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Prognosis of on-Q wave myocardial infarction (nQMI) has been the subject of considerable controversy over the last few years and a systematically aggressive approach with PTCA or coronary by-pass surgery (CBS) has been advocated as a means to reduce subsequent coronary events rate. To investigate clinical outcome and possibly identify high-risk subgroups 131 consecutive patients (pts) meeting diagnostic criteria for nQMI, admitted to our CCU for their first myocardial infarction between January 1980 and June 1985, were followed-up for a mean period of 34 months (range 6-72). Mean age of pts was 59 +/- 7 yrs; 101 (76%) were males, 30 (24%) females. No pt was lost to follow-up. During the same period 684 pts were admitted for Q wave myocardial infarction. Major coronary events such as angina, reinfarction, CBS, cardiac death as well as overall early and late mortality were considered for statistical evaluation with uni-multivariate analysis taking into account multiple data from pts history and acute clinical presentation. Angina appeared or recurred in 71 pts (54%), reinfarction occurred in 14 (10.7%); 25 pts underwent CBC (19%). Early cardiac deaths were 7 (5.3%), late cardiac deaths 12 (9.2%); overall mortality rate 18.1%. Uni- and multivariate statistical analysis did not disclose significant criteria predicting major coronary events and no high-risk subgroup could be identified, confirming uncertainties and doubts from literature.

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.