ECG Round: A man with dizziness

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ECG Round: A 40-year-old lady with palpitation

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Different uses of angiostensin - converting enzyme inhibitors

The renin-angiotensin-a/dosterone system plays a keyrole in the regulation of fluid and electrolyte balance. Angiotensinconverting enzyme inhibitors (ACE/s) inhibit angiotensin-converting enzyme and have been shown to be effective in many cardiovascular diseases, including hypertension, heart failure, myocardial infarction and diabetic nephropathy. ACE/s are the most effective class of drugs in reversing left ventricular hypertrophy due to hypertension. ACE/s improve cardiac function and reduce mortality in congestive heart failure and after myocardial infarction. ACE/s should be considered in diabetics with microalbuminuria or albuminuria, especially in the presence of hypertension. There are many different ACE/s available now; they are largely similar in their effects, but differ particularly in pharmacokinetics. Choice will depend on previous experience, availability and price. There are a number of side-effects associated with ACEIs; periodic monitoring of renal function and electrolytes is required.published_or_final_versio

Current issues on the management of hypertension

Hypertension is one of the most prevalent vascular diseases in the general population and is a major contributor to cardiovascular mortality and morbidity. Recent clinical trials have confirmed the benefits of treatment of hypertension to prevent stroke, congestive heart failure, and left ventricular hypertrophy. Despite the availability of many newer agent, blood pressure continues to be inadequately controlled in the majority of the hypertensive patients. There is still a lot of controversy in some of the issues in the management of hypertension. The present article summarizes some of the recent studies and published guidelines in the management of hypertension and provides some insight to these questions. Although the answers to some of these questions are still unclear, ongoing large scale studies should soon provide additional answers to these questions.published_or_final_versio

Transcatheter Leadless Cardiac Pacing with Limited Venous Access

Entirely leadless cardiac pacemakers that are delivered transvenously required the use of large diameter delivery sheath and femoral venous approach. The complexity of external femoral and iliac venous anatomy may limit their implantation. We describe a patient without subclavian venous access and a conventional pacemaker with a failed right ventricular lead, who had difficult iliac venous anatomy that was also compressed by an external endovascular abdominal aortic stent. Successful leadless pacing using a Micra™ (Medtronic Inc) was accomplished with a strong support wire, hydrophilic delivery sheath and guided by venography. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.postprin

ECG Round: A lady with dyspnoea

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ECG Round

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Risk factor assessment and prevention for coronary artery disease

Observational studies have identified a number of patient characteristics predictive of subsequent development of coronary artery disease. Most of these risk factors are modifiable. There are now compelling evidence that modification of some of these risk factors can prevent progression and promote regression of coronary artery disease. This article reviews the evidence for the causative role of these risk factors in coronary atherosclerosis, possible preventive measures and treatment goals.published_or_final_versio

Treatment with fosinopril decreases left ventricular mass in patients with essential hypertension

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ECG Round: Cardiac arrest

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