British Cardiac Society Research Articles

Challenge of cardiovascular prevention in primary care: achievement of lifestyle, blood pressure, lipids and diabetes targets for primary prevention in England – results from ASPIRE-3-PREVENT cross-sectional survey

BackgroundImplementation of the cardiovascular disease (CVD) prevention guidelines in the UK has been repeatedly evaluated under the auspices of the British Cardiovascular Society in three Action on Secondary and Primary...

British Cardiovascular Society survey of the provision and structure of cardiology multidisciplinary meetings in England

Multidisciplinary meetings (MDMs) are central to clinical decision-making in many areas of cardiology. This study assessed current provision and structure of cardiology MDMs in England in comparison with national guidelines.British Cardiovascular Society (BCS) members were surveyed regarding frequency, core attendees, and organisational aspects of cardiology MDMs for myocardial revascularisation, endocarditis, heart failure, aortic valve, mitral and tricuspid valve MDMs, whether local, regional or outside of the region. Access to electrophysiology (EP), inherited cardiac conditions, and adult congenital heart disease (ACHD) MDMs was also assessed.Survey responses were received from 64 hospitals across England, of which 40 (62%) were secondary care centres and 24 (38%) were tertiary care centres. All units had access to revascularisation MDMs, although 6% of them (all in secondary care centres) lacked any surgical representation. Heart failure MDMs were available in 94% of centres, but 7% reported no attendance by a cardiologist with specialist interest in heart failure, and 23% reported no attendance by a device specialist. 61% of centres had access to dedicated endocarditis MDMs; however, 11% were not attended by a microbiologist or infectious disease physician, and 22% were not attended by a surgeon. Aortic valve MDMs were available in 69% of centres, while mitral and tricuspid valve MDMs were available in 56% of centres. One quarter of centres reported no access to EP, and one third of centres reported no access to ICC or ACHD MDMs.Substantial improvements in provision and structure of cardiology MDMs in England are needed in order to meet national guidance.

Characteristics and Outcomes of Patients Who Underwent Coronary Atherectomy in Centers With and Without On-Site Cardiac Surgery

We aimed to describe the clinical characteristics and outcomes of patients who underwent atherectomy at the time of percutaneous coronary intervention in centers with on-site surgical centers (SCs) versus nonsurgical centers (NSCs). Patients treated with coronary atherectomy between January 1, 2006, to December 31, 2019, from the British Cardiovascular Society Intervention (BCIS) registry were included. Primary outcomes were in-hospital all-cause mortality and major adverse cardiovascular and cerebrovascular events. A total of 20,833 patients were treated with coronary atherectomy, of which 7,983 (38%) were performed at NSC. The proportion of coronary atherectomies performed in NSC increased from 12.5% in 2006 to 42% in 2019. Compared with patients treated at SC, patients treated in NSC were older (mean age 75.1 ± SD years vs 74.2 ± SD, p <0.001), but had comparable prevalence of hypertension (NSC 73.9% vs SC 72.8%, p=0.085), diabetes mellitus (NSC 32.2% vs SC 31.6%, p=0.43) and renal disease (NSC 6.0% vs SC 6.0%, p=0.99). Intracoronary imaging was used more often in NSC than SC (22.3% vs 19.4%, p <0.001). After adjustment, the odds of in-hospital mortality (odds ratios [OR] 0.76, 95% confidence intervals [CI] 0.50 to 1.16), major adverse cardiovascular and cerebrovascular events (OR 0.80, 95% CI 0.53 to 1.21), emergency coronary artery bypass graft (OR 0.49, 95% CI 0.15 to 1.57), major bleeding (OR 0.67, 95% CI 0.36 to 1.24) and coronary perforation (OR 1.07, 95% CI 0.97 to 1.43) in NSC were comparable with SC. In conclusion, coronary atherectomy in hospitals with off-site surgical cover has become more frequent, with no association with poorer outcomes, compared with hospitals with on-site surgical cover.

Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: prognostic insights from UK Biobank

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health and Care Research British Cardiovascular Society. Background Cardiovascular magnetic resonance imaging (CMR) can estimate left ventricular filling pressure (LVFP). The relationship between LVFP, determined by CMR measurements, and established risk factors for cardiovascular disease is unknown. This study quantifies these associations and investigates the prognostic value of CMR-derived LVFP compared to known risk factors for cardiovascular disease. Methods Using data from the UK Biobank prospective observational cohort study, CMR-derived LVFP was calculated using a model incorporating left atrial volume and left ventricular mass. Logistic regression was used to explore the relationships between raised LVFP (≥15mmHg) and typical cardiovascular risk factors. The non-linear relationship between LVFP and age was analysed using ordinary least squares regression and a restricted cubic spline of age with nine knots. Cox proportional hazards regression was used to analyse the relationships between typical cardiovascular risk factors and CMR-derived LVFP, and outcomes of incident heart failure and major adverse cardiovascular events. Results In this prospective population-based cohort study, 39,163 UK Biobank participants had CMR with adequate image quality. In a multivariable logistic regression model, male sex (OR 4.55, 95% CI 3.85–5.42, p&amp;lt;0.001), age (OR 1.89, 95% CI 1.72 - 2.09, per decade increment, p&amp;lt;0.001), BMI (OR 1.57, 95% CI 1.48–1.67, per SD increment, p&amp;lt;0.001), and hypertension (OR 1.46, 95% CI 1.26–1.68, p&amp;lt;0.001) were associated with increased odds of raised LVFP (Figure 1a). A non-linear regression model of the relationship between age and LVFP, adjusted for all covariables studied, showed little correlation between CMR-derived LVFP and age until 70 years, after which LVFP increased rapidly with age (Figure 2). In multivariable Cox regression models, elevated CMR-derived LVFP was associated with increased hazard of incident heart failure (HR 3.31, 95% CI 1.99–5.49, p&amp;lt;0.001) but not MACE (HR 1.33, 95% CI 0.86–2.07, p = 0.20) (Figure 1b). Conclusions Raised LVFP, as determined using CMR, is independently associated with male sex, age, BMI and hypertension. CMR-derived LVFP is independently associated with incident heart failure. These findings may have implications for clinical risk stratification, targeted population screening strategies and public health measures to reduce the risk of heart failure development.

A look at the impact of the advanced clinical practitioner role in the realm of cardiology

As an advanced clinical practitioner, registered nurse, founding member of the cardiology nurse forum Facebook group and podcast, and a recently elected ordinary council member of the BANCC, Charles Spencer explores the impact of the advanced clinical practitioner role in cardiology, expanding on his ‘top topic’ session at the recent British Cardiovascular Society conference in June.

THE CONCEPTION, PLAN AND DELIVERY OF THE BRITISH CARDIOVASCULAR SOCIETY DIGITAL KNOWLEDGE HUB

The British Cardiovascular Society (BCS) is a registered charity in the United Kingdom (UK) and serves a community of cardiologists and allied health professionals. As part of our role in supporting education and training, we planned a dedicated web portal of educational content, called the Digital Knowledge Hub (DKH) to launch at the centenary of the BCS this year.

Is virtual cardiology training here to stay in the post-COVID era?

Abstract Background In April 2020, face-face UK cardiology training was paused due to COVID-19. We adapted by utilising a video-conferencing platform to continue some form of education on a national scale (CardioWebinar). We studied the effectiveness of delivering virtual Cardiology education 1 year into the COVID pandemic. Methods Expert speakers throughout the UK were sought after via social media and “word of mouth”. Weekly webinars were organised and advertised (Canva posters) on social media (Twitter), as well as via the British Cardiovascular Society and British Junior Cardiologists' Association (BJCA) media links. Each webinar was scheduled mid-week at 17:30 (UK). Interested attendees registered for free using an online ticketing platform (Eventbrite). Webinars were delivered using an online video conferencing platform (Zoom) which required a £14.99 monthly subscription. Each webinar consisted of a 40-minute presentation followed by Q&amp;A (20mins). All webinars were recorded and later accessible for free on the BJCA TV Gallery. A Learning Management System (LMS) collected feedback after each session and generated certificates of attendance. We systematically reviewed the LMS feedback from 6 consecutive webinars delivered between Jan-Feb 2021. We further surveyed our most recent (March 2021) attendees via an extended questionnaire exploring their experiences of our virtual education. Results 55 CardioWebinars have been delivered since April 2020. The speakers have been predominantly Consultant Cardiologists from the UK. Some of the recordings have had &amp;gt;1000 views. Other than the video platform subscription, no cost was incurred in the delivery of this entire programme. We collected feedback from 392 respondents (∼65 live attendees per webinar) from each session between Jan-Feb 2021. The sessions were rated as “very good-excellent” by 97%. We collected a further 145 extended responses from March 2021 attendees. 90% rated the whole series as “very good –excellent” in supporting their cardiology education during the Covid pandemic, and 84% felt the programme sufficiently covered even the more challenging areas of the curriculum (e.g. aortopathies). 90% of the respondents felt that their work-life schedule allowed them to join the live webinars. The respondents where predominantly from the UK (91%), though included an international audience (9%). Whilst 74% of attendees were cardiology trainees, the remaining 26% included physiologists, nurses, consultants and other junior doctors. 99% felt that virtual education should continue to play a formal part in their training after the COVID pandemic. Conclusion Webinars allow everyone interested in cardiac care across the world the opportunity to hear experts teach, and without a travel cost. They are cheap and easy to organise. This study suggests that webinars will remain an integral part of the post-COVID era. Funding Acknowledgement Type of funding sources: None.

The British Cardiovascular Society Young Investigator Award 2021

Five finalists were selected for the 2021 British Cardiovascular Society (BCS) Young Investigator Award (YIA) from a competitive pool of young researchers. At the virtual BCS meeting in June, each...

The British Cardiovascular Society Annual Conference, 7–10 June 2021: the Vice President’s message

On behalf of the President, Board, Executive and Programme Committee at the British Cardiovascular Society (BCS), we look forward to welcoming you in June for the BCS 2021 Annual Conference. It is the first time we are holding this as a virtual Conference and our theme this year is ‘Cardiology and the Environment’. The past year or so has been challenging, going through the COVID-19 pandemic with most unprecedented circumstances, which makes the theme of the conference even more relevant. The conference will be opened by the BCS President, Professor Simon Ray, followed by the keynote opening lecture entitled ‘Cardiovascular disease on a changing planet’ delivered by Professor Sir Andrew Haines. This is a named BCS Desmond Julian lecture in honour of the late Professor Desmond Julian, ex-president of the BCS (1985–87), who passed away in 2019. Professor Haines, who had collaborated with Professor Julian in the past, is Professor of Environmental Change and Public Health and was the Director of the London School of Hygiene & Tropical Medicine (2001–10) and co-chair of the Rockefeller Foundation / Lancet Commission on Planetary Health (2014/15). His research focus has been on the effects of environmental change on health and the impact of polices to adapt to or mitigate these changes and currently co-chairs the InterAcademy Partnership working group on climate change and health and participates in the Lancet Commission on Pollution and the Lancet Commission on the COVID-19 response. This year is the 60th anniversary of the British Heart Foundation (BHF). To mark this important milestone, there is a BHF Lecture to be given by Professor Salim Yusuf, Distinguished University Professor of Medicine at McMaster University, Canada. Professor Yusuf has close links with the BHF and the UK, having obtained his DPhil at Oxford supported by a BHF Junior Research Fellowship …

Heartbeat: the COVID-19 pandemic and the future of cardiology

The COVID-19 pandemic created challenges which exposed inefficiencies, inequities, lack of resiliency and outdated models for the delivery of cardiovascular care around the globe. At the same time, the response...

Highlights of the British Cardiovascular Society’s Future of Cardiology Working Group paper

The COVID-19 pandemic presented the NHS with a unique set of challenges which, although immensely disruptive, has also enabled a speed of adaption, adoption and transformation that has never previously...

Are conflict of interest declarations appropriate to allow sufficient consideration of potential bias in presentations?

Potential conflicts of interest (CoI) are common in medical research, necessitating the use of CoI declarations. There is currently no consensus document or external authority guiding CoI declarations in conference settings, resulting in declarations of variable quality and utility. We explored four CoI declaration parameters (sufficient slide display time; the presence of any verbal explanation pertaining to relevant CoI; the use of an adequate font size; and whether the nature and relevance of the CoI was described). Parameters were graded from one to three points, with the sum of parameters providing an overall declaration quality out of 12. We then applied this scoring system to recordings of presentations from the British Cardiovascular Society (BCS) annual conference 2018 which were available online. Sixty-nine presentations were suitable for inclusion, of which 47 (68%) contained a CoI statement. Thirty-six of the 47 (77%) presentations declared that they had no CoI. In the remaining 11 (23%) with reported CoI, the median time spent displaying CoI was 1 second (interquartile range (IQR) 0.7-3.3). The median quality score for presentations was 7 (IQR 6-10). This study demonstrates utility in considering aspects of CoI declarations at conferences to improve transparency.

Advocating for our patients: Speaking up and being heard

Does the following scenario sound familiar? A multidisciplinary team meeting between cardiac surgeons, interventional and non-invasive cardiologists convened for important decisions to be made about patient management. Many confident individuals...

SPONTANEOUS CORONARY ARTERY DISSECTION PRESENTING WITH STEMI AND CARDIOGENIC SHOCK

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Spontaneous coronary artery dissection (SCAD) is a rare phenomenon, diagnosed in 0.1% of all patients who undergo coronary angiography with a mean age at presentation of 35-40 years [1, 2]. Several predispositions have been associated with SCAD, including female sex, atherosclerotic disease, recent pregnancy, and connective tissue disorders [3]. CASE PRESENTATION: A 35-year-old nulliparous female with polycystic ovarian disease alone presented with complaints of sudden-onset substernal “chest burning”. She presented two days prior to an outside facility with similar chest pain and was found to have an elevated troponin to 0.34 ng/dL, a small pericardial effusion on transthoracic echo (TTE), and a negative PE-CT. The diagnosis was viral myopericarditis. Upon arrival to our ED, her EKG revealed ST-segment elevation in V2-V4 and troponin levels were >100,000 ng/L. She was taken emergently for cardiac catheterization and underwent Impella placement for stabilization of cardiogenic shock. Left heart catheterization (LHC) demonstrated a SCAD of the left main (LM) coronary artery with extension into the left anterior descending (LAD) and left circumflex artery (LCX) with TIMI 0 flow into the LAD. She underwent PCI to the ostial LM, ostial to distal LAD, and proximal LCX with restoration of flow down the LAD, covering the flap of the LM dissection. After reperfusion, TTE revealed an ejection fraction (EF) of 25-30% with severe hypokinesis of the entire anteroseptal, periapical, and inferoseptal walls. Her stay was complicated by brief ventricular fibrillation. Her cardiac output normalized, her Impella was removed, and by hospital day 10 her LVEF improved to 40-45%. Additional workup included unremarkable carotid and renal dopplers, ANA, and ANCA. She was discharged home with a wearable defibrillator. DISCUSSION: Presentations of SCAD vary depending on severity and can include acute coronary syndrome, heart failure, or sudden cardiac death [4]. SCAD is typically diagnosed with coronary angiography, most commonly manifesting as the diffuse smooth stenosis pattern. Treatment depends on severity, and large or multivessel involvement requires revascularization [1, 5, 6]. Our case, a young patient without typical risk factors for cardiac disease, highlights the morbidity associated with SCAD and the importance of early diagnosis. Therefore, it is reasonable to look for evidence of vasculopathy, including fibromuscular dysplasia, and dissection in other vascular beds. While recognized hereditary connective tissue disorders are rare, an association with a defect in PHACTR1/EDN1 genetic locus has been noted [7]. Morbidity from SCAD is high, and in addition to high rates of major adverse cardiac events, recurrence is reported to be ∼10% at 3 years [6]. CONCLUSIONS: Our case demonstrates the importance of considering alternative diagnoses of chest pain in young females without typical cardiac risk factors. Reference #1: 1. Maeder, M., et al., Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment. Int J Cardiol, 2005. 101(3): p. 363-9. Reference #2: 2. DeMaio, S.J., Jr., S.H. Kinsella, and M.E. Silverman, Clinical course and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol, 1989. 64(8): p. 471-4. Reference #3: 3. Biswas, M., A. Sethi, and S.J. Voyce, Spontaneous coronary artery dissection: case report and review of literature. Heart Views, 2012. 13(4): p. 149-54. 4. Sabatine, M.S., et al., Case records of the Massachusetts General Hospital. Case 28-2010. A 32-year-old woman, 3 weeks post partum, with substernal chest pain. N Engl J Med, 2010. 363(12): p. 1164-73. 5. Auer, J., et al., Spontaneous coronary artery dissection involving the left main stem: assessment by intravascular ultrasound. Heart (British Cardiac Society), 2004. 90(7): p. e39-e39. 6. Hayes, S.N., et al., Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation, 2018. 137(19): p. e523-e557. 7. Adlam, D., et al., Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection. J Am Coll Cardiol, 2019. 73(1): p. 58-66. DISCLOSURES: No relevant relationships by Waleed Al-Darzi, source=Web Response No relevant relationships by Hussayn Alrayes, source=Web Response Speaker/Speaker's Bureau relationship with Abbott Please note: $1001 - $5000 Added 03/14/2019 by Jennifer Cowger, source=Web Response, value=Honoraria Advisory Committee Member relationship with Medtronic Please note: $1001 - $5000 Added 03/14/2019 by Jennifer Cowger, source=Web Response, value=Consulting fee Scientific Medical Advisor relationship with Procyrion Please note: $1-$1000 Added 03/14/2019 by Jennifer Cowger, source=Web Response, value=Travel Speaker/Speaker's Bureau relationship with Medtronic Please note: $1001 - $5000 Added 03/14/2019 by Jennifer Cowger, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Abbott Please note: $1-$1000 Added 03/14/2019 by Jennifer Cowger, source=Web Response, value=Travel Speaker/Speaker's Bureau relationship with Medtronic Please note: $1-$1000 Added 03/14/2019 by Jennifer Cowger, source=Web Response, value=Travel No relevant relationships by Alexander Michaels, source=Web Response

British Cardiovascular Society Young Investigator Award 2019

The four finalists for the 2019 British Cardiovascular Society (BCS) Young Investigator Award (YIA) were selected from a competitive pool of young researchers. At the BCS meeting in Manchester last...

The British Cardiovascular Society Annual Conference 2019.

The British Cardiovascular Society Annual Conference 2019.

The digital health revolution: a British Cardiovascular Society conference reflection

The digital health revolution: a British Cardiovascular Society conference reflection

Reflections on Randomized Trials and Observational Studies: "Big Is Beautiful" A Conversation With Sir Rory Collins, FRS.

Rory Collins is the Head, Nuffield Department of Population Health, University of Oxford, Principal Investigator and Chief Executive, UK Biobank, and the British Heart Foundation Professor of Medicine and Epidemiology at the University of Oxford. He was born in Hong Kong and received his medical degree from St Thomas's Hospital Medical School, University of London. He was Knighted for Services to Science in 2011 and became a Fellow of the Royal Society in 2015. He has delivered the Paul Dudley White International Lecture of the American Heart Association and the Royal Society of Medicine William Harvey Lecture, and he has received both the European Society of Cardiology Gold Medal and the British Cardiovascular Society MacKenzie Medal.

Complete Versus Culprit only Revascularisation in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction: Incidence and Outcomes from the London Heart Attack Group

BackgroundDespite advances in technology, patients with Cardiogenic Shock (CS) presenting with ST-segment myocardial infarction (STEMI) still have a poor prognosis with high mortality rates. A large proportion of these patients have multi-vessel coronary artery disease, the treatment of which is still unclear. We aimed to assess the trends in management of CS patients with multi-vessel disease (MVD), particularly looking at the incidence and outcomes of complete revascularisation compared to culprit vessel only. Methods and resultsWe undertook an observational cohort study of 21,210 STEMI patients treated between 2005 and 2015 at the 8 Heart Attack Centres in London, UK. Patients' details were recorded prospectively into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. 1058 patients presented with CS and MVD. Primary outcome was all-cause mortality. Patients were followed-up for a median of 4.1 years (IQR range: 2.2–5.8 years).497 (47.0%) patients underwent complete revascularisation during primary PCI for CS with stable rates seen over time. These patients were more likely to be male, hypertensive and more likely to have poor LV function compared to the culprit vessel intervention group. Although crude, in hospital major adverse cardiac events (MACE) rates were similar (40.8% vs. 36.0%, p = 0.558) between the two groups. Kaplan-Meier analysis demonstrated no significant differences in mortality rates between the two groups (53.8% complete revascularisation vs. 46.8% culprit vessel intervention, p = 0.252) during the follow-up period. After multivariate cox analysis (HR 0.69 95% CI (0.44–0.98)) and the use of propensity matching (HR: 0.81 95% CI: 0.62–0.97) complete revascularisation was associated with reduced mortality. A number of co-variates were included in the model, including age, gender, diabetes, hypertension, hypercholesterolaemia, previous PCI, previous MI, chronic renal failure, Anterior infarct, number of treated vessels, pre-procedure TIMI flow, procedural success and GP IIb/IIIA use. ConclusionIn a contemporary observational series of CS patients with MVD, complete revascularisation appears to be associated with better outcomes compared to culprit vessel only intervention. This supports on-going clinical trials in this area and provides further evidence of the association of complete revascularisation in STEMI with good outcomes.

PULMONARY HYPERTENSION AND ISOLATED RIGHT HEART FAILURE: AN UNUSUAL PRESENTATION OF THYROID STORM

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 1 SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/09/2018 03:45 PM - 04:45 PM INTRODUCTION: Graves' disease and other hyperthyroid states are known to have significant effects on the cardiovascular system. These may include increase in heart rate, increase in cardiac output, and decrease in systemic vascular resistance[1]. When heart failure is present, left ventricular dysfunction is frequently reported[2,3]. Thyrotoxicosis rarely presents with pulmonary hypertension and isolated right heart failure. CASE PRESENTATION: A 42-year-old African-American female with no past medical history was sent into the hospital by her outpatient physician for tachycardia. History revealed unintentional 70-pound weight loss over one year. Vital signs were notable for tachycardia identified as atrial fibrillation with rapid ventricular response(>150bpm) on ECG[Figure 1]. Physical exam revealed exophthalmos, symmetrically enlarged and non-tender thyroid, JVD 11 cm, irregularly-irregular tachycardia, decreased breath sounds right lung base, bilateral 2+ pitting edema of lower extremities, and hyperreflexia. Laboratory values indicated suppressed TSH(<0.004 uIU/mL) with elevated T3 Total, T4, and TSH-receptor antibody(494ng/dL, 23.14ug/dL, 111.10IU/L respectively). Diagnosis of Graves' disease was made. Burch-Wartofsky Point Scale of 55 suggesting thyroid storm. Treatment initiated with propranolol, methimazole, glucocorticoids. Chest x-ray showed right pleural effusion, cardiomegaly, and mediastinal widening[Figure 2]. Ultrasound thyroid showed enlarged, heterogeneous, hypervascular gland. Radioactive iodine scan showed diffuse uptake. Echocardiogram showed severe pulmonary hypertension(PASP 88mmHg), right ventricular systolic dysfunction, severe tricuspid regurgitation, left ventricular ejection fraction of 60%. Workup for causes of pulmonary hypertension negative for HIV, connective tissue disease, drugs, toxins, underlying pulmonary disease, and thromboembolic disease. Patient discharged after radioiodine ablation of thyroid gland. Follow up echocardiogram approximately six months after treatment showed significant improvement of both pulmonary hypertension (PASP 35 mmHg) and right heart systolic function. DISCUSSION: This case demonstrates that thyrotoxicosis can induce pulmonary hypertension and right-sided heart failure independent of left-heart disease. Proposed mechanisms of pulmonary hypertension in thyrotoxicosis include autoimmune endothelial dysfunction, endothelial damage from high cardiac output, changes in metabolism of vasodilators or vasoconstrictors, and sympathetic pulmonary vasoconstriction. CONCLUSIONS: It is important to consider thyrotoxicosis in patients with pulmonary hypertension and right heart failure since normalizing thyroid hormones can reverse even severe cardiopulmonary disease. Reference #1: Klein, I., & Ojamaa, K. (2001). Thyroid hormone and the cardiovascular system. The New England Journal of Medicine, 344(7), 501-509. https://doi.org/10.1056/NEJM200102153440707 Reference #2: Klein, I., & Danzi, S. (2007). Thyroid Disease and the Heart. Circulation, 116(15), 1725-1735. https://doi.org/10.1161/CIRCULATIONAHA.106.678326 Reference #3: Siu, C.-W., Yeung, C.-Y., Lau, C.-P., Kung, A. W. C., & Tse, H.-F. (2007). Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism. Heart (British Cardiac Society), 93(4), 483-487. https://doi.org/10.1136/hrt.2006.100628 DISCLOSURES: No relevant relationships by Mina Bushra, source=Admin input No relevant relationships by Kevin Rabii, source=Web Response No relevant relationships by Sally Ziatabar, source=Web Response