We conclude that atrial natriuretic peptide can induce a gradual decrease in blood pressure, sometimes followed by symptomatic hypotension, which occurs suddenly. This phenomenon depends on the duration of the infusion as well as the dose. Moreover, the dose effect is enhanced during low sodium intake. This warrants careful observation of patients with essential hypertension who are given infusions of atrial natriuretic peptide over longer periods. The effect ofdesmopressin on nocturnal polyuria, overnight weight loss, and morning postural hypotension in patients with autonomic failure CHRISTOPHER J MATHIAS, PAUL FOSBRAEY, DAVID F DA COSTA, ANDREW THORNLEY, ROGER BANNISTER Abstract Day and night urine volume, morning and evening body weight, and supine and sitting blood pressure were measured in five patients with chronic autonomic failure who were not receiving treatment with drugs. AU had nocturnal polyuria, overnight weight loss, and a pronounced postural fall in blood pressure, with lowest levels in the morning. Desmopressin (24 ,ug given intramuscularly at 8 pm) reduced nocturnal polyuria, diminished overnight weight loss, raised supine blood pressure, and reduced the postural fail, especially in the morning, when patients were often at their worst.

No abstract

The combined experience from randomized trials suggests that the use of anti-embolic devices does not decrease early mortality or reinfarction during PCI for native vessel AMI. Whether their use improves longer term outcomes is unknown. Further research is needed to clarify the indication and optimal devices for anti-embolic protection.

BackgroundOptions for patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and/or catheter ablation remain limited. Stereotactic radiotherapy has been described as a novel treatment option.MethodsSeven patients with recurrent refractory VT, deemed high risk for either first time or redo invasive catheter ablation, were treated across three UK centres with non-invasive cardiac stereotactic ablative radiotherapy (SABR). Prior catheter ablation data and non-invasive mapping were combined with cross-sectional imaging to generate radiotherapy plans with aim to deliver a single 25 Gy treatment. Shared planning and treatment guidelines and prospective peer review were used.ResultsAcute suppression of VT was seen in all seven patients. For five patients with at least 6 months follow-up, overall reduction in VT burden was 85%. No high-grade radiotherapy treatment-related side effects were documented. Three deaths (two early, one late) occurred due to heart failure.ConclusionsCardiac SABR showed reasonable VT suppression in a high-risk population where conventional treatment had failed.

No abstract