

Chest pain is a common chief complaint. It may be caused by either benign or life-threatening aetiologies and is usually divided into cardiac and non-cardiac causes. James E. Brown, Professor and Chair, Wright State University Boonshoft School of Medicine, Kettering, Ohio, gives us an overview of assessing chest pain in the emergency setting.
On this week’s podcast, how the molecular structure of tooth enamel may impact decay, adhesive patches to heal heart attacks, and a mysterious planetary core from a half-formed gas giant.In this episode:
00:46 Unravelling tooth enamel
Researchers have been looking into the structure and composition of enamel in an effort to better understand tooth decay. Research Article: DeRocher et al.
07:02 Research Highlights
An adhesive patch to help heal heart-attacks, and a new technique to inspect the structure of 2D ‘wonder materials’. Research Highlight: A healing patch holds tight to a beating heart; Research Highlight: A snapshot shows off super-material only two atoms thick
09:21 Unusual planet
In the region close to stars known as the ‘hot Neptune desert’ planets of Neptune’s size are rarely found, but this week scientists have uncovered one and are trying to untangle its mysteries. Research Article: Armstrong et al.
14:52 Briefing Chat
We take a look at some highlights from the Nature Briefing. This time we talk about the pitfalls of using CRISPR in human embryos, and renaming of moon craters inadvertently named after Nazi scientists. Nature News: CRISPR gene editing in human embryos wreaks chromosomal mayhem; Prospect Magazine: Astronomers unknowingly dedicated moon craters to Nazis. Will the next historical reckoning be at cosmic level?

Hospitals across the U.S. are experiencing an influx of COVID-19 patients, but clinicians are reportedly seeing fewer patients going to the emergency room for heart attack or stroke.
Experts worry that patients who need critical care are delaying their treatment over COVID-19 concerns.
To encourage patients to pay close attention to their symptoms and call 9-1-1 immediately if they believe they are having a heart attack or stroke, ACC’s CardioSmart team developed the Coronavirus and Your Heart Infographic.
The infographic urges patients not to ignore symptoms, especially if they have a heart condition, and reassures them that hospitals have safety measures to protect patients from infection with the novel coronavirus.
Cardiovascular consults are way down. Is the threat of COVID-19 infection scaring people away from ED’s?We caught up with Dr. Comilla Sasson, the American Heart Association’s VP for science and innovation. She’s an emergency physician who teaches at the University of Colorado. She’d traveled to New York City to “help with the response,” and she talked with us from a field hospital that had been set up on a tennis court in Central Park.
She had lots to say about what’s driving patients away from emergency departments these days and what’s likely to happen in medicine (hello, telemedicine!) once the pandemic abates.
Running time: 15 minutes
From a “Circulation: Heart Failure” Journal study (Feb 25, 2020):
The study shows that wearable sensors coupled with machine learning analytics have predictive accuracy comparable to implanted devices.
We demonstrate that machine learning analytics using data from a wearable sensor can accurately predict hospitalization for heart failure exacerbation…at a median time of 6.5 days before the admission.
Heart failure (HF) is a major public health problem affecting >23 million patients worldwide. Hospitalization costs for HF represent 80% of costs attributed to HF care. Thus, accurate and timely detection of worsening HF could allow for interventions aimed at reducing the risk of HF admission.

Several such approaches have been tested. Tracking of daily weight, as recommended by current HF guidelines, did not lead to reduction of the risk of HF hospitalization, most likely because the weight gain is a contemporaneous or lagging indicator rather than a leading event. Interventions based on intrathoracic impedance monitoring also did not result in reduction of readmission risk. The results suggest that physiological parameters other than weight or intrathoracic impedance in isolation may be needed to detect HF decompensation in a timely manner. In fact, 28% reduction of rehospitalization rates has been shown with interventions based on pulmonary artery hemodynamic monitoring. More recently, in the MultiSENSE study (Multisensor Chronic Evaluation in Ambulatory HF Patients), an algorithm based on physiological data from sensors in the implantable cardiac resynchronization therapy defibrillators, was shown to have 70% sensitivity in predicting the risk of HF hospitalization or outpatient visit with intravenous therapies for worsening of HF.
Heart disease is the number one cause of death among women in the United States. It takes the lives of nearly twice as many women as all forms of cancer combined, yet many women know very little about their heart health.
Heart attack symptoms in women
Women tend to have subtler symptoms, and they may begin up to a month before the heart attack. Symptoms include:
Because many of these symptoms can be associated with common illnesses such as the flu, women are more likely to brush them off or assume something less serious is going on — and that can be a serious or even fatal mistake. If you experience these symptoms, don’t ignore them. Play it safe and call 911. The sooner you get treatment, the greater the chances of recovery.
From a British Medical Journal (BMJ) Open Heart online article:
The intake of marine omega-3s has consistently been found to have antiarrhythmic effects. When marine omega-3s are consumed, there is an increase in cellular membrane fluidity, inhibition of L-type calcium channels and a reduction in the chance of arrhythmic events during susceptible times. Prospective data suggest that maintaining an omega-3 index of about 8%, which requires consuming seafood rich in omega-3 up to five times per week or consuming over 3 g of EPA and DHA per day, may provide the greatest protection against arrhythmic events.
Omega-3s have been theorised to increase membrane fluidity by reducing compression of the acyl chains of membrane phospholipid fatty acids, which can lead to a reduction in the ‘spring-like’ tension on membrane ion channels. This spring-like tension can reduce the ability of ions to freely move in and out of the ion channel and hence reduce its conductance. This is known as the ‘Andersen membrane spring-like tension hypothesis’ and is just one way marine omega-3s may prevent arrhythmias.
Dietary omega-3s are mainly consumed as triglycerides, which are absorbed as free fatty acids and monoglycerides. These fats then get rapidly resynthesised in the intestine and liver back to triglycerides with subsequent integration into chylomicrons, very low-density lipoprotein and low-density lipoprotein (LDL) (LDL can actually deliver omega-3s to tissues via LDL receptors).
From a Wall Street Journal online article (01/14/20):
Americans are dying of heart disease and strokes at a rising rate in middle age, normally considered the prime years of life. An analysis of U.S. mortality statistics by The Wall Street Journal shows the problem is geographically widespread.
Death rates from cardiovascular disease among people between the ages of 45 and 64 are rising in cities all across the country, including in some of the most unlikely places.
In the Journal’s analysis, three metro areas east of Colorado’s Rocky Mountains—Colorado Springs, Fort Collins and Greeley—recorded some of the biggest increases. Death rates in each rose almost 25%. The three cities boast robust access to exercise and health care. There are bike trails, good heart-disease treatment-and-prevention programs and nearby skiing and hiking.
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From a New Atlas online article (Jan 1, 2020):
“This is an entirely new approach with no current treatments able to change scar in this way,” says Associate Professor James Chong who led the research. “By improving cardiac function and scar formation following heart attack, treatment with rhPDGF-AB led to an overall increase in survival rate in our study.”
The research centers on a protein therapy called recombinant human platelet-derived growth factor-AB (rhPDGF-AB), which had previously been shown to improve heart function in mice that had suffered a heart attack. In a new study aimed at bringing the treatment closer to human trials, a team set out to discover if it produced similar results in large animals, namely pigs.
The researchers from the Westmead Institute for Medical Research (WIMR) and the University of Sydney found that when pigs that had suffered a heart attack received an infusion of rhPDGF, it did indeed prompt the formation of new blood vessels in the heart and led to a reduction of potentially fatal heart arrhythmia.