We present the case of a 71-year-old man, with known Parkinson's disease and previous coronary artery bypass surgery, who presented with acute chest pain. His initial 12 lead electrocardiogram (ECG) was unremarkable; however, a repeat 12 lead ECG during further chest pain suggested a ventricular tachycardia (VT) for which he was commenced on an intravenous amiodarone infusion. However, later analysis of his ECGs revealed that the apparent VT was, in fact, an artefact related to his parkinsonian tremor.
When the general public look from the outside at the armed services, their impression is often one of earnest young men and women who are the pinnacle of physical fitness and health, and put their lives on the line for their country. There is usually sadness and respect for those killed on active operations, having put themselves in harm's way. Therefore, when the public discover that more than 1 in 10 deaths in the UK Armed Forces are due to cardiovascular disease, the air of sadness is invariably replaced with surprise and disbelief. These figures, while lower than those due to deaths in accidents, are approaching the numbers of those due to suicide in the armed services; yet deaths from cardiac disease are barely recognised by society, in spite of many of them being avoidable. This article reviews the epidemiology of cardiac disease in the UK Armed Forces, both in terms of morbidity and mortality. It outlines current understanding and gaps in the knowledge regarding the burden of cardiovascular disease in the military population. The particular demographics of the Armed Forces and its influence on cardiac disease burden are discussed. The role of inherited and congenital diseases in younger servicemen and women is highlighted, as is the trend that with increasing age, the burden of disease shifts to ischaemic heart disease, which becomes the dominant cause of both death and disability.
Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries, International Journal of Cardiology (2017Cardiology ( ), doi:10.1016Cardiology ( /j.ijcard.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT
Conflicts of interest: None to declareKeywords: Aortic valve calcification score, coronary microvascular dysfunction, calcific aortic valve disease.
A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 Abstract:Background: Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) -a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation.Methods: 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay.Results: Mean(±SD) participant age was 59.8(9.6) years. Mean AVCS was 68 (258)
Conclusion:Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation.
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