In the majority of cases the area ratios are in close agreement with the theoretically predicted values for forward matched junctions. Minimal pulse wave reflections are therefore expected to arise from the junctions of a healthy arterial system. We therefore consider that, contrary to the established view, the presence of reflected waves in the central arterial system is a potential pathological phenomenon and not a characteristic of the healthy system. This may have important theoretical implications for the way hemodynamic findings are interpreted. Finally we suggest that arterial area ratio can be considered as another criterion of normality of arterial junctions in the interpretation of angiograms.

Glossopharyngeal neuralgia associated with cardiac syncope developed in a 53 year old man. Symptoms were controlled with temporary and permanent transvenous pacing and carbamazepine. pacemaker (fig 2).Further examination of his throat showed congestion of the posterior pharyngeal wall with oedema of the uvula and tonsillar fauces. The left upper molars were loose and carious. During the dental examination the patient developed typical pain, followed by asystole which was interrupted by pacemaker intervention. A trigger zone was noted around the left peritonsillar and paramolar region, which when touched with cotton wool or ethyl chloride spray induced an attack. There was no evidence of hypersensitivity of the carotid sinus-carotid massage on either side did not produce significant bradycardia, hypotension, or asystole.' Somatic pain produced by squeezing the achilles tendon failed to induce an attack.

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