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Two patients are described with continuous murmurs, maximum over the lower sternum, due to internal mammary artery fistulas. In 1 subject the continuous murmur was due to an internal mammary arteriovenous fistula; in the other, there was a communication between the internal mammary artery and the pulmonary arterial and venous branches to the left upper pulmonary lobe. Thorough diagnostic evaluation, including selective angiographic studies, is essential before removal of a thoracic wall arteriovenous fistula.

The effects of graded increments of passive head-up tilt on the duration of the systolic time intervals corrected for heart rate were investigated in 15 normal subjects. Head-up tilt caused a prolongation of the pre-ejection period and a shortening of the left ventricular ejection time, while total electromechanical systole diminished minimally. The lengthening of the pre-ejection period and abbreviation of the left ventricular ejection time increased progressively with stepwise increments of head-up tilt. The application of venous occlusive tourniquets produced changes in the systolic intervals directionally similar to those observed with head-up tilt. In contrast to the normal subjects, three patients with congestive heart failure demonstrated no change in the systolic time intervals during head-up tilt. After diuresis in two of the patients with heart failure, the responses of their systolic time intervals to head-up tilt returned toward normal.

Excerpt Permanent endocardial pacemaker offers an alternative approach to epicardial pacemaker implantation in the elderly patient with symptomatic complete heart block. This report compares the cl...