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Cardiovascular abnormalities developed in a patient during a protein-sparing modified fasting diet. Syncope was the complaint at the time of examination. Hypotension, persistent QTc interval prolongation, and a low QRS voltage were observed before the development of refractory ventricular tachycardia. At autopsy, antemortem thrombi were attached to the left ventricular endocardium and a fenestrated aortic valvule. Strick protein-sparing modified fasting is not without risk of sudden death even with close medical supervision.

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It has been previously proposed that a method of distinguishing sinus venosus atrial septal defects from ostium secundum atrial septal defects is a leftward axis deviation (less than +300) of the P waves on the electrocardiograms of patients with sinus venosus defects. The electrocardiograms of i5o patients with surgically corrected atrial septal defects were reviewed to test this proposition. The preoperative P wave axis was not useful in predicting the anatomical location of atrial septal defects.