Allan Harkness - Academia.edu (original) (raw)

Papers by Allan Harkness

Echo Research & Practice

Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes ... more Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes which result in structural and functional adaptations in the cardiovascular system. An understanding of the myocardial adaptations is important for echocardiographers and clinicians undertaking or interpreting echocardiograms on pregnant and post-partum women. This guideline, on behalf of the British Society of Echocardiography and United Kingdom Maternal Cardiology Society, reviews the expected echocardiographic findings in normal pregnancy and in different cardiac disease states, as well as echocardiographic signs of decompensation. It aims to lay out a structure for echocardiographic scanning and surveillance during and after pregnancy as well as suggesting practical advice on scanning pregnant women.

Echo Research & Practice

Transthoracic echocardiography is an essential tool in the diagnosis, assessment, and management ... more Transthoracic echocardiography is an essential tool in the diagnosis, assessment, and management of paediatric and adult populations with suspected or confirmed congenital heart disease. Congenital echocardiography is highly operator-dependent, requiring advanced technical acquisition and interpretative skill levels. This document is designed to complement previous congenital echocardiography literature by providing detailed practical echocardiography imaging guidance on sequential segmental analysis, and is intended for implementation predominantly, but not exclusively, within adult congenital heart disease settings. It encompasses the recommended dataset to be performed and is structured in the preferred order for a complete anatomical and functional sequential segmental congenital echocardiogram. It is recommended that this level of study be performed at least once on all patients being assessed by a specialist congenital cardiology service. This document will be supplemented by ...

Echo Research and Practice

Echo research and practice, 2020

We thank Dr Kanagala and Professor Squire for their keen interest in our paper and their insight ... more We thank Dr Kanagala and Professor Squire for their keen interest in our paper and their insight into the challenge of grading left ventricular ejection fraction (LVEF). We must emphasise that our paper's remit was not to be a clinical guide on heart failure nor on its treatment. We have briefly outlined the rationale and context for the BSE cutoff for severe LVEF and why we continue to differ from our European and American colleagues. We then discuss the need for stating the actual LVEF% in reports as opposed to a category alone for guiding appropriate therapeutic choices. Finally we address the concerns raised over clinical harm they perceive may occur from adopting our guideline.

Echo Research and Practice

Hypertrophic cardiomyopathy (HCM) is common, inherited and characterised by unexplained thickenin... more Hypertrophic cardiomyopathy (HCM) is common, inherited and characterised by unexplained thickening of the myocardium. The British Society of Echocardiography (BSE) has recently published a minimum dataset for transthoracic echocardiography detailing the core views needed for a standard echocardiogram. For patients with confirmed or suspected HCM, additional views and measurements are necessary. This guideline, therefore, supplements the minimum dataset and describes a tailored, stepwise approach to the echocardiographic examination, and echocardiography’s position in the diagnostic pathway, before advising on the imaging of disease complications and invasive treatments.

Echo Research and Practice

The guideline provides a practical step-by-step guide in order to facilitate high-quality echocar... more The guideline provides a practical step-by-step guide in order to facilitate high-quality echocardiographic studies of patients with aortic stenosis. In addition, it addresses commonly encountered yet challenging clinical scenarios and covers the use of advanced echocardiographic techniques, including TOE and Dobutamine stress echocardiography in the assessment of aortic stenosis.

Echo Research and Practice

Mitral valve disease is common. Mitral regurgitation is the second most frequent indication for v... more Mitral valve disease is common. Mitral regurgitation is the second most frequent indication for valve surgery in Europe and despite the decline of rheumatic fever in Western societies, mitral stenosis of any aetiology is a regular finding in all echo departments. Mitral valve disease is, therefore, one of the most common pathologies encountered by echocardiographers, as both a primary indication for echocardiography and a secondary finding when investigating other cardiovascular disease processes. Transthoracic, transoesophageal and exercise stress echocardiography play a crucial role in the assessment of mitral valve disease and are essential to identifying the aetiology, mechanism and severity of disease, and for helping to determine the appropriate timing and method of intervention. This guideline from the British Society of Echocardiography (BSE) describes the assessment of mitral regurgitation and mitral stenosis, and replaces previous BSE guidelines that describe the echocardi...

Echo Research and Practice

Transthoracic echocardiography is the first-line imaging modality in the assessment of right-side... more Transthoracic echocardiography is the first-line imaging modality in the assessment of right-sided valve disease. The principle objectives of the echocardiographic study are to determine the aetiology, mechanism and severity of valvular dysfunction, as well as consequences on right heart remodelling and estimations of pulmonary artery pressure. Echocardiographic data must be integrated with symptoms, to inform optimal timing and technique of interventions. The most common tricuspid valve abnormality is regurgitation secondary to annular dilatation in the context of atrial fibrillation or left-sided heart disease. Significant pulmonary valve disease is most commonly seen in congenital heart abnormalities. The aetiology and mechanism of tricuspid and pulmonary valve disease can usually be identified by 2D assessment of leaflet morphology and motion. Colour flow and spectral Doppler are required for assessment of severity, which must integrate data from multiple imaging planes and moda...

Echo Research and Practice

Since cardiac ultrasound was introduced into medical practice around the middle twentieth century... more Since cardiac ultrasound was introduced into medical practice around the middle twentieth century, transthoracic echocardiography has developed to become a highly sophisticated and widely performed cardiac imaging modality in the diagnosis of heart disease. This evolution from an emerging technique with limited application, into a complex modality capable of detailed cardiac assessment has been driven by technological innovations that have both refined ‘standard’ 2D and Doppler imaging and led to the development of new diagnostic techniques. Accordingly, the adult transthoracic echocardiogram has evolved to become a comprehensive assessment of complex cardiac anatomy, function and haemodynamics. This guideline protocol from the British Society of Echocardiography aims to outline the minimum dataset required to confirm normal cardiac structure and function when performing a comprehensive standard adult echocardiogram and is structured according to the recommended sequence of acquisit...

Echo Research and Practice

The structure and function of the right side of the heart is influenced by a wide range of physio... more The structure and function of the right side of the heart is influenced by a wide range of physiological and pathological conditions. Quantification of right heart parameters is important in a variety of clinical scenarios including diagnosis, prognostication, and monitoring response to therapy. Although echocardiography remains the first-line imaging investigation for right heart assessment, published guidance is relatively sparse in comparison to that for the left ventricle. This guideline document from the British Society of Echocardiography describes the principles and practical aspects of right heart assessment by echocardiography, including quantification of chamber dimensions and function, as well as assessment of valvular function. While cut-off values for normality are included, a disease-oriented approach is advocated due to the considerable heterogeneity of structural and functional changes seen across the spectrum of diseases affecting the right heart. The complex anatom...

Echo Research and Practice

Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right h... more Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmati...

Echo research and practice, 2018

Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right h... more Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmati...

Echo research and practice, 2018

Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-partici... more Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-participation cardiac screening is mandatory across many sporting disciplines to identify those athletes at risk. Echocardiography is a primary investigation utilized in the pre-participation setting and in 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint policy document providing guidance on the role of echocardiography in this setting. Recent developments in our understanding of the athlete's heart and the application of echocardiography have prompted this 2018 update.

Echo research and practice, 2017

Heart failure (HF) is a debilitating and life-threatening condition, with 5-year survival rate lo... more Heart failure (HF) is a debilitating and life-threatening condition, with 5-year survival rate lower than breast or prostate cancer. It is the leading cause of hospital admission in over 65s, and these admissions are projected to rise by more than 50% over the next 25 years. Transthoracic echocardiography (TTE) is the first-line step in diagnosis in acute and chronic HF and provides immediate information on chamber volumes, ventricular systolic and diastolic function, wall thickness, valve function and the presence of pericardial effusion, while contributing to information on aetiology. Dilated cardiomyopathy (DCM) is the third most common cause of HF and is the most common cardiomyopathy. It is defined by the presence of left ventricular dilatation and left ventricular systolic dysfunction in the absence of abnormal loading conditions (hypertension and valve disease) or coronary artery disease sufficient to cause global systolic impairment. This document provides a practical approa...

Echo Research and Practice, 2015

The World Health Organisation (WHO) launched the Surgical Safety Checklist in 2008. The introduct... more The World Health Organisation (WHO) launched the Surgical Safety Checklist in 2008. The introduction of this checklist resulted in a significant reduction in the incidence of complications and death in patients undergoing surgery. Consequently, the WHO Surgical Safety checklist is recommended for use by the National Patient Safety Agency for all patients undergoing surgery. However, many invasive or interventional procedures occur outside the theatre setting and there are increasing requirements for a safety checklist to be used prior to such procedures. Transoesophageal echocardiography (TOE) is an invasive procedure and although generally considered to be safe, it carries the risk of serious and potentially life-threatening complications. Strict adherence to a safety checklist may reduce the rate of significant complications during TOE. However, the standard WHO Surgical Safety Checklist is not designed for procedures outside the theatre environment and therefore this document is ...

Bmj British Medical Journal, May 6, 2000

to hospital were relatively short and use of the equipment was low; had each health centre seen 1... more to hospital were relatively short and use of the equipment was low; had each health centre seen 12 patients a week and the patients lived an average of 40 km from the hospital, teledermatology would have been as cheap. Other factors, such as cheaper equipment, would also improve the relative economics for telemedicine. Nevertheless it is clear that, although real time teledermatology is both clinically effective and economic in the appropriate circumstances, it is not likely to be useful in large cities, except possibly for secondary-to-tertiary consulting or for educational use. Its place in the overall management of dermatology patients from primary care, and indeed the place of pre-recorded teledermatology ("store-andforward") remains to be established in future trials.

Endocrinology, Diabetes & Metabolism Case Reports, 2015

Summary A 55-year-old female patient presented to the endocrine clinic with Grave's disease. ... more Summary A 55-year-old female patient presented to the endocrine clinic with Grave's disease. She was initially treated with carbimazole. After an early relapse, a decision was made to proceed with radioactive iodine therapy. Four days after radioiodine administration, she presented to the emergency department with chest tightness and dyspnea due to heart failure. Biochemistry revealed thyrotoxicosis and significantly elevated Troponin-T. There was ST segment elevation on electrocardiography. However, coronary angiography was normal. Ventricular function was fully restored after 6 weeks of supportive medical management. A diagnosis of stress cardiomyopathy following radioactive iodine therapy was made. This is the second case reported in the literature so far to the best of our knowledge. Learning points Stress cardiomyopathy in the context of radiation thyroiditis is a rare complication following radioiodine therapy. A degree of awareness is essential because the approach is mul...

Clinical medicine (London, England), 2015

To identify the reasons for direct access echocardiography, to identify whether N-terminal pro-br... more To identify the reasons for direct access echocardiography, to identify whether N-terminal pro-brain natriuretic peptide (NT pro-BNP) is used to target scanning effectively and to identify whether patients would otherwise have been referred to a cardiology clinic.

BMJ, 2000

to hospital were relatively short and use of the equipment was low; had each health centre seen 1... more to hospital were relatively short and use of the equipment was low; had each health centre seen 12 patients a week and the patients lived an average of 40 km from the hospital, teledermatology would have been as cheap. Other factors, such as cheaper equipment, would also improve the relative economics for telemedicine. Nevertheless it is clear that, although real time teledermatology is both clinically effective and economic in the appropriate circumstances, it is not likely to be useful in large cities, except possibly for secondary-to-tertiary consulting or for educational use. Its place in the overall management of dermatology patients from primary care, and indeed the place of pre-recorded teledermatology ("store-andforward") remains to be established in future trials.

Echo Research & Practice

Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes ... more Pregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes which result in structural and functional adaptations in the cardiovascular system. An understanding of the myocardial adaptations is important for echocardiographers and clinicians undertaking or interpreting echocardiograms on pregnant and post-partum women. This guideline, on behalf of the British Society of Echocardiography and United Kingdom Maternal Cardiology Society, reviews the expected echocardiographic findings in normal pregnancy and in different cardiac disease states, as well as echocardiographic signs of decompensation. It aims to lay out a structure for echocardiographic scanning and surveillance during and after pregnancy as well as suggesting practical advice on scanning pregnant women.

Echo Research & Practice

Transthoracic echocardiography is an essential tool in the diagnosis, assessment, and management ... more Transthoracic echocardiography is an essential tool in the diagnosis, assessment, and management of paediatric and adult populations with suspected or confirmed congenital heart disease. Congenital echocardiography is highly operator-dependent, requiring advanced technical acquisition and interpretative skill levels. This document is designed to complement previous congenital echocardiography literature by providing detailed practical echocardiography imaging guidance on sequential segmental analysis, and is intended for implementation predominantly, but not exclusively, within adult congenital heart disease settings. It encompasses the recommended dataset to be performed and is structured in the preferred order for a complete anatomical and functional sequential segmental congenital echocardiogram. It is recommended that this level of study be performed at least once on all patients being assessed by a specialist congenital cardiology service. This document will be supplemented by ...

Echo Research and Practice

Echo research and practice, 2020

We thank Dr Kanagala and Professor Squire for their keen interest in our paper and their insight ... more We thank Dr Kanagala and Professor Squire for their keen interest in our paper and their insight into the challenge of grading left ventricular ejection fraction (LVEF). We must emphasise that our paper's remit was not to be a clinical guide on heart failure nor on its treatment. We have briefly outlined the rationale and context for the BSE cutoff for severe LVEF and why we continue to differ from our European and American colleagues. We then discuss the need for stating the actual LVEF% in reports as opposed to a category alone for guiding appropriate therapeutic choices. Finally we address the concerns raised over clinical harm they perceive may occur from adopting our guideline.

Echo Research and Practice

Hypertrophic cardiomyopathy (HCM) is common, inherited and characterised by unexplained thickenin... more Hypertrophic cardiomyopathy (HCM) is common, inherited and characterised by unexplained thickening of the myocardium. The British Society of Echocardiography (BSE) has recently published a minimum dataset for transthoracic echocardiography detailing the core views needed for a standard echocardiogram. For patients with confirmed or suspected HCM, additional views and measurements are necessary. This guideline, therefore, supplements the minimum dataset and describes a tailored, stepwise approach to the echocardiographic examination, and echocardiography’s position in the diagnostic pathway, before advising on the imaging of disease complications and invasive treatments.

Echo Research and Practice

The guideline provides a practical step-by-step guide in order to facilitate high-quality echocar... more The guideline provides a practical step-by-step guide in order to facilitate high-quality echocardiographic studies of patients with aortic stenosis. In addition, it addresses commonly encountered yet challenging clinical scenarios and covers the use of advanced echocardiographic techniques, including TOE and Dobutamine stress echocardiography in the assessment of aortic stenosis.

Echo Research and Practice

Mitral valve disease is common. Mitral regurgitation is the second most frequent indication for v... more Mitral valve disease is common. Mitral regurgitation is the second most frequent indication for valve surgery in Europe and despite the decline of rheumatic fever in Western societies, mitral stenosis of any aetiology is a regular finding in all echo departments. Mitral valve disease is, therefore, one of the most common pathologies encountered by echocardiographers, as both a primary indication for echocardiography and a secondary finding when investigating other cardiovascular disease processes. Transthoracic, transoesophageal and exercise stress echocardiography play a crucial role in the assessment of mitral valve disease and are essential to identifying the aetiology, mechanism and severity of disease, and for helping to determine the appropriate timing and method of intervention. This guideline from the British Society of Echocardiography (BSE) describes the assessment of mitral regurgitation and mitral stenosis, and replaces previous BSE guidelines that describe the echocardi...

Echo Research and Practice

Transthoracic echocardiography is the first-line imaging modality in the assessment of right-side... more Transthoracic echocardiography is the first-line imaging modality in the assessment of right-sided valve disease. The principle objectives of the echocardiographic study are to determine the aetiology, mechanism and severity of valvular dysfunction, as well as consequences on right heart remodelling and estimations of pulmonary artery pressure. Echocardiographic data must be integrated with symptoms, to inform optimal timing and technique of interventions. The most common tricuspid valve abnormality is regurgitation secondary to annular dilatation in the context of atrial fibrillation or left-sided heart disease. Significant pulmonary valve disease is most commonly seen in congenital heart abnormalities. The aetiology and mechanism of tricuspid and pulmonary valve disease can usually be identified by 2D assessment of leaflet morphology and motion. Colour flow and spectral Doppler are required for assessment of severity, which must integrate data from multiple imaging planes and moda...

Echo Research and Practice

Since cardiac ultrasound was introduced into medical practice around the middle twentieth century... more Since cardiac ultrasound was introduced into medical practice around the middle twentieth century, transthoracic echocardiography has developed to become a highly sophisticated and widely performed cardiac imaging modality in the diagnosis of heart disease. This evolution from an emerging technique with limited application, into a complex modality capable of detailed cardiac assessment has been driven by technological innovations that have both refined ‘standard’ 2D and Doppler imaging and led to the development of new diagnostic techniques. Accordingly, the adult transthoracic echocardiogram has evolved to become a comprehensive assessment of complex cardiac anatomy, function and haemodynamics. This guideline protocol from the British Society of Echocardiography aims to outline the minimum dataset required to confirm normal cardiac structure and function when performing a comprehensive standard adult echocardiogram and is structured according to the recommended sequence of acquisit...

Echo Research and Practice

The structure and function of the right side of the heart is influenced by a wide range of physio... more The structure and function of the right side of the heart is influenced by a wide range of physiological and pathological conditions. Quantification of right heart parameters is important in a variety of clinical scenarios including diagnosis, prognostication, and monitoring response to therapy. Although echocardiography remains the first-line imaging investigation for right heart assessment, published guidance is relatively sparse in comparison to that for the left ventricle. This guideline document from the British Society of Echocardiography describes the principles and practical aspects of right heart assessment by echocardiography, including quantification of chamber dimensions and function, as well as assessment of valvular function. While cut-off values for normality are included, a disease-oriented approach is advocated due to the considerable heterogeneity of structural and functional changes seen across the spectrum of diseases affecting the right heart. The complex anatom...

Echo Research and Practice

Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right h... more Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmati...

Echo research and practice, 2018

Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right h... more Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmati...

Echo research and practice, 2018

Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-partici... more Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-participation cardiac screening is mandatory across many sporting disciplines to identify those athletes at risk. Echocardiography is a primary investigation utilized in the pre-participation setting and in 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint policy document providing guidance on the role of echocardiography in this setting. Recent developments in our understanding of the athlete's heart and the application of echocardiography have prompted this 2018 update.

Echo research and practice, 2017

Heart failure (HF) is a debilitating and life-threatening condition, with 5-year survival rate lo... more Heart failure (HF) is a debilitating and life-threatening condition, with 5-year survival rate lower than breast or prostate cancer. It is the leading cause of hospital admission in over 65s, and these admissions are projected to rise by more than 50% over the next 25 years. Transthoracic echocardiography (TTE) is the first-line step in diagnosis in acute and chronic HF and provides immediate information on chamber volumes, ventricular systolic and diastolic function, wall thickness, valve function and the presence of pericardial effusion, while contributing to information on aetiology. Dilated cardiomyopathy (DCM) is the third most common cause of HF and is the most common cardiomyopathy. It is defined by the presence of left ventricular dilatation and left ventricular systolic dysfunction in the absence of abnormal loading conditions (hypertension and valve disease) or coronary artery disease sufficient to cause global systolic impairment. This document provides a practical approa...

Echo Research and Practice, 2015

The World Health Organisation (WHO) launched the Surgical Safety Checklist in 2008. The introduct... more The World Health Organisation (WHO) launched the Surgical Safety Checklist in 2008. The introduction of this checklist resulted in a significant reduction in the incidence of complications and death in patients undergoing surgery. Consequently, the WHO Surgical Safety checklist is recommended for use by the National Patient Safety Agency for all patients undergoing surgery. However, many invasive or interventional procedures occur outside the theatre setting and there are increasing requirements for a safety checklist to be used prior to such procedures. Transoesophageal echocardiography (TOE) is an invasive procedure and although generally considered to be safe, it carries the risk of serious and potentially life-threatening complications. Strict adherence to a safety checklist may reduce the rate of significant complications during TOE. However, the standard WHO Surgical Safety Checklist is not designed for procedures outside the theatre environment and therefore this document is ...

Bmj British Medical Journal, May 6, 2000

to hospital were relatively short and use of the equipment was low; had each health centre seen 1... more to hospital were relatively short and use of the equipment was low; had each health centre seen 12 patients a week and the patients lived an average of 40 km from the hospital, teledermatology would have been as cheap. Other factors, such as cheaper equipment, would also improve the relative economics for telemedicine. Nevertheless it is clear that, although real time teledermatology is both clinically effective and economic in the appropriate circumstances, it is not likely to be useful in large cities, except possibly for secondary-to-tertiary consulting or for educational use. Its place in the overall management of dermatology patients from primary care, and indeed the place of pre-recorded teledermatology ("store-andforward") remains to be established in future trials.

Endocrinology, Diabetes & Metabolism Case Reports, 2015

Summary A 55-year-old female patient presented to the endocrine clinic with Grave's disease. ... more Summary A 55-year-old female patient presented to the endocrine clinic with Grave's disease. She was initially treated with carbimazole. After an early relapse, a decision was made to proceed with radioactive iodine therapy. Four days after radioiodine administration, she presented to the emergency department with chest tightness and dyspnea due to heart failure. Biochemistry revealed thyrotoxicosis and significantly elevated Troponin-T. There was ST segment elevation on electrocardiography. However, coronary angiography was normal. Ventricular function was fully restored after 6 weeks of supportive medical management. A diagnosis of stress cardiomyopathy following radioactive iodine therapy was made. This is the second case reported in the literature so far to the best of our knowledge. Learning points Stress cardiomyopathy in the context of radiation thyroiditis is a rare complication following radioiodine therapy. A degree of awareness is essential because the approach is mul...

Clinical medicine (London, England), 2015

To identify the reasons for direct access echocardiography, to identify whether N-terminal pro-br... more To identify the reasons for direct access echocardiography, to identify whether N-terminal pro-brain natriuretic peptide (NT pro-BNP) is used to target scanning effectively and to identify whether patients would otherwise have been referred to a cardiology clinic.

BMJ, 2000

to hospital were relatively short and use of the equipment was low; had each health centre seen 1... more to hospital were relatively short and use of the equipment was low; had each health centre seen 12 patients a week and the patients lived an average of 40 km from the hospital, teledermatology would have been as cheap. Other factors, such as cheaper equipment, would also improve the relative economics for telemedicine. Nevertheless it is clear that, although real time teledermatology is both clinically effective and economic in the appropriate circumstances, it is not likely to be useful in large cities, except possibly for secondary-to-tertiary consulting or for educational use. Its place in the overall management of dermatology patients from primary care, and indeed the place of pre-recorded teledermatology ("store-andforward") remains to be established in future trials.