More and more of our cardiac patients are having scans to check what is going on in their hearts. There were about 1,200 single photon emission computed tomography (SPECT) scans per million population in the UK in 2000, according to the British Nuclear Cardiology Society (BNCS) survey. The National Institute for Health and Clinical Excellence (NICE) has recommended this should increase to about 4,000 scans per million population per year, based on current revascularisation and coronary angiogram rates. This article explains what is involved in a myocardial perfusion scan (MPS), giving you the information to answer your patients' questions.
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.
Approximately 5% of adults aged over 40 years have stable angina, appear on our coronary heart disease (CHD) registers and are recalled at least annually for reviews. People with angina are often prescribed four or more regular items, and it is widely believed that patients are more likely to take their medicines effectively when they agree to their prescription and feel involved in decision-making. The medication review involves patients in prescribing decisions, and supports them in taking their medicines most effectively, so improving health outcomes and satisfaction with their care.
Higher cardiac mortality in the winter has long been recognised. It may be due to colder temperatures, which have been associated with depression of heart rate variability and increases in vascular resistance, coronary vasospasm, blood pressure and haemostasis. The peak in cardiac mortality around Christmas and New Year is likely to be compounded by factors that accompany the holiday season: overindulgence in food, salt and alcohol, emotional stress or depression, exposure to particulates from fireplaces, holiday-induced delays in seeking medical attention and reduced staffing of healthcare facilities. How can we help our patients to reduce their risk?