Paresh A Mehta

Mode of death in patients with newly diagnosed heart failure in the general population.

Early prognosis for incident (new) heart failure (HF) patients in the general population is poor. Clinical trials suggest approximately half of chronic HF patients die suddenly but mode of death for incident HF cases in the general population has not been evaluated.

Improving survival in the 6 months after diagnosis of heart failure in the past decade: population-based data from the UK.

Objective: To investigate the secular trend in survival after a new diagnosis of heart failure in the UK population. Design and Setting: Comparison of all-cause mortality in the 6 months after diagnosis of heart failure in population-based studies in the south east of England in 2004–5 (Hillingdon–Hastings Study) and 1995–7 (Hillingdon–Bromley Studies). Participants: 396 patients in the 2004–5 cohort and 552 patients in the 1995–7 cohort with incident (new) heart failure. Main Outcome Measures: All-cause mortality. Results: All-cause mortality rates were 6% (95% CI 3% to 8%) at 1 month, 11% (8% to 14%) at 3 months and 14% (11% to 18%) at 6 months in the 2004–5 cohort compared with 16% (13% to 20%), 22% (19% to 25%) and 26% (22% to 29%), respectively, in the 1995–7 cohort (difference between the two cohorts, p<0.001). The difference in survival was not explained by any difference in the demographics or severity of heart failure at presentation. There was a difference at baseline and thereafter in the use of neurohormonal antagonists (β-blockers and angiotensin-converting enzyme inhibitors). Conclusions: Although early mortality remains high among patients with newly diagnosed heart failure in the UK general population, there is strong evidence of a marked improvement in survival from 1995–7 to 2004–5, perhaps partly explained by an increased usage of neurohormonal antagonists.

Pituitary tumour apoplexy following acute coronary syndrome management.

An 85-year-old male presented with chest pain. The patient was bradycardic at 48 beats/min and hypotensive at 110/80 mm Hg. His past medical history included hypertension, currently treated with irbesartan. An electrocardiogram and cardiac bio markers (troponin I, 1.19 μg/l) confirmed a diagnosis of a non-ST elevation myocardial infarction. Conventional acute coronary management included clopidogrel, aspirin and low molecular …

An unusual case of palpitations

A 66 year old white man presented with a three year history of intermittent frequent (daily) palpitations and associated malaise, but no syncope. He was taking no drugs and had no family history of arrhythmia or of unexplained, sudden, or premature death. Clinically he was afebrile, in sinus rhythm at 60 beats/min, had blood pressure of 130/80 mm Hg, and had normal heart sounds. Serum electrolytes, including magnesium, and haematology and hepatic and thyroid function tests were normal. His electrocardiogram (ECG) is shown in the figure 1⇓. A seven day ECG event recorder showed two episodes (of 16 and 17 hours’ duration) of spontaneous atrial fibrillation at rates of up to 160 beats/min. These episodes coincided with symptoms. Chest x ray and cardiac imaging were entirely normal.