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Cardiovascular disease is a major clinical problem in the elderly, with coronary heart disease the most frequent cause of death and with hypertension present in as many as 50% of these patients. The cardiovascular manifestations of aging must be differentiated from those due to disease. There are clinical manifestations and responses to therapy in the elderly that differ from those in younger patients. The extent of diagnostic and therapeutic procedures undertaken should be based on the patient's physiologic age, the presence and severity of concomitant diseases, mental status and cognitive ability, and the patient's expectations from medical care. Preventive approaches are also warranted. [ABSTRACT FROM AUTHOR]

Assesses the effects of oral propranolol and digoxin alone and in combination on angina frequency, heart size, systolic time intervals and treadmill exercise tolerance in 20 patients with coronary heart disease. Treatment for patients with angina pectoris; Statistical data on heart rate recorded during the treatment periods.

Presents several letters to the editor on topics related to internal medicine. Clindamycin-associated colitis; Significance of the goal of improved early detection of prostatic cancer; Platelet function in lupus erythematosus.

Fifty-three consecutive patients with inferior myocardial infarction were evaluated prospectively, by physical examination and right heart catheterization within 36 hours of the onset of symptoms, to determine whether physical findings can separate such patients into those with and without associated right ventricular infarction. Hemodynamic findings consistent with right ventricular infarction were defined as right atrial pressure of 10 mm Hg or greater and a right atrial: pulmonary artery wedge pressure ratio of 0.80 or greater. Eight patients (Group 1) had hemodynamic evidence of right ventricular infarction, whereas 45 patients (Group 2) did not meet these criteria. Group 1, compared with Group 2, had a lower cardiac index (1.8 +/- 0.3 versus 2.6 +/- 0.6 L/min X m2, p less than 0.001), and a lower right ventricular stroke work index (4.1 +/- 3.6 versus 7.3 +/- 3.2 g X m/m2, p less than 0.05). An elevated jugular venous pressure of 8 cm H2O or more was seen in 7 of 8 Group 1 and 14 of 45 Group 2 patients (p less than 0.01). In addition, a Kussmaul's sign, substantiated by hemodynamic findings, was seen in all 8 Group 1 and in no Group 2 patients (p less than 0.001). The absence of both an elevated jugular venous pressure and a Kussmaul's sign in patients with inferior myocardial infarction makes the presence of a hemodynamically significant right ventricular infarction highly unlikely. [ABSTRACT FROM AUTHOR]

Presents a study that evaluated patients with predischarge and six-week post myocardial infarction treadmill exercise tests to determine the importance of repeat tests to identify abnormalities of known prognostic value. Background on the safety and feasibility of modified treadmill exercise testing before hospital discharge after myocardial infarction; Analysis of individual variability of treadmill abnormality responses; Results and implications.

Presents letters to the editors related to internal medicine. Importance of knowing the relation of interval between stopping aspirin therapy and having surgery with postoperative bleeding in patients; Assessment of the severity of aortic stenosis; Opinion on an article regarding ambulatory electrocardiography.

To assess the value of continuous ambulatory electrocardiogram (ECG) monitoring for detecting coronary artery disease in symptomatic patients, we evaluated 70 patients with chest pain and normal resting ECGs prospectively by calibrated ambulatory monitoring, graded treadmill exercise, and selective coronary cineangiography. Ischemic-type ST-wave changes were detected by monitoring in 24 of the 39 patients with coronary artery disease (62% sensitivity). Twenty-six of the 39 patients had a positive treadmill (67% sensitivity). Of the 31 patients without coronary disease on angiography, 19 had negative monitoring studies (61% specificity). The treadmill was negative in 23 of these 31 patients (75% specificity). When the results of both tests were combined, 85% of the cases of coronary artery disease were detected, but only 52% of the patients without disease had negative studies. We conclude that continuous ambulatory monitoring is of limited value for detecting or excluding coronary artery disease in symptomatic patients with normal resting ECGs. [ABSTRACT FROM AUTHOR]

Describes several cases of patients in whom endocarditis have been verified at autopsy hade the pathogegenic organism isolated from aspirates of Osler's nodes. Details on the case histories; Discussion on the cases.

Transient arterial occlusion of both arms with blood pressure cuffs inflated to 20 to 40 mm Hg above systolic pressure for 20 seconds augmented the intensity of left-sided regurgitant murmurs caused by aortic regurgitation, mitral regurgitation, and ventricular septal defect. We compared this new maneuver with handgrip exercise, squatting, and amyl nitrite inhalation in 30 patients with left-sided regurgitant murmurs and in 30 patients with murmurs not caused by left-sided regurgitation. Transient arterial occlusion increased the intensity of left-sided regurgitant murmurs more than squatting (p = 0.02) and did not statistically differ from isometric handgrip exercise and amyl nitrite inhalation in ability to identify the presence of these murmurs. A false-positive diagnosis of left-sided regurgitant murmur was less likely when using transient arterial occlusion than when using handgrip exercise (p = 0.05) and squatting (p less than 0.001). Thus, transient arterial occlusion works as well as or better than other standard bedside maneuvers for diagnosing or excluding left-sided regurgitant murmurs and can be applied to all patients. [ABSTRACT FROM AUTHOR]

Objective data on the reliability of precordial palpation in detecting left ventricular enlargement are scarce. Therefore, we evaluated 41 patients by physical examination and two-dimensional echocardiography to determine the relation between the location of the apex and left ventricular end-diastolic volume. An apical impulse lateral to the mid-clavicular line or greater than 10 cm from the mid-sternal line was sensitive but not specific as an indicator of left ventricular enlargement. In patients without left ventricular hypertrophy, an apical diameter greater than 3 cm in the left lateral decubitus was sensitive (92%) and specific (91%) for an enlarged left ventricle. The positive and negative predictive values were 86% and 95% respectively. Therefore, the location of the apical impulse in relation to the mid-clavicular line or the mid-sternal line is not a reliable indicator of increased left ventricular end-diastolic volume. However, an apical impulse greater than 3 cm may be an accurate indicator of left ventricular enlargement. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the efficiency of percutaneous transluminal coronary angioplasty in the 1970s. Use of the method in the dilatation of stenotic coronary arteries; Potential advantages of the method; Considerations in the use of the method.