The two-dimensional echocardiographic features of three patients with congenital aneurysms of the left atrium are described. The aneurysm arose from the left atrial appendage in two patients and from the posterior left atrial wall in one. The aneurysms were characterized by their origin from an otherwise normal left atrium, a well-defined neck, their position within the pericardial space, and distortion of the left ventricular free wall by the aneurysmal body. The differentiation of these structures from other abnormalities of the left atrium are also discussed. Two-dimensional echocardiography is a safe and reliable method for diagnosing congenital aneurysm of the left atrium, and such studies should be considered in any patient with an otherwise unexplained abnormality on the chest radiograph.

Objective-To assess racial differences in cardiac structure and function in patients presenting with previously untreated hypertension.Design-Untreated black patients with hypertension were compared with untreated white patients matched for age and sex. Both groups had similar body mass indices, blood pressures, and reported duration ofhypertension. IntroductionStudies from the United States and the United Kingdom have shown that the prevalence of hypertension is higher in black than in white populations."4 Furthermore, the prevalence of left ventricular hypertrophy, a powerful independent predictor of sudden death, cardiovascular disease, and cardiac

SUMMARY The diagnosis of cardiac sarcoidosis, particularly when there is no overt systemic involvement, is frequently delayed because of its varied manifestations. Focal left ventricular wall motion abnormalities were recognised in five patients with sarcoidosis. Three patients showed abnormal regional wall motion in the basal portion of the ventricular septum and free wall with sparing of the apex. The angiographic appearances supported the echocardiographic findings which were atypical of ischaemic heart disease. The remaining two patients both had diffuse left ventricular hypokinesia, with a focal abnormality that was most pronounced in the anteroapical region; this pattern is often seen with coronary disease.The recognition by echocardiography or angiography of focal abnormalities of wall motion affecting the basal portion of the ventricular septum should suggest the possibility of myocardial sarcoidosis even in the absence of recognised systemic manifestations.Focal abnormalities of left ventricular wall motion are uncommon except in coronary artery disease in which the distribution is dependent on coronary artery anatomy. It is therefore unusual to find wall motion abnormalities localised to the basal part of the septum with sparing of the apical portion. This report of five cases shows that although sarcoid granuloma can occur anywhere in the heart a pattern of fibrosis distinct from coronary disease may be recognised by echocardiography and angiography. Accepted for publication 23 October 1986 coronary angiography, and cross sectional echocardiography. Three patients shared several clinical characteristics. None of these three had clinical evidence of heart failure. All had normal physical examination, normal laboratory indices of bone marrow, renal, and hepatic function. All had left anterior hemiblock and right bundle branch block. Left ventricular end diastolic and pulmonary artery pressures were normal and there was no disease of the major epicardial coronary arteries. The table summarises the investigations that were performed to assess disease activity and distribution.In patient 1 systemic sarcoidosis was not diagnosed during life. He presented with a two year history of palpitation and ventricular tachycardia associated with syncope and evidence of a progressive conduction system disturbance. During cross sectional echocardiography from the parasternal long axis view (fig la) the basal part of the ventricular septum was thin and akinetic with increased echo reflectivity and paradoxical systolic motion. The same abnormality was seen in serial short axis views at the level of mitral valve and papillary muscle (fig 2). The apical third of the ventricular septum, the posterior wall of the ventricle, and the right ventricular free wall were normal. Left 256