Ayurveda is a traditional medicine native to India but is used in many parts of the world as an alternative or adjunct to standard medicine. Preparation can involve incorporation of heavy metals, including lead. We report the case of a 64-year-old man presenting with malaise, abdominal pain, anaemia and very high lead levels. He was found to be taking ayurvedic medicines to help his diabetic control. Analysis of the ayurvedic medications showed several with very high lead content. Following treatment with an oral chelating agent, the patient's symptoms and blood abnormalities resolved. This case highlights the need to be aware of potentially toxic alternative medications patients take and the efficacy of oral treatment choices in lead poisoning.

Aim: To review the presenting characteristics of myocarditis patients and the significance of ST-elevation (STE) on ECG in a New Zealand DHB population.Method: Retrospective review of clinical records of patients >15 years old with a confirmed or suspected diagnosis of myocarditis at Waitemata DHB 2007-2016.Results: Over 10 years, 178 patients had a diagnosis of myocarditis. Most were male (71%) with a distribution to younger age groups (median age 39). Men were significantly younger than women (37.5 vs 50.9 years, p < 0.05). Ethnicity was concordant with the demographics of Waitemata DHB; Europeans (69%), Maori (12%), Pacific Islanders (10%). Presenting symptoms included chest pain (73%), dyspnoea (32%) and fever (25%). Men had both higher presenting troponin I levels (5938 ng/L vs 3307 ng/L, p < 0.05) and maximum troponin I levels (8661 ng/L vs 3946 ng/L, p < 0.05) than women.Eighty-one patients had ECG changes: 59% STE, 6% STdepression and 35% other changes. Patients with STE were more likely than those with non-STE to be male (85% vs 66%, p < 0.05), younger (mean age 35.4 vs 43.5 years, p < 0.05) and to have chest pain (94% vs 65%, p < 0.05). Patients with STE had higher troponin I levels both on presentation (8537 ng/L vs 3931 ng/L, p < 0.05) and at peak (13313 ng/L vs 5067 ng/ L, p < 0.05). STE and non-STE groups had similar rates of coronary angiography (48% vs 47%), echocardiography (83% vs 92%), and cardiac MRI (54% vs 52%) (p = ns for all).Conclusion: There was an apparent predilection for males, and the gender differences in presenting symptoms and biomarker elevation were unexpected. The usage rates of invasive and non-invasive imaging were not affected by the presence of STE. Further study is warranted to review the outcomes in these groups of patients.

Western NSW radiology practices have previously reported high levels of coronary artery calcification scores (2000-4600)