Paired biopsy specimens from the right or left atrial appendage have been taken from patients undergoing cardiopulmonary bypass surgery after various periods of intermittent coronary artery occlusion and analysed for potassium, sodium, and chloride content, total tissue water, and extracellular fluid volume.Tissue potassium content is reduced after coronary artery occlusion, and potassium loss bears an apparently linear relationship to the duration of occlusion. After 150 minutes of occlusion the potassium content had decreased by nearly 50%.For the first 50 minutes of occlusion the myocardial cells swelled at the expense of the extracellular fluid volume. Thereafter there was movement of water in the opposite direction, with subsequent cell shrinkage.The loss of potassium and the alteration in cellular hydration exert profound effects on the calculated gradient of potassium across the cell membrane. This is discussed in relation to the arrhythmias and low cardiac output after myocardial ischaemia. An attempt to rationalize treatment is made.