General gastroenterologists supported by paediatricians can provide endoscopic services for children safely and promptly in their local hospital. This is appropriate for the management of common gastrointestinal problems affecting children.
The reduction in patients presenting with ST-elevation myocardial infarction (STEMI) during the COVID19 crisis could have resulted from fears about developing COVID-19 infection in hospital. Patients who delay presenting with STEMI are more likely to develop mechanical complications, including acute ischemic mitral regurgitation (MR). We present a 69-year-old women with an inferior STEMI and cardiogenic shock due to acute ischemic MR who delayed presenting to hospital due to the fear of COVID-19. Early identification of this mechanical complication using transthoracic echocardiography in the Emergency Department enabled the team to target her optimisation. Ultimately these patients require urgent surgery to repair the mitral valve and revascularize the myocardium but they are often too unwell to undergo surgery and even when it is feasible the outcomes are poor.
Conclusions Hypertension is prevalent, under diagnosed, and contributes to the development of potentially unstable coronary artery disease in healthy male endurance athletes. Recommendations for cardiovascular evaluation of master athletes should consider a low threshold for non-invasive exercise testing and ambulatory BP monitoring for for athletes with hypertension and even high-normal BP. Table 1. ESC definitions of hypertension. Table 2. Prevalence of hypertension according to ESC guideline classifications. Table 3. Logistic regression P values, odds ratios and confidence intervals for a 5mmHg increase in BP parameters.
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