Description
Welcome to the third issue of the CME Bulletin in Cardiology. It remains open season on our profession, with a stream of bad news stories on hospitals, particularly in our own specialty. Many of us are feeling a new sense of vulnerability as the media’s seemingly insatiable appetite for ‘exposing’ errors and oversights continues. Journalists fill column inch after column inch with often unfounded allegations which of course sell newspapers, but which even if disproved, leave some adherent mud. There is little that we can do to stop medical witch hunts, but we are obliged to do everything in our power to conform to Good Clinical Practice, and that includes keeping up to date. CME is therefore a weapon we can use to defend ourselves against charges of intellectual idleness, and should not be seen as a threat or even yet another burden in an increasingly complicated professional life.
In this issue, Mark Anderson sets out some strategies for the management of the survivor of out-of-hospital cardiac arrest. Defibrillators may be expensive, but studies are showing improved survival compared to anti-arrhythmic drugs. Cost imperatives will increase the pressure on us to ration the use of defibrillators, but we have a duty to resist these non-clinical pressures when data support their benefit to patients. If Evidence Based Medicine is used as a stick to beat us, we must use it against those who would deny costly treatment to our patients.
Jane Shipsey describes the assessment of left atrial masses by trans-thoracic and trans-oesophageal echocardiography, demonstrating both the benefits and limitations of technology. In particular, the fact that left atrial thrombus may develop so quickly after stopping warfarin in a patient being prepared for mitral valvuloplasty is of paramount importance in clinical practice, and of course could have enormous medico-legal consequences should complications arise.
Paul Das and Jonathan Swan detail an interesting case of myocarditis mimicking acute myocardial infarction. Who would dare withhold thrombolytic therapy in a case like this (unless with the aid of hindsight)? Nigel Stephens gives us an insight into the role of vitamins in primary and secondary prevention. As more and more of our patients read the burgeoning health pages of the newspapers, which seem obsessed with this week’s magic life saving vegetable or mineral, this is a topic we need to keep our eyes on.
Finally, please send in interesting case reports, images, or reviews which you feel impact on clinical practice, and do claim your CME credits by answering the MCQ’s at the back.
