Heart Matters Vol 14 No 2 - 2023

Introduction

Leave nothing behind - drug-coated balloons (DCBs)

The era of percutaneous coronary intervention was ushered in by Andreas Gruentzig in 1977. Since then, many new technologies have been developed in the field of interventional cardiology. Each device developed solved an existing problem, but also had its own limitations. Elastic recoil and flow-limiting dissections seen with plain old balloon (POBA) was address with the introduction of bare-metal stents (BMS). Drug-eluting stents (DES) were subsequently developed to negate neo-intimal hyperplasia that led to a restenosis rate of up to 30% with the use of bare-metal stents. Despite the advantages of drug-eluting stent, many clinical issues remain, such as late stent thrombosis, vascular inflammation, hypersensitivity, neo-atherosclerosis and late luminal enlargement.

10 pearls/pitfalls in the treatment of hypertension

As with all procedures, correct positioning is vital to ensure accurate measurements. The correct position is detailed in the International Society of Hypertension (ISH) Hypertension guidelines.  Briefly, people should be seated for 5 minutes having avoided stimulants (including cigarettes) for 30 minutes prior; feet should be flat on the floor and the back supported with the arm at the level of the heart; the correct cuff size needs to be used and no talking during the procedure.

Unobstructed coronaries – a practical approach

In this paper, we will review an approach to a patient who presents with symptoms suggestive of myocardial ischemia, but who has no evidence of flow limiting or obstructive coronary artery disease at coronary angiography. We will approach this problem both from the perspective of a patient presenting with a presumed diagnosis of CCS, and then from the perspective of a patient presenting with an ACS. 

Clinical negligence - understanding claims and compensation

In this article, the fourth of a medicolegal series of articles, Dr Volker Hitzeroth, Medicolegal Consultant at Medical Protection, discusses an allegation of clinical negligence and the process involved with such a claim.

Treating and caring for the unwell is an endeavour that is not without risk and unfortunately adverse incidents do occur. Similarly, many clinical trajectories are unpredictable, and outcomes are unforeseeable. Some patients who have suffered harm or an injury, or their family, may seek financial redress by instituting a claim in clinical negligence.