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The appearance of the QRS complex in leads V3R and V4R was analysed in a series of 94

To evaluate the acute effects of cigarette smoking on coronary arteries (CA), repeated coronary angiograms were performed in 13 patients with angina at rest and with normal coronary angiograms at basal state, during smoking, and then after methylergometrine (MEM) and after intracoronary nitroglycerin. Smoking induced anginal pain in three patients, triggered spasm (focal narrowing) in six, and/or an abnormal segmental diffuse narrowing (greater than 30%) in eight. The narrowing of the left CA was on average -21 +/- 13% (P less than 0.001), with more important narrowing of the mid-left anterior descending (-29 +/- 19%, P less than 0.001). The mean of the maximal segmental narrowing by patient was -34 +/- 13% (P less than 0.001). MEM produced similar effects and induced focal CA spasms in nearly the same patients at the same sites. Cigarette smoking may induce vasoconstrictive effects on CA in patients with rest angina and normal coronary angiograms. This action is not dose-dependent and may be initiated by less than one cigarette. These observations offer a new perspective for the understanding of the role of smoking in the precipitation of coronary events.

Constrictive fibrous endocarditis is a pathological entity described by Loëffler in 1936. Its etiology is unknown. The clinical course is characterized by an evolution towards cardiac insufficiency leading rapidly to a fatal outcome. Moderen paraclinical investigations are necessary to assess the diagnostic. Caridac catheterization brings the proof of adiastole and angiogardiography reveals the shape of amputation of the ventricle with auriculoventricular regurgitation. The operative procedure consists of resection of the ventricular fibrosis including the valves and auriculo-ventricular valve replacement by a prosthetic valve. The disease affects both Caucasians and Negros. Our experience includes 5 cases. The indications for operation and their results are discussed.