The Foundation Years最新文献

History taking is central to making a diagnosis in patients with heart disease. Chest pain should be evaluated with particular attention to its reproducible precipitation by exertion and prompt relief by rest. Only four common arrhythmias cause palpitation. Ectopic beats present as a sensation of missed beats and thumps; paroxysmal supraventricular tachycardia with very clearly defined attacks usually lasting minutes only; paroxysmal atrial fibrillation with longer but still clearly defined attacks. In sinus tachycardia there is an almost constant feeling of palpitation, often with other symptoms of anxiety. Cardiac breathlessness may be associated with orthopnoea, paroxysmal nocturnal dyspnoea and peripheral oedema, though can be very difficult to distinguish from other causes. Syncope is most commonly vasovagal with recognisable precipitants; when due to arrhythmia is very sudden in onset and recovery. Epilepsy is distinguished by an aura and abnormal movements at the onset; maintained (rather than floppy) body tone during the attack and a post-ictal phase. Time spent taking a careful history will yield more towards a diagnosis than any number of sophisticated and expensive tests.

Atrial fibrillation (AF) is the commonest clinical arrhythmia and one that will be faced frequently by doctors throughout their medical career. AF is a significant cause of symptoms, hospitalisation, morbidity and mortality. With an increasing and ageing population, the number of patients being treated with AF continues to rise with enormous demands on healthcare funds and resources. In spite of tremendous advances in cardiovascular medicine over the last century, antiarrhythmic therapy remains only moderately effective at preventing AF, it needs to be patient-tailored and it can be associated with significant side-effects. Additionally, oral anti-thrombotic therapy has barely altered in the last fifty years. New electrophysiological techniques are now allowing patients to be offered ablation therapy to reduce AF onsets with promising results. With the likelihood of new anti-arrhythmics and anti-thrombotic medications on the horizon, perhaps we can be optimistic about the future for the patient with this stubborn condition. This article discusses current aspects of AF diagnosis, clinical management and therapies and examines the role of drug therapy, stroke risk reduction and the use of ablation.

Heart failure is a common problem in the UK and is associated with significant morbidity and mortality. It is a complex pathophysiological process which requires prompt diagnosis and management. Patients presenting in acute heart failure must be assessed rapidly for underlying precipitants, whilst treatment to alleviate symptoms is commenced.

Coronary heart disease (CHD) remains the single most common cause of death in the UK, causing 22% of premature deaths in men and 12% of premature deaths in women. There has been a recent reduction in CHD death rates, and this is due in no small part to the decline in major risk factors (predominantly smoking cessation); the remainder is due to individual treatments and secondary prevention. This contribution will explore the treatment of acute coronary syndromes (ACS). A significant improvement in survival can be made by prompt diagnosis and appropriate initiation of therapy.