We report a case of a large unruptured aneurysm of the right sinus of Valsalva which caused severe right ventricular outflow tract obstruction and presented dramatically with a life threatening ventricular tachycardia. Despite severe aortic incompetence prior to surgery it was possible to resect the aneurysm and repair the aortic root without resort to aortic valve replacement and thus return the anatomy to normal.

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Orienteering is a sport in which it is common for most participants to be aged over 40 years, but research into the demands of the sport has focused almost exclusively on elite participants aged 21-35 years. The aim of the present study was to examine the heart rate responses of older male orienteers. Thirty-nine competitive male orienteers were divided into three groups: group 1 (international competitive standard, n = 11, age 21-67 years), group 2 (national competitive standard, n = 15, age 24-66 years) and group 3 (club competitive standard, n = 13, age 23-60 years). Each participant had his heart rate monitored during two orienteering races of contrasting technical difficulty. The results were analysed using analysis of covariance, with age as a covariate, and Pearson product-moment correlation coefficients to determine whether age was related to the observed heart rate responses. The groups did not differ in their peak (175 +/- 12 beats x min(-1), P = 0.643) or mean (159 +/- 13 beats x min(-1), P = 0.171) heart rates during the races. There was a decline of 6 beats x min(-1) x decade(-1) (P = 0.001) for peak heart rate and 5 beats x min(-1) x decade(-1) (P < 0.001) for mean heart rate. Mean heart rates were 86 +/- 6% of the participants' maximal heart rates and were not associated with age. The orienteers in group 1 displayed a lower (P < 0.005) within-race standard deviation in heart rate (6 +/- 2 beats x min(-1)) than those in groups 2 and 3 (10 +/- 3 and 10 +/- 4 beats x min(-1), respectively). In conclusion, the mean heart rates indicated that all three groups of orienteers ran at a relative high intensity and the international competitive standard orienteers displayed a less variable heart rate, which may have been related to fewer instances of slowing down to relocate and being able to navigate while running at relatively high speeds.

Objectives: To compare the heart rate responses of women orienteers of different standards and to assess any relation between heart rate responses and age. Methods: Eighteen competitive women orienteers completed the study. They were divided into two groups: eight national standard orienteers (ages 23-67 years); 10 club standard orienteers (ages 24-67 years). Each participant had her heart rate monitored during a race recognised by the British Orienteering Federation. Peak heart rate (HR PEAK ), mean heart rate (HR MEAN ), standard deviation of her heart rate during each orienteering race (HR SD ), and mean change in heart rate at each control point (∆HR CONTROL ) were identified. The data were analysed using analysis of covariance with age as a covariate. Results: National standard orienteers displayed a lower within orienteering race standard deviation in heart rate (6 (2) v 12 (2) beats/min, p<0.001) and a lower ∆HR CONTROL (5 (1) v 17 (4) beats/min, p<0.001). The mean heart rate during competition was higher in the national standard group (170 (11) v 158 (11) beats/min, p = 0.025). The HR MEAN for the national and club standard groups were 99 (8)% and 88 (9)% of their age predicted maximum heart rate (220−age) respectively. All orienteers aged >55 years (n = 4) recorded HR MEAN greater than their age predicted maximum. Conclusions:The heart rate responses indicate that national and club standard women orienteers of all ages participate in the sport at a vigorous intensity. The higher ∆HR CONTROL of club standard orienteers is probably due to failing to plan ahead before arriving at the controls and this, coupled with slowing down to navigate or relocate when lost, produced a higher HR SD . P revious research into the physiological demands of women's orienteering has primarily focused on elite level orienteers aged 21-35 years. The high level of fitness required at an elite level is reflected in the maximum aerobic power of women from the Danish (59.1 ml/kg/min) 1 and Norwegian (66.4 ml/kg/min) 2 national teams, and research into the physiological demands of the sport has recorded mean blood lactate levels of 3.4 mmol/l for women of the Norwegian national team during simulated orienteering races. 2Heart rate monitoring during competitive orienteering races has indicated mean heart rates of 172 beats/min for elite British Women 3 and 179 beats/min for members of the Norwegian women's national team.2 According to Creagh and Reilly, 3 these values are similar to those observed during marathon running, but the variability in heart rate is much greater. For example, the standard deviation in heart rate for elite women within an orienteering race are generally reported to be in the region of 10 beats/min. Masters age categories for orienteering increase in five year increments from the age of 35 years, thereby providing an age related competitive structure at local, regional, national, and international orienteering races up to and including 90+ years. According to the International Orienteering Federation, 5 over ...

Though the pulmonary blood vessels appear to be abundantly supplied with autonomic neurones from both the sympathetic and parasympathetic nervous systems, the functional activities of these fibres in man continue to elude precise definition. Equally obscure is the part played in the maintenance of normal pulmonary vascular tone by the endogenous circulating catecholamines.In this latter respect, previously reported studies, which appear to have been entirely concerned with the effects of adrenergic blocking agents in patients suffering from severe pulmonary vascular diseases, have yielded largely irreconcilable results. Further, there appear to be no reports of the effect of these drugs on the systemic venous pressure of man. The present report, part of a larger study of the over-all circulatory effects of one of these agents, phentolamine, concerns an analysis of the effects of this drug on the pulmonary and venous circulations of normal subjects and of patients suffering from hypertensive vascular disease. SUBJECTS AND METHODSClinical Data. Studies were made on 6 normal subjects and 6 hypertensive patients; details of each are listed in Table I.All the hypertensive patients were considered to be suffering from essential hypertension on the basis of the usual diagnostic clinical criteria. None had any symptoms referable to the cardiovascular system except patient A.A., who had mild exertional dyspncra. In 5 of the 6 patients the resting diastolic pressure, recorded in the supine position, exceeded 120 mm. Hg. In 4 of the hypertensive patients (E.B., J.W., J.N., and F.E.) there was no radiological or electrocardiographic evidence of left ventricular enlargement. In the remaining 2 patients there was radiological evidence of cardiac hypertrophy without dilatation and in both instances this was associated with electrocardiographic changes indicative of moderate left ventricular hypertrophy. The optic fundi were without papilloedema, hkmorrhages, or exudates in all 6 hypertensive patients; routine tests of renal function were also within normal limits and arteriographs showed no evidence of renal vascular disease. The 24-hour urinary excretion of vanillylmandelic acid was within normal limits in all the hypertensive patients.Plan of Investigation. The investigation was designed to study the changes occurring in the pulmonary circulation following the abrupt intravenous injection of phentolamine in the dose usually used in clinical diagnostic procedures. In all individuals pulmonary arterial and wedge pressures, systemic arterial and right atrial pressures, cardiac output, and heart rate were measured during a control period of 10 minutes and then for a further 30 minutes following the rapid intravenous injection of 5 mg. phentolamine in a volume of 2 ml.; the injection was completed within two seconds.All vascular pressures and heart rate were recorded continuously throughout the study. Cardiac output was determined on alternate minutes during the control period, every minute for the 6 minutes after injection of th...