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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.