Heart failure with preserved ejection fraction epidemiology, pathophysiology, diagnosis and treatment strategies
Why is it important to the Med SpR?
HFpEF is a common syndrome encountered on the medical take that is somewhat more challenging to diagnose than its relative HFrEF
What does it say?
This review goes through the epidemiology, pathophysiology, diagnosis and treatment of HFpEF
It introduces 2 new (to me at least!) diagnostic scoring systems for HFpEF: the H2FPEF score and the HFA-PEFF score
It describes Echo findings that would support a potential diagnosis of HFpEF
What limitations should I be aware of?
Nothing major
Where can I read more?
Towards an explanation for ‘unexplained’ dizziness in older people
Why is it important to the Med SpR?
Unexplained dizziness is common in the elderly and frequently triggers a referral from ED
This study would suggest that some of what is described as 'dizziness' in these patients may actually be anxiety around falling, potentially enabling a rapid discharge from ED if sinister aetiologies are ruled out
What does it say?
This study involved 30 patients with idiopathic dizziness (ID) and 30 age-matched controls, using dynamic balance tasks and questionnaires to assess the link between postural stability and perceived instability.
Despite similar sway measurements between patients and controls, ID patients report higher levels of perceived instability, particularly in low-challenge situations, indicating a distorted perception of balance.
The study also finds that patients exhibit lower thresholds for initiating protective foot responses, possibly as an overcompensating strategy linked to anxiety about falling.
What limitations should I be aware of?
This is a very small study including only 30 cases and 30 controls
Patients were recruited from a neuro-otology clinic so the generalisability to the ED population is unclear
Where can I read more?
External Validation of the Recalibrated HEART Score for Evaluation of Possible Acute Coronary Syndrome
Why is it important to the Med SpR?
ED love the HEART score so you can be assured rHEART is coming to a Medical Take near you, likely attached to a referral of a patient with CKD5
What does it say?
This study evaluates the recalibrated HEART (rHEART) score for identifying patients at low risk of acute myocardial infarction (AMI) and major adverse cardiac events (MACE) within 30 days using a single high-sensitivity cardiac troponin (hs-TnT) measurement rather than the usual serial measurements
The study found that an rHEART score of ≤3 had a high sensitivity (94.4%) and negative predictive value (99.3%) for ruling out MACE, with similar performance for gender-specific troponin thresholds.
What limitations should I be aware of?
The score classified only 37% of patients as low-risk, with 48% in the intermediate-risk category, limiting its utility
This validation study was conducted at a single centre in the US, and the original rHEART study was conducted at only two centres (both in the UK)
Where can I read more?
Research Updates
Magnesium Disorders
Why is it important to the Med SpR?
Our understanding of electrolytes beyond sodium and potassium can get a little hand-wavy but Magnesium is a real electrolyte with hopes and dreams like any other!
On a more serious note, severe deficiency can cause significant cardiac and neurological problems
What does it say?
This review discusses the normal physiology of magnesium homeostasis before addressing its clinical manifestations and how to investigate and treat it
It also discusses the interplay between magnesium, potassium and calcium within the body which is great if, like me, you skew towards the nerd end of the Med SpR spectrum
What limitations should I be aware of?
None really!
Where can I read more?
Guideline Corner
This month's guideline is the Emergency management of severe and moderately severely symptomatic hyponatraemia in adult patients from the Society for Endocrinology
Want to avoid looking stupid in front of your friendly neighbourhood endocrinologist after spending the entire night getting tied in knots over sodium? Read on here
Things We Do For No Reason
This month's entry from the iconic Things We Do For No Reason series of the Journal of Hospital Medicine is all about... Routine coverage of anaerobes in aspiration pneumonia!
I can hear you all muttering in disbelief from here, so read the article and make up your own mind!
And Finally...
This month's Something Lighter goes to the Circulation article on Long-Term Incidence of Bradycardia and Pacemaker Implantations Among Cross-Country Skiers: A Cohort Study.
Exercise is great for all of us but it transpires that cross-country skiers have a higher rate of pacemaker insertion than the general population in Sweden, and that the better a skier you are the greater your odds are of an appointment with the pacing lab! Read more here.
Heart failure with preserved ejection fraction epidemiology, pathophysiology, diagnosis and treatment strategies
Why is it important to the Med SpR?
HFpEF is a common syndrome encountered on the medical take that is somewhat more challenging to diagnose than its relative HFrEF
What does it say?
This review goes through the epidemiology, pathophysiology, diagnosis and treatment of HFpEF
It introduces 2 new (to me at least!) diagnostic scoring systems for HFpEF: the H2FPEF score and the HFA-PEFF score
It describes Echo findings that would support a potential diagnosis of HFpEF
What limitations should I be aware of?
Nothing major
Where can I read more?
Towards an explanation for ‘unexplained’ dizziness in older people
Why is it important to the Med SpR?
Unexplained dizziness is common in the elderly and frequently triggers a referral from ED
This study would suggest that some of what is described as 'dizziness' in these patients may actually be anxiety around falling, potentially enabling a rapid discharge from ED if sinister aetiologies are ruled out
What does it say?
This study involved 30 patients with idiopathic dizziness (ID) and 30 age-matched controls, using dynamic balance tasks and questionnaires to assess the link between postural stability and perceived instability.
Despite similar sway measurements between patients and controls, ID patients report higher levels of perceived instability, particularly in low-challenge situations, indicating a distorted perception of balance.
The study also finds that patients exhibit lower thresholds for initiating protective foot responses, possibly as an overcompensating strategy linked to anxiety about falling.
What limitations should I be aware of?
This is a very small study including only 30 cases and 30 controls
Patients were recruited from a neuro-otology clinic so the generalisability to the ED population is unclear
Where can I read more?
External Validation of the Recalibrated HEART Score for Evaluation of Possible Acute Coronary Syndrome
Why is it important to the Med SpR?
ED love the HEART score so you can be assured rHEART is coming to a Medical Take near you, likely attached to a referral of a patient with CKD5
What does it say?
This study evaluates the recalibrated HEART (rHEART) score for identifying patients at low risk of acute myocardial infarction (AMI) and major adverse cardiac events (MACE) within 30 days using a single high-sensitivity cardiac troponin (hs-TnT) measurement rather than the usual serial measurements
The study found that an rHEART score of ≤3 had a high sensitivity (94.4%) and negative predictive value (99.3%) for ruling out MACE, with similar performance for gender-specific troponin thresholds.
What limitations should I be aware of?
The score classified only 37% of patients as low-risk, with 48% in the intermediate-risk category, limiting its utility
This validation study was conducted at a single centre in the US, and the original rHEART study was conducted at only two centres (both in the UK)
Where can I read more?
Research Updates
Magnesium Disorders
Why is it important to the Med SpR?
Our understanding of electrolytes beyond sodium and potassium can get a little hand-wavy but Magnesium is a real electrolyte with hopes and dreams like any other!
On a more serious note, severe deficiency can cause significant cardiac and neurological problems
What does it say?
This review discusses the normal physiology of magnesium homeostasis before addressing its clinical manifestations and how to investigate and treat it
It also discusses the interplay between magnesium, potassium and calcium within the body which is great if, like me, you skew towards the nerd end of the Med SpR spectrum
What limitations should I be aware of?
None really!
Where can I read more?
Guideline Corner
This month's guideline is the Emergency management of severe and moderately severely symptomatic hyponatraemia in adult patients from the Society for Endocrinology
Want to avoid looking stupid in front of your friendly neighbourhood endocrinologist after spending the entire night getting tied in knots over sodium? Read on here
Things We Do For No Reason
This month's entry from the iconic Things We Do For No Reason series of the Journal of Hospital Medicine is all about... Routine coverage of anaerobes in aspiration pneumonia!
I can hear you all muttering in disbelief from here, so read the article and make up your own mind!
And Finally...
This month's Something Lighter goes to the Circulation article on Long-Term Incidence of Bradycardia and Pacemaker Implantations Among Cross-Country Skiers: A Cohort Study.
Exercise is great for all of us but it transpires that cross-country skiers have a higher rate of pacemaker insertion than the general population in Sweden, and that the better a skier you are the greater your odds are of an appointment with the pacing lab! Read more here.