Cardiac auscultation has limited accuracy for the detection of VHD in asymptomatic patients and is a poor diagnostic screening tool in primary care, particularly for overweight subjects. Ensuring easy access to echocardiography in patients with symptoms suggesting VHD is likely to represent a better diagnostic strategy.

ObjectivesTo evaluate the appropriateness of proton pump inhibitor (PPI) prescribing by conducting an audit of medical inpatients against recommended guidelines.DesignQuestionnaire-based study. All medical wards were audited and different information was documented by patients' medical records review (both hospital visit notes and general practitioner's letters) and short interview, where we asked them to name the clinical reason for using PPI.SettingThis study was carried out in the setting of a regional hospital (537-bed, secondary care referral centre) in Ireland.ParticipantsThe study participants were all consecutive medical patients admitted to the medical wards at Waterford Regional Hospital, Waterford.Main outcome measuresThe appropriateness of PPI usage in our regional hospital by assessing the level of its prescribing against published guidelines (NICE, 2000).ResultsDuring the audit period, 205 consecutive medical inpatients were assessed. Seventy-nine percent (162 out of 205) of the studied patients were found to be using PPI. For 45% (n = 73) of patients, there was no documentation of valid indication for being on PPI. Overall, 64% of patients were prescribed PPI by hospital doctors, either during their current or previous admissions. We noted that 31% (n = 51) of patients were taking PPI for ≥2 years and another 25% of patients were using PPI for about one year. Only 12% (n = 20) of patients had undergone endoscopy procedures.ConclusionInappropriate use of PPI remains common in hospital practice. The risks of using long-term PPI must be weighed against the benefits.

recorded were age, gender, number of blood cultures taken and the final diagnosis stated in the discharge summary. Results 112 episodes were identified in 72 females and 40 males (mean age 40 years, range<1-97). The mean number of blood cultures was 2.57 (range1-12) and 85 (76%) patients had only one blood culture taken. The infections recorded are shown in Figure 1. The cause of the bacteraemia was not stated in 33 (29.5%) cases. Community acquired pneumonia (n=31) was the commonest infection, followed by catheterrelated bloodstream infection (n=8) and then IE and soft-tissue infection (both n=7). Details of the streptococcal species are shown in Table 1 and the results have been divided using age less than or greater than 18 years. 50% of bacteraemias were caused by oral streptococci. IE was confirmed in only 7 (1.2%).Abstract 135 Figure 1 Conclusions Among all streptococcal bacteraemias, IE is an uncommon cause but is more common when considering oral streptococci in adults (12.5%) compared with those aged less than 18 years (0%). Oral streptococci remain an important cause of IE particularly in adults. This diagnosis should be considered even if only one blood culture is taken and is positive. The high rate of single blood culture sampling (76%) may be an unintended consequence of the Surviving Sepsis campaign and the drive to initiating empirical antibiotic therapy earlier. Under these circumstances the reliability of the Duke criteria will be reduced. Ideally, patients at increased risk of IE require multiple blood cultures if they have a significant pyrexial illness in order to determine if a sustained bacteraemia is present. Introduction Cardiac auscultation is an important clinical skill used by physicians in assessing and diagnosing valvular heart disease (VHD). The widespread use of echocardiography in the last three decades has coincided with a perceived decline in the utility of auscultation, particularly by general physicians. The ability of generalists to identify VHD in an unselected population has not been well characterised, so we aimed to determine the accuracy of auscultation in primary care for diagnosing VHD. Methods 251 participants aged 65 and over who were participating in the OxValve population cohort study were included. They were recruited from two participating GP surgeries and had no previous diagnosis of VHD. The participants underwent cardiac auscultation during the OxValve study visit by two experienced General Practitioners (GPs), neither of whom had a specialist interest in cardiology. A 5-point Likert scale was used to rate the ability to hear heart sounds (1=not at all; 5=perfectly) in addition to the presence or absence of a murmur, type of murmur and the ability to make a diagnosis based upon the auscultation findings. This was compared to transthoracic echocardiography performed at the same visit, but GPs were blind to the echocardiogram result, which was performed after auscultation. VHD was categorised as mild (either mild regurgitation [excluding trace/physiological] or...

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ObjectiveCardiac sarcoidosis (CS) may present with cardiac arrest or life-threatening arrhythmias. There are limited data on this subgroup of patients with CS. Advanced imaging including cardiovascular magnetic resonance (CMR) and cardiac 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) are used for diagnosis. This study aimed to describe advanced imaging patterns suggestive of CS among patients presenting with cardiac arrest or life-threatening arrhythmias.MethodsAn imaging database of a CS referral centre (Royal Brompton Hospital, London) was screened for patients presenting with cardiac arrest or life-threatening arrhythmias and having imaging features of suspected CS. Patients diagnosed with definite or probable/possible CS were included.ResultsStudy population included 60 patients (median age 49 years) with male predominance (76.7%). The left ventricle was usually non-dilated with mildly reduced ejection fraction (53.4±14.8%). CMR studies showed extensive late gadolinium enhancement (LGE) with 5 (4–8) myocardial segments per patient affected; the right ventricular (RV) side of the septum (28/45) and basal anteroseptum (28/45) were most frequently involved. Myocardial inflammation by FDG-PET was detected in 45 out of 58 patients vs 11 out of 33 patients with oedema imaging available on CMR. When PET was treated as reference to detect myocardial inflammation, CMR oedema imaging was 33.3% sensitive and 77% specific.ConclusionsIn patients with CS presenting with cardiac arrest or life-threatening arrhythmias, LGE was located in areas where the cardiac conduction system travels (basal anteroseptal wall and RV side of the septum). While CMR was the imaging technique that raised possibility of cardiac scarring, oedema imaging had low sensitivity to detect myocardial inflammation compared with FDG-PET.

This case highlights the importance of correlating ECG findings with history and clinical examination and of using 12 lead ECGs for rhythm interpretation especially to confirm consistence of arrhythmias in all leads.

This case stresses the importance of investigating and treating cardiac arrhythmias underlying seizure activity.

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