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November 25, 1974

Infarction in Patients Treated With Propranolol

Author Affiliations

Royal Victoria Hospital Belfast, Northern Ireland

JAMA. 1974;230(8):1126. doi:10.1001/jama.1974.03240080016011

To the Editor.—  The Figure represents the findings in the angiogram of a patient discharged on a drug regimen for angina pectoris from a hospital in the United States. The right coronary artery showed high-grade obstruction at the usual site of obstruction, just proximal to the origin of the branch to the atrioventricular node. It is not unreasonable to suppose that in such a situation there exists a high risk of complete obstruction and consequent acute myocardial infarction. It may, therefore, be salutary to consider the immediate effects of acute occlusion. Observations on 21 patients within 30 minutes of the onset of posterior infarction when this was a first infarct showed that 17 had bradycardia, 16 with associated hypotension. Eight of the 17 had a systolic blood pressure not greater than 80 mm Hg, and in two patients the blood pressure was unrecordable. Thus, eight of the 21, or one