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Myocarditis occasionally masquerades as acute myocardial infarction because patients may present with severe chest pain, electrocardiographic changes, and elevated serum levels of creatine kinase. In patients with normal coronary arteries who presumably died of acute myocardial infarction, myocarditis has been reported as an incidental abnormality at autopsy1–4. Although there have been anecdotal clinical reports of myocarditis mimicking myocardial infarction in patients with normal coronary arteries, this association has almost always relied on a demonstration of diffuse electrocardiographic abnormalities or a preceding viral illness in young patients with few coronary risk factors5–7. In most cases no definitive . . .

To determine its utility as an aid in diagnosis of renovascular hypertension, we administered nonapeptide converting-enzyme inhibitor (CEI) (which inhibits conversion of angiotensin I to angiotensin II) (0.25 mg per kilogram) to 14 unselected hypertensive patients undergoing bilateral renal-vein catheterization. In seven (Group I) predominantly unilateral disease was discovered by angiography (renal-artery stenosis in six and hydronephrosis in one); in the remaining seven (Group II) no rennal-artery abnormality was found. In Group I, mean (+/- S.E.) ratio of involved to uninvolved renal-vein plasma renin activity (PRA) increased from 2.94 +/- 0.91 before to 8.36 +/- 2.94 after CEI (P less than 0.01). In Group II, the ratio (of the initially higher to the lower side) was 1.99 +/- 0.49 before and 1.17 +/- 0.07 after CEI (P greater 0.02). Post-CEI PRA was predicted by pretreatment PRA. Mean blood pressure fell in both groups after CEI, and the decrement was predicted by pre-CEI PRA. These data suggest that CEI can be of use at the time of renal-vein catheterization, serving to increase diagnostic accuracy by increasing the difference in PRA between the two sides when there is unilateral disease.

Presentation of Case A fifty-seven-year-old man was admitted to the hospital for elective surgery. He had been well until one year before admission, when he had a febrile illness with a cough, shor...

CARDIAC arrhythmias are frequent, serious complications of acute myocardial infarction1 2 3 and are associated with a 7 to 17 per cent increase in mortality.2 , 4 The extent to which arrhythmias are a direct cause of death in acute myocardial infarction has been estimated from clinical and pathological studies,5 6 7 but there has been little electrocardiographic documentation of the immediate preterminal rhythms. Documentation of possible transient disturbances of rhythm before the terminal arrhythmias has also been limited. Availability of a continuous electrocardiographic monitoring device has made it possible to detect and document the arrhythmias that follow myocardial infarction. The cardiac rhythm of 30 patients . . .

Presentation of Case First admission. A fifty-two-year-old woman entered the hospital because of dyspnea. She had been well until the onset of exertional dyspnea, palpitation, orthopnea and peripheral edema two years previously. Treatment with a diuretic medication and digitalis caused symptomatic improvement, although she complained intermittently of pain beneath the left breast. Several months before admission, at a time of emotional strain, the pain became more frequent, and dyspnea and orthopnea recurred, with marked fatigue. One week before entry she was admitted to another hospital, where treatment resulted in only slight improvement, and she was transferred to this hospital. The . . .

ISONICOTINIC acid hydrazine is a drug remarkably free of toxic reactions at the dosage levels ordinarily employed. The most common side effects relate to Central-nervous-system hyperexcitability and peripheral neuropathy.1 Drug fever and jaundice are infrequently reported, only a few documented cases of each being found in the literature. However, these toxic reactions are not uncommonly associated with para-aminosalicylic acid administration.2 Since this drug is often given together with isonicotinic acid hydrazine, it is of some importance to point out that certain of the side effects of both drugs may be similar. It was noted in early animal experiments that long-term . . .

PRESENTATION OF CASE First admission. A sixty-seven-year-old woman was admitted to the hospital because of dyspnea. She had been well until thirty years previously, when she experienced an episode ...