Cardiac Catheterization ; instrumentation ; methods ; Echocardiography, Three-Dimensional ; instrumentation ; methods ; Heart Valve Prosthesis ; adverse effects ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Middle Aged ; Mitral Valve ; pathology ; Mitral Valve Insufficiency ; pathology ; therapy

Adult ; Cardiology ; methods ; Cardiomyopathy, Dilated ; diagnosis ; mortality ; Female ; Humans ; Obstetrics ; methods ; Peripartum Period ; Pregnancy ; Pregnancy Complications, Cardiovascular ; diagnosis ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Puerperal Disorders ; diagnosis ; mortality ; Risk Factors ; Ventricular Dysfunction, Left ; diagnosis ; mortality

Although the treatment of aortic coarctation in adults with the use of stents has shown favourable results and reduced complications, there have been few studies involving elderly patients. We highlight the clinical challenges faced in the management of such patients, with attention to severe calcification at the coarctation site. The midterm results were good in our patient, showing an improvement in blood pressure control and maintenance of stent patency.
Aged ; Aortic Coarctation ; therapy ; Blood Pressure ; Calcinosis ; complications ; Cardiology ; methods ; Female ; Geriatrics ; methods ; Hemodynamics ; Humans ; Magnetic Resonance Angiography ; methods ; Myocardial Infarction ; therapy ; Stents ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Troponin I ; blood

Aged, 80 and over ; Aortic Aneurysm, Thoracic ; complications ; surgery ; Aortic Valve Stenosis ; complications ; surgery ; Combined Modality Therapy ; Endovascular Procedures ; Humans ; Male ; Transcatheter Aortic Valve Replacement

INTRODUCTIONThe treatment of aortic valve stenosis (AS) is seeing renewed interest mainly due to the availability of transcatheter therapies. However, the number of epidemiological studies of this disease in Singapore is limited. We aimed to describe the aetiology and clinical presentation of AS in Singapore, as well as patients' attitudes toward it. Our findings may facilitate the future planning and utilisation of resources to better manage these patients.

METHODS249 consecutive patients who underwent transthoracic echocardiography (from April 1999 to April 2008) and diagnosed with severe AS were assessed. Demographic and clinical data were collected, and patients' decisions on surgery were determined.

RESULTSThe mean patient age was 71 (range 23-98) years. 50.2% of patients were male. The commonest presenting symptom was dyspnoea, and 40 (16.0%) patients had coexistent atrial fibrillation. The aetiology of AS was degenerative in 216 (86.7%), rheumatic in 11 (4.4%) and related to a bicuspid valve in 22 (8.9%) patients. The average peak velocity across the aortic valve was 4.2 ± 0.8 m/s and the mean aortic valve area was 0.76 ± 0.13 cm2. The overall mean logistic EuroSCORE was 10.7 ± 12.3. 105 (42.2%) patients who were offered surgery refused. 87 (35%) deaths were seen during the follow-up period (mean duration 14.5 months), which also saw 68 (27%) patients undergo surgery and 86 (34%) patients hospitalised for heart failure.

CONCLUSIONDegenerative AS was the commonest aetiology in this contemporary cohort of patients. Despite the known benefits of surgery, the refusal rate for surgery remained high.

Adult ; Aged ; Aged, 80 and over ; Aortic Valve ; pathology ; Aortic Valve Stenosis ; complications ; diagnosis ; epidemiology ; Asian Continental Ancestry Group ; Atrial Fibrillation ; complications ; diagnosis ; Cohort Studies ; Dyspnea ; complications ; diagnosis ; Echocardiography ; methods ; Electrocardiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Singapore

INTRODUCTIONThis study aimed to assess the effectiveness of the use of a cardiopulmonary patient simulator in the teaching of second-year medical students. Effectiveness was measured in terms of the extent of knowledge retention and students' ability to apply the skills learned in subsequent real-life patient contact.

METHODSIn this study, ten third-year medical students who had previously undergone simulator training as part of their second-year curriculum underwent an objective structured clinical examination (OSCE) and a multiple-choice question (MCQ) test to assess their ability to apply the knowledge gained during the simulator training when dealing with real patients. The performance of this group of students was compared with that of a group of ten fourth-year medical students who did not undergo simulation training.

RESULTSAlthough the third-year medical students performed well in the OSCE, they were outperformed by the group of fourth-year medical students, who had an extra year of clinical exposure. The MCQ scores of the two groups of students were similar. Post-simulation training survey revealed that students were generally in favour of incorporating cardiopulmonary simulator training in the preclinical curriculum.

CONCLUSIONCardiopulmonary simulator training is a useful tool for the education of preclinical medical students. It aids the translation of preclinical knowledge into real-life clinical skills.

Cardiology ; education ; Clinical Clerkship ; Computer Simulation ; Curriculum ; Education, Medical ; organization & administration ; Educational Measurement ; Female ; Humans ; Learning ; Male ; Singapore ; Students, Medical ; Surveys and Questionnaires ; Universities