This is the 3rd dimension - increasing array of therapeutic options for patients. He highlighted the multitude of options for aortic & mitral valve interventions available today
Next was a presentation by former ESC President and multi-modality cardiac imager Dr Jeroen Bax, who discussed the role and place of the Heart Team in the guidelines
Dr Bax explained the changes between the 2017 & 2021 ESC guidelines on VHD...explaining the reasons for including Heart Team discussions - usually for the most complex cases or ones in which several treatment options exist
A great flowchart showing the flow of care between networks
Last year, the @BrHeartValveSoc produced its Blueprint which discussed the importance of network-based care. Not all hospitals / centres have all options and expertise - and they don't all need to!
Then a very interesting talk (for me!) on whether imaging still leads to best decisions for patients - pleased to hear early on a resounding Yes from Dr Unbehaun!
Great example relating to V-in-V TAVI...imaging can tell you likelihood of coronary obstruction and thus whether the #BASILICA technique will be required
Over 70 transcatheter devices on the market; none suitable for all patients...and no Dr can be expert in all of these...so, have to select the right device for the right patient to be done by right operator(s) in the right centre...and that'll need a Heart Team
Transthoracic echocardiography (TTE), when performed with care and diligence, can reveal a lot about the valve. TOE isn't necessary in all cases to determine leaflet pathology.
A worked example below:
In the PLAX view, you can assess the scallops of the leaflets
In a true PLAX view with aortic valve clearly visible, you mostly see the A2-P2 interface. Here, you can see a clear & large prolapse of the posterior leaflet
If you tilt upwards towards the PLAX RV outflow (pulmonary valve) view you see mostly the A1-P1 interface
Here, you can see the valve looks slightly different & no prolapse is seen
PE has garnered a reputation for huge profits as they typically buy into a company, aggressively ⬇️ costs whilst ⬆️ profit margins, leverage debt if needed, and then sell, often at a large profit
Does this matter when it comes to delivering healthcare services?
Sixty years ago this month - October 1963 - US cardiologist Dr Robert Bruce published a paper detailing his efforts to devise a multi-stage treadmill test
Little did he know this would go on to become the Bruce protocol the most widely used for exercise testing
A thread...
Prior to this, 'stress testing' to evaluate cardiac function was performed using the Masters 2-step technique, first described in 1935. This crude but simple test involved repeated steps up & down over 90 seconds
Bruce, amongst others, recognized the limitations of this test & set about developing an exercise treadmill test
His initial work focused upon a single stage protocol, but he soon realized this wasn't stressing fitter patients enough & the test was taking too long!
We know now that it is perfectly possible for symptomatic individuals to have abnormal stress tests, with inducible ischaemia, but not have significant epicardial CAD on angiography
So we should stop using epicardial CAD as the arbiter of whether the test is 'right' or 'wrong'
I helped recruit patients for #ISCHEMIA between 2012-13; we saw at least a dozen patients with barn door (core lab verified) abnormal stress tests but normal coronaries on angiography
Here is just one example! Rest on left, stress (exercise) on right...
Today – July 5th 2023 – marks exactly 75 years since the National Health Service (NHS) was established in 🇬🇧
Long admired around the 🌍for its free-at-the-point-of-care principle, today the NHS is itself on life support
Let us remind ourselves how the NHS came to be
#NHS
1/
The establishment of the NHS was the culmination of attempts to provide healthcare services to Britain’s citizens for at least a century
The designers of the NHS did not start with a clean slate - the service was a rationalisation of services that already existed
#NHS75
2/
In the early 20th century, medical wards were full of patients with pneumococcal pneumonia, lung abscess, acute nephritis, rheumatic heart disease, TB, syphilis & brucellosis. Treatment was often based on good nursing & bed rest with barbiturate sedation at night.