The influenza vaccine reduced major cardiovascular events in patients with ACS. Therefore, it should be encouraged as a secondary prevention in this group of patients.

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Objective: To determine the association between splenectomy and pulmonary hypertension in patients with thalassaemia with anaemia. Design: Prospective cross-sectional study. Methods: 68 patients with thalassaemia, who had a haemoglobin concentration of less than 100 g/l, were recruited into this study. Echocardiography was performed before clinical data were reviewed. Pulmonary artery pressure was estimated by measuring the systolic transtricuspid pressure gradient from tricuspid regurgitation and adding it to the right atrial pressure, which was estimated by the response of the inferior vena cava to inspiration. Pulmonary hypertension was defined as systolic pulmonary artery pressure . 35 mm Hg. History of splenectomy and other clinical data were compared between patients with and without pulmonary hypertension. Results: 29 patients had pulmonary hypertension and 39 did not. Patients with pulmonary hypertension had significantly more nucleated red blood cells and higher platelet counts, and a higher prevalence of splenectomy (75.8% v 25.6%, odds ratio 9.1, 95% confidence interval 3.0 to 27.7). In multivariate analysis, splenectomy was the only factor significantly related to pulmonary hypertension. Conclusion: Splenectomy is a strong risk factor for pulmonary hypertension in patients with thalassaemia.H eart disease is a major cause of mortality and morbidity in patients with thalassaemia after the first decade of life, 1 despite improved prognosis with iron chelation. The common cardiac abnormalities that have been reported in patients with thalassaemia are cardiac hypertrophy, ventricular systolic dysfunction, pericarditis and pulmonary hypertension. Pulmonary hypertension is found in about 59-75% of patients with thalassaemia and can be the leading cause of heart failure in these patients.2 4 5 Factors affecting pulmonary artery pressure include high cardiac output caused by anaemia, left ventricular (LV) systolic dysfunction, chronic pulmonary haemosiderosis, recurrent respiratory tract infections, hypoxaemia and pulmonary fibrosis.5 6 Another proposed cause is the hypercoagulable state with thrombotic obstruction of the pulmonary arteries.7-9 Although most of the reported patients with thalassaemia with pulmonary hypertension were splenectomised, 2 5 6 non-splenectomised patients can also have pulmonary hypertension whereas some of them have normal pulmonary arterial pressure.2 The relationship between splenectomy and pulmonary hypertension in thalassaemia has not been clearly established. The purpose of this study was to explore this relationship. METHODS PatientsWe studied patients with thalassaemia with haemoglobin concentration less than 100 g/l who were being treated at the haematology outpatient clinic from January 2000 to December 2001. They were free from cardiac symptoms and had no evidence of clinical heart failure or signs of chronic liver disease. None were taking cardioactive drugs at the time of examination. We excluded patients with significant valvular heart disease, congenital heart diseas...

Objective: To evaluate the effects of an educational board game on heart failure (HF) patients' knowledge and self-care behavior. Methods: In this randomized controlled study with a follow-up of 3 months, 76 patients with HF with reduced ejection fraction, who had been enrolled in our multidisciplinary HF program, were divided into two groups. During their follow-up appointment at the HF clinic usually 2 weeks after discharge, the interventional group participated in an HF educational board game conducted in Thai language, while the control group received the usual care including standard education. The primary outcome was the change of score achieved in the specialized HF knowledge and self-care behavior assessment. Results: In the intervention group, the knowledge and self-care behavior significantly improved (all P < 0.001), whereas both scores were unchanged in the control group (P = 0.09 and P = 0.21). Mean score change for knowledge and self-care behavior showed greater improvement in the intervention group when compared with the control group (P < 0.002 and P < 0.006). Conclusion: Participation in an interactive educational board game resulted in an increase in the HF patients' knowledge and self-care behavior. Practice Implications: An interactive educational board game may be used as an alternative educational tool in HF patients.

This case report concerns a young woman who, during her pregnancy, suffered severe mitral regurgitation. It was discovered at the same time that she had a left atrial myxoma. During the early postpartum period she successfully underwent an anterior minithoracotomy to remove the left atrial myxoma in conjunction with repair of the mitral valve. The thoracotomy approach in this specific patient was chosen as it would give a better chance of successful mother-child bonding because the patient would be able to avoid the precautions which would have been necessary following a sternotomy, especially the limitation of her ability to hold her child during the first 4–6 weeks postoperatively.