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A case of severe angina non suitable for revascularisation - Conclusion and take home message.

Session Are clinical guidelines the standard of care in real practice?

Speaker Christian Hamm

Event : ESC Congress 2015

  • Topic : hypertension
  • Sub-topic : Hypertension - Other
  • Session type : Guidelines in Daily Practice

Are clinical guidelines the standard of care in real practice?

  • Taking a family history is a key part of cardiac assessment
  • Risk stratification is important in managing patients with HCM
  • Patient collaboration for risk factor modification is central to management of angina
  • CABG improves the prognosis of diabetic patients with multivessel disease, but the improvement should not be over stated in discussion with patients 

 

The session opened with the presentation of a case of sudden cardiac death in a young man by Lorenzo Monserrat. The family history regarding sudden cardiac death had not been explored. Initial post mortem analysis suggested myocardial infarction as the cause of death, but when the histology was reviewed by an expert cardiac pathologist, the diagnosis of hypertrophic cardiomyopathy (HCM) was made.

 

Els Petronella Pieper explored how guidelines can help in managing this patient and their family. Family history, risk stratification including family screening, and application of the guidelines were essential.

 

In the panel discussion with Maria Angela Losi (Naples, IT) and Perry Mark Elliott (London, GB), exercise intensity advice was discussed, emphasizing that physical fitness is a good thing for all patients including those with HCM.

The second half opened with a case of coronary artery disease presented by Ricardo Fontes Carvalho, involving a non-compliant diabetic patient with raised blood pressure, BMI and lipids. Angina was due to multivessel coronary artery disease.

 

Udo Sechtem underlined the longstanding debate about the benefits of revascularisation by PCI or CABG. This was further explored in the panel discussion with Jose Luis Lopez-Sendon and Roxana Mehran. Cardiologists continue to believe that revascularisation improves prognosis, but the data are convincing for a modest improvement in prognosis by CABG only. A heart team discussion for these cases is important and recommended in the guidelines. Medical therapy including cardiac rehabilitation and partnership working with the patient remain essential parts of angina management. Second and third line antianginals eg ranolazine for diabetics were also explored. 

Overall this session focussed on the importance of guidelines to manage patients but equally, the importance of understanding the patient and involving them in choices and engagement in their care.

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