Summary:We reviewed our experience with the diagnosis of cardiac myxoma in 10 patients seen between 1960 and 1981. At surgery, large myxomas (>5 cm) were found in the left atrium in 6 patients, right atrium in 3, and right ventricle in 1. The correct preoperative diagnosis was made in 9 patients: clinically in 3 and at catheterization and angiocardiography in 6. Diagnoses were falsely negative in 3/ 13 (23%) catheterizations and 2/ 10 (20%) angiocardiograms. Echocardiography (echo) was positive in 5 / 5 (100%). Gated blood-pool scans confirmed a right atrial myxoma in 1 patient. The interval between onset of symptoms and surgery was 30.5 months, (range, 2-120) and was not significantly different in the eras before and after echo. The age at diagnosis exceeded 40 years in 9 patients and was not significantly less in the echo era. The size and site of the tumor at surgery agreed with findings on M-mode echo (n=5) or two-dimensional (2-D) echo (n=2), but the size (85 vs. 88 cm3) and mass (81 vs. 88 g) of the tumors were

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Low-dose intravenous nitroglycerin infusion for the first 48 h is becoming routine in the management of acute myocardial infarction in North America. It is most widely used as primary therapy in patients admitted more than 6 h after acute infarction. Such therapy has been shown to limit infarct size, infarct complications and remodeling. However, it is being applied increasingly more as an adjunct before, during and after thrombolytic therapy. Several trials are underway to test the effectiveness of more prolonged therapy, with early intravenous nitroglycerin followed by buccal or oral formulations for several weeks, in further limitation of ventricular remodeling, dilatation, aneurysm formation and in preserving function. Nitrates may prove to be a useful adjunct or alternative to angiotensin-converting-enzyme (ACE) inhibitors for long-term therapy.

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