The electrocardiogram in 1,029 obese subjects was correlated with the severity of obesity and with age, sex and blood pressure. The heart rate, PR interval, QRS duration, QTc interval and voltage (R + S or Q wave in leads I, II and III) increased, and the QRS vector shifted to the left with increasing obesity. These changes were independent of age, sex and blood pressure. Bradycardia was present in 19% of the patients, but tachycardia in only 0.5%. ST and T wave abnormalities were present in 11%, correlating better with increasing age and blood pressure than with severity of obesity. Conduction abnormalities were infrequent. Low voltage was present in only 3.9% of the patients and QTc prolongation was present in 28.3%. The heart rate and QRS voltage increase with increasing obesity. Conduction is slowed, and the QRS vector shifts toward the left as percent overweight increases. These changes must be considered when evaluating both baseline electrocardiographic studies in obese patients and the changes seen during weight reduction.

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All nondiabetic patients admitted to a coronary care unit with suspected myocardial infarction (MI) had glycosylated hemoglobin (Hb A1) determinations to aid in the interpretation of hyperglycemia. Hyperglycemia was frequent among patients with a confirmed MI, whereas an elevated Hb A1 level was less common and affected patients with and without MI equally. With the use of a fasting plasma glucose level of 140 mg/dL and an Hb A1 level of more than 8.5% as combined diagnostic criteria, 9% of patients (8/93) with MI and 12% of patients (8/68) without MI had previously unrecognized diabetes. Follow-up studies three months after the acute episode supported these results. The Hb A1 measurements provide a practical method to separate hyperglycemia due to stress from that due to diabetes mellitus. Marked hyperglycemia with a normal Hb A1 level indicates a severe MI.

A seminar and workshop were conducted to train students in the indications, techniques and hazards of common diagnostic and therapeutic procedures in general medicine. Cadavers were utilized to teach the techniques of thoracentesis, pleural biopsy, chest-tube insertion, bone marrow biopsy and aspiration, paracentesis, percutaneous liver biopsy and arthrocentesis. The use of cadavers was realistic and provided standardized instruction to each student. The method gave students an opportunity to become familiar with equipment, techniques, indications and hazards of each procedure prior to actual performance. It is readily adapted to a wide variety of additional procedures.