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The Stokes-Adams syndrome is an abrupt, transient loss of consciousness due to a sudden but pronounced decrease in the cardiac output, which is caused by a paroxysmal shift in the mechanism of the heart beat. Most patients have complete heart block, with ventricular irritability or asystole during syncopal attacks, but both supraventricular and ventricular tachyarrhythmias without atrioventricular (A-V) block may be the responsible mechanism. Multiple different arrhythmias may produce Stokes-Adams syncope in the same patient. Continuous cardiac monitoring and the refinement of electrical pacemakers have resulted in improved diagnosis and treatment. The etiology, electrocardiographic mechanisms, clinical presentation and treatment of arrhythmia-induced syncope are reviewed.

Sixteen patients with acute myocardial infarction were studied with continuous cardiac monitoring for 1 to 3 weeks. Patients were excluded from the study if arrhythmias were present on admission or if arrhythmias might have occurred as a result of treatment. The results indicate that cardiac arrhythmias occur with a much higher frequency (94 per cent) than previously reported. They may occur many days after the infarction. They occur in asymptomatic patients and may go undetected by conventional observation. Continuous cardiac monitoring has immediate practicality in the management of these patients, and might, if used as a guide to therapy, [see table in the PDF file] reduce the mortality from acute myocardial infarction.

The increasing number of children admitted to this hospital with poisoning by tricyclic antidepressants is causing concern. Of 60 children admitted between January 1966 and July 1973, half were admitted in the last 18 months. In 60% of these patients the tricyclic compounds had been prescribed for nocturnal enuresis. One child aged 2 years and 4 months died of imipramine poisoning. It is imperative that all children with poisoning by tricyclic compounds, irrespective of the dosage, are admitted to hospital for continuous cardiac monitoring. Cardiac arrhythmias induced in children by amitriptyline and imipramine are prominent and dangerous.In the earlier years of this survey the antidepressants taken by children had usually been prescribed for adults, but recently they have been increasingly prescribed as a treatment for enuresis in children themselves. Medicine for a trivial complaint is unlikely to be regarded by parents as potentially dangerous and practitioners should therefore warn them accordingly; if, indeed, the transient effect of these potentially dangerous drugs upon the average case of bed-wetting in childhood can be justified.

The treatment of 17 persons incapacitated by refractory angina pectoris was initiated during a three-week hospital program. The patients ranged in age from the mid 30's to mid 60's and included one woman and 16 men. They were unable to walk more than half a block without inducing anginal attacks. These patients required daily 15 to 25 nitroglycerin tablets taken sublingually. The program consisted of graded increments of treadmill exercise preceded by administration of nitroglycerin and with continuous cardiac monitoring. Its basis was to increase the work load of the heart during the maximal dilatory effects of nitroglycerin taken sublingually, the end result being permanent enlargement of the collateral circulation and more efficient myocardial extraction of oxygen. All 17 patients improved and none suffered further myocardial damage during or after the program, while continuing their exercises at home. Follow-up over one year has shown continued improvement in 15 patients.

In his great novel, The Magic Mountain , Thomas Mann comments, "A man lives not only his personal life, as an individual, but also, consciously or unconsciously, the life of his epoch and his contemporaries." On reflection, it seems incredible that coronary care units have existed in our hospitals for no more than ten years, since medical practice for many of us has been so profoundly affected by the concepts of continuous cardiac monitoring and aggressive preventive care. The editors have invited contributors from eight nations to discuss 50 subjects related to coronary care, including the diagnosis and clinical course of acute myocardial infarction and the management of its major complications. An attempt has been made throughout to provide hard data about the subject material, such as the incidence of each complication and a critical appraisal of the recommended therapy. Indeed, the effectiveness of the entire system of coronary care is