Heartbeat: diagnosis and management of pericardial disease

[ ]in this issue of Heart is a short summary of the key changes in the European Society of Cardiology 2020 Guidelines for management of acute coronary syndromes without ST-elevation 5 A few of the major points are use of 0 and 1 hours rapid rule-out protocols, a preference for prasugrel over ticagrelor in patients undergoing invasive intervention, delayed angiography after resuscitated out-of-hospital cardiac arrest in haemodynamically stable patients and consideration of complete revascularisation in patients with multivessel disease who are not in cardiogenic shock The unfolding story of the interaction between the COVID-19 pandemic and cardiovascular mortality is addressed in a systematic review and meta-analysis showing that despite reduced rates of admission for ST-elevation myocardial infarction (STEMI) during the COVID-19 pandemic, hospital mortality was unchanged 6 Danchin and Marijon7 express the concern that although this apparent decrease in STEMI might be due to an actual decrease in event rates, it also is possible that ‘if the decrease was primarily due to fear of getting admitted in patients actually having had an AMI, we should observe an unusually increased rate in late complications potentially related to larger myocardial infarctions caused by the lack of appropriate management at the acute stage (eg, congestive heart failure or ventricular arrhythmias) ’ The article then focuses on multimodality imaging for ischaemic heart disease;discussing the strengths and limitation of exercise treadmill testing, coronary CT angiography, exercise or pharmacological single-photon emission (SPECT), or positron emission tomographic (PET) myocardial perfusion imaging, stress cardiovascular magnetic resonance or stress echocardiography