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Patients may present with double vision or a drooping eyelid at the end of the day. Other facial muscles may be affected, resulting in difficulty in chewing, an abnormal smile, or nasal speech. In severe cases there may be difficulty in swallowing with the risk of aspirating food into the lungs and difficulty in breathing, due to weakness of the respiratory muscles, which can be life threatening if untreated. Not all muscle groups are affected in all patients, and the disease has a variable progression.

With ageing, body composition changes such that there is more body fat with respect to total body weight, and the proportion of body water falls. The importance of this is that highly lipid-soluble drugs, for example benzodiazepines, tend to have prolonged duration of action. Plasma protein concentration also falls with age.

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When used prophylactically, tolerance may develop to the vasodilator effects of nitrates. To avoid this, patients have to have drug free periods each day, when they know they are least likely to suffer and angina attack. Typical adverse effects include headache, postural hypotension and flushing, which often restrict the use of nitrates.

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This lowers blood pressure, reduces the work the heart has to do and improves oedema by encouraging the movement of fluid from the tissues into the circulation. Of the different types of diuretics, the ones used in cardiac failure and hypertension are thiazide diuretics and loop diuretics.

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