William J. Kostuk MD, FRCPC, FACC, FACP, Professor of Medicine, University of Western Ontario; Cardiologist, University Campus London Health Sciences Centre, London, ON.

Heart failure is the most rapidly rising cardiovascular condition in Canada. At times, the clinical presentation of heart failure may not make the diagnosis obvious. The diagnosis of heart failure should be considered when an older individual presents with complaints of exertional dyspnea or fatigue. In such individuals, the physician should not assume the symptoms are merely the result of age, obesity or chest disease. Physical examination and a few simple investigations,reviewed here, can be extremely helpful and may delay or even prevent the progression to symptomatic disease.
Key words: heart failure, diagnosis, dyspnea, fatigue, evaluation in older adults.

Robert J. Fingerote, MD, MSc, FRCPC, Consultant in Gastroenterology and Internal Medicine, Queensway Carlton Hospital, Ottawa, ON.

Primary biliary cirrhosis (PBC) is a disease of unknown origin that causes chronic liver injury. It has an insidious onset, is associated with slow progression and ultimately leads to liver failure and either death or liver transplantation. It is presumed to be of autoimmune origin, is frequently associated with other autoimmune disorders and typically affects middle-aged and elderly women. Patients may be asymptomatic at diagnosis or present with typical symptoms of fatigue, pruritus and jaundice. Although current therapy may slow the progression of disease, no therapy has yet been proven to arrest or reverse the disease process.
Key words: cirrhosis, fatigue, autoimmune, cholestasis, antimitochondrial antibodies.