Spontaneous pneumothorax in older people may arise from a number of causes which produce localised areas of emphysema or dilation of the airsacs. Rupture occurs spontaneously and is not related to straining at work or sport.
There is a sudden onset of chest pain, usually made worse by breathing, associated with shortness of breath. The symptoms are marked and often distress the victim so much he is convinced he has suffered a heart attack.
Examination by the doctor should provide the correct diagnosis and could be confirmed by an X-ray of the chest.
Small pneumothoraces may be left to resorb the air and allow the lung to re-expand. Larger ones will require drainage of the air.
This is achieved by inserting a rubber catheter or tube into the pleural space from the upper chest and connecting this tube to an underwater seal.
As the person breathes and coughs, the air is forced down the tube and bubbles out through the water, but the water rises in the tube and prevents more air from entering the pleural space.
In recurrent cases of spontaneous pneumothorax, it may be necessary to obliterate the pleural space to prevent recurrence.
This can be achieved by operation or instilling irritants into the pleural cavity to cause inflammation of the surfaces of the pleura so that they stick together.
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In some countries, the requirements for operation are not as stringent and surgeons are operating because the disease is present and amenable to operation, even if the patient is not greatly inconvenienced.
The patient’s age, general condition and occupation are all considered before operation. Several investigations may be necessary to establish the extent of the disease and which arteries are involved and where is the narrowed portion.
These investigations include an electrocardiogram (ECG) and chest X-ray. Echograms using ultrasound may show the outlines of the heart chambers.
Stress testing, where the person is exercised and monitored with cardiographs, may indicate not only the presence of artery disease, but also its extent. The most important investigation however, is the procedure of coronary angiography.
In this, a thin flexible tube or catheter is inserted into an artery in the arm or leg and pushed along until it enters the aorta. It is then guided into the opening of the coronary arteries.
A radio-opaque dye is injected through the catheter and flows along the coronary arteries. X-rays are taken and show the arteries and whether they are narrowed or blocked.
A bypass operation is major surgery, but the benefits are certainly greater than the risks.
Coronary artery bypass surgery is no longer experimental. It has an established place in the management of coronary artery disease and can be offered to selected patients as a means of reducing the severe effects of the disease and improving their chances of returning to full and productive life. It also holds the potential of increasing the lifespan of those with established disease in their coronary arteries.
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