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The two current criteria for diagnosis of left anterior fascicular block (LAFB) were evaluated; they are marked left axis deviation (LAD) and a delay in the time of inscription of the intrinsicoid deflection (ID) in lead aVL asynchronous to V6. From 400 electrocardiograms with a LAD of --30 degrees or greater, 62 percent showed asynchronous activation of the left ventricle. There was only a general relationship between the degree of LAD and delayed ID in aVL. The incidence of delayed ID in aVL was as follows: 2 percent with mean frontal QRS axis at 0 degrees; 9 percent at --15 degrees; 41 percent at --30 degrees; 69 percent at --45 degrees; 82 percent at --60 degrees; and 100 percent at --75 degrees or greater. The lack of correlation between both criteria in many instances questions their validity. The LAD alone should not be considered synonymous with LAFB. Recognition of delayed inscription of the ID in aVL is a useful supplemental criterion for diagnosis.

A new radiologic index indicative of pulmonary artery hypertension is presented. It was obtained by measuring the horizontal distances from the midline to the first divisions of the right and left pulmonary arteris, and dividing the sum of these distances by the maximum transverse diameter of the thorax. The index was significantly different in groups with and without pulmonary hypertension and was abnormal (above 38 percent in 111 of 150 patients with cardiovascular disease and pulmonary arterial hypertension (PAH). None of the cases with increased pulmonary flow from cardiac shunts but normal PAP had an anbormal index. Thus, an abnormal index suggested PAH but correlated poorly with the extent of hypertension.

Two cases, a sixteen-month-old girl and a 13 year-old bol, were presented who developed myocardial infarction as a consequence of angiocardiographic study. The boy (case 1) showed electrocardiographic signs of lower necrosis with elevation of the TGO and DHL and having a satisfactory clinic evolution. The girl (case 2), in the electrocardiogram, showed an inactivatable zone on the lateral wall and signs suggesting anteroseptal subendocardic necrosis, and enzymatic elevation. She died the fourth day following the hemodynamic study. The literature regarding this complication and the possible triggering causes are reviewed.

Although pulmonary artery disease in Takayasu's arteritis has been described since 1940, it has received little attention. The clinical, hemodynamic, and angiographic features of the pulmonary involvement were studied in 22 patients with systemic arterial disease. Pulmonary involvement was found in 50 percent of the cases. Moderate pulmonary hypertension was a common finding (73 percent). Lesions were generally localized to the large and medium pulmonary vessels. None of the patients had pulmonary symptoms, but in 63 percent there were clinical, radiologic and electrocardiographic findings suggesting pulmonary hypertension or right heart strain. We believe that the pulmonary circulation should be routinely studied in patients with Takayasu's arteritis and that pulmonary involvement should be included in the classification of the disease.