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should not be entertained. Half a tablet of aspirin (acetylsalicylic acid) is of immense help.

Thyrocardiosis or a sub clinical hyperthyroid state may cause inappropriate tachycardia. Acute left ventricular failure may ensue. Hence counting the pulse rate becomes very essential in the clinical examination. On examination, patient with ischaemic heart disease is pale and sweating excessively. The pulse rate may be below 60/ minute. The pulse is feeble and weak in anterior wall ischaemia, which is associated with severe hypertension. In inferior wall ischaemia involving the conduction system, there may be various types of arrhythmias and pulse is irregularly irregular. Ischaemia involving the papillary muscles may give rise to transient musical midsystolic click, and mitral incompetence.

Patient may also show evidence of left ventricular failure, such as dyspnoea, and pulmonary oedema.

All cases of coronary ischaemia usually need detailed investigation and careful management. They are sent to a referral hospital.

THE ABOVE PROGRAMME TOOK TWO HOURS WITH THE FIRST LECTURE ON HYPERTENSION AND SECOND LECTURE ON ISCHAEMIC HEART DISEASES. THREE CASES OF HYPERTENSION-ONE OF THEM WITH SYMPTOMS OF CONGESTIVE CARDIAC FAILURE. TWO CASES OF ISCHAEMIC HEART DISEASE-ONE OF THEM WITH MULTIPLE EXTRASYSTOLES WERE DEMONSTRATED THEY WERE ALLRECEIVING TREATMENT AT THE PHC AFTER CONSULTATION WITH THE PROJECT SPECIALIST CONSULTANT.

-M. Chandramohan

RESPIRATORY DISORDERS

The Important respiratory diseases occurring in the elderly are pulmonary tuberculosis, chronic bronchitis bronchial asthma, bronchiectasis, tropical eosinophila, pneumonitis, and carcinoma-lung. They present with cough of more than two weeks duration.

Chronic bronchitis is otherwise called 'Blue bloaster' syndrome. Dyspnoea is of the expiratory type. Smoking and cotton dust and occupational hazard are important predisposing factors. It should be remembered that antibiotics are administered for a period of 30 to 50 days, with rotation of antibiotics once in ten days so as to combat the lurking residual mixed infection. If signs of congestive cardiac failure appear, the dose of antibiotic should be raised.

Emphysema is charterised by dyspnoea without wheeze. It is called 'pink buffees' syndrome. Breathing exercises must be taught to the patient. Infections are avoided by prophylactic long acting penicillin.

High fever, dyspnoea, with contraction of alar nasae and features of consolidation are characteristic of pneumonitis. It is found that death rate is increased ten fold due to pneumonitis as pulmonary compliance is low and immune machanisms are less efficacious in the elderly. Amoxycilin and aminoglycocide antibiotics are indicated.

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