A patient is described in whom lymphoma infiltrated the pericardium and myocardium resulting in right ventricular rupture. Pericardial blood and lymphoma deposit were demonstrated echocardiographically as echolucent and echodense areas respectively and confirmed at autopsy. The patient presented with the clinical and haemodynamic features of cardiac tamponade.

The effect of Corwin, a new oral beta, partial agonist, on the ventricular response to atrial fibrillation was studied in digitalised patients during 24 hour ambulatory electrocardiography and during exercise on a treadmill in a double blind placebo controlled crossover trial. Corwin reduced the maximum heart rate during exercise from 162(16) beats/min to 120(9) beats/min and reduced the peak heart rate during ambulatory electrocardiography from 113(11) to 90(6) beats/min consistent with a beta adrenoreceptor antagonist action at higher levels of sympathetic nervous system activity. Minimum heart rate during ambulatory electrocardiography was increased from 62(5) to 70(5) beats/min indicating that at lower levels of sympathetic activity the drug acts as a beta agonist. The drug increased exercise tolerance significantly. Serum digoxin concentrations were not affected by the drug. Thus Corwin appears to be effective in stabilising heart rate during atrial fibrillation both at rest and during exercise in digitalised patients.

In order to determine whether the use of a smaller catheter would allow day-case cardiac catheterization by the femoral route, the performance of the Superflow (5F) and the 8F catheters was compared in 34 adults who underwent left ventriculography and coronary angiography. As shown by the significantly lower fluoroscopy time [2.8 +/- 1.2 min vs 4.5 +/- 2.7 min, (m +/- SD), p = 0.027] the 8F catheter was more maneuverable than the Superflow (5F) catheter. Poor left ventriculograms were obtained in a higher proportion of patients in whom the Superflow (5F) catheter was used. There was no significant difference in the time to achieve hemostasis at the puncture site in the two groups of patients (13 +/- 5 min vs 10 +/- 3 min, p = 0.09). It is concluded that the use of the Superflow (5F) catheter confers no advantage, while it is associated with longer screening time and poorer left ventriculograms.

The effect of xamoterol, a beta1 adrenoceptor partial agonist, on resting haemodynamic measurements and exercise tolerance was studied in 10 patients with dyspnoea of effort. All patients had poor left ventricular function due to myocardial infarction with ejection fractions ranging from 15% to 35% (mean 28%). The cardiac index and stroke work index both rose significantly. The mean pulmonary artery pressure fell from 20(2) mm Hg to 16(2) mm Hg and pulmonary artery wedge pressure from 14(2) mm Hg to 10(2) mm Hg within the first four hours. Exercise tolerance, measured on the treadmill, increased significantly in seven patients but was unchanged in the three who had the lowest left ventricular ejection fractions. Exercise heart rate response was attenuated by the drug in all patients. It is concluded that xamoterol may be beneficial in patients with poor left ventricular function but can be harmful in extremely poor left ventricular function where high sympathetic drive may be important.