risk. A great practical article, and definitely worth a read. Check it out here.

source | The Lancet

image | National Institute of Health, via Wikimedia Commons

Doing percutaneous coronary intervention – without a surgical backup

In the early days of percutaneous intervention – stenting and so on – you’d always want to have cardiothoracics around to crack the chest in case of emergency bypass surgery. As the population gets larger, and further away from major centres, more places are doing diagnostic angiography, and some of them are starting to stent.  This month’s NEJM has a look at the safety of doing PCI without surgical backup. Continue reading

A overview on transcatheter aortic valve implantation

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Transcatheter aortic valve replacement, or TAVI, had a lot of publicity over the past few years. Prior to TAVI, when faced with those elderly patients with multiple co-morbidities, who were really very restricted symptomatically from aortic stenosis, there really wasn’t much choice. But with any new advent, people question every complication. So now, the NEJM has got a few different articles looking at the TAVI situation. Continue reading