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SUMMARYA 45-year-old Japanese man with paroxysmal atrial fibrillation (AF) developed acute anteroseptal myocardial infarction (MI). He had used 1 % topical minoxidil (RiUP ® ) once a day for 4 months before the onset of MI for treatment of baldness. Coronary angiography demonstrated severe stenosis at the proximal portion of the left anterior descending coronary artery with a filling defect. Electrocardiographic monitoring revealed paroxysmal AF and sinus bradycardia with sinus arrests, suggestive of sick sinus syndrome. Topical minoxidil is now widely used for the treatment of male pattern baldness. Although it may be difficult to relate topical use of minoxidil to myocardial ischemia, a greater awareness of its toxicity will be necessary, and patients with cardiovascular disorders should be excluded from the therapy. (Jpn Heart J 2000; 41: 519-523)

SUMMARYA 40-year-old housewife with left atrial myxoma was reported and discussed. The following findings, as observed in our case, would be valuable in diagnosis of left atrial myxoma prior to cardiac catheterization: 1) a prolonged first heart sound in the phonocardiogram; 2) one or two notches in the systolic upstroke of the apexcardiogram; and 3) an extra positive wave just after the systolic downstroke of the apexcardiogram.At right heart catheterization, prominent C and V waves and a rapid Y descent are suggestive of left atrial myxoma in the absence of other features of significant mitral regurgitation. A marked spontaneous fl uctuation of the V wave in the pulmonary wedge pressure would be an additional feature suggesting left atrial myxoma. A right pleural effusion was observed to persist in our case and was attributed to impaired venous return from the right pulmonary veins by the tumor.

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