Electrocardiographic changes in a right-sided pneumothorax.

A pneumothorax is an extrapulmonary air accumulation within the pleural space between the lung and the chest wall. Symptoms usually reported include dyspnoea and chest pain. However, there are many life-threatening conditions with the same symptomology making early pneumothorax diagnosis challenging, such as acute coronary syndrome. Electrocardiogram (ECG) changes caused by left and right sided pneumathoraces have been reported, but awareness remains poor. This case describes a 51-year old male who presented with a right-sided pneumothorax, new ECG changes and elevated troponin. The case highlights the importance of recognising right-sided pneumothorax-associated ECG manifestations in patients presenting with acute chest symptoms.

Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study.

AIMS: Stress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy is reported in expert hands but is dependent on operator training and image quality. The EVAREST study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography. METHODS AND RESULTS: Participants undergoing stress echocardiography for CAD were recruited from 31 hospitals. Participants were followed up through health records which underwent expert adjudication. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, medical management of ischaemia, acute coronary syndrome, or cardiac-related death within 6 months. A total of 5131 patients (55% male) participated with a median age of 65 years (interquartile range 57-74). 72.9% of studies used dobutamine and 68.5% were contrast studies. Inducible ischaemia was present in 19.3% of scans. Sensitivity and specificity for prediction of a cardiac outcome were 95.4% and 96.0%, respectively, with an accuracy of 95.9%. Sub-group analysis revealed high levels of predictive accuracy across a wide range of patient and protocol sub-groups, with the presence of a resting regional wall motion abnormalitiy significantly reducing the performance of both dobutamine (P < 0.01) and exercise (P < 0.05) stress echocardiography. Overall accuracy remained consistently high across all participating hospitals. CONCLUSION: Stress echocardiography has high accuracy across UK-based hospitals and thus indicates stress echocardiography is being delivered effectively in real-world practice, reinforcing its role as a first-line investigation in the assessment of patients with stable chest pain.

Cardiac MR imaging with external respirator: synchronizing cardiac and respiratory motion--feasibility study.

The feasibility of electrocardiography (ECG)-synchronized respiration with an external cuirass-type respirator in cardiac magnetic resonance (MR) imaging was evaluated. Cardiac MR imaging was performed in 10 nonsedated healthy volunteers with an ECG-triggered external respirator that was modified for use in the MR environment. Coronary MR angiograms and multiphase gradient-echo cine images were acquired with one respiratory cycle performed per cardiac cycle. The technique was feasible and in this group of volunteers resulted in equivalent image quality but shorter acquisition times than those of conventional free-breathing and breath-holding techniques.