ECG of the month

In this issue's ECG of the month, Martin Regan presents a case of a 68-year-old man who was referred by his GP after experiencing chest pain, breathlessness and pins and needles for several weeks.

Predictors of sexual function among men after myocardial infarction: a pilot study

Background/Aims Sexual dysfunction often persists among men who have had a myocardial infarction. While some cross-sectional and longitudinal research has been conducted, there are still no known modifiable targets for intervention. This pilot study aimed to model hypothesised predictive factors of higher sexual function in a cohort of men post myocardial infarction. Methods Using a longitudinal study design, data on sexual function, sexual fear, anxiety and depressive symptoms, and use of coping strategies were collected using the Male Sexual Function Index, Multidimensional Sexuality Questionnaire, Patient-Reported Outcomes Measurement Information System and Coping Strategy Indicator respectively. Spearman correlations were estimated to examine associations between factors at 2 weeks and 3 months following myocardial infarction. Linear regression models were conducted for sexual function while controlling for age. Results The data for 14 men were analysed. Sexual fear and use of problem-solving and support-seeking coping strategies were moderately correlated with sexual function at 3 months post myocardial infarction. Increased use of problem-solving and support-seeking coping strategies was associated with increased sexual function at 3 months. Conclusions Use of coping strategies may predict increased sexual function 3 months post myocardial infarction. However, additional studies are needed to further examine these hypothesised relationships with a larger and more diverse sample.

An evaluation of the use of investigations in a nurse-led rapid access chest pain clinic

Background/Aims Chest pain is a common symptom, but its presentation and cause varies widely, making diagnosis a challenge. This study describes the authors' experience of a nurse-led rapid access chest pain clinic, and associated use of investigation and patient outcomes. Methods A retrospective service evaluation of patients referred to a nurse-led rapid access chest pain clinic was performed. Routinely-recorded data on patient demographics, symptoms, comorbidities, medications, cardiology clinic attendances and investigations were collected. In addition, admissions to accident and emergency or inpatient, death, acute myocardial infarction and percutaneous coronary intervention within 1 year were obtained. Results A total of 279 patients were included in the evaluation between January and February 2019. Chest pain was present as a symptom in 92.8% of patients, while 37.6% of patients had shortness of breath. Only 16.8% had typical angina, while 34.4% had atypical angina. The majority (93.9%) had two or fewer cardiology clinic appointments, the most common imaging investigation used was computed tomography coronary angiogram (47.3%) and 8.2% had a stress echocardiogram or invasive angiogram. Approximately one in five patients had a hospital admission within 1 year. The mortality rate within 1 year was 1.4%, but were all non-cardiac causes. Only 3.6% underwent percutaneous coronary intervention and there was only one mortality. Conclusions This service evaluation shows that a nurse-led rapid access chest pain clinic can be safe, efficient and closely adhere to National Institute for Health and Care Excellence guidelines. Many patients do not require unnecessary and potentially harmful investigations and revascularisation rates are low.

ECG of the month

In this issue's ECG of the month, Martin Regan presents a case of a 71-year-old man who presented to his GP with breathlessness and an irregular heart rate.

Congenital heart disease and beyond

In this final patient story of the year, Linda McStay attempts to put into words the rollercoaster of emotion she has been on since learning she now requires a double transplant]

What drove the reduction in myocardial infarction admissions during COVID-19? Reasons and implications

COVID-19 represents a major public health threat. With the emphasis on self-isolation and the implementation of social restrictions such as lockdowns to reduce disease transmission, significant changes in health practices have occurred worldwide. This includes a substantial reduction in the number of patients being admitted for acute coronary syndrome and acute myocardial infarction, particularly among patients with non-ST elevation myocardial infarction. A combination of patient- and system-related factors have contributed to this decline, including human behaviour, the delivery of healthcare services and changes in the prevalence of risk factors and environmental conditions. This article reviews current knowledge regarding admission rates for acute coronary syndrome and acute myocardial infarction during the COVID-19 pandemic and explores the reasons for this decline, as well as the potential impact on patients and implications for nursing and healthcare practice.

Blood pressure targets: comparing lower versus standard targets for people with hypertension

In this commentary, Hamer, Hill and Harrison critically appraise a systematic review comparing lower versus standard targeted blood pressure and how this impacts morbidity and mortality in people with hypertension.