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Ten patients in sinus rhythm with symptomatic cardiac failure participated in a study investigating the value of digitalis at rest and during dynamic exercise. A haemodynamic profile and left ventricular ejection fraction were measured before treatment, after intravenous ouabain, and after six weeks of maintenance treatment with digoxin. There was no significant change in the haemodynamic profile or in the left ventricular ejection fraction at rest after either glycoside. During exercise there was a significant reduction in left ventricular filling pressure from 39 +/- 3 mm Hg to 34 +/- 3 mm Hg (p less than 0.05) after ouabain and to 33 +/- 3 mm Hg (p less than 0.02) after digoxin. Cardiac index improved from 33 +/- 0.3 1/min/m2 to 4.0 +/- 0.4 l/min/m2 (p less than 0.01) after ouabain and to 3.8 +/- 0.4 l/min/m2 (p less than 0.01) after digoxin. During exercise stroke volume index and stroke work index also improved significantly with both glycosides. This was accompanied by an increase in left ventricular ejection fraction from 29 +/- 2% to 36 +/- 3% (p less than 0.05) after ouabain and digoxin. In this study both intravenous ouabain and maintenance treatment with oral digoxin exerted a modest positive inotropic effect in patients with cardiac failure in sinus rhythm. The haemodynamic benefit, however, was manifest only during exertion.

A system was devised so that a peripheral hospital could transmit electrocardiograms (ECGs) to a central computer for interpretation. The link that transmits both ECGs and reports is provided by the telephone network. Initial results showed that telephone transmission did not significantly affect the accuracy of the ECG interpretation. The centralised computer programme could be much more widely used to provide ECG interpretations. A telephone link would not be justified in health centres, where the demand for ECGs is fairly small, but ECGs recorded at a health centre can be sent to the computer for interpretation and returned the next day. The most cost-effective method of providing computer interpretation for several health centres in a large city would be to have a portable electrocardiograph and transmission facilities, which could be moved from centre to centre.

The prehospital management of acute myocardial infarction by general practitioners and emergency-treatment service physicians was analysed in 53 patients. The correct clinical diagnosis was made or suggested before admission in 47 patients. Only 25 patients received analgesics from the general practitioner, and 32 were still in pain and needed diamorphine on admission to hospital. Only one patient received antiarrythmic treatment. The findings suggest that, despite accurate clinical diagnosis of acute myocardial infarction, deficiencies exist in the prehospital phase of management and that education programmes are worth consideration.