Annotations

ovation for her discovery by the 400 astrophysicists in the audience. She had not visited the U.S. previously and would have not been able to attend the symposium except for the invitation extended to her.’ She was not envious of the Nobel decision and even expressed her opinion that the supervisor should receive both credit and blame for a graduate student’s results. “Besides,” she said at the banquet, “it’s no skin off my nose; look at the company I’m in.“;

Such is the reward of research and of awards. George E. Burch, M.D.

Tulane University School of Medicine and Charity Hospital of Louisiana

New Orleans, La.

REFERENCES

1. Wade, N.: Discovery of pulsars: a graduate student‘s story, Science 189358, 1975.

2. Hewish. A.. Bell. S. J.. Pilkington. J. D. H.. Scott. P. F.. and Coilins, R. A.: Observation of a rapidly pulsating radio source, Nature 217:709, 1968.

3. Findlay, J. W.: The 1974 Nobel Prize in Physics, Science 186:620, 1974.

4. Hewish, A.: Pulsars and high density f+h>sics. Science 188:1079, 1975.

5. Metz, W. D.: Astrophysics: Discovery and rhe ubiquity of black holes, Science 195:276. 1977.

The carbon-copy pain of myocardial infarction*

It is a matter of considerable practical importance to decide whether an episode of spontaneous chest pain in a patient with a history of angina is cardiac or not. Patients with angina tend to be abnormally aware of sensations in the chest which others would ignore, so that this is a problem which not uncommonly presents itself to doctors.

Most authorities state or imply that the site of the pain in myocardial infarction is identical with that of angina, though it has long been recognized that the pain of infarction may be felt in the epigastrium.’

Three hundred and thirty patients with angina pectoris were followed until death or until an average of six and a half years had elapsed from the onset of their symptoms. The site of the angina1 pain, though differing from patient to patient, was constant for each individual, except that it tended to spread to other parts of the torso if the attacks were severe. Among the 330 patients studied, there were 145 in whom the site of the angina1 pain had been precisely recorded and who subsequently developed myocardial infarction. In 136 (94 per cent), the epicenter of the pain of infarction was similar to that of the preceding angina (though the pain often extended more widely). This was true even when the site of angina had been unusual; e.g., in the right side of the chest or the back. In nine (6 per cent) of the patients, however, the pain of

infarction had a different epicenter from that of the preceding angina. In each of these nine cases, the pain of infarction was lower than (caudal to) that of the angina. Thus, if the pain of angina had been felt in the upper chest, that of infarction was felt in the mid-chest; if the pain of angina had been felt at the lower end of the sternum, that of infarction was felt in the epigastrium. Many of our patients developed pains which were lateral to or at a higher site than that of their angina, but in such cases there was never any evidence of acute cardiac ischemia or infarction, however severe the pain might be.

Thus the pain of infarction may be thought of as a carbon copy of the angina, the copy being usually more intense than the original and occasionally slipping t,o a lower level. Pain which does not have the same epicenter as the angina, or is not immediately below it, is unlikely to be cardiac in origin.

Dacid Short. Ph.D., F.R.C.P. Consultant Physician

Mary Stouw-s, M.B., B.S. Rtasenrch Assistant

Cardiac Department A herdeen Royal Infirmarg

Foresterhill it brrdeen , A B9 2ZE

Scotland REFERENCE

*We are indebted to the British Heart Foundation for a generous grant 1. Friedberg, C. K.: Diseases of the heart. 3rd ed., l’hiladel- in support of this study. phia, 1966, W. B. Saunders Company. 1). 798.

The effect of a new beta-blocking agent, levo-bunoiol,

on exercise-induced or augmented ventricular

arrhythmias*

The control of ventricular ectopic arrhythmias continues to be a significant clinical problem. Recent studies have stressed

‘This work was supported in part by a grant from the Veterans Admin- &ration.

the inefficacy of conventional drugs and the high incidence of their deleterious side effects.‘-’ In addition, these reports have stressed the need to demonstrate efficacy through exercise stress and/or long-term monitoring rather than with brief routine electrocardiograms.

0002-8703/78/0396-0417$00.20/O 0 1978 The C. V. Mosby Co. American Heal-f Journal 417