The extent and severity of coronary arteriographic and left ventriculographic findings were analyzed in aged patients. 119 patients over 60 years old (96 male and 23 female) were selected out of 900 patients studied in this laboratory. The average age was 64 years, range 60 and 78 years. 100 patients (84%) had the clinical diagnosis of coronary artery disease (CAD), 15 had valvular disease and 5 had cardiomyopathy. In 100 patients with CAD (83 male, 17 female), 37 patients (37%) developed significant stenosis of 3 or 4 major coronary artery (94.5% male, 5.5% female) and 24 patients (24%) had obstractions of 2 vessels and 16 (16%) had a single vessel disease and 10 patients had lesions less than 50% narrowing of lumen diameter, while 4 patients (4%) exhibited coronary spasm during the procedure. The remaining 9 (4 male, 5 female) had normal arteriogram. The anterior desending was affected in 58 patients, of which 33 patients presented complete occlusion. The right coronary artery was involved in 32 patients and 26 patients of these presented complete occlusion. The main left coronary was involved in 13 patients (13%). Moreover, 57 patients (57%) had major ventricular aneurysm or akinesis is left ventriculography, which resulted in impairment of left ventricular function. The risk of CAD appeared to rise in proportion to the high level of serum triglyceride and the low level of HDL-cholesterol concentration. The extent and severity of coronary artery seemed to be related to the exsistence of hypertention, glucose intolerance and cigarettes habit. These results indicate that coronary artery is affected by the atherosclerotic process as the individual becomes older, which results in the extensive myocardial ischemia and severe pump failure. In conclusion, it is necessary to correct or protect these coronary risk factors for the treatment of CAD in aged patients.
An enzyme, elastase (Elastase, Eisai Co., 450ELU/Kg. b.w./day) showed the following effects on the experimentally induced atherosclerosis in rats with Vit. D2, 3.5×105units/Kg b.w./day, for 4 days, and with atherogenic diet for 9 days, 4 and 6 weeks. 1) Elastase activity, for suc(Ala)3pNA, was specifically increased in serum in 9 days. 2) Abnormally increased, or decreased amount of elastin and collagen in the tissues (heart and aorta) were normalized to the normal range in 9 days or 4 weeks. 3) Abnormally increased total cholesterol in the tissues (heart, aorta, kidney and liver) were lowered in 4 weeks. 4) Abnormally increased total cholesterol in kidney was lowered in 6 weeks. It may be suggested from the above findings that the externally administered elastase improved experimentally induced abnormal metabolisms of lipid and connective tissues, which may be considered to be one of the improving factors in the atherosclerosis.
The present study was designed to investigate the role of urinary dopamine (DA) in natriuresis and the possibility of DA participation in the blood-pressure-modulating mechanism in 10 male and 11 female elderly subjects (age from 71 to 91 years) by measuring urinary DA, adrenaline (Ad), noradrenaline (NA), sodium excretion and mean arterial pressure (MAP). The ratio of DA to Ad·NA(DA/Ad·NA)was significantly correlated with MAP (γ=0.51, p<0.02). Urinary DA excretion was significantly correlated with that of sodium (γ=0.58, p<0.01). Urinary DA excretion as well as sodium excretion increased significantly (both p<0.02) after furosemide 40mg/day P. O. administration, whereas urinary DA excretion decreased insignificantly despite the significant increase of urinary sodium excretion (p<0.05) after spironolactone 75mg/day P. O. administration. These results suggest that DA concentration in the urine is closely associated with natriuresis and related to blood-pressure-modulating mechanism as well. It is speculated that kidney plays an important role in the mechanism controlling urinary DA excretion. Furthermore, an association between DA and aldosterone is discussed.
This report is concerned with contents of sodium and potassium in the various tissues removed from 48 dissected elderly patients with mean age of 78 years, and the relation between potassium concentrations in serum and in various tissues have been investigated. Pieces of skeletal muscle, cardiac muscle, aorta, brain, spinal cord, kidney, lung, liver, pancreas, stomach, intestine, spleen, thyroid, adrenal, skin and adipose were ashed, and a flame photometer was used to determine the contents of sodium and potassium in the tissues. The electrolytes contents of samples were expressed as amounts per kg wet weight. Potassium and sodium contents were correlated negatively in skeletal muscles, but positively in intestines. Potassium content of serum was correlated with those of skeletal muscle and intestine, but not correlated with kidney, liver and other various tissues. In the emaciated group with hypoproteinemia and hypokalemia, the means for tissue potassium in skeletal muscle, heart muscle, lung, liver, intestine and spleen were lower significantly than those in the control elderly. There were no statistical difference between these two groups for potassium contents in kidney, brain, thyroid, adrenal, skin and adipose. As potassium has been considered an index of catabolism in tissue, these results may suggest the difference in the grade of catabolism in the various tissues. In the disabled elderly, the enhanced catabolism and decreased potassium intake might cause tissue potassium depletion, which might be reflected in hypokalemia.
Hemodynamics and plasma norepinephrine concentration (NE) at rest and during supine graded exercise were measured in 7 healthy males of 8th decade and compared with 20 young volunteers aged 19 to 37. Using a bicycle ergometer, exercise was started with 25W and the work load was increased by 25W every 3 minutes until the subject could no longer continue. At rest, the mean values of cardiac output (CO), heart rate (HR) and stroke volume (SV), and diastolic blood pressure in the aged group were not significantly different from those in the young group, while systolic blood pressure and pulse pressure were high in the aged, reflecting the decreased aortic elasticity. E in the aged was significantly high under the resting state (240±37 vs 159±30pg/ml, p<0.01). During exercise, both CO and HR increased linearly with increasing work load, although maximum values were markedly lower in the aged than in the young (near-maximum CO: 11.24±1.11 vs 19.74±1.04l/min, maximum HR: 120±7 vs 178±2beats/min, p<0.001). However, CO at each stage of submaximal exercise was essentially the same in the aged as in the young, but the aged had the small increase in SV and the large increase in HR, and the rise in blood pressure during exercise was greater in the aged than in the young, corresponding to the smaller increase in total systemic conductance (SC). An increase in SV during exercise was achieved by a greater systolic emptying and unchanged left ventricular end-diastolic dimension in the presence of increased afterload, meaning the enhanced left ventricular myocardial contractility rather than the Frank-Starling effect. A small increase in SC suggested the decreased adjustment of vascular tone in working muscles. It was considered that the reduced aortic compliance and/or small change in SC in the aged would partly play a role in a small increase in SV during exercise by inducing the marked systolic pressure load on the left ventricle. Although maximum work output in the aged was one half of that in the young (75 vs 150W) and maximum HR was markedly reduced, NE at exhaustion attained a similar high concentration on both groups (715±121 vs 702±99pg/ml). These demonstrated that the sympathetic activity during exercise remains unchanged and the cardiac response to sympathetic drive declines with advancing age.