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The diagnosis of myocardial ischemia is not confine to the alteration of the RS-T segment and of the T wave. Conduction disorders at any level can be caused by the ischemia itself and contribute to the diagnosis, as well as the ventricular arrhythmias. On the other hand, conduction blocks do not hinder or hide the diagnosis of ischemia. The primary and secondary characteristics of the T wave and RS-T segment are discussed. The relevance of the knowledge of ventricular activation vectors in bundle branch blocks is shown, as well as their alteration in case of associated myocardial infarction. Emphasis is made on the importance of the deductive method in the electrocardiographic interpretation.

The electro-physio-metabolic bases of a new treatment of recent myocardial infarction directed to the cellular level and called "polarizing" are presented. The treatment consists of intravenous infusion of a 1000 ml. of 10 per cent glucose in water solution with added 40 mEq. of KCl and 20 units of regular insulin (G-I-K solution). The effects of this solution were studied both in dogs and in humans. 1.Electrophysiology. (a)Electrocardiographic morphology of the three zones of infarction. (b)Arrhythmias. (c)Activation in the area of the infarction. 2.Electrolytes.The intra- and extracellular K, Na and water was determined in the different zones of the infarction in the control and treated animals. 3.Macro- and microscopic morphology. The macro- and microscopic changes were studied in control and treated dogs after ligation of the anterior descending coronary artery. 4.Clinical study.The clinical and electrocardiographic evolution was compared in 25 control patients and in 25 patients treated with the polarizing solution administered continuously for three to seven days.The polarizing solution has shown favorable results in all instances.It is concluded that this type of treatment may be helpful in various cardiovascular conditions which are associated with aggressive agents. However, much experimentation will be necessary.

Acute anoxia was produced in 80 dogs under anesthesia with sodium pentobarbital. Respiration was maintained with a Palmer's pump through an endotracheal tube. The anoxia was produced by stopping the pump and occluding the endotracheal tube. Polarizing solution (glucose-potassium-insulin) was perfused in 40 of the animals, starting three hours prior to the anoxia. The remaining 40 dogs comprised the control group. Peripheral electrocardiograms, as well as electroencephalograms, were simultaneously recorded before and during the period of anoxia. Recordings were continuously obtained until no more than one ventricular complex in a ten-second period was observed, even though the electrical brain activity had disappeared by this time. Our present experimental work suggests the beneficial effect of polarizing solutions by delaying the anoxic degradation of the electrical phenomenon of the heart and the brain.