Chest pain and discomfort are common symptoms that account for 1% of visits to primary care, 5% of visits to accident and emergency departments and 25% of emergency hospital admissions. Coronary artery disease (CAD) is one of many causes of chest pain and is the commonest cause of death in the UK. However, there are treatments available that can improve symptoms and prolong life, making prompt assessment and diagnosis essential. The National Institute for Health and Clinical Excellence (NICE) has recently published a new guideline on the assessment and investigation of patients presenting with acute chest pain suggestive of acute coronary syndrome (ACS) and stable chest pain suggestive of angina. It includes recommendations that will mean some changes to the way these patients are managed in practice. This article looks at how we can put these changes into action.
“Heredity sets limits, environment decides the exact position within these limits” – Edwin Carleton MacDowell, 1887-1973
This quotation, although made more than one hundred years ago, remains very true today. New evidence from the INTERSTROKE study, published recently in The Lancet, shows that ten risk factors – many associated with lifestyle – account for 90% of the risk of stroke.1 Analysis of data from 6,000 people, half suffering strokes and the other half matched controls, from 22 countries worldwide between March 2007 and April 2010, revealed these risk factors are: high blood pressure, smoking, waist-to-hip ratio (abdominal obesity), physical inactivity, diet, lipids, diabetes, alcohol intake, stress and depression, and heart disorders.
Endometrial ablation
What are omega-3 fatty acids and what is their role in cardiovascular health?
The research supporting omega-3 fatty acids in preventing cardiovascular disease (CVD)
How to use omega-3 fatty acids for the prevention of CVD
The argument against an HbA1c target of 6.5%
How low is too low: should we be aiming for an HbA1c target of 6.5%?
How can patients increase their dietary intake of omega-3 fatty acids?
Caring for patients with diabetes who have intercurrent illness
Modern treatments available to people with diabetes enable the 1.3 million living with the condition in England alone to minimise and control its impact on their daily lives like never before. But what happens when a person with diabetes develops intercurrent illness, such as a cold or flu? We review the steps to take to ensure that these patients maintain good glycaemic control throughout the ups and downs of other health challenges.
Cardiac Resynchronisation: A New Approach To Managing Chronic Heart Failure
Heart failure affects around three in every hundred people aged 65 to 74 years, and increases with age. About 40% of patients with heart failure will die within one year of diagnosis, underlining the need for prompt diagnosis and effective therapy. In this article we explore what goes wrong in heart failure, and how cardiac resynchronisation can help.
Beating the post-MI blues: improving detection and treatment of depression after a heart attack
Depression after myocardial infarction (MI) is extremely common, affecting almost half of all patients. The combination of MI and depression reduces the chance of recovery and makes it much more likely that patients will have another cardiac event. Depressed patients are also less likely to get back to work and they use health services more than those who are not depressed. We carried out a survey to investigate the perceptions, attitudes and skills of primary care practitioners in recognising and treating depression in patients following an MI to explore how this important co-morbidity is managed in practice. Readers of the British Journal of Primary Care Nursing (BJPCN) were invited to participate in an online survey, together with readers of the Primary Care Cardiovascular Journal. The survey results show that although primary healthcare practitioners realise that depression after MI is a significant problem, many underestimate quite how common it is and have received little or no training in recognising or managing depression.
