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We evaluated the clinical application of echocardiography (M and 2D modes) in the assessment of cardiac patients with fever and an underlying valvular abnormality in whom the diagnosis of infective endocarditis was suspected.One or more of the clasiic clinical features of the disease were present in 50 patients (group A). Vegetations were detected by echocardiography in 17 (47%) out of the 36 patients within this group A who had positive blood cultures. Four (28·5%) of the remaining 14 patients with unequivocal endocarditis clinically and negative blood cultures had demonstrable vegetations on ultrasound. Anatomical complications resulting from the septic process (valve destruction or detachment, aortic root abscess) were visualized in 18 (36%) of the 50 patients in group A.The clinical features of endocarditis were lacking in the other 53 patients with fever and a murmur (group B). This group included 12 patients with other sources of bacteraemia besides endocarditis. Unsuspected vegetations were detected only in 2 (3·7%) out of the 53 cases.Thus echocardiography is useful in confirming the clinical diagnosis of infective endocarditis, but only rarely detects vegetations in patients who lack the characteristic clinical features of endocarditis, regardless of whether they have positive or negative blood cultures. [ABSTRACT FROM PUBLISHER]

The effects of isosorbide dinitrate on acute myocardial ischaemia were studied in 19 patients during coronary angioplasty. The duration of balloon inflation to the onset of ST segment depression was increased by the administration of intracoronary isosorbide dinitrate from (mean ± SEM) 13 ± 2 to 20 ± 2s (48%) (P < 0·01) and the duration to 1 mm ST segment depression increased form 23 ± 2 to 29 ± 3s (28%) (P < 0·01). Systolic blood pressure fellfrom 118 ± 3 to 111 ± 4 mmHg but there was no change in intracoronary distal occlusion pressure. Thus during coronary occlusion isosorbide dinitrate prolongs the time to the onset of myocardial ischaemia. [ABSTRACT FROM PUBLISHER]