A detailed history is essential in patients with coronary artery disease (CAD) to elucidate red flag symptoms necessitating urgent specialist assessment. Red flags include syncope and presyncope, particularly in patients with concomitant left ventricular systolic dysfunction. Palpitations with severe chest pain and breathlessness also warrant urgent assessment. Undiagnosed atrial fibrillation (AF) is common in older populations. LVEF of 35% or less is a predictor of increased risk of sudden death. All patients with CAD should therefore undergo assessment of LVEF, usually by transthoracic echocardiography.

Heart disease in children and adolescents can be congenital, in which structural defects of the heart and major blood vessels are present from birth, acquired, whereby disease develops during life, or genetic, including diseases affecting the heart muscle, electrical system or the aorta. The incidence of congenital heart disease has decreased over the past 30 years, with approximately 1 in 180 babies born with congenital heart disease in the UK each year. Several cardiac diseases are genetic and can manifest in childhood. Most are primary cardiomyopathies, ion channel diseases, coronary artery disease from familial hypercholesterolaemia or aortopathies.

In general practice palpitations are reported in around 8 per 1,000 persons per year. The differential diagnosis includes cardiac and psychiatric causes, as well as numerous others e.g. anaemia, hyperthyroidism, prescribed medication, caffeine and recreational drugs. Factors that point towards a cardiac aetiology are male sex, irregular heartbeat, history of heart disease, event duration > 5 minutes, frequent palpitations, and palpitations that occur at work or disturb sleep.

During the Siege of Paris wounds were of exceptional gravity. Older surgeons, who had had much experience in wars, admitted that the wounds during the siege were of unexampled and unprecedented fatality. In cases I had observed a violent contusion of the marrow extending very high up; it was obvious to me that this marked injury was of immediate origin. At the same time, the bones themselves presented the most serious lesions; there was splitting and splintering of the bone, extending as high up as the great trochanter, for instance, in cases of fractured femur. Amputation was, at the beginning, universally employed. The results were disastrous, the mortality was absolute and general. Most strenuous exertions were made by Paris surgeons, and were much insisted on by myself, in the direction of conservative surgery in wounds which engaged the bones, and particularly the femur.

The general practitioner  is often puzzled to know how to deal with a case in which suicide is frequently threatened,  but, provided his diagnosis of an anxiety neurosis is correct, it is probably better to treat these cases by psychotherapeutic methods, and take the slight risk of suicide than adopt such a course as warning and consequently scaring the relatives, or advising a constant attendant or admission to an institution, for such steps are often productive of more harm than good. On the other hand, in manic depressive conditions and paranoia, the risk of suicide is real and ever present. Too great watchfulness cannot be exercised, and such patients should only be sent to institutions for the treatment of mental diseases where the condition is fully understood and effective precautions are taken; for it is remarkable what cunning will be displayed, even by an apparently stuporous melancholic, to elude the vigilance of his attendants and seize an opportunity to kill himself.