An opt out BBV testing program in the ED is feasible and effective at finding new cases. However, the testing rate was low at 24%. Although QI interventions led to some improvement in testing rates, further studies are required to identify ways to achieve sustained increases in testing in this setting.

The clinical aspects of rheumatic heart disease in relation to pregnancy are reviewed in a combined series of patients chiefly from the Newcastle General Hospital studied over a period of 28 years, and from the Western General Hospital in Edinburgh studied over 25 years. In both centres, since about I960, there has been a progressive decrease in the number of patients found in antenatal clinics to have rheumatic heart disease, and also in the severity of this condition. There has also been a significant fall in the incidence of major complications, such as pulmonary oedema, right heart failure, and atrialfibrillation which formerly were often encountered. In addition to the changes in the natural course of the disease, improved medical management of the more severe cases, together with the introduction of cardiac surgery, has been responsiblefor a much more favourable course in the pregnant patient. The disadvantages and potential dangers of the New York Heart Association classification are emphasized and illustrated. The risks of valvotomy during pregnancy are no greater than in cases of comparable severity in the nonpregnant state. Subsequent close medical supervision is important because complications may still occur later in pregnancy. Likewise should pregnancy occur after successful valvotomy, close observation throughout is essential. Current concepts ofmedical, surgical, and obstetric management are outlined. Routine medical examinations at about IO, I5, and 20 years of age with appropriate management would render pregnancy virtually safefor every patient with rheumatic heart disease. As judged by the number of new patients found at present to have rheumatic heart disease when examined in antenatal clinics in Newcastle, Edinburgh, and in three other regions of Scotland (Szekely, i968; Turner, I968b; R. W. D. Turner and N. M. B. Dean, i969, unpublished data), and by the decreasing frequency of serious complications during pregnancy such as pulmonary oedema, right heart failure, and atrial fibrillation, the prevalence and the severity of rheumatic heart disease have declined in recent years. A similar trend has recently been reported from London (Barnes, I970). A recent inquiry carried out by one of us regarding the number of first mitral valvotomies performed anually since its introduction in i8 centres of cardiac surgery in Britain also confirms the clinical impression of a continuing decline in the incidence and severity of rheumatic heart disease in this country (R. W. D.

No abstract

THis paper is the first of a series on the retinal vessels and is concerned with the normal range of the retinal vascular pattern. It is intended to serve as a foundation for a long-term study of the vascular changes in patients undergoing treatment for hypertension. In particular, its purpose is to expose fallacies in the customary method of assessing arteriolar calibre by the arteriovenous ratio and to discuss diffuse arteriolar narrowing as an early sign of hypertension.In recent years the number ofpatients with severe hypertensive disease has considerably decreased. Presumably this is mainly due to the efficacy of modern antihypertensive drugs and the increasing tendency to treat patients relatively early before secondary changes have occurred. At all events, the proportion of patients with papilloedema and advanced hypertensive retinopathy or with severe clinical manifestations such as encephalopathy has decreased and, unless seen at the late stage of renal failure or following some important complication such as cerebral haemorrhage, most patients under treatment now survive at least for many years. As a result, the retinal changes of hypertension described in textbooks are unbalanced and there should be greater emphasis on the relatively early vascular changes than on retinopathy.All physicians regard the fundus as an important guide to prognosis and take this into consideration in deciding whether or not the patient should be treated. The ophthalmologist who is requested to give an opinion is now frequently confronted with an earlier stage in the retinal picture in the form of pure arteriolar changes with minimal, if any, exudates or haemorrhages. It is clear, however, that there is much confusion with regard to the earlier changes which involve arteriolar calibre, tortuosity, or straightening, and the arteriovenous crossings.From our observations there can be no doubt that there is considerable variation in calibre and tortuosity throughout the healthy population and this may, in part,

No abstract

No abstract

No abstract

SummaryIn the U.K., coronary heart disease has reached epidemic proportions. It is the commonest cause of death after the age of 35 years and the fastest rate of increase is in early middle age. The epidemic is due mainly to our way of life. The most important factors are dietary, with smoking, physical inactivity and stress also contributing. Twenty independent working parties from different countries have reviewed the dietary evidence and reached a strong consensus on dietary recommendations. Little action has been taken in the U.K.