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The mortality also was higher for recurrent acute myocardial infarctions than for first attacks. The fiveyear mortality for women was less (20.5%, age-adjusted) than for men (31-6%). This is mainly because of the higher incidence of nontransmural infarcts in women. Acute ischaemic heart disease is more common, more often fatal, and has a poorer long-term prognosis in men than in women in Helsinki. The acute mortality from acute ischaemic heart disease is high in Helsinki when compared with other WHO registers and, in addition, the long-term prognosis seems to be relatively poor in Helsinki. Received for publication 14 May 1979 The high acute myocardial infarction attack rate among Finns and their high early mortality have been shown in several studies,1-5 but it is not known if the long-term prognosis after myocardial infarction is worse than elsewhere.In the present study the five-year survival after the acute phase of acute myocardial infarction of the 728 patients from the Helsinki Coronary Register was studied in relation to age, sex, previous infarction, and transmural infarction. Patients and methodsThe Coronary Register in Helsinki records all cases suspected of having an attack of acute ischaemic heart disease among residents of Helsinki under 66 years of age. The completeness of recording is checked in many ways. A detailed description of the operation of the WHO Registers and in particular of the Helsinki Register5 has been published previously.6-8 Collection of data was almost complete for deceased cases as the death certificates of all Helsinki residents are sent to the municipality 176

Recent life-change data were gathered from 279 survivors of documented myocardial infarctions and from 226 cases of abrupt coronary death in Helsinki. In nearly half of the infarction cases, recent lifechange data were also collected through a separate interview of spouses. Spouses provided the life-change data for all coronarydeath victims. In all but one group of subjects, marked elevations in magnitude of life changes during the six months immediately prior to infarction or death were seen, compared to the same time interval one year earlier. This elevation was particularly apparent for sudden-death victims. Women showed recent increases similar to those of men.

Twenty-eight patients younger than age 40 years, treated for Hodgkin's disease with mediastinal irradiation, were examined no less than 5 years after the irradiation in order to evaluate the frequency of cardiac abnormalities. Twelve patients (43%) had had some pericardial event after radiation: a diagnosed pericarditis, remarkably increased heart volume, or a conspicuous change of cardiac silhouette, suggesting pericardial fluid. On evaluation, 50% of the patients complained of symptoms, and 13 patients had to stop the exercise test on a low level because of chest pain, dyspnea, or general fatigue. In 13 patients some of the following abnormalities in the electrocardiogram (ECG) was found: right bundle branch block (four), first-degree atrioventricular block (four), abnormal P terminal force (five), or a low voltage (two). In ten patients (38%) an increase of the pericardial fluid was seen in the echocardiogram, and in nine patients the right ventricle wall thickness had increased. In two patients a severe coronary artery disease was found. One died suddenly after an acute myocardial infarction (AMI), and the other had a large anterior AMI. Two patients with chronic pericardial fluid underwent partial pericardectomy. Two cases of mild pulmonary valve stenosis, one pulmonary subvalvular stenosis and two aortic valve deformities were discovered. Eight patients went through cardiac catheterization, and in all but one case the pressures were slightly elevated suggesting diminished diastolic compliance. In summary, 19 of 28 patients had some abnormal cardiac findings, but only three of them were serious ones.

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