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A case of rhabdomyosarcoma of the right atrium is presented. Fits of dyspnoea and cyanosis, provoked by postural changes, and pulmonary embolism were the most typical symptoms. Abnormal features were: the long history and the unspecific findings at auscultation and x-ray examination. Histologically the part of the tumour contiguous with the atrial wall was composed of fairly well differentiated rhabdomyoblasts, while the part protruding into the atrium was anaplastic and necrotic. There were multiple pulmonary emboli, which originated from the anaplastic part.

Data are presented on patients referred for ambulatory ECG recording because of syncope or dizziness during a 2-year period. Of the 272 consecutive patients subjected to the recording, 107 (39.3%) had syncope or dizziness as the main indication for referral. Sixteen of these patients (14.9%) experienced the presenting symptom during the recording, and in 8 (50%) of these the simultaneous ECG finding was interpreted as causative. In patients who were symptom-free during the recording, sinus arrests exceeding 2.5 seconds seemed to be a valuable finding to support the cardiac aetiology of the syncopal symptoms, whereas the diagnostic value of second degree AV block with either Wenckebach or Mobitz II like patterns, as such, and of ventricular tachycardia remained mostly unsettled.

The response of peripheral venous plasma angiotensin II (A-II) to upright posture combined with an injection of furosemide was higher in patients with hypertension and associated renal parenchymal disease, renal artery stenosis or malignant hypertension than in patients with essential hypertension and normotensive control patients. Very low responses to the same stimuli were observed in primary aldosteronism. Markedly increased A-II levels were measured in the renal veins of the affected kidneys in hypertensive patients with associated unilateral renal parenchymal disease or renal artery stenosis, suggesting that human kidneys contain considerable converting enzyme activity. Plasma A-II levels were normalized in three patients with primary aldosteronism after removal of an adrenal adenoma and in one patient with malignant hypertension after bilateral nephrectomy and renal transplantation.

The antihypertensive and biochemical effects of 25 mg hydrochlorothiazide alone or 50 mg hydrochlorothiazide alone or in combination with triamterene (either 37.5 or 75 mg) once daily were studied in 26 patients with essential hypertension. After a 5-week run-in period the patients were randomized to receive active therapy in a cross-over manner. Each treatment period lasted 3 months. All drugs significantly (p less than 0.01) lowered both systolic and diastolic blood pressure. There were no differences in blood pressure between the medication periods. Serum potassium concentration was slightly lower during all medication periods than during the run-in period. This change was statistically significant (p less than 0.01) only on 50 mg hydrochlorothiazide daily. There were no significant changes in serum magnesium during any of the periods compared to the run-in period. The lowest values were recorded on 50 mg hydrochlorothiazide alone and the highest on 50 mg hydrochlorothiazide plus 75 mg triamterene daily. A slight increase in serum urate was recorded in all medication periods compared to the run-in period. No significant changes were observed in serum total cholesterol, HDL cholesterol or triglycerides between any of the periods. It can be concluded that 25 mg of hydrochlorothiazide is as effective in lowering blood pressure as higher doses of the diuretic. Higher doses of thiazides will in some patients cause adverse metabolic reactions of which the fall in serum potassium and magnesium is effectively hindered by triamterene.

A total of 38 patients aged 61 to 89 years, mean age 72 years, were treated with the β-adrenergic blocking agent, alprenolol, in a dosage of 400 mg daily for three months. Blood pressure decreased significantly. While the systolic blood pressure decreased to a greater extent during the first week of treatment, the diastolic pressure declined continuously. A significant decrease of heart rate occurred. After one week's treatment signs of congestive heart failure appeared in three patients and were compensated by digitalis in two cases. In one case treatment with alprenolol had to be interrupted. No signs of heart failure after alprenolol appeared later during the treatment. The concomitant use of alprenolol with digitalis, diuretics or oral hypoglycemic agents did not cause any negative interaction.

The efficacy and safety of gemfibrozil in treating dyslipidaemias was investigated in a 5-year follow-up study of 254 patients with primary dyslipidaemias. Most were middle-aged males of type IIA or IIB. A significant correction of serum lipid level was seen in about 90% of dyslipidaemias, irrespective of the type. It was not possible to find a clear cause for non-responsiveness, although cirrhosis of the liver was suggested in some cases. Overall, gemfibrozil decreased serum total cholesterol by 16% LDL cholesterol by 23% and the triglyceride level by 40%; HDL cholesterol rose by 23% and HDL cholesterol as percentage of total cholesterol from 14.3% to 20.8% to approach the value of matched controls in the population without dyslipidaemia (24.2%). Side-effects were few. Among the treated subjects the observed number of myocardial infarctions was much less (4 vs 14) than expected. This by no means proves that gemfibrozil will prevent myocardial infarction, but is evidence to support that raising HDL and lowering LDL may give clinical benefit in the prevention of coronary heart disease. A more substantial primary prevention study in a population of patients at high risk, i.e. middle-aged males with dyslipidaemia, is warranted.

The relative efficacies of potassium chloride, amiloride, triamterene and spironolactone in maintaining potassium balance were studied in 40 patients with essential hypertension receiving diuretic therapy. The preparations were administered in random order in a cross-over manner. In 31 patients treated with 50 mg hydrochlorothiazide daily, addition of 1500 mg potassium chloride daily was the weakest and 50 mg spironolactone daily the most effective agent for maintaining serum potassium. Amiloride (5 mg daily) and triamterene (75 mg daily) were less effective and equally so. Similar results were obtained with 9 patients treated with double dosages of the diuretic and supplements. Despite changes in serum potassium, total body potassium remained constant throughout the trial.

Five hypertensive patients with left ventricular hypertrophy and minimal pulmonary signs of left-sided heart failure were treated for five weeks with oral Trasicor®, a new beta-adrenergic blocking agent. During the course of the treatment the basal arterial pressure in the upright position declined very slightly. Haemodynamic studies were performed at rest and during submaximal supine exercise before and during beta blockade. Negative chronotropic action on the heart was obvious. Whether the drug had any negative or positive inotropic effects on the heart remained uncertain, because of inconsistent haemodynamic changes and because of the relatively profound reflex and autoregulatory alterations in left ventricular performance induced by exercise.

Cardiac rhythm during sleep was analysed in 168 healthy men aged 19 to 30 (mean 21.8) years using continuous nocturnal ECG recordings. Thirty five of the subjects were endurance athletes; 99 were recorded at home and 69 at a garrison during military service. The number of short term (less than one min) accelerations of heart rate of more than ten beats per minute ranged from 1.3 to 14.3 per hour; the number or accelerations (greater than one min) of more than 25 beats per minute typical of nocturnal restlessness ranged from zero to 6.1 per hour. The accelerations indicating nocturnal restlessness were more common during recordings done at the garrison than at home (2.2 per hour vs 1.3 per hour, P less than 0.01), whereas the short term accelerations were not (5.8 per hour vs 5.1 per hour, NS). Sinus pauses exceeding 2.00 sec occurred in 17 men (13 in athletes), occasional second degree atrioventricular block in 19 (eight in athletes) and ventricular premature beats in 37. Eighty-two per cent of sinus pauses, 83% of second degree atrioventricular blocks, and 81% of ventricular premature beats (when less than ten in the same subject) were associated with short term changes in heart rate. In conclusion, rapid changes in heart rate, presumably as a results of autonomic activation, are closely associated with most arrhythmias in healthy men during sleep, whereas changes in heart rate typical of nocturnal restlessness have little arrhythmogenic effect.

A case of the Romano-Ward syndrome in a 26-year-old woman is reported. The patient presented on account of recurrent ep sodes of syncope. The electrocardiogram showed a grossly abnormal T-U-wave complex producing apparent great prolongation of the Q-T interval. This was mostly due to fusion of the abnormally prominent U wave with the T wave. Hemodynamic studies showed normal structure and function of the heart, which, however, was exceptionally liable to develop ventricular tachycardia and fibrillation.

Following administration of 0.15 mg of 17α-ethynyl-oestra-1, 3, 5 (10)-triene-3, 17β-diol 3-methyl ether (=Mestranol) +5 mg of 17α-ethynyl-oestr-4-ene-17β-ol (=Lynestrenol=Orgametril, Organon) (both components=1 tablet of Lyndiol, Organon) daily to 16 postmenopausal women for 2 weeks significant increases in serum transaminases, copper, non-coeruloplasmin copper, coeruloplasmin, γ-glutamyl peptidase and α1-globulins were noted. When treatment with 0.15 mg of the oestrogen was continued for another two weeks a significant decrease of serum albumin was noted as compared with the pretreatment level and the total copper, coeruloplasmin, and α1-globulin values continued to increase. When, in another group of subjects, the Mestranol+Lynestrenol treatment was followed by treatment with 5 mg of the progestogen for two weeks, the albumin value did not decrease and the copper, coeruloplasmin, α1-globulins, and γ-glutamyl peptidase values remained unchanged. However, in the group treated with Mestranol + Lynestrenol...

Liver-function tests were studied in 40 postmenopausal women receiving synthetic steroids. 10 received .15 mg mestranol daily 10 received 5 mg lynestrenol 10 received .05 mg 17alpha-ethinyl estradiol and 10 received 4 mg megestrol acetate daily. In the 2nd phase of the test the estrogen groups had the progestin compound added and the progestin group had the estrogen added. However 4 serious thromboembolic phenomena during this phase and therapy was discontinued. The subjects were aged 52-78 years and used no drugs known to produce intrahepatic cholestasis. Laboratory tests included serum total bilirubin thymol turbidity alkaline phosphatase serum asp artate transaminase serum alanine transaminase serum cholesterol prothrombin index and bromsulphthalein retention (BSP). All tests were normal with ethinyl estradiol; 1 of the 10 showed slight BSP retention increase when megestrol acetate was added. In 5 of 9 treated with mestranol there developed increased BSP and in 1 of this group elevated serum transaminases levels occurred. 8 of the 10 lynestrenol women showed increased BSP retention. When treatment was continued with the combination of lynestrenol-mestranol BSP retention increased still further in the 4 of 6 women still in the study and in this group serum transaminases were most clearly elevated.

To assess the effects of angiotensin-converting enzyme inhibition with quinapril on blood lipid profile, serum total cholesterol and triglycerides, together with high-density and low-density lipoprotein cholesterol were analysed in 23 hypertensive patients receiving either placebo (7 patients) or quinapril hydrochloride (16 patients). After 12 weeks of therapy there were no significant changes in blood lipids in either group. No unfavourable changes in blood lipid profile were observed even after 1 year of therapy with quinapril hydrochloride in 13 patients.

One hundred and four digitalized patients with chronic heart failure (71 females, 33 males, mean age 62 years) earlier treated with diuretics were administered 50 mg hydroclorothiazide b.i.d. for six weeks. Serum potassium and magnesium values and ECG were followed throughout the study. Total body potassium was determined at the end. Serum potassium fell below 3.6 mmoll-1 in 46% of the patients during the treatment. Hypokalemia (S-K ≤ 3.5 mmoll-1) was more common in females, in patients with initially low potassium values and in patients with a simultaneous concomitant decrease in serum magnesium values. The ECG-changes and symptoms of defective potassium balance were attributable to serum potassium rather than to total body potassium. There were no differences in total body potassium nor in the daily dietary intake of potassium and magnesium between normokalemic and hypokalemic patients. The daily dietary intake seems sufficient to maintain normokalemia if a patient has no tendency to develop hypokalemia. On the other hand, subjects prone to hypokalemia should be administered potassium supplementation or potassium sparing agents. Some patients seem to require magnesium supplementation, too, in order to maintain their potassium balance.

The occurrence of ventricular arrhythmias during exercise testing, jogging, and sedentary life with and without preceding exercise was studied with the aid of ambulatory electrocardiographic monitoring in healthy physically active men, healthy sedentary men, and men with previous myocardial infarction (15 men in each group). Ventricular premature beats of the same grade were found during exercise testing and jogging in ten of the 15 healthy physically active men, in ten of the 15 healthy sedentary men, and in eight of the 15 men with previous myocardial infarction. When unifocal ventricular premature beats were omitted, the corresponding figures were 14/15, 11/15, and 15/15, respectively. Healthy physically active men had less ventricular arrhythmias in all of the tested situations. The greatest number and also the highest grades of ventricular arrhythmias during the exercises were found in healthy sedentary men, whereas the men with previous myocardial infarction had ventricular arrhythmias more during sedentary life.

The effect of upright posture on radioimmunologically measured venous plasma angiotensin II was studied in healthy volunteers, using active (continuous walking) and passive (head-up tilting) types of upright posture. Blood samples were drawn 1, 3, 10, 30 and 90 minutes after assumption of an upright posture. Significantly increased concentrations of angiotensin II were found 10 minutes after the change of posture. In the active test the initial rise was more marked, whereas at 90 minutes significantly more angiotensin II was found in the passive test. The initial rise in the active test was slightly slower in subjects over 60 years of age. During the conditions used the diurnal variation of angiotensin II was not found to affect markedly the response of angiotensin II to upright posture. The present data suggest that angiotensin II does not play any significant role in the maintenance of blood pressure right after the change of posture from supine to upright. Later, angiotensin II is obviously linked to t...

Ambulatory electrocardiographic recording (AER) was performed on 27 adult patients with mild or moderate myotonic dystrophy (MD) and in 12 adult patients with mild myotonia congenita (MC) to determine whether characteristic arrhythmias and conduction disturbances occur in the early stages of these myotonic disorders. In MD and MC, AER showed at least one finding regarded as normal in 93% and 0% of cases, respectively. The most common abnormalities in MD were first degree atrioventricular (A-V) block (in 70% of cases) and QTc greater than or equal to 0.46 s (in 33%). Abnormal sinus intervals and frequent second degree A-V block were rare, each occurring in 4% of patients. Ventricular tachycardia did not occur. It is concluded that signs of involvement of cardiac conductive tissue in the MD disease process are very common, even in the early stages. Delayed A-V conduction in the most common single finding. Sinus nodal dysfunction, severe disturbances in A-V conduction, and ventricular arrhythmias are not common in mild disease. Repeated AER is indicated, to evaluate whether conduction disturbances in MD are progressing.

From time to time it has been claimed that the thermal stress caused by sauna bathing can be harmful to persons with cardiovascular disorders. Furthermore, elderly persons in general, who have experienced no symptoms from bathing, have also been cautioned. However, several studies carried out in Finland did not confirm the adverse effects of bathing on the elderly and cardiovascular patients. The controversial results obtained in Finnish and in some foreign studies are at least partly due to the different test conditions. The typical Finnish sauna bath is safe, and even patients who have recovered from acute myocardial infarction can enjoy the sauna without incurring any harmful cardiovascular effects.

The role of daily dietary intake of potassium and magnesium in the maintenance of potassium balance was studied in 104 digitalized outpatients with chronic cardiac insufficiency receiving 50 mg hydrochlorothiazide twice daily for 6 weeks. The food consumption data were collected once a week by the 24-hour recall method during the 1st, 2nd and 3rd weeks of the investigation. Serum potassium and magnesium values were followed throughout the study, and total body potassium was measured at the end. During the hydrochlorothiazide treatment, potassium and magnesium levels decreased significantly (p less than 0.001). 46% of the patients became hypokalemic (serum potassium less than or equal to 3.5 mmol/l), hypokalemia being more common (64%) in the patients with a concomitant decrease (-0.063 +/- 0.08 mmol/l) in serum magnesium values. Mean intake of potassium and magnesium was 3.4 g and 299 mg in females and 4.2 g and 380 mg in males, respectively. There was no significant difference in the daily intake of potassium and magnesium between the patients becoming hypokalemic and those remaining normokalemic.

Data from ambulatory electrocardiographic recording in 35 highly trained endurance athletes and in 35 non-athletic controls of similar ages are given. The minimal, mean hourly, and maximal heart rates were significantly lower in the athletes. Thirteen athletes (37 . 1%) but only two controls (5 . 7%) had sinus pauses exceeding 2 . 0 seconds. First degree atrioventricular block was observed in 13 athletes (37 . 1%) and five controls (14 . 3%), second degree Wenckebach type block in eight athletes (22 . 9%) and two controls (5 . 7%), and second degree block with Mobitz II-like pattern in three athletes (8 . 6%) and no control. All athletes with Mobitz II-type pattern also had first degree and Wenckebach-type second degree atrioventricular block. The behavior of sinus rate on development of atrioventricular block varied, not only interindividually but also intraindividually, from absence of change to an increase or decrease in most subjects in both study groups. A decrease in sinus rate on appearance of atrioventricular block was found constantly in only two athletes and one control. Atrioventricular dissociation with junctional rhythm occurred in seven athletes (20%) and with ventricular rhythm in one athlete. Neither of these phenomena was seen in the group of controls. The athletes had slightly fewer ventricular extrasystoles than controls, and no athlete had ventricular tachycardia, whereas two controls had ventricular tachycardia.

Diuretic therapy is usually accompanied by biochemical changes, such as hypokalemia, impaired glucose tolerance and hyperuricaemia. Tienilic acid is a new long-acting diuretic with antihypertensive effect, combined with uricosuric property. For the purpose of evaluating the effect of tienilic acid in patients with impaired renal function, eleven patients with hypertension and slight to moderate renal impairment were randomized to either hydrochlorothiazide or tienilic acid therapy. During eight weeks of treatment no changes occurred in serum-creatinine, creatinine-clearance, serum-sodium, or urea. Despite renal impairment, serum uric acid decreased during tienilic acid treatment. Compared with placebo, a significant decrease in uric acid was seen as early as after one week of treatment (p less than 0.01) and after 8 weeks the difference was still of the same order (p less than 0.01). During hydrochlorothiazide therapy, serum uric acid increased progressively. The difference was p less than 0.002 at 4 weeks and p less than 0.0005 at 8 weeks of treatment, compared with placebo. The results of this study show that the uricosuric effect of tienilic acid is maintained in patients with mild to moderate renal impairment.

The response of elderly hypertensive patients to labetalol, possessing alpha- and beta-blocking properties, was studied. The dosage was first titrated out and assessed in a double-blind cross-over trial. Altogether 24 patients were treated for one year. The dosage established during the titration period maintained its efficacy. In most cases 200 mg labetalol daily gave satisfactory result. The side-effects were few. The only reason for discontinuance of the drug was gastrointestinal discomfort. Because of the low dosage, the typical side-effects of beta-blockade were lacking and alpha-blockade seemed to be well tolerated. The normal precautions in the treatment of elderly hypertensive patients should be observed.

Ambulatory electrocardiographic recordings were obtained from 35 male athletes between 14 and 16 years old, and from 35 male non-athlete controls of the same ages, in order to determine the effects of regular physical training on cardiac electrical activity. In the young athletes, the heart rates were significantly (P less than 0.01) lower than in the nonathletes. Sinus intervals over 2.00 s were present in five athletes (14%) and one control (3%). First-degree atrioventricular block was detected in eight athletes (23%) and four controls (11%), and second-degree block was detected in seven athletes (20%) and one control (3%) (P less than 0.05). Ventricular premature beats were present in 60% of athletes and 57% of controls. The bradycardia in athletes did not predispose to ventricular ectopic activity, since heart rates at the times of occurrence of extrasystoles were higher in athletes than in controls. Even after two years of regular physical training there are significant differences in sinus nodal function and atrioventricular conduction as between young athletes and controls.

Plasma catecholamines were measured by a modified single-isotope radioenzymic assay in five healthy medical students during and after a Finnish sauna bath with or without previous beta-blockade. The plasma noradrenaline rose more than twofold after 10 min in the hot room (100 degrees C) while the plasma adrenaline content exhibited smaller increases. The plasma noradrenaline concentration remained elevated or further increased after 5 min in a cool swimming pool (22 degrees C) whereas the exposure to cool water restored the plasma adrenaline concentration to resting values. Plasma noradrenaline, but not adrenaline, was still markedly elevated after a rest period of 15 min after the cool pool. Oxprenolol (40 mg) given 30 min before the sauna did not alter the plasma catecholamine pattern although it effectively lowered the heart rate before, during, and after the exposure to the heat stress.

In a double-blind crossover study the antihypertensive effect of acebutol (I.S.A. and M.S.A.) 400 to 800 mg daily was compared with that of metoprolol (non-I.S.A. and non-M.S.A.) 200 to 400 mg daily. Blood pressure and heart-rate were measured sitting, lying and post-exercise. Twenty-eight patients entered the trial, but 4 were withdrawn for reasons not connected with active treatment. There was no significant difference between the drugs in their ability to reduce the systolic and diastolic blood pressure sitting, lying or post-exercise or reduce the heart-rate post-exercise. Metoprolol reduced the heart-rate sitting and lying to a significantly greater degree (p less than 0.05) than acebutolol. While the antihypertensive effect seems to be entirely dependent on beta-blockade, the I.S.A. may still have some value for patients with a low heart rate at rest.

In order to analyse the essential parameters of the ocular pulse wave, oculosphygmography (OSG) combined with electrocardiography was performed on 45 healthy volunteers. The method was applied on 23 patients with symptoms of ischaemic cerebrovascular disease or ischaemia of one upper limb. All these 23 patients were examined with aortic arch angiography. A statistical analysis of the results obtained from the healthy volunteers showed that the time from the R of the QRS complex of ECG to the onset of the pulse wave t (R-f), and to the peak of the ocular pulse wave t (R-p) were the most constant parameters. The amplitude (h), and the ascending (α) and descending slopes (β) of the pulse wave showed considerable interand intraindividual variation. Analysis of the results in occlusive disease of the cervical arteries showed the t (R-f) and t (R-p) to be most easily affected. The results indicated that the need of considerable circulatory impairment, either stenosis or total occlusion of one or more cervical arteries brought about a significant change in the pulse wave. Thus the method does not seem useful for screening purposes.

In a previous study in postmenopausal women elevated serum levels of glutamic oxaloacetic transaminase and glutamic pyruvic transaminase were found in every case whereas other workers found no evidence of abnormal liver function in premenopausal women. A study is reported which was undertaken to explain this apparent discrepancy. The incidence of abnormal liver-function tests was studied in 109 premenopausal women (mean age 29.4) taking contraceptive tablets. Volidan was given to 45 women and Lyndiol to 39 women aged 17-41 for contraception; Orgametril was administered therapeutically to 25 women aged 23-52. Standard liver-function tests were performed at regular intervals in every case. The same low incidence of abnormal results was found in the Volidan and Orgametril groups; serum-transaminase levels were raised in 4% of women and the bromsulphthalein (BSP) retention was increased in 19%. In the Lyndiol group however the incidence was much higher with raised serum-transaminase levels in 18% of cases and increased BSP retention in 48%. In all cases the liver-function tests returned to normal within 4 weeks of withdrawal of the drug.