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Faculty of Cardiology

Welcome to the IICMS Faculty of Cardiology

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19th Cardiac Physiologists Meeting at the Irish Cardiac Society

The 19th Cardiac Clinical Physiology Meeting will be held on the 5th of October during the Irish Cardiac Society Meeting in Galway.  The Irish Cardiac Society is being held in the Galway Bay Hotel, Salthill in Galway.  The program will include talks on

  • CPD Opportinuties
  • Post Graduate Opportunities
  • Interactive IEGM Session
  • Speckle tracking in Sleep Apnoea
  • Atrial Fibrillation and NOAC Update


Interesting case studies or research for the Dr Gerard King Award can be emailed before 5pm on Oct 1st to paulg.nolan@hse.ie

If you wish to attend the even you must pre-register on the form below

Name:
E-mail:
Hospital Address

 

Note due to changes in rules around sponsorship, companies have contributed to a fund, managed by the Irish Cardiac Society.  To access sponsorship to attend the Cardiac Physiologists Meeting please apply through this online portal
http://www.conferencediary.ie/irishcardiacsociety/welcome_funding.php

 

SCST Diploma in ECG Interpretation Course - Belfast

The SCST Diploma in ECG Interpretation Course will this year be being held in Belfast for the first time.

The three-day course takes place over three days from 27th September 2018 To 29th September 2018.

This is the professionally recognised course for all those who are reporting on both 12 lead and ambulatory ECGs.

This is designed as a preparation course for those planning to sit the Diploma in ECG Interpretation examination.

It is suitable for associate practitioners, cardiac scientists, specialist nurses, doctors and any other health care professionals wishing to demonstrate skills and knowledge beyond Certificate level.

Examination for this award is in the form of a 3 hour written paper, registration form available through www.scst.org.uk or by emailing exams@scst.org.uk

Further information from:

Email: Website: www.scst.org.uk

Link to registration

 

National Review of Specialist Cardiac Services

Please see below information in regard to the review of cardiac services.

The Minister for Health, Simon Harris TD, established the National Review of Specialist Cardiac Services in late 2017 under the independent chairmanship of Professor Philip Nolan of Maynooth University. A Steering Group of key stakeholders, including patient representatives, met for the first time at the end of January 2018 and agreed on a programme of work for the National Review. This public consultation is an important element of the National Review and will be a key influence in regard to what is recommended as a blueprint for future services. This National Review is being supported by the Clinical Effectiveness Unit of the National Patient Safety Office located in the Department of Health, which provides patient safety policy leadership. Patient safety is at the core of our health service and is a key priority for the Department of Health (see further detail on the work of the National Patient Safety Office (NPSO) at http://health.gov.ie/national-patient-safety-office/).

Aim and Scope of the National Review

The aim of the National Review of Specialist Cardiac Services is to achieve optimal patient outcomes at the population level with particular emphasis on the safety, quality and sustainability of the services that patients receive by establishing the need for an optimal configuration of a national adult cardiac service. The scope of the National Review is broad and national. It will examine services for adults that address elective, urgent and emergency need for hospital-based diagnosis and treatment of cardiac disease, including diagnostic and interventional cardiac procedures and the associated interdependent services. Patient outcomes, patient safety and ensuring public confidence in cardiac services are central to the Review and as such this public consultation is an essential element of the Review

 

Specialist Cardiac Services

Specialist Cardiac Services mainly refers to the treatment of patients with heart attacks, heart failure and abnormal heart rhythms, but also covers a range of other conditions (e.g. adult congenital heart disease) and includes the full range of diagnostic, treatment, rehabilitation and prevention services related to heart disease. For the purposes of the National Review, the focus is on adult specialist cardiac services.

Your Opinion Matters

This public consultation takes the form of an online survey that you may answer as an individual or on behalf of an organisation. Please note that if you are responding on behalf of an organisation, the response should be signed off at the appropriate management level. If you are responding as an individual, with your permission and in the interest of transparency, your name will be published as a contributor to the consultation.

In addition, all submissions received by the Department are subject to the Freedom of Information (FOI) Act, 2014 and may be released in response to an FOI request. The Department publishes the text of FOI requests on FOI disclosure logs on the Department’s website.

Completing the Questionnaire

A number of questions within the questionnaire are compulsory. These compulsory questions are those which offer you a choice of options or which ask you to confirm that you understand certain statements. Other questions will ask you for your opinions or experiences in your own words - we call this free text. The free text answers are not compulsory which means you can skip them if you desire. When answering in free text, you need to write as concisely as possible as there are word limits on the amount of text that is available. These word limits have been put in place to allow for the thorough consideration of all responses. If you are completing the consultation online, please press submit when you have finished answering the questions.

For those who wish to respond as Gaelige, you are required to download the Irish PDF version, complete it and return by post by 1 p.m. on Friday 17th August to:

National Review of Clinical Services

11th Floor Hawkins House

Hawkins Street

Dublin, D02 VW90

Update on Long QT Syndrome

One of the worlds leading authorities on Long QT Syndrome will speak at a free event titled:

An update on Long QT syndrome in the Irish population and the role of surgical left cardiac sympathetic denervation

This will take place on Saturday, June 7th in the Fintan Gunne Lecture theatre, Catherine McAuley Education and Research Centre, 21 Nelson street (opposite the main entrance to Mater Misericordiae University Hospital), Phibsborough, Dublin 7

Further details here

 

Open access cardiomyopathy resources

Full text of the guideline paper available below and a complete list of the guidelines published in Echo Research and Practice can be found here.

Diagnosis and assessment of dilated cardiomyopathy: a guideline protocol from the British Society of Echocardiography by Thomas Mathew et al. Echo Res Pract June 1, 2017 vol. 4 no. 2 G1-G13

 

 

 

 

 

Successful Hands On Introduction to Echo Course held

The IICMS Hands on Introduction to Echo Course was held on Saturday, in St Vincent's University Hospital, and the twenty attendees appeared to enjoy the day which was split into 20 minute theoretical talks covering everything from the LV, RV and valves to optimal machine settings.  The afternoon allowed candidates to put the theory into practice at various echo workstations.  The day was supported by the HSE's Health and Social Care Professions (HSCP) Education and Professional Development Office.

Great thanks must be given to the faculty of Anita Deane, Mary Murphy, Dr Gerard King, Paul Nolan and Anne Tierney.  Special thanks must be given to Mary Murphy, from St Vincent's, who put in Trojan work organising the room, catering, echo machines, echo subjects and the logistics.  Many thanks

We hope to run more CPD events in 2017, so ensure you sign up for 2017 membership to avail of the CPD opportunities.

 

CPD Funds Available

BSE & IBHRE exam funding available through the Cardiology Faculty of the IICMS. For application forms please contact: iicmscpd@gmail.com

Overview of new BSE Accreditation Procedure

Anita Deane, Senior Cardiac Physiologist in Sligo University Hospital, has kindly shared a rpesentation she gave recently which covered an overview of the British Society of Echocardiography Adult Transthoracic Echocardiography Exam & the ‘New Practical Assessment’ element which has been introduced.  Just to let you know if you fail either logbook or video cases stations, you may be asked to resubmit a certain amount of cases with feedback taken on board and then re do BSE practical exam day, within 3 months, without doing exam again in certain cases.

To access the presentation click here

 

Updates on the ECG in Acute Coronary Syndrome

The electrocardiogram (ECG) is the initial test in patients with suspected ACS. The ECG is the defining element of ST-segment elevation myocardial infarction (STEMI). Its most important use is in the detection of acute coronary obstruction, and it is the most important, cost-effective, and immediately available initial test in the decision for emergency reperfusion therapy. There is a recent interest in refining the sensitivity and specificity of the ECG for coronary occlusion, and thus for identifying subtle STEMI, as well as in recognizing pseudoinfarction patterns and thus avoiding false positive cath lab activations. Studies assessing the accuracy of cath lab activation, the differentiation of precordial ST-segment elevation due to normal variant from that of anterior STEMI, the diagnosis of STEMI in the presence of left bundle branch block, the differentiation of benign inferior ST-segment elevation from that of inferior STEMI, and the importance of ST-segment elevation in lead aVR are discussed in thsi recent review by Dr Stephen W Smith, from the Hennepin County Medical Center, University of Minnesota.

Access the full text of the article here

 

Report of the HSE Acute Coronary Syndrome National Clinical Program released

The report from the HSE National ACS program which looks at data pertaining to the delivery of the program in 2014 has been released.  The main points of the report are

  • 2014 saw data on 1,247 patients with STEMI were recorded from eight out of the nine PCI centres
  • major change in the way patients with STEMI are treated has occurred in Ireland with a shift from both thrombolysis and PPCI used in equal measure in 2011 compared with a rate of 92% PPCI in 2013 and 2014 in reperfusion treated patients
  • achievement has been realised to a high degree in all PPCI centres reflecting change equally across the country
  • this high level of PPCI compares favourably with other countries such as England 97% and Wales 72%

To download the full report simply click here

 

Long-term cardiac monitoring in older adults with unexplained falls and syncope

Aims Unexplained falls account for 20% of falls in older cohorts. The role of the implantable loop recorder (ILR) in the detection of arrhythmias in patients with unexplained falls is unknown. We aimed to examine the diagnostic utility of the ILR in detection of arrhythmogenic causes of unexplained falls in older patients.

Methods A single centre, prospective, observational cohort study of recurrent fallers over the age of 50 years with two or more unexplained falls presenting to an emergency department. Insertion of an ILR (Reveal, Medtronic, Minnesota, USA) was used to detect arrhythmia. The primary outcome was detection of cardiac arrhythmia associated with a fall or syncope. The secondary outcome was detection of cardiac arrhythmia independent of falls or syncope, and falls or syncope without associated arrhythmia.

Results Seventy patients, mean age 70 years (51–85 years) received an ILR. In 70% of patients cardiac arrhythmias were detected at a mean time of 47.3 days (SD 48.25). In 20%, falls were attributable to a modifiable cardiac arrhythmia; 10 (14%) received a cardiac pacemaker, 4 (6%) had treatment for supraventricular tachycardia. Patients who had a cardiac arrhythmia detected were more likely to experience a further fall.

Conclusions 14 (20%) patients demonstrated an arrhythmia which was attributable as the cause of their fall. Patients who have cardiac arrhythmia are
significantly more likely to experience future falls. Further research is important to investigate if early detection of arrhythmogenic causes of falls using the ILR prevents future falls in older patients.

Access the study in Heart Journal

 

Is First Degree Heart Block associated with a poor cardiovascular outcome

First-degree atrioventricular block generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. A recently published meta-analysis by Kwok and colleagues, published in Heart, aimed to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality.

Their literature search yielded 14 studies that were undertaken between 1972 and 2011 with 400 750 participants. Among the studies that adjusted for potential confounders, the pooled results suggest an increased risk of mortality with prolonged PR interval risk ratio (RR) 1.24 95% CI 1.02 to 1.51, five studies. Prolonged PR interval was associated with significant risk of heart failure or left ventricular dysfunction (RR 1.39 95% CI 1.18 to 1.65, three studies) and atrial fibrillation (RR 1.45 95% CI 1.23 to 1.71, eight studies) but not cardiovascular mortality, coronary heart disease or myocardial infarction or stroke or TIA. Similar observations were recorded when limited to studies of first-degree heart block.

Data from observational studies suggests a possible association between prolonged PR interval and significant increases in atrial fibrillation, heart failure and mortality. Future prospective studies are needed to confirm the relationships reported, consider possible mechanisms and define the optimal monitoring strategy for such patients.

So chicken or egg? Is PR interval prolongation significant, what do you think, email info@iicms.ie.  Access the study here.

Free online CPD in Advanced ICD Follow-up on Medtronic Academy

Medtronic Academy has free online CPD around Advanced ICD follow-up.  The advanced level of the learning plan on ICD Follow-Up covers:

  • Considerations for programming ICDs for shock reduction based on proven clinical evidence
  • Patient benefits and healthcare costs associated with reducing inappropriate shocks
  • Basic steps of troubleshooting and programming options/solutions for device-related issues
  • Device interrogation, evaluation, and programming considerations based on test results and diagnostic information

To access this free resource, simply register on Medtronic Academy

 

Death of a partner increases Atrial Fibrillation risk

ABSTRACT
Objectives: Severe psychological stress is generally associated with an increased risk of acute cardiovascular diseases, such as myocardial infarction, but it remains unknown whether it also applies to atrial fibrillation. We conducted a population-based case–control study using nationwide Danish health registers to examine the risk of atrial fibrillation after the deathof a partner.
Methods: From 1995 through 2014, we identified88 612 cases with a hospital diagnosis of atrial fibrillation and 886 120 age-matched and sex-matched controls based on risk-set sampling. The conditional logistic regression model was used to calculate adjusted ORs of atrial fibrillation with 95% CIs.
Results: Partner bereavement was experienced by 17 478 cases and 168 940 controls and was associated with a transiently higher risk of atrial fibrillation; the risk was highest 8–14 days after the loss (1.90; 95% CI 1.34 to 2.69), after which it gradually declined. One year after the loss, the risk was almost the same as in the non-bereaved population. Overall, the OR of atrial fibrillation within 30 days after bereavement was 1.41 (95% CI 1.17 to 1.70), but it tended to be higher in persons below the age of 60 years (2.34; 95% CI 1.02 to 5.40) and in persons whose partner had a low predicted mortality 1 month before the death, that is, ≤5 points on the age-adjusted Charlson Comorbidity Index (1.57; 95% CI 1.13 to 2.17).
Conclusions: The severely stressful life event of losing a partner was followed by a transiently increased risk of atrial fibrillation lasting for 1 year, especially for the least predicted losses.

Access the full paper from OpenHeart Journal here

 

Irish Cardiac Physiologist co-authors article in Heart Rhythm Journal

Congratulations to Paul Ryan, Senior Cardiac Physiologist in the Mater Hospital in Dublin who has co-authored an interesting ICD case report which was published recently in the Heart Rhythm Journal.  The case highlights some key learning points

 

  • Inappropriate ICD therapies due to lead noise can be fatal.
  • Lead noise-discrimination algorithms have the ability to detect lead noise and withhold high-voltage therapies, but this function is limited by preprogrammed time-outs. These time-outs can be manually extended or disabled by the clinician. Such programming can be the difference between life and death (as in this case).
  • Postmortem ICD interrogation should be indicated in cases of sudden unexplained death in an ICD recipient, as catastrophic system failures may be highlighted.
Congratulations again to Paul and his colleagues

 

HRS release expert consensus document on optimal ICD programming and testing

The Heart Rhythm Society and the European Hear Rhythm Society have release their latest consensus document which looks at the optimal programming and testing of ICDs.  The comprehensive document discusses

  • Bradycardia Mode and Rate
  • Algorithms to reduce Right Ventricular Pacing
  • CRT programming
  • Tachycardia detection
  • SVT algorithms
  • Subcutaneous ICDs

The full paper can be accessed here

 

Medtronic Academy - Optimising CRT through Device Programming

A new online course has been added to the Medtronic Academia website.

The Optimizing CRT through Device Programming level of the CRT Follow-Up Learning Plan covers:

  • Review of the CRT follow-up steps using the PBL-STOP method
  • Clinical evidence on the detrimental impact of RV pacing in some CRT patients
  • Overview of five integrated algorithms that work together to ensure CRT during challenging conditions, including the AdaptivCRT algorithm, which automatically optimizes CRT pacing parameters based on the patient's conduction status and activity level
  • Patient case studies exhibiting how to use heart failure diagnostics to effectively optimize the device, including programming of AdaptivCRT between patient follow-ups
  • Overview and methods for testing the AttainTM PerformaTM Quadripolar LV lead, including the Vector Express Test and the Phrenic Nerve Stimulation Test

The Medtronic Academia website can be accessed free of charge, although there is a simple registration process.  Many of the courses provide IBHRE points/hours towards your 5 year IBHRE re-accreditation.

 

HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices released

The Heart Rhythm Society in the US have released a consensus statement on Remote Monitoring of Implantable Cardiac Devices.  The full statement can be accessed here

 

Guidelines on safe use of MRI in patients with Implanted Cardiac Devices released

MR scanning in patients with cardiac implantable electronic devices (CIEDs) was formerly felt to be contraindicated, but an increasing number of patients have an implanted MR conditional device, allowing them to safely undergo MR scanning, provided the manufacturer’s guidance is adhered to. In addition, some patients with non-MR conditional devices may undergo MR scanning if no other imaging modality is deemed suitable and there is a clear clinical indication for scanning which outweighs the potential risk. The following guidance has been formulated by the British Heart Rhythm Society and endorsed by the British Cardiovascular Society and others. It describes protocols that should be followed for patients with CIEDs undergoing MR scanning. The recommendations, principles and conclusions are supported by the Royal College of Radiologists.

To access the full text click here

 

IICMS CPD Funding still available

Just a reminder that funding from the IICMS, in partnership with the HSE HSCP Professional Development Office, is still available to support people undergoing accreditation processes such as

  • Bristish Society of Echocardiography
  • European Echocardiography Association
  • Internation Board of Heart Rhythm Examinaners (NASPE)
  • Heart Rhythm UK
  • European Heart Rhythm Association

Remember funding is only available to paid up members, another reason to join, and application forms can be obtained from Fiona Keegan, our CPD Officer.  Email iicmscpd@gmail.com

 

Latest from European Society of Cardiology Congress in London

New Clinical Guidelines Launched

ESC CONGRESS 2015 sees the launch of five new ESC Guidelines.  They cover

  • Pulmonary Hypertension
  • Ventricular Arrhythmias and Sudden Cardiac Death
  • Acute Coronary Syndromes-NSTE Guidelines
  • Pericardial Diseases Guidelines
  • Infective Endocarditis

The new guidelines can be accessed here

 

Portable Electronic Devices Unlikely to Interfere with Pacemakers and ICD's

‘The reality of modern living is that we’re surrounded by multiple devices which communicate with each other wirelessly,’ explains Mohammad Amin, from the Cardiac Centre, Bahrain. ‘Problems can arise when this technology coexists in the same environment as heart devices. Complete avoidance is impractical, so it’s important for patients to get advice before having devices implanted. We reassure them that the environment is safe so long as they stick to a few simple rules and remain vigilant for risks.’
If devices do detect EMIs, explains Haran Burri, from University Hospital, Geneva, this can result in either inhibition of pacing (ie, no pacing, even in a patient without his own rhythm, which is life threatening), asynchronous pacing (which does not take into account the patient’s intrinsic beats) or inappropriate ICD therapy (shocks because the device believes there is an arrhythmia).    
Device manufacturers and regulatory authorities currently recommend safety distances of 15 cm between pacemakers or ICDs and mobile phones. Such recommendations are based on studies from over a decade ago, which described EMI between cell phones and pacemakers before the advent of effective filters. ‘The device companies continue to issue these recommendations in order to stay conservative, despite voluntary testing of pacemakers and ICDs to ensure compatibility with cell phones without any restrictions of distance,’ says Burri.    
In a study presented earlier this year 308 ICD patients were exposed to electromagnetic fields induced by three common smartphones placed directly above the device. Results showed that one patient was affected by EMI when the patient’s MRI-compatible ICD mis-detected electromagnetic waves from two of the smartphones.     
‘The study needs further investigation and should not lead to hasty conclusions,’ says Burri. ‘The overwhelming evidence does not show any interference whatsoever between modern pacemakers, ICDs and cell phones.’ Burri found no evidence of cell phone interference in his own study in 63 ICD patients., and says: ’Recommendations regarding cell phone use should be evidence based, pragmatic, and allow device patients to live as normally as possible without unnecessary stress.’    
While inappropriate ICD shocks and pacemaker inhibition have been associated with prolonged (several minutes) exposure to electromagnetic security systems (such as antishoplifting gates and metal detectors), such problems are rarely seen in exposures lasting 10 to 15 seconds ‘The general advice is for patients to walk briskly across electronic surveillance devices,’ says Chi-KeongChing, from National Heart Centre, Singapore. If scanning with a hand-held metal detector is necessary, he adds, patients should warn security staff and ask them not to hold the metal detector near the device any longer than necessary, or ask for an alternative form of personal search.    
While portable digital music devices (such as iPods) and headsets (which contain magnets) can interfere with cardiac devices, risks are low. ‘There aren’t any actual case reports showing adverse events,’ says Amin. The general recommendations, he adds, are to keep media players and headsets at least 15 cm from the device and to avoid draping headphones around their neck over the device.    
Portable media players also must be turned off when patients go to the clinic for regular device follow-up appointments. ‘The issue here is that portable media players emit electromagnetic waves in the same range as used for device interrogation. While this doesn’t affect pacemaker function, it can affect interrogation readings,’ cautions Amin.

 

Is 3-D Printing the Future of Cardiovascular Imaging

Three dimensional printing, said Luigi Badano, is a game changing innovation in cardiovascular imaging with the potential to allow the bio-printing of tissues - and ultimately entire organs. In 3D printing objects are being created by laying down one thin layer of material which bonds to another thin layer derived from such imaging modalities as computerised tomography, cardiac magnetic resonance and 3D echocardiography. ‘We can use 3D printers to understand complex anatomy . . . to hold the physical structure of the heart in our hands,’ said Badano, from Padua, Italy. ‘We can use it to teach anatomy to medical students, plan surgical interventions and communicate with patients, showing them exact structures revolutionising the concept of informed consent.’
One recent study comparing identical cardiac surgical procedures performed with and without 3D printing showed that 3D printing shaved 30 minutes off the time taken.
Using bio-ink and bio-paper, which acts as a temporary scaffold, bioprinting takes 3D printing one step further, allowing live endothelial cells to be formed into structures. ‘This provides an opportunity to design valves that will fit the exact body size of your patient,’ said Badano.
Recently the Wake Forest Baptist Medical Center Institute in the US  modified adult human skin cells into functional heart cells with the ability to generate a beat. Such cells, Badano said, might eventually be used by 3D printers to create functional hearts.


Study suggests tailored driving guidelines required for ICD patients

Current guidelines for restricting driving by patients who have received therapy from an implantable cardioverter-defibrillator (ICD), either shocks or antitachycardia pacing (ATP), should be tightened up for some patients and made looser for others, depending on type of device therapy delivered and the number of events, suggests a new analysis from the OMNI registry[1].

The subanalysis of more than 2000 patients with ICDs, mostly for primary prevention, showed that 28% received at least one appropriate therapy, either ATP or shocks, for ventricular arrhythmia (VA).

In addition, patients who receive shock as their initial VA-terminating treatment were three times more likely to receive another shock at 6 months vs those who were initially treated with ATP. Median time to a second event when ATP was first therapy was 6.4 months compared with just 3.4 months for shock as first therapy.

For full article please visit www.medscape.com

 

Intervention in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a highly heterogeneous disease with varied patterns of hypertrophy. Basal septal hypertrophy and systolic anterior motion (SAM) of the mitral valve (MV) are the key pathophysiological components to left ventricular outflow tract (LVOT) obstruction in HCM. LVOT is associated with higher morbidity and mortality in patients with HCM. Percutaneous septal reduction therapy with alcohol septal ablation (ASA) can lead to a significant improvement in left ventricle haemodynamics, patient symptoms and perhaps prognosis. ASA delivers pure alcohol to an area of myocardium via septal coronary arteries; this creates damage to tissue akin to a myocardial infarction. The basal septal myocardium involved in SAM–septal contact is the target for this iatrogenic infarct. Appropriate patient selection and accurate delivery of alcohol are critical to safe and effective ASA. Securing the correct diagnosis and ensuring suitable cardiac anatomy are essential before considering ASA. Pre-procedural planning and intra-procedural imaging guidance are important to delivering precise damage to the desired area. The procedure is performed worldwide and is generally safe; the need for a pacemaker is the most prominent complication. It is successful in the majority of patients but room for improvement exists. New techniques have been proposed to perform percutaneous septal reduction. We present a review of the relevant pathophysiology, current methods and a summary of available evidence for ASA. We also provide a glimpse into emerging techniques to deliver percutaneous septal reduction therapy

Download the full paper here


BSE release systematic approach to HCM

The British Society of Echocardiography have released an artice outliining their recommended systematic approach to echocardiography in patients with Hypertrophic Cardiomyopathy.

Click here to donwload the full article

 

Exercise and the Heart, the good, the bad and the ugly

The benefits of exercise are irrefutable. Individuals engaging in regular exercise have a favourable cardiovascular risk profile for coronary artery disease and reduce their risk of myocardial infarction by 50%. Exercise promotes longevity of life, reduces the risk of some malignancies, retards the onset of dementia, and is as considered an antidepressant. Most of these benefits are attributable to moderate exercise, whereas athletes perform way beyond the recommended levels of physical activity and constantly push back the frontiers of human endurance. The cardiovascular adaptation for generating a large and sustained increase in cardiac output during prolonged exercise includes a 10–20% increase in cardiac dimensions.
In rare instances, these physiological increases in cardiac size overlap with morphologically mild expressions of the primary cardiomyopathies and resolving the diagnostic dilemma can be challenging. Intense exercise may infrequently trigger arrhythmogenic sudden cardiac death in an athlete harbouring asymptomatic cardiac disease. In parallel with the extraordinary athletic milieu of physical performances previously considered unachievable, there is emerging data indicating that long-standing vigorous exercise may be associated with adverse electrical and structural remodelling in otherwise normal hearts. Finally, in the current era of celebrity athletes and lucrative sport contracts, several athletes have succumbed to using performance enhancing agents for success which are detrimental to cardiac health. This article by Sanjay Sharma et al, published in the European Heart Journal discusses the issues abovementioned, which can be broadly classified as the good, bad, and ugly aspects of sports cardiology.  Download the full article here

 

Interested in gaining Departmental Echo Accreditation

If you are inspired by the team in Tallaght and are thinking about gaining European accreditation for your Echo Department we have uploaded a short article from the European Society of Cardiology about the process.  Download it here

 

 

Resources

ECG

AHA/ACC Recommendations for the Standardization and Interpretation of the 12-Lead ECG (Updated 2009)

Part I: The Electrocardiogram and it's technology
Part II: Electrocardiography Diagnostic Statement List
Part III: Intraventricular Conduction Disturbances
Part IV: ST, T, U wave and QT interval
Part V: ECG changes associated with chamber hypertrophy
Part VI: Acute ischaemia/Infarction

 

Stress Testing

AHA Recommendations for Clinical Exercise Laboratories (2009)

 

Echocardiography

Recommendations for Evaluation of Prosthetic Valves using Echocardiography and Doppler Ultrasound(2009)

Basic Perioperative Transesophageal Echocardiography Examination: A Consensus Statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists - this document contains an excellent diagram showing all the standard TOE views which could be laminated and used as reference during scans

 

Pacing and Defibrillation

2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

www.medtronicfeatures.com - this is a resource giving an overview of all Medtronic features for pacemakers, ICDs and CRT devices.  It is an easy to navigate website providing an easy to read synopsis of Medtronic devices and features

 

Miscellaneous

Cove Point Foundation - the world's largest resource for paeditric and adult congenital heart disease