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A psychiatric assessment was carried out before operation, and at three months and 12 months after operation, in 77 men undergoing coronary artery bypass graft surgery. Neither psychiatric assessment before the operation nor perioperative surgical assessment could predict the physical outcome of surgery. The physical results of surgery were good, but there was a 20% decrease in the number of patients who were in employment after the operation. Abnormally high scores on measures of anxiety and depression were present in about 50% of patients before the operation, and in about one‐third of patients after the operation. Impairment in various aspects of personality‐functioning since surgery was reported by 7%–29% of patients. These complaints were not correlated with the surgical result. Attention is drawn to this area of persisting postoperative morbidity.

Mitral valve prolapse is a relatively common condition in the general population. The syndrome appears more common in females, and is often associated with a family history. Patients may be asymptomatic or may present with a variety of symptoms ranging from mild chest aches and anxiety to severe angina‐like chest pain, palpitations and dizziness. The common auscultatory features include mid‐systolic clicks and a late systolic murmur, either alone or in combination. The wide spectrum of symptoms and signs may be explained by ventriculovalvular disproportion, where either the ventricle is too small for the valve, or the valve is too large for the ventricle. The long‐term prognosis is very good; severe mitral regurgitation can occasionally develop, but both sudden death and bacterial endocarditis are rare. No treatment is required for asymptomatic patients, beyond antibiotic cover for dental procedures and surgery.

Verapamil administered by the intravenous route restored sinus rhythm in 33 out of 40 episodes of supraventricular tachycardia. The drug was also effective in reducing ventricular rate in patients with atrial fibrillation. Intracardiac conduction studies using His bundle electrograms showed prolongation of atrioventricular nodal conduction in eight out of nine cases after 5 mg of verapamil were given. The distal conduction was unaffected. Bradycardia and hypotension occurred in two cases and responded promptly to Intravenous administration of atropine. Verapamil Is an effective antiarrhythmic agent which is, In general, free from significant side effects.

Twenty‐five patients entered a prospective study to assess the usefulness of atropine and lignocaine autoinjectors for coronary events after discharge from hospital after a definite, complicated myocardial infarction. They were selected on the basis of being at high risk of sudden death and reinfarction, being less than 70 years of age and being able to maintain a close liaison with the hospital. One or both autoinjectors were used for five reported events (four of collapse, one of chest pain) in four patients, with possible benefit in two instances. Six patients collapsed and died, despite the use of autoinjectors in three of their fatal collapses. In our experience, the use of autoinjectors has been of little observable benefit, perhaps due to the lack of specific warning symptoms preceding the onset of lethal arrhythmias, so that the injectors were often used for unobserved collapses when the chances of survival were remote.