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What medicine lacks in an increasingly specialised world is the medical polymath (or should it be medical bimath?) - the man who is an acknowledged expert in more than one field of medicine. Super
pecialisation in the professional sense is an attempt to know more and more about less and less. It can be the microscopist's view of reality and such a microcosm can become also a refuge from realities. One reality difficult for the very specialised doctor to accept is that diseases don't exist. Only people with diseases exist and people do not always conform to convenient categories and compartments. It would be nice if they did but somehow they never do. A cherished medical tradition in Britain is that specialists are not hatched straight from medical schools. Indeed, young doctors are actively discouraged from taking too narrow an interest but are plunged for at least four years into the unspecific pool of general medicine until they have developed a broad awareness of the totality of human disease. Before this they are not allowed to narrow their sights on one particular target.

Rheumatic Diseases and the Heart

1 Rheumatic Fever.- History.- Aetiology.- Incidence and Epidemiology.- Rheumatic Fever in the Third World.- Immunopathology.- Morbid Anatomy.- Clinical Features.- Investigations.- Diagnosis.- Treatment.- References.- 2 Rheumatic Heart Disease I.- Incidence.- Pathology.- General.- Valve Lesions.- Myocardium.- Pericardium.- The Lungs.- Natural History.- Mitral Valve Lesions.- Mitral Stenosis: Haemodynamics.- Mitral Stenosis: Clinical Effects.- Mitral Incompetence: Haemodynamics.- Mitral Incompetence: Clinical Effects.- Aortic Valve Lesions.- Aortic Incompetence: Haemodynamics.- Aortic Incompetence: Clinical Effects.- Aortic Stenosis: Haemodynamics.- Aortic Stenosis: Clinical Effects.- Tricuspid and Pulmonary Valves.- The Myocardium.- References.- 3 Rheumatic Heart Disease II.- Symptoms.- Complications.- Arrhythmias.- Pulmonary Embolism.- Systemic Embolism.- Infective Endocarditis.- Diagnostic Procedures.- Radiology.- Electrocardiography.- Echocardiography.- Angiocardiography.- Differential Diagnosis.- Prognosis.- Medical Management.- Surgical Management.- References.- 4 Infective Endocarditis.- Aetiology.- Pathology.- Immunology.- Clinical Features.- Classification.- Clinical Effects.- Musculoskeletal Symptoms.- Diagnosis.- Treatment.- Prophylaxis.- References.- 5 Rheumatoid Arthritis: Rheumatoid Heart Disease I: Pericarditis.- Immunology.- Pathology.- The Synovium.- Nodules.- Vasculitis.- Clinical Features.- Arthritis.- Extra-articular Lesions.- Pleurisy.- Rheumatoid Heart Disease.- Summary.- History.- Pericarditis.- Incidence.- Pathology.- Clinical Features.- Diagnosis of Pericarditis.- Treatment of Pericarditis.- Complications of Pericarditis.- References.- 6 Rheumatoid Heart Disease II: Valve Lesions, Heart Block, Juvenile Arthritis.- Valve Lesions.- Incidence.- Pathology.- Clinical Features.- Diagnosis.- Treatment.- Heart Block.- Incidence.- Pathology.- Clinical Features.- Diagnosis.- Treatment.- Myocarditis.- Coronary Arteritis.- Juvenile Arthritis.- Pericarditis.- Valve Lesions.- Adult Still's Disease.- References.- 7 Systemic Lupus Erythematosus.- Prevalence.- Immunopathology.- Autoantibodies.- Aetiology.- Vasculitis.- Pathology.- Drug-Induced SLE.- Overlap Syndromes.- Clinical Features of SLE.- General.- Musculoskeletal Symptoms.- Renal Symptoms.- Neuropsychiatry Symptoms.- Cutaneous Lesions.- Haematological Changes.- Pleural and Pulmonary Symptoms.- Cardiac Features.- Pericarditis.- Incidence.- Pathology.- Clinical Features.- Complications.- Diagnosis.- Treatment.- Valve Lesions.- General.- Incidence.- Pathology.- Clinical Features.- Diagnosis.- Treatment.- Myocarditis.- Incidence.- Pathology.- Clinical Features.- Diagnosis.- Treatment.- Heart Block.- Adult Form.- Congenital Form.- Coronary Arteritis.- Hypertension.- Pulmonary Hypertension.- References.- 8 Ankylosing Spondylitis and Reiter's Disease.- Seronegative Spondylarthropathy and HLA-B27.- Seronegative Spondylarthropathy.- HLA-B27.- Reactive Arthritis.- Ankylosing Spondylitis.- Description.- Prevalence.- Pathology.- Causation.- Cardiovascular Lesions.- Reiter's Disease.- Description.- Prevalence.- Pathology.- The Heart.- The Aortic Lesion.- Historical.- Description.- Pathology.- Prevalence.- Clinical Features.- Treatment.- Heart Block.- Description.- Pathology.- Prevalence.- Clinical Features.- Electrophysiology.- Other Spondylarthropathies.- Psoriatic Arthropy.- Inflammatory Bowel Disease.- Behcet's Syndrome.- References.- 9 Systemic Sclerosis.- Scleroderma.- Visceral Lesions.- The CREST Syndrome.- Mixed Connective Tissue Disease.- Prevalence and Course.- Diagnosis.- Pathology.- Immunology.- The Heart in Systemic Sclerosis.- Pericardium.- Myocardium.- Valve Lesions.- Electrocardiographic Abnormalities.- Left Ventricular Hypertrophy.- Pulmonary Hypertension.- Treatment.- Scleroderma.- Cardiovascular Lesions.- References.- 10 Miscellaneous Conditions.- Giant Cell Arteritis and Polymyalgia Rheumatica.- Giant Cell Arteritis (GCA).- Polymyalgia Rheumatica (PMR).- Aetiology.- Pathology.- Immunology.- Cardiovascular Lesions.- Diagnosis.- Treatment.- Polyarteritis Nodosa.- Aetiology.- Pathology.- Clinical Features.- Diagnosis.- Treatment.- Takayasu's Disease.- Clinical Features.- Pathology.- Management.- Polymyositis and Dermatomyositis.- Polymyositis.- Dermatomyositis.- Behcet's Syndrome.- The Syndrome.- Cardiovascular Lesions.- Relapsing Polychondritis.- Description.- Pathology.- Heart and Aorta.- Treatment.- Inherited Disorders of Connective Tissue.- The Hypermobility Syndrome and Mitral Valve Prolapse.- The Hypermobility Syndrome.- Mitral Valve Prolapse.- Treatment.- Lyme Disease.- Description.- Pathology.- The Heart.- Treatment.- Atrial Myxoma.- Clinical Features.- Management.- References.