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The article presents information on the etiology of chronic heart failure (CHF). CHF is the syndrome brought about by the inability of the heart to provide an adequate output to meet physiological demands. It is reported that the aetiology of CHF is wide and varied. Ischaemic heart disease with previous myocardial infarction remains the commonest cause in the developed world. The most obvious symptom of CHF is dyspnoea.

The article focuses on issues related to treatment of hypertension. An elevated blood pressure is a major risk factor for cardiovascular death and disability and its treatment effectively reduces the morbidity and mortality from cardiovascular disease. Beta blockers are prognostically important post-myocardial infarction and they relieve anginal pain, as do calcium antagonists. Finally, the Heart Protection Study and ASCOT-LLA show that, irrespective of baseline cholesterol or blood pressure, statins reduce the risk of stroke and cardiovascular disease. As most hypertensive men over 50 years of age are at increased cardiovascular disease risk, statins should be routinely prescribed. All patients should be considered for statin and aspirin therapy as part of long-term risk reduction.

The article focuses on the latest management of patients following myocardial infarction (MI), and the implications of the new contract. In Great Britain, there are about 65,000 myocardial infarctions per year in men aged under 65 and 19,500 in women. Modern management of the post-MI patient should focus on changing lifestyle, targeting risk factors, ensuring appropriate follow-up and prescribing drugs of benefit in secondary prevention. Every general practitioner will have about 50 patients with a myocardial infarction on their list and see about three new patients with a myocardial infarction each year.

The article focuses on the 1-year results from the Reduction of Atherothrombosis for Continued Health (REACH) Registry and the practical implications for identifying and managing patients at high risk of the cardiovascular (CV) disease, Atherothrombosis. Aherothrombosis, the unifying pathology underlying ischaemic stroke, transient ischaemic attack (TIA), myocardial infarction (MI) and peripheral arterial disease (PAD), is the leading global cause of morbidity and mortality.

The article presents information on how general practitioners (GP) can make patients take a stroke more seriously. Stroke is the third biggest killer, and the morbidity of those that manage to survive is bad. Stroke patients must be admitted to the hospital immediately, and they should be scanned and be able to see a specialist within 3 hours. GPs should now react to possible strokes as they do to possible heart attacks. They should decline visits and advise the caller to dial 999 immediately.

A 63-year-old ex-smoker collapsed while he was out with his wife. At A&E, he was found to be in a trial fibrillation, with a ventricular rate of 190 beats per minute. Over the previous three days he had suffered from intermittent chest pain, radiating to both shoulders, which was worse at night and aggravated by coughing. DC cardioversion was carried out to restore sinus rhythm and this EGG was recorded. The history is typical of pericardial pain, which is aggravated by deep inspiration and coughing and is postural. Such patients are usually admitted to hospital, largely because of the fear that there may be acute myocardial infarction.