Cardiovascular Disease

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  Anaphylaxis
In January 2008 the Resuscitation Council produced new guidelines on the treatment of anaphylaxis(www.resus.org.uk/pages/reaction.pdf). Here I have summarised them, including the updates issued in February and March 2008. You will be pleased to hear they are much simpler than previous guidance issued in 2005!
  Cardiac Imaging
This Factfile from the British Heart Foundation helpfully summarises some of the latest techniques for assessing the heart, especially as we move away from using the exercise tolerance test to diagnose angina.
  Endocarditis prophylaxis
In 2006 the British Society for Antimicrobial Chemotherapy produced guidance on endocarditis prophylaxis. They concluded that the risks of endocarditis are much lower than had previously been thought and that very few individuals actually need prophylaxis.
  Chest pain and Angina
A study of over 1000 people presenting with chest pain identified the symptoms that increased or reduced the chance of the diagnosis being cardiac.
  Peripheral arterial disease
As a medical student I was told the treatment for intermittent claudication was 'Stop smoking, keep walking'. So 15 years on, has the recipe changed? Well, yes and no! These are still vitally important but there are a few more ingredients we can add to this treatment!
  Familial hypercholesterolaemia

I've always struggled to know when I should consider familial hypercholesterolaemia as a diagnosis. These guidelines help clear this up.
  Statins: evidence and use
In this section I will cover:

What role for fibrates?
Benefits and harms of statins
Do statins cause diabetes?
Starting and monitoring statins
What about ezetimibe?
Statins and muscles, cancer, pneumonia and dementia.
  Cardiovascular risk and lipids
When you ask for a cholesterol test, what results do you get back? Total cholesterol? HDL? LDL? TGs? Chol:HDL ratio? What matters? And do you need to fast?
  Atrial fibrillation
You notice Mrs Jones (85y) is in AF. What do you do?
  Chronic heart failure

'Currently the NHS spends £1 billion/year, apparently on managing heart failure badly'

This was the conclusion of the Lancet editorial on the National Heart Failure Audit 2010 (Lancet 2011;376:2041). So let's look at the audit, and then the NICE guidelines on CHF from August 2010.
  Stroke and TIA
John Brown's wife rings you to say her husband (72y) woke this morning unable to move the left side of his body, particularly his arm. Do you visit or admit? Do you recommend aspirin or not? If you see him and he is hypertensive do you lower his BP?
  Aspirin and cancer
'Aspirin reduces cancer risk by 20%' said the headlines. However, all the commentators were quick to point out that aspirin was associated with harms and that people considering taking aspirin should see their GP. But what does a 20% relative risk reduction mean to the patient sitting in front of us? What sort of a benefit is that in real terms? And what are the harms?
  Cardiovascular benefits of aspirin
What about the cardiovascular benefits of aspirin? Of course we are now increasingly using clopidogrel for secondary prevention after CVA, but continue to use aspirin for secondary prevention post-MI or in IHD.
  Aspirin, clopidogrel & dipyridamole: which drug when?
NICE have issued new guidance on secondary prevention of CVD events in those who have had a TIA or CVA or who have peripheral vascular disease or multi-vascular disease (meaning more than one vascular disease (e.g. CVA and PVD) (NICE 2010, TA210))
  Hypertension
Hypertension is not a disease, it is a risk factor for cardiovascular disease (CVD). What is more, unlike age and sex, it is a modifiable risk factor! NICE, in conjunction with the British Hypertension Society, have just published new guidelines on the management of hypertension (NICE CG127, August 2011).
 
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