One thousand women younger than age 50 years suspected of having coronary disease were followed for at least 5 years (average 8.4 years) to determine their course after coronary arteriography. Three patients were lost to follow-up; all had normal arteriograms. The survival rate was 96.9% at 5 years for 761 patients who had less than 50% narrowing of any artery. One patient who had coronary ectasia died within 5 years, and one woman who had minimal lesions suffered sudden death. Seven of 727 women who had normal arteries or less than 30% narrowing of any artery had coronary events (death, myocardial infarction, bypass operation for progressive disease), and six of 34 women who had 30 to almost 50% obstruction of at least one artery had coronary events. Calculations of survival for 236 women who had severe coronary lesions were affected by withdrawal for operation. Five-year survival was 74%.
A 3 1/2-year-old child with incessant supraventricular tachycardia was investigated with intravenous vago-mimetic drugs, which had unexpected beneficial results. These observations suggested selection of digitalis as the antiarrhythmic drug, which would not otherwise have been chosen. The potential advantages of non-invasive, acute autonomic modulation for optimal drug selection in children with arrhythmias are illustrated by this case.
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