Clinical medicine (London, England)
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A 31-year-old man presented with central chest heaviness. He was a smoker of 15 pack-years, but otherwise had no other comorbidities. He was also a professional footballer. ⋯ Unfortunately, there remains a lack of evidence to help guide treatment decisions. Furthermore, there are no known guidelines on managing coronary anomalies in athletes, such as the case presented. As the majority of national guidelines have largely recommended CTCA as first-line investigation in patients with low to intermediate risk of CAD with chest pain, incidental finding of coronary anomalies will become more common, urging the need for guidelines to help with directing management in such cases.
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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.