Objectives-To assess the incidence and significance of anticardiolipin antibodies after myocardial infarction and in unstable angina.Design-A prospective study of all patients under 60 admitted to the coronary care unit over a 12 month period with a diagnosis of acute myocardial infarction who were followed up for a further 12 months. Patients admitted with unstable angina were similarly assessed but not followed up. Anticardiolipin antibody concentrations were compared with those of age matched controls.Setting-A district general hospital.Patients-307 patients with acute myocardial infarction and 160 patients with unstable angina.Results-Anticardiolipin antibody concentrations in the two patient groups did not differ significantly from those in the control groups. Antibody concentrations were not related to a history of angina or myocardial infarction nor were they related to subsequent cardiovascular complications.Conclusion-This study shows no significant association between anticardiolipin antibody concentrations and either myocardial infarction or unstable angina. (Br Heart3r 1993;69:391-394)

Background-Inhalation of nitric oxide with oxygen could be a promising treatment in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension. However, the current methods of delivery of NO are cumbersome and unsuitable for long term use. The present study was undertaken to investigate the safety and eYcacy of a mixture of nitric oxide (NO) and oxygen administered via a nasal cannula for 24 hours in patients with oxygen dependent COPD. Methods-Twenty five parts per million (ppm) of NO was administered by inhalation combined with supplemental oxygen at a flow rate of 2 l/min via a nasal cannula for 24 hours to 11 ambulatory men with stable, oxygen dependent COPD. Room air with supplemental oxygen at 2 l/min was administered in an identical manner for another 24 hours as control therapy in a randomised, double blind, crossover fashion to all patients. Pulmonary function tests, exercise tolerance, dyspnoea grade, and lung volumes were measured at baseline, 24, and 48 hours. Pulmonary artery pressure (PAP), cardiac output (CO), pulmonary vascular resistance (PVR), arterial blood gas tensions, and minute ventilation were measured at baseline, after 30 minutes and 24 hours of breathing NO and oxygen. Venous admixture ratio (Qs/Qt) and dead space ratio (Vd/Vt) were also calculated. Concentrations of nitrogen dioxide (NO 2 ) and NO in the inhaled and ambient air were monitored continuously. DiVerences in pulmonary function, arterial blood gas tensions, pulmonary haemodynamics, exercise tolerance, and dyspnoea between oxygen and NO breathing periods were analysed for significance using paired t tests.

Our patient presented with typical features ofpyomyositis: fever, malaise, and a tender hard mass. Ultrasonography suggested either an abscess or a necrotic tumour, and the diagnosis was made by open biopsy. No Myocardial infarction due to amphetamineWe report on a patient with myocardial infarction probably resulting from self administration of intravenous amphetamine. Case reportA 33 year old white building labourer was admitted with chest pain. He was a known drug addict, taking 500-750 mg of heroin intravenously each week and occasionally taking other substances. One hour before the onset ofhis pain he had injected himself with about 60 mg of amphetamine, having injected 40 mg of heroin several hours earlier. Two years previously he had been admitted with similar chest pain; at the time no history of drug abuse was elicited, but later he had admitted to taking amphetamine intravenously one hour before. He cleaned his needles in hot water and occasionally shared needles. He smoked about 20 cigarettes a day and drank alcohol occasionally. His mother had died of myocardial infarction at the age of 41.On admission he was drowsy and in pain. There were no abnormal signs apart from venepuncture scars on his arms. Serial electrocardiograms showed the development of abnormal Q waves and typical ST-T segment changes due to an inferolateral myocardial infarct (figure). Peak serum enzyme concentrations were raised: aspartate aminotransferase 235 IU (normal 15-40 IU/1) and lactate dehydrogenase 708 IU/l (normal 115-235 IU/1). Blood glucose concentration measured at random was normal at 5-6 mmol/l. Results of serological tests for human immunodeficiency virus were negative. Hepatitis B surface antibody was present in low titre, but hepatitis B surface antigen and e antigens were absent. On his previous admission pericarditis had been diagnosed, but enzyme concentrations were not measured. Electrocardiograms at that time showed changes compatible with a non-Q wave anterolateral infarct.He made an uneventful recovery from his presumed second infarct and had no withdrawal symptoms. On discharge from hospital seven days later he was not receiving any drugs. At follow up he denied smoking or taking drugs. Coronary arteriograms performed three months after the infarction were normal. A left ventricular angiogram was also normal apart from slightly diminished apical contraction. Blood lipid concentrations were normal, with a cholesterol concentration of 5-2 mmol/l. CommentAmphetamine is a sympathomimetic drug which acts by releasing noradrenaline from sympathetic nerve endings. Catecholamines can cause myocardial damage by increasing myocardial oxygen demand or by causing platelet aggregation. In animals pretreatment with antiplatelet drugs may prevent catecholamine induced myocardial necrosis.' Noradrenaline usually causes dilatation, but in some people it may cause coronary artery spasm.2 As far as we are aware acute myocardial ischaemia due to heroin has not been reported, although this drug is known to cause pulmonary oe...

Objective-To assess the safety and cost benefit of left heart catheterisation by a modified Judkins technique performed as a day patient procedure.Design-Review study ofcase notes ofconsecutive patients examined by the procedure over three years January 1984 to December 1986).Setting-Outpatient referrals in a regional cardiac centre within a district general hospital.Patients-Nine hundred patients aged 18-76 (mean 54) selected at a previous clinic as suitable for the procedure.Main results-Eight hundred and fifty patients (94.4%) were discharged home on the day of the procedure. Forty others (4-4%) could not be discharged owing to complications during or just after the procedure. Of these patients, two died (0.2%), six suffered a myocardial infarction (0-7%), and two had major vascular complications. The remaining 30 patients were admitted because of chest pain without infarction (10 cases), minor vascular incidents (six), haemorrhage at the puncture site (five), arrhythmia (four), pulmonary oedema (three), and contrast reaction (two). Ten patients were admitted for either urgent coronary artery bypass grafting or social reasons.Conclusions-Cardiac catheterisation is safe as an outpatient procedure in most cases. Beds are spared and roughly £35 000 is saved for every 500 procedures performed.

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