Atifur Rahman

Review article: elevated troponin: diagnostic gold or fool's gold?

Troponin is a highly sensitive biomarker of myocardial injury and has been used extensively in everyday clinical practice in the community as well as in hospitals for the diagnosis of acute myocardial infarction (AMI) and for risk stratification of patients with acute coronary symptoms. Dynamic elevations in biomarkers (troponin) are considered fundamental to the diagnosis of AMI. Unfortunately, many clinical conditions can cause troponin elevation in the absence of myocardial ischaemia, and elevated levels sometimes pose a diagnostic dilemma. In some cases, inappropriate diagnosis of ‘AMI’ based primarily on a raised troponin can have a deleterious impact on an individual, including on driving, insurance and other medicolegal matters. An incorrect diagnosis of myocardial infarction can also lead to the oversight of serious life‐threatening alternative causes of troponin elevation (e.g. pulmonary embolism). This article discusses the role of troponin in our everyday clinical practice in the ED.

Multimodality imaging of cor triatriatum sinistrum diagnosed in an adult female

A 66-year-old female with a history of hypertension presented for an elective transthoracic ultrasound. The study revealed normal left and right ventricular size and function and an echogenic band running along a normally sized left atrium. Subsequently a transesophageal echocardiogram (TEE) was organised which revealed a thin partial membrane arising from the roof of the left atrium (LA) and extending across to the interatrial septum (IAS) ( Fig. 1A, B, C and D ). Colour Doppler imaging revealed unidirectional, laminar flow through the membrane ( Fig. 1E and F). The remainder of the study was unremarkable, with normal left and right ventricular function and absent valvular pathology.

Management of oral anticoagulation in the surgical patient.

New oral anticoagulants (NOACs) have recently emerged as an alternative for vitamin K antagonists and are now widely available. Although there is good evidence for their roles in the appropriate clinical settings, so far no reversal agent is currently available. Likewise, there is no readily available laboratory test to quantify drug levels but coagulation assays may provide qualitative information about the presence of some NOACs. We aim to review the current literature regarding the optimal management of oral anticoagulation in the perioperative setting.

Myocardial infarction from isolated coronary artery vasculitis in a young patient: a rare case.

Symptomatic coronary artery disease (CAD) primarily occurs in patients over the age of 40, however younger men and women can also be affected. The pathophysiology of CAD in this group is often not due to atherosclerotic plaque rupture, except for those with genetically predetermined risk such as familial hypercholesterolaemia. In an autopsy study of victims aged 15–34 years, advanced coronary atheromas were seen only in 2% of males aged 15–19 years, and none in females [ 1 ]. Many of these cases may have had severe heterozygous familial hypercholesterolaemia (FH), which occurs with a frequency of 1:300–1:500 of the general population, and in which total cholesterol levels are very high (usually > 8 mmol/L) [ 2 ].

Accurate Reporting of Door-to-Balloon Times.

We recently audited our hospitals door-to-balloon times. In the years between 2011 and 2014 we achieved a door-to-balloon time of less than 90 mins in 81% of cases ( Figure 1). The overall median time was 65 mins. While the review showed we are meeting recommended targets we also wonder whether we are selling ourselves short [ 1 ].