Previous small clinical trials have suggested that treatment with nitric oxide donors in suspected myocardial infarction can reduce mortality by 30-35%. To confirm this finding in a large-scale trial, we compared molsidomine and its active metabolite linsidomine (a nitric oxide donor) with placebo in 4017 patients with acute myocardial infarction.In our trial, patients without signs of overt heart failure (Killip III/lV) were randomly assigned in a double-blind design within 24 h of symptom onset to receive linsidomine 1 mg/h intravenously for 48 h, followed by 16 mg molsidomine by mouth daily for 12 days (n = 2007), or an identical placebo (n = 2010). All other treatments could be used at the responsible physician's discretion with the exception of systematic vasodilator treatment. The molsidomine and placebo groups showed similar all-cause 35-day mortality (168 [8.4%] vs 176 [8.8%] deaths, p = 0.66), and adjustment for baseline variables in a Cox model had no effect. Similarly, we found no difference for long-term mortality(mean follow-up 13 months; 294 [14.7%] vs 285 [14.2%] deaths, p = 0.67). The two groups showed similar frequencies of major and minor adverse events; only headache was significantly more common in the molsidomine group.Changes in treatment practices and the lower risk profile of our study subjects than of participants in previous trials may explain the results. It is still not clear whether nitric oxide donors can improve survival in higher-risk myocardial infarction patients.

One hundred and twenty-seven patients admitted for dizziness, syncope, or a fall were studied prospectively over a six-month period. History taking, a thorough physical evaluation, routine blood tests, a carboxy-hemoglobin serum assay and an ECG with carotid sinus compression were carried out as the initial workup. Additional investigations were then performed as indicated. Most patients were females above 65 years of age. A cause was identified in 87 % of cases. Cardiovascular disease was the leading cause (50 %), followed by neurologic disease, falls due to clumsiness, and abuse of alcohol. The initial workup ensured the diagnosis in 79 % of cases ; more sophisticated investigations provided decisive information in only 10 % of patients. Clinical findings were found to have the greatest diagnostic value (66 %). Among sophisticated investigations, continuous ECG monitoring was most informative (25 %), whereas investigations of the brain were less likely to be helpful. In half the cases, the hospital stay was extended to adjust previous therapy or investigate a disease state discovered during the current hospitalization. These data show that inhospital evaluation, even of short duration, is beneficial in patients with dizziness, syncope or a fall.

127 patients were admitted to medical units because of malaises, syncopes and falls. The causes were found in 87% of the patients, mainly cardiovascular. In 50% of the patients, admission resulted in adjustment of treatment or finding and other pathology.