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Journal Scan 2 – Dr Iqbal Malik

Migraine with aura and cardiovascular risk.

http://www.bmj.com/content/341/bmj.c4410.short

Does having migraine mean you have a higher risk of heart attack and stroke? If you have common migraine, and no warning symptoms such as halos, then the answer is ” not much”. If you have classical migraine, with the aura that comes before the headache, then the risk of heart attack is 1.28x increased and stroke 1.4x. Remember that when you are in your 30’s and 40’s, that is still a low risk ( 1.4 x a small number is still a small number). However, if you are worried, it should stimulate you to look at other risk factors, such as smoking and blood pressure. A separate study suggested increased risk of brain bleeding, and this would make be focus on blood pressure in particular.

If you are worried, come and see a cardiovascular specialist for a risk assessment.


 

Does presenting with non- cardiac chest pain confer an adverse prognosis?

http://heart.bmj.com/content/96/13/1043.abstract?sid=4612f9ff-0ffd-4d16-be4c-6d5d48c9a8dd

This study from a few years ago suggests that with improvements in care, mainly, I think with more tests to rule out blood clots and heart attacks, of you have non cardiac chest pain now, and are reassured, then your outcome is likely to be fine. The key is to be properly assessed. A short examination in The emergency room is to ably not enough. Being seen by a cardiologist is the gold standard, with the expert deciding what tests are needed. I can sometimes reassure with just a history, examination and ECG, but usually an Echocardiogram and Exercise test add benefit by ruling out pathology and giving the patient confidence to get back to full activity.


 

If you have a low blood pressure and gave severe aortic valve stenosis, is it all over?

http://heart.bmj.com/content/97/10/838.abstract?sid=122ef035-de16-4327-bb5b-c6cd2edd721f

This series of patients was managed with circulatory support with a ballon pump. This invasive machine can tide the patient over until the valve is operated on, or a balloon aortic valvotomy is performed. We have had success in getting patients through this crisis and onto recovery. A transcatheter aortic valve (TAVI) may be the right option. It is always worth trying!


 

 

Posted on 12 April 2012
Author: LCC
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