Septal interstitial expansion is seen in adults late after atrial redirection surgery for TGA. It correlates well with NT-proBNP and CI and may have a role in the development of RV systolic impairment. Measuring interstitial expansion in the RV free wall is difficult using this methodology.

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Myocarditis is inflammation of the cardiac muscle. The symptoms, signs and basic investigation findings can mimic that of myocardial infarction. The most common cause is infection (most commonly viral). Cardiovascular magnetic resonance (CMR) is the gold standard non-invasive diagnostic test for potential acute myocarditis as it allows assessment of myocardial oedema and scar. A man aged 25 years was admitted with chest pain, dizziness, headache, palpitations and sweating. His troponin was mildly positive. A CMR was performed which showed mild myocarditis and a right suprarenal mass which was confirmed to be a phaeochromocytoma based on biochemistry and a dedicated imaging workup. Phaeochromocytoma can lead to cardiac involvement in the form of left ventricular dysfunction, or catecholamine-induced myocarditis.

, the National Institute for Health and Care Excellence (NICE) released an update of its 2010 Clinical Guideline CG95 1 on patients presenting with stable chest pain. 2 This article covers the main changes in the updated CG95, and comments on how GPs can expect the management of patients referred to a cardiology/rapid-access chest pain clinic (RACPC) to change. CHEST PAIN ASSESSMENT Accurate assessment of patients presenting with chest pain is challenging. The combination of a detailed clinical history of the pain, with concomitant risk factors provides the most accurate clinical assessment. 3,4 The 2010 guidance used pre-test probability scoring to guide patient investigation and management. The 2016 NICE guidelines do not advocate this and rely on a purely qualitative approach because all those with a clinical suspicion of angina will be investigated the same way. Presenting symptoms are divided into 'typical' and 'atypical'. 'Typical' chest pain is classified as including all three of the following features: 1. Constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms; 2. Precipitated by physical exertion; and 3. Relieved by rest or sublingual nitrate within approximately 5 minutes. • Non-invasive: safer than invasive coronary angiography.