David C. Gaze

By David C. Gaze

Part of the book: Coronary Artery Disease

By David C. Gaze

Part of the book: Ischemic Heart Disease

By David C. Gaze

Part of the book: Ischemic Heart Disease

By David C. Gaze

Rapid cardiovascular diagnostics have played an integral role in the development of the clinical utility of cardiac biomarkers. Rapid qualitative and quantitative tests are used as an alternative to clinical chemistry laboratories, where urgent testing for cardiac biomarkers has been unavailable. Biomarkers are clinically available for diagnosis and prognosis across the heart disease continuum. Early risk markers of plaque formation and destabilisation are non‐urgent and can be performed routinely as part of the pathology laboratory repertoire. Rapid diagnostic tests are best suited for markers of ischaemia, necrosis and heart failure, where patients often present acutely to emergency medical services. This chapter reviews the evolution of rapid cardiovascular diagnostics both in the pre‐hospital and emergency department setting, compared to the utility of centralised laboratory testing. Further, limitations to their use and improvements by novel technology are discussed.

Part of the book: Proof and Concepts in Rapid Diagnostic Tests and Technologies

By David C. Gaze

Part of the book: Congenital Heart Disease

By David C. Gaze

Since the emergence in China of coronavirus disease (COVID-19) in December 2019; the virus causing the pandemic has infected the human population in almost every country and territory on the globe. At the time of writing there are over 84 million confirmed cases of infection and over 1.8 million deaths globally. Rates of infection differ as does the number of severe cases and subsequent deaths between countries and continents. This is due in part to lockdown measures, social distancing and wearing of face coverings. It is also reflected by how healthcare systems record coronavirus deaths along with access to testing as well as tracking and tracing of infected individuals. Symptoms of COVID-19 include a novel persistent cough, fever and anosmia (loss of smell). In most cases, such symptoms are mild. A small proportion of those who become infected however, have a severe reaction to the disease affecting multiple organ systems and often require respiratory support in the intensive care setting. One such physiological system affected is the cardiovascular system. This is likely due to the increased number of ACE2 receptors in co-morbid cardiac pathologies. ACE2 receptors serve as the entry port for the coronavirus into human cells. Those individuals with underlying cardiovascular risk factors are therefore disproportionately at risk of COVID-19 infection. This chapter reviews the aetiology and epidemiology of the coronavirus infection; potential pathophysiological mechanisms of disease involving the cardiovascular system including the clinical utility of biomarkers, electrocardiography and echocardiography as well as autopsy cardiac pathology and histopathology.

Part of the book: Cardiac Diseases

By David C. Gaze

The diagnosis of acute cardiac pathology is a clinical challenge in both the living and in the postmortem setting. Cardiac troponin (cTn) T and cardiac troponin I released from the contractile apparatus of cardiomyocytes into the circulation can be detected by sensitive and specific immunoassays and are the gold standard biochemical test for diagnosis of acute coronary syndromes (ACS). Recently with the advent of more sensitive detection methods, elevation in non-ACS has become apparent causing clinical confusion. In most cases, these elevations are related to subclinical cardiac damage and often confer poor prognosis in cTn-positive patients. Biomarkers of cardiomyocyte damage may be of value in routine hospital and medico-legal autopsy. A significant body of evidence has emerged since the late 1990s, assessing the clinical utility of cardiac troponin in biological fluids or in immunohistochemical staining of cardiac tissue to aid in the diagnosis of acute cardiac pathology when standard microscopic evidence is inconclusive. This chapter reviews the extensive literature on the subject and details the disparity between pericardial fluid and serum for the use of cTn in the postmortem setting.

Part of the book: Novel Pathogenesis and Treatments for Cardiovascular Disease