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We describe a case of a man with acute myocardial infarction of the inferior wall complicated by cardiogenic shock due to acute mitral regurgitation. Transesophageal echocardiography showed the rupture of the posteromedial papillary muscle. The examination (otherwise difficult) was facilitated by the mechanical ventilation by means of an endotracheal intubation.

The association between the presence of areas of myocardial fibrosis and the appearance of unexpected DEVIATIONS OF THE QRS loop-outline on the vectorcardiographic tracing (bites) has been reported. In order to re-evaluate the correlation between the presence of bites and the possible existence of scars we have studied 511 patients. On the basis of clinical data, laboratory data, rest and exercise electrocardiograms, the subjects have been divided into four groups; 195 normal subjects; 267 with ischemic heart disease, 16 with arterial hypertension and 33 with diabetes mellitus (the last two groups as representative of subjects with higher risk for myocardial ischemia). Bites in at least one plane were detected in 9.7% of normal subjects, 27.8% of ischemic patients, 56.3% of hypertensive patients and 18.2% of diabetics (less than 0.001). The genesis of bites and reliability of the diagnostic criteria are discussed. With more restrictive criteria the frequency in the normal subjects falls to 1%, while in the other three groups it remains much higher (10.1%-12.5%-6.1%).

Amiodarone is a very active antiarrhythmic agent, but true incidence of Amiodarone-related side effects is still questionable. In a prospective trial of 400 or 200 mg of Amiodarone day for 56 days in 58 patients, we monitored thyroid and liver function, blood count, chest x-ray, ecg. In addiction we took regularly notice of subjective disturbances and physical signs. Side effects were: conduction disturbances 6%, bradycardia less than 50/min. 2%, gastrointestinal 12%, sleep disorders 12%, hyperthyroidism 4,15% and hypothyroidism 6.25%. Blood levels of Amiodarone and desethylamiodarone were not predictive of side effects. Noteworthy was the absence of cutaneous and pulmonary side effects. On the other hand, thyroid function should be monitored carefully because disfunction is not rare (10.4%) and in the case of hyperthyroidism could be related to worsening of arrhythmias.

The ECG in Ostium Secundum Atrial Septal Defect (O.S. ASD) shows typically a pattern of incomplete right bundle branch block with right axis deviation and a 12 year old boy suspected of having O.S. ASD on the basis of x-ray and echocardiographic findings showed an ECG pattern of incomplete left bundle branch block. Physical examination and a phonocardiogram revealed a single second heart sound. An ECG recorded at age five showed a typical pattern consistent with O.S. ASD. The angiographic examination confirmed the suggested diagnosis. This is, to our knowledge, the first case of O.S. ASD with incomplete left bundle branch block. The conduction disorder may have abolished the fixed splitting of the second heart sound.