By John A. Cosh MA MD (Cantab), FRCP, John V. Lever BSc MBChB, FRCPath (auth.)
What drugs lacks in an more and more specialized global is the scientific polymath (or may still or not it's scientific bimath?) - the fellow who's an stated professional in additional than one box of medication. Super§pecialisation within the expert experience is an try and recognize progressively more approximately much less and not more. it may be the microscopist's view of truth and any such microcosm can turn into additionally a shelter from realities. One truth tricky for the very specialized general practitioner to just accept is that ailments do not exist. in basic terms individuals with illnesses exist and other people don't continually agree to handy different types and booths. it might be great in the event that they did yet in some way they by no means do. A loved clinical culture in Britain is that experts aren't hatched immediately from clinical faculties. certainly, younger medical professionals are actively discouraged from taking too slim an curiosity yet are plunged for a minimum of 4 years into the unspecific pool of basic medication till they've got built a huge know-how of the totality of human sickness. earlier than this they aren't allowed to slim their attractions on one specific target.
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Additional info for Rheumatic Diseases and the Heart
Raised left atrial pressure causes congestion of the pulmonary veins, particularly the upper ones, which become prominent above the main pulmonary arteries. A further rise in venous pressure leads to oedema in the interlobar septa, shown as Kerley's lines. These are best seen in the relatively translucent costophrenic angles (Figs. 3).
Atrial flutter too may be paroxysmal. If it becomes established for a period it is unlikely to be permanent, but while it is established the patient may be conscious of sudden changes in heart rate as the degree of A: V block changes. 1: 1 A: V conduction gives rise to a heart rate of 250 to 300/minute but is fortunately uncommon; it is distressing and may cause faintness or syncope in the older patient due to the sudden fall in cardiac output. The heart rate may drop spontaneously or as a result of treatment to 140 or 70/minute as A:V conduction changes to 2:1 or 4:1.
If there is tachycardia it is important to check the sleeping pulse rate, especially in children. Drugs are needed for the relief of pain and an antibiotic, first as therapy and later as prophylaxis, which should be continued as part of long-term supervision. With recovery graded exercise and rehabilitation are needed appropriate to the degree of cardiac involvement. Where children require long periods of hospitalisation some form of schooling is valuable within the limits imposed by confinement to bed or to the ward.