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The effect of the beta-adrenergic blocking agent propranolol on morbidity and mortality risk after acute myocardial infarction was studied relative to coronary anatomy and left ventricular (LV) ejection fraction in a subset of 406 patients participating in a randomized study of 3,837 patients in the Beta Blocker Heart Attack Trial (BHAT). Median follow-up for this subset of patients was 28 months. The mortality rate was 2% (2 of 100) in patients with 2- and 3-vessel coronary artery disease taking propranolol and 10% (12 of 126) in those taking placebo (p less than 0.02). In patients with 2- and 3-vessel coronary artery disease with decreased LV function (defined as ejection fraction less than 50%), no patient taking propranolol died, whereas 17% (7 of 42) taking placebo died (p less than 0.04). The salutary effect of propranolol on mortality in the larger BHAT after acute myocardial infarction also was evident in this population studied in regard to their coronary and LV anatomy and function.

Cardiac toxicity is a major complication which limits the use of adriamycin as a chemotherapeutic agent. Cardiomyopathy is frequent when the total dose exceeds 600 mg/m2 and occurs within one to six months after cessation of therapy. A patient is reported who developed progressive cardiomyopathy two and one-half years after receiving 580 mg/m2 which apparently represents late, late cardiotoxicity.

A 38-year-old black woman with thyrotoxicosis, whose first symptom was angina pectoris, is described. Chest pain became progressively more frequent, and an unstable angina pattern developed. Angina attacks were associated with transient ischemic electrocardiographic changes and recurrent ventricular tachycardia was documented. Coronary angiography revealed no significant obstructive lesions. The patient became free of pain with antithyroid treatment and angina has not recurred.It is important to recognize that angina pectoris may be the major presenting symptom of thyrotoxicosis; unstable angina requires careful work-up and management including the performance of coronary angiography.