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A new series on cardiovascular disease
This issue of Postgraduate Medical Journal introduces a new series that will review some recent developments, and some emerging technologies, in cardiovascular medicine and how they impact on patient care.
Medical practice has undergone revolutionary changes in the last 20 years, not least in the field of cardiology. Clinical investigators, aided by an eager pharmaceutical industry, have published a wide variety of well designed and conducted clinical trials which have established the benefits of novel and exciting approaches to treatment, resulting in a greatly expanded medical and surgical armamentarium. As a result, patients with the common presentations of cardiac disease, particularly heart failure, acute coronary syndromes and hypertension, have benefited from therapy which has reduced morbidity and mortality, accompanied by significantly improved quality of life.
The electronics’ industry has played an important part too, developing new modalities of imaging which have largely replaced invasive tests, particularly in paediatric care; for example, echocardiography achieves more in five minutes with baby on Mum’s lap than does cardiac catheterisation of an anaesthetised infant. Magnetic resonance imaging is at an early stage of development but holds the promise of non-invasive visualisation of the coronary arteries.
New diagnostic tests have emerged. For example, the enzyme creatine kinase and the structural component troponin have displaced non-specific markers such as aspartate aminotransferase, lactate dehydrogenase, and hydroxybutyrate dehydrogenase. This has led to a reappraisal of the diagnosis of acute manifestations of coronary disease, myocardial infarction, and unstable angina and their reclassification as the acute coronary syndromes.
The next 20 years are likely to prove as exciting as the last, with new drugs, new surgical approaches and new lines of research, not least in DNA technology. Enthusiasts, and the next generation of doctors, must wait to see whether the potential of DNA profiling to identify those at risk of coronary and other disease benefits patients and society or proves a bonanza for the insurance world.
This series will cover aspects of basic science, clinical trials, investigation, and treatment of cardiac disease to keep readers up to date with recent and future developments in cardiovascular disease.