Medicine in Europe: The changing scene in general practice in Europe

Abstract

raised jugular venous pressure, as in this woman.Both conditions produce a pansystolic murmur at the left sternal edge.A high pulmonary artery oxygen satur- ation in a patient with a low cardiac output gives the diagnosis when echocardiography is not available.AJR: Is there ever any confusion between acquired and congenital ventricular septal defects when someone presents with an infarct?CMO: Patients with a congenital condition usually know their diagnosis and also would have a murmur at the outset, unlike people with an acquired ventricular septal defect.Most congenital ventricular septal defects in adults are perimembranous and have a different location in the echocardiogram.AJR: What causes ventricular septal rupture?CMO: The underlying pathological finding is transmural infarction.Coronary angiographic studies show that about 40-50% of patients have single vessel disease and seem to have fewer collateral vessels to the septum.This may explain the full thickness necrosis.'PKM: Whether treatment with streptokinase affects the incidence of septal rupture is unclear,'8 but rupture seems to occur earlier, at around 24 hours, in patients who have been given thrombolysis.19GJD: Elderly people, women, and those with hyper- tension seem to be at greatest risk.Many patients who die of myocardial infarction do so because of cardiac rupture; this just happens to be an internal rupture.The fact that mortality from infarction is higher in elderly people might be explained by the frailty of their tissues or the more advanced state of their coronary disease as they do not seem to have larger infarcts.