Andrew Apps

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Chronic cough has a wide differential, of which thoracic aortic aneurysm is a rare but potentially devastating cause. We present a patient with previous aortic valve replacement for a bicuspid valve who had been suffering from a chronic cough for 8 months and who developed subsequent voice hoarseness. This had been initially managed in the community with(More)
BACKGROUND Primary percutaneous coronary intervention (PPCI) programmes vary in admission criteria from open referral to acceptance of electrocardiogram (ECG) protocol positive patients only. Rigid criteria may result in some patients with acutely occluded coronary arteries not receiving timely reperfusion therapy. OBJECTIVE To compare the prevalence of(More)
A 31-year-old female pharmacist of Nigerian origin, now resident in London, described 4 months of worsening left-sided subscapular pain despite the use of increasingly potent analgesia. She also described progressive dysphagia, first to solids and later to liquid foods. She remained systemically well, with no associated symptoms and normal physiological(More)
Primary cardiac lymphoma (PCL) is rare, accounting for 2% of all primary cardiac malignancies. Diagnosis is sometimes slow due to the non-specific nature of symptoms, causing a delay to treatment with potentially curative anthracycline chemotherapy. We report an unusual presentation of primary cardiac lymphoma in an immunocompetent man presenting with(More)
A patient taking regular flecainide for paroxysmal atrial fibrillation presented with broad complex tachycardia and circulatory compromise. With no history of pacemaker insertion and no pacing spikes visible on the ECG, this was presumed to be ventricular tachycardia and treated with electrical cardioversion, leading to p-wave asystole. An indwelling(More)