Postgraduate medical journal
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To determine the normal range for carbon monoxide concentrations in the exhaled breath of subjects in the emergency department and to develop a protocol for the use of a breath analyser to detect abnormal carbon monoxide exposure. ⋯ Breath analysis was rapid and results correlated well with carbon monoxide exposure. In this population subjects with breath carbon monoxide concentrations greater than 6 ppm should be assessed for the risk of carbon monoxide poisoning. However even carbon monoxide concentrations less than 6 ppm do not exclude carbon monoxide poisoning within the last 24 hours.
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Limb shaking is an under-recognised form of transient ischaemic attack (TIA), which can easily be confused with focal motor seizures. However, it is important to distinguish limb shaking TIAs and focal seizures, as patients with this form of TIA almost invariably have severe carotid occlusive disease and are at high risk of stroke. A patient with limb shaking TIAs is presented in whom the diagnosis was missed.
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Case Reports
Aortic root abscess presenting as unstable angina due to extrinsic compression of the left coronary artery.
Coronary ischaemia in acute endocarditis is usually due to pre-existing coronary disease or occasionally as a result of embolism from vegetations. A 68 year old man with known mixed aortic valve disease presented with a four week history of progressive exertional angina, which became unstable. He was apyrexial with no peripheral signs of endocarditis. ⋯ Coronary angiography showed severe proximal narrowing of the left anterior descending and circumflex arteries with an unusual long and tapering contour. Emergency surgery revealed a large anterior aortic root abscess which had destroyed the left and right coronary cusps. Aortic root abscess and other rare causes of extrinsic coronary compression are discussed.