Clinical medicine (London, England)
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We present the case of a late presenting ST-elevation myocardial infarction with a coronary dissection. After primary percutaneous coronary intervention, the patient went on to develop pericardial effusion with tamponade. Despite only a small volume of fluid, we demonstrate how it can have significant clinical consequences in the diseased heart. We also highlight the value of being able to carry out bedside echocardiography in the acutely unwell post-myocardial infarction patient.
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Just under 1 million people in the UK have symptomatic heart failure. Decompensated heart failure is associated with a particularly poor prognosis with in-hospital mortality at around 10%. Over the last 30 years renin-angiotensin-aldosterone system antagonists have been shown to have incremental benefit on improved quality of life, reduced hospitalisation and mortality rates in those with heart failure with reduced ejection fraction. ⋯ This leaves the patient still in a state of congestion without the prognostic medication at discharge, with resultant adverse outcome. The British Society for Heart Failure and the Renal Association have produced consensus guidance to help guide management in a more consistent fashion based on heart failure classification, whether the patient is congested and the degree of renal impairment. Early heart failure specialist review is associated with improved patient outcomes.