Cervical origin of right subclavian artery associated with tetralogy of Fallot

We present a case of an infant with tetralogy of Fallot with pulmonary atresia with an incidentally detected cervical origin of right subclavian artery. We highlight the importance of identifying this rare variation and the potential complications that may ensue.     

Effects of carbohydrate type on postprandial blood pressure,neuroendocrine and gastrointestinal hormone changes in the elderly

Previous studies have demonstrated that blood pressure falls postprandially in fit elderly subjects, the greatest changes occurring after meals with a high carbohydrate content. To evaluate the influence of the type of carbohydrate on postprandial blood pressure, the effects of equivalent energy content (2.4 MJ) high complex (starch) and high simple (monosaccharide) carbohydrate meals were studied in seven healthy elderly subjects. Blood pressure, heart rate, autonomic function, plasma catecholamines, insulin and neurotensin levels were measured pre- and postprandially. Greater falls in supine and erect systolic blood pressure occurred after the high simple than the high complex carbohydrate meal (p < 0.05). No differences were found in supine or erect diastolic blood pressure, heart rate or in any of the biochemical parameters measured between the meal types. It is concluded that a simple carbohydrate meal results in a greater postprandial fall in blood pressure than an equivalent energy complex carbohydrate meal in the elderly, although the mechanisms for these changes are unknown.