Mobile coronary care and mortality from ischaemic heart disease in a predominantly rural community.

The mobile coronary care unit based at Coleraine Hospital was called to 155 patients in the community during a six-monthly period, 74 of whom had sustained a myocardial infarction. Over the same period, 25 of 49 patients admitted via the ordinary ambulance with suspected ischaemic heart disease had sustained a myocardial infarction and received medical care significantly later than those seen by the mobile unit. A further 12 patients out of 39 with suspected ischaemic heart disease admitted by other means (the accident and emergency department or other hospital units) brought the total number of patients admitted to hospital with myocardial infarction during the study period to 111.Overall mortality from myocardial infarction was 19.8% and was significantly higher in those >/= 70 years of age. Nine patients with myocardial infarction seen by the mobile coronary care unit required early defibrillation (four outside hospital) and eight of these survived to be discharged. No patients admitted by other means required emergency defibrillation. Although no significant difference in mortality was demonstrated between those seen before or after three hours from the onset of symptoms or between patients admitted by the mobile unit or by the ordinary ambulance, a subgroup of patients below 70 years of age and seen by the mobile unit less than three hours after the onset of symptoms had the lowest mortality of 6.7%. Estimated overall mortality from ischaemic heart disease in this community over the study period was in excess of those deaths accounted for in this survey, implying a high mortality in those not admitted to hospital.

Grading of dyspnoea and walking speed in cardiac disease and in chronic airflow obstruction.

A five-point dyspnoea scale (modified MRC questionnaire) and 12-minute walking test were used to compare the relationship between subjective assessment of dyspnoea and objective measurement of disability in patients with chronic airflow limitation, cardiac disease, and normal subjects. There was no overall difference in exercise performance between the cardiac and respiratory groups. There was a significant correlation between vital capacity and exercise performance, and the slope of the regression line was similar in the two groups. There was no correlation between vital capacity and exercise performance in the group of normal subjects. The five-point dyspnoea scale predicts similar levels of performance in the 12-minute walking test whether the dyspnoea is a result of cardiac or respiratory disease.

Premenstrual exacerbation of asthma.

Questionnaires and twice daily peak expiratory flow measurements were used to evaluate the effects of the menstrual cycle in asthmatic women. Forty per cent of women reported premenstrual deterioration in their symptoms and this was confirmed by peak flow recordings. No correlations were found between premenstrual exacerbation of asthma and symptoms of premenstrual tension, consumption of aspirin, use of the contraceptive pill, cycle length, or behaviour of asthma during pregnancy.

Radiographic appearances of mycoplasma pneumonia.

The chest radiographs of 60 adult patients with serologically proven mycoplasma pneumonia were reviewed. Confluent or patchy consolidation was most commonly seen, and involved one lobe only in 40% of patients. Widespread nodular opacities were seen much less frequently (7%). Pleural fluid was rare. Complete resolution was almost invariable, 40% of radiographs having cleared by four weeks and 96% by eight weeks.

Primary mediastinal choriocarcinoma in a Black youth.

A primary mediastinal choriocarcinoma in a Black youth is described. The tumour was resistant to treatment and the patient deteriorated rapidly. No testicular tumour was present. The clinical, biochemical and autopsy findings are described.