Diastolic dysfunction is common, especially in elderly patients, and can coexist with systolic dysfunction. Systemic hypertension and coronary heart disease are the most common causes of diastolic dysfunction in elderly patients, occurring against a background of age-related changes in myocardial compliance. The gold standard for diagnosis of diastolic function is direct assessment via cardiac catheterisation and haemodynamic studies. However, several noninvasive techniques are available - the most convenient and commonly used of these is Doppler echocardiograhy. At present, data from large randomised trials are not available for the pharmacological treatment of diastolic heart failure. Control of aetiological factors, particularly hypertension, coronary heart disease and arrthythmias, constitutes the mainstay of management of diastolic heart failure. Diuretics are effective in reducing pulmonary congestion and provide symptomatic relief, but must be used judiciously. Beta blockers, rate-limiting calcium channel antagonists and ACE inhibitors (or angiotensin II antagonists if there is true intolerance to ACE inhibitors) may be used to improve ventricular filling and/or retard venticular remodelling. The choice of agent (or agents) should also be detemined by comorbid conditions.*\13 • Viral bronchitis is a common cause of cough. Whooping cough should be considered in a child with prolonged cough. Cough without wheeze is usually not asthma. Chest x-ray is the first investigation to consider in the child with prolonged or recurrent cough. CT scan of the chest is the investigation of choice for bronchiectasis. A thorough history is of more value than most available investigations.
|Number of pages||7|
|Publication status||Published - 1 Nov 2002|