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.
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
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.