No abstract

The incidence of headache has been assessed in 100 patients with high blood pressure and in 100 normotensive controls. Headache was more frequent in patients with diastolic blood pressures of 130 mm. Hg and over, being typically diffuse, occurring in the morning and tending to ease after a few hours. It is likely to be relieved by control of the blood pressure. No difference in incidence of headache was found between the normotensive controls and the hypertensive patients with diastolic blood pressures less than 130 mm.Hg. In hypertensive patients with occipital headache unrelieved by moderate or good blood pressure control, cervical spondylosis should be considered as a possible cause of the headache.

Angina is a relatively common complaint in patients with aortic valve disease, and recent communications (Basta et al., 1975;Harris et al., 1975;Mandal and Gray, 1976) have indicated the value of selective coronary arteriography in distinguishing angina caused by accompanying coronary artery disease from that caused solely by severe aortic valve disease with diminished coronary blood flow. To date, however, very little has been published on the significance of angina in mitral disease. We therefore studied 129 consecutive patients with either mitral or aortic valve disease being assessed for surgical treatment to ascertain first of all the incidence of both angina and coronary artery disease and secondly whether there was any significant difference in the incidence of either angina or coronary artery disease in the two groups. Patients and methiodsOne hundred and twenty-nine consecutive patients with either mitral or aortic valve disease were investigated to assess the presence of coronary artery disease. The age range was 40 to 64 years (mean 52 years), and there were 78 women and 51 men. All were symptomatic, exertional dyspnoea and chest pain being the most prominent complaints.Received for publication 7 November 1977 Eighty-two patients had solitary mitral valve disease and 47 had isolated aortic valve disease.Standard 12-lead electrocardiography, right heart catheterisation for recording resting pulmonary artery and mean wedge pressures, and left heart studies were performed in all patients. Left ventricular function was assessed from a study of the cineangiogram and the end-diastolic pressure recorded before and after angiography. Finally, selective coronary arteriography was carried out in all by the Judkins technique, a film being obtained in both oblique positions after separate injections into each coronary artery. Reduction of the vessel lumen by more than 50 per cent was used as the yardstick for indicating significant disease, and was classified as single, double, or triple vessel disease (right coronary, left anterior descending, and circumflex). Involvement of the origin of the left main coronary artery was not encountered in any of our patients. There were no deaths attributable to coronary arteriography, and complications were few and not serious. ResultsAngina was present in 55 (42%) of the 129 patients, and was classified simply as: grade 1-angina occurring only with severe exertion; grade 2-angina with ordinary activity, stress, or exposure to 918 on 7 May 2018 by guest. Protected by copyright.

Background: The conventional use of high-sensitivity troponins (hs-troponins) is for diagnosing myocardial infarction however they also have a role in chronic disease management. This pilot study assessed the relationship of hs-troponins with echocardiographic markers of left ventricular hypertrophy (LVH) and structural heart disease.Methods: Patients undergoing CT coronary angiogram for low-intermediate risk chest pain, and healthy volunteers were recruited. Hs-troponins Singulex I, Abbott I and Roche T and NT-proBNP were evaluated in relation to clinical characteristics, interventricular thickness (IVSd), left atrial enlargement (LAE) and composite structural heart disease (SHD) on echocardiography.Results: 78 subjects who underwent echocardiography were included in this study. Male gender and hypertension were associated with higher hs-troponins (p < 0.001). Both Singulex and Abbott hs-troponins had high discriminatory accuracy for all SHD measures (Table 1). Optimal cutpoints for Singulex, Abbott, Roche assays and NT-proBNP for SHD were >1.5 ng/L, >1.7 ng/L, >6.5 ng/L and >6.3 pmol/L respectively. Correlation was strong between the two hs-troponin I assays, Spearman coefficient r = 0.85, but weaker between I and T assays r = 0.46/0.54 (Abbott/Singulex with Roche).Conclusion: These results advocate the potential role of hstroponins as screening tools for structural heart disease with theranostic implications.http://dx.Background: Accurate diagnosis of cardiomyopathies can be challenging. Combining the strengths of new techniques across different imaging modalities aids work-up and management. Three illustrative cases (sarcoidosis, amyloidosis and lymphoma) are provided.Case presentations: A 44-year-old man presented with complete heart block. Transthoracic echocardiography (TTE) revealed a dilated cardiomyopathy with focal thinning and akinesis. Late gadolinium enhancement (LGE) was noted by cardiac MRI (CMR) in two analogous foci, suspicious for cardiac sarcoidosis. A 67-Gallium-citrate nuclear scan showed avid foci in a biventricular and pulmonary pattern, consistent with that diagnosis and guiding further biopsy.A 77-year-old man, with an initial diagnosis of ischaemic cardiomyopathy, presented with dyspnoea and recurrent pleural effusions. CMR showed severe left ventricular systolic dysfunction with focal thinning/akinesis. LGE was dense in the thinned/akinetic areas and diffuse elsewhere in all four chambers. A nuclear medicine planar and SPECT scan showed marked four chamber Tc-DPD activity. Taken together findings were consistent with cardiac amyloidosis and infarction.A 48-year-old man was recently diagnosed with lymphoma. His F-18-fludeoxyglucose CT-PET scan demonstrated heterogeneous avidity in the left ventricle. CMR showed multiple focal myocardial masses in the same pattern (most clearly by reduced uptake in early LGE sequences), with relatively preserved ventricular contractility. Following review of the CMR images anthrocycline including chemotherapy was commenced.Discussion: Determination of ca...