General principles of the treatment of infective endocarditis.

The early diagnosis of infective endocarditis is important so that effective antibiotic treatment may be started without delay. When this is achieved other treatment problems are minimised. Heart failure and rhythm changes are treated in the conventional way. The use of necessary surgery at any stage of the disease has greatly improved the prognosis. The timing of surgery is important and is best achieved by close consultation between cardiologist, microbiologist and surgeon. In general, any failure, either haemodynamic or microbiological, of the patient to make a good response will be an indication to consider surgery.

Sarcoid heart disease.

Sarcoid heart disease has had slow recognition but it is now being increasingly diagnosed in life and at necropsy. Recognition is important as energetic treatment may greatly improve the prognosis. Although patients with 'classical' sarcoidosis may be found to have cardiac involvement, most of the clinically important cases present with cardiac problems--sudden death, heart block, tachyarrhythmias and 'cardiomyopathy'--are the most frequent presentations. Sarcoidosis should be thought of in any case of difficult heart disease for which there is no obvious aetiology. Histological confirmation of sarcoidosis in some organ should be sought. Energetic treatment and follow up show that the prognosis is not necessarily bad.

Aneurysm of left ventricle and left coronary artery after non-penetrating chest trauma.

A 17 year old boy who sustained blunt chest trauma to his chest developed a proximal left anterior descending coronary artery aneurysm and an aneurysm of the left ventricle. He underwent left ventricular aneurysmectomy and was discharged to outpatient follow up.

Cardiac damage presenting late after road accidents.

Six examples of cardiac damage secondary to non-penetrating trauma in road accidents are described. In all six cases the lesion was not recognised at the time of the accident but became clinically important two days to 17 years later. As the patients were young or had unusual lesions, the damage could be attributed to the accident. In older patients with common cardiac problems the trauma might not be recognised as the underlying cause.

Sarcoid heart disease.

Myocardial sarcoidosis is not a rare disease in the UK and it is still probably under-diagnosed. A high index of suspicion in necessary for diagnosis of myocardial sarcoidosis, which should be thought of in any unusual form of heart disease for which there is no adequate explanation, particularly if there are serious rhythm changes or unexplained heart failure. Mitral systolic murmurs occur frequently. Histological proof of the aetiology should be sought. The heart is frequently massively involved when other organs have little involvement. Most of these patients present with cardiac symptoms or signs and the high incidence of sudden death is disturbing. The high rate of occurrence in East Anglia is noted, and merits further study. Treatment should be energetic where indicated--but its effects are difficult to assess. This study, representing the largest single source of information on this topic, continues in the hope of shedding more light on a sinister disease.