Our studies recently conducted on the correlation between pulmonary vascular resistance and pulmonary arterial diastolic pressure in 467 cases, identified an extremely high correlation between the two. The correla-tion coefficient between pulmonary arterial diastolic pressure (PAdp) and pulmonary to systemic resistance ratio (Rp/Rs) was 0.799 and that between pulmonary vascular resistance index (RP-index) and PAdp was found to be 0.791. And a still higher correlation was observed between pul-monary vascular resistance and pressure gradient between PAdp and left atrial mean pressure (LAmp), where the correlation coefficient between Rp/Rs and (PAdp-LAmp) was 0.851 and that between Rp-index and (PAdp-LAmp) was 0.813.
Those correlations are found to be higher in degree than the correla-tions between pulmonary arterial mean pressure or pulmonary arterial systolic pressure and pulmonary vascular resistance, leading to the con-clusion that the pulmonary arterial diastolic pressure is of extremely high clinical importance as an index for increase in pulmonary vascular re-sistance

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Electrophysiological and histopathological examinations were carried out in 2 patients with persistent atrial standstill. Intracardiac studies revealed that atrial standstill was due to atrial inexcitability. It was demonstrated in both patients that prolongation of the H-V interval and the duration of H deflection was associated with complete right bundle branch block and that the escape rhythm was an A-V junctional origin. Histologically, marked fibrosis of the right atrium and fibrous strands in the right ventricle were demonstrated in a 69-year-old man with idiopathic cardiomyopathy. In another female patient with peripartum heart disease aged 40 years, there was moderate degeneration of the myocardium in the right ventricle. The results of electron microscopic observations are also presented. The importance of the examination of His bundle electro-graphy in persistent atrial standstill and the diagnostic criteria and treatment of this lesion are discussed

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Cranial blood flow, mean cranial transit time and cranial blood volume were measured by the intravenous RISA technique in 10 patients with cerebral transient ischemic attacks (TIA) at the various time intervals from the onset of last attack. Cranial blood flow was subnormal in 5 out of 11 determinations and mean transit time trended to be prolonged in the diseased hemisphere in cases suggestive of the unilateral hemispheric lesion.
A decrease in cranial blood flow was observed in TIA with lowering of heart rate below 60/min, or with atrial fibrillation, whereas no obvious correlation was present between heart rate and cranial blood flow either in 94 partients with, or in 62 patients without cerebrovascular diseases.
Cardiac dysrhythmias including bradycardia, leading to reduce perfusion to the brain was discussed as a possible factor for producing TIA

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Serum zinc concentration was measured by atomic absorption spectrophotometry in 30 normal males, 17 normal females, 20 patients with arteriosclerosis obliterans, 26 patients with thromboangiitis obliterans, 40 patients with Takayasu's disease.
The mean serum zinc concentration was 93.9±S.E.4.0μg/100ml in the normal male controls, 75.1±3.3μg/100ml in patients with arteriosclerosis obliterans without ulcers (P<0.05) and 79.2±6.5μg/100ml in patients with thromboangiitis obliterans without ulcers. Serum zinc concentration showed to be more decreased in patients with these diseases who had ulcers. The mean serum zinc concentration was 77.9±4.0μg/100ml in the normal female controls, 71.8±5.1μg/100ml in patients with Takayasu's disease who had never been treated with steroids and 59.1±2.7 μg/100ml in patients with this disease who had been treated with this drug (P<0.01).
The zinc level was significantly lower in CRP positive patients with Takayasu's disease than in CRP negative patients (P<0.05)

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Blood glucose, free fatty acid and insulin responses to oral glucose and the fasting serum lipids were measured in 3 groups: 32 non-obese (mean age: 47.5 years) and 9 obese (mean age: 84.5 years), male patients with coronary heart disease and 12 non-obese male controls (mean age: 46.5 years). The oral glucose tolerance tests were repeated after 3 years in 16 of the non-obese patients with coronary heart disease.
The results were as follows:
1) Glucose tolerance was impaired in 19 of 32 non-obese patients (59.4%). There was a significant correlation between impaired glucose tolerance and hyperlipidemia (hypercholesterolemia and/or hyper-triglyceridemia).
2) In obese patients FFA levels at 30, 60, and 120 min after oral glucose administration were significantly elevated and FFA decrease was delayed with a drop to minimum levels at 180 min.
3) The insulin response after oral glucose administration in the group of non-obese patients with normal glucose tolerance was similar to that of non-obese controls. In the group of non-obese patients with impaired glucose tolerance, serum insulin levels went up to normal levels, but the peak was delayed. The serum insulin levels in obese patients were significantly higher than those of controls at 0, 60, 120, and 180 min. After 3 years the change in insulin response to oral glucose was not related to anginal symptoms or ECG findings, but was related to body weight change in patients with minor changes in glucose tolerance.
4) The metabolic pattern in the non-obese group with impaired glucose tolerance resembled that of "mild diabetes" in delayed response of in-sulin and FFA, and mild hyperlipidemia.
These findings suggest that obesity may contribute to hyperinsuline-mia in patients with coronary heart disease and that impaired glucose tolerance observed in patients with coronary heart disease is in part due to "latent diabetes"

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Echocardiographic tracings of posterior left atrial wall motion were examined in 30 normal subjects, 17 patients of mitral stenosis with sinus rhythm and 31 coronary patients with elevated left ventricular enddiastolic pressure. Because of the plane of the posterior left atrial wall motion and the angle of the sound beam, usually the postero-inferior portion of the left atrial wall was recorded. In normal subjects, there were 3 positive waves (A, C, V waves) and 2 negative waves (X and Y waves). The A wave during atrial contraction period occurred in the closing motion of the mitral valve and was initiated by a slight negative wave. The fourth heart sound was consistent with the ascending limb of the A wave. The C wave coincided with the first heart sound followed by the pronounced negative depression (X wave). The X trough coincided with the beginning of the mitral valve opening in early diastole and was the deepest point in the motion curve. The V wave was a peaked anterior motion during rapid filling period and followed by the third heart sound. The Y wave was a slight negative depression following the V wave, and its trough occurred when the both leaflets of the mitral valve assumed a semiclosed position.
In both mitral stenosis and coronary artery disease, significant increase (p<0.01) of the A wave excursion and significant decrease (p<0.01) of the V wave excursion were observed, resulting in marked increase (p<0.01) of the A/V ratio. The slope of the ascending limb of the V wave was also decreased apparently in both conditions. These findings might reflect increased resistance to left atrial emptying in mitral stenosis and decreased left ventricular filling rate in coronary artery disease. This study shows that echocardiographic examination of the posterior left atrial wall motion is feasible and useful in estimating the presence of either mitral stenosis or decreased left ventricular filling rate

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This research is an attempt to measure blood flow without doing any hurt to the body. When the body is placed in a high magnetic field the blood-flow-induced electromotive force (EMF) can be detected with the surface electrodes using the same principle as an electromagnetic flow-meter. This blood flow measurement is named magnetorheography (its recording: MRG).
A theoretical analysis of the potential in the tissue shows that blood flow can be calculated from the surface-induced EMF (MRG) without measuring the radius and the depth of the vessel from the skin surface, when the surface is fairly flat in the vicinity of the vessel. A model ex-periment verified the theory.
In order to apply the theory to the measurement in an in situ situa-tion, a structural coefficient was introduced which is related to the ex-ternal shape, internal tissue compositions and their impedance of the body. Using such a coefficient the flow calculated from MRG, by an equation including the coefficient, agreed with the flow actually recorded.
In experiments on the thighs of 8 dogs weighing 7 to 17Kg, MRG proved to be proportional to arterial flow and the coefficients were ap-proximately constant. These results indicate that blood flow may possibly be estimated by the calculation from MRG

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Thirteen isolated canine right atria were perfused with blood conducted from a support dog. The selective injection of verapamil into the cannulated sinus node artery at a dose level above 1μg usually induced dose-dependent negative chronotropic and negative inotropic effects. At a dose of 30μg, verapamil caused sinus arrest in 4 cases out of 7 with marked suppression of the isometric tension development. At 100μg, in all cases it caused sinus arrest which continued about 1 hour. When calcium chloride was injected into the sinus node artery, a positive inotropic effect was dose-relatedly produced above a dose level of 100μg, but the threshold dose for inducing a positive chronotropic effect of calcium chloride was approximately 1mg. On the other hand, norepinephrine when injected into the sinus node artery simultaneously induced a positive chronotropic and inotropic effect at the same threshold dose. A dose level of 10-30μg of verapamil did not significantly inhibit positive chronotropic and inotropic responses to norepinephrine and a positive inotropic response to calcium chloride in per cent. The negative inotropic response as well as the positive chronotropic and inotropic responses to electric stimulation of the epicardium were not blocked by verapamil which caused marked suppression of the tension development

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Cardiac output of unanesthetized spontaneously hypertensive rats (SHR) and normotensive control rats (NCR) was measured by an aortic pressure pulse contour method. A catheter was introduced into the aortic arch under ether anesthesia and aortic pressure curves were recorded after the recovery from anesthesia. Stroke volume was calculated by reading required pressure and time data on the tracings and substituting them into a special equation. Cardiac output per min per body weight was not significantly different between SHR and NCR. Arterial pressure and total peripheral resistance were higher in SHR than in NCR. On ganglion blockade with hexamethonium bromide in the conscious state, arterial pressure decreased more markedly in SHR than in NCR. Though arterial pressure was still significantly (P<0.05) higher in SHR after blockade, cardiac output was larger in SHR more than to account for the difference in arterial pressure. Total peripheral resistance was lower in SHR than in NCR after blockade. It is concluded that, even in the conscious state as in the anesthetized state, the major contribution to the hypertensive state in SHR is an increase in total peripheral resistance due to an elevation of the sympathetic tone

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The present investigation was designed to study the relationship between mechanical and electrophysiological actions on the heart of digitalis and the effects on it of K administration.
Nineteen anesthetized dogs were given acetylstrophanthidin (AS) (30γ/Kg, followed by 1γ/Kg/min. When ectopic tachycardia occurred, sinus rhythm was restored with an infusion of K (5mEq/Kg/hour, for 5min).
As the dose of AS was increased beyond 30-40γ/Kg, ventricular rate during electrically induced atrial fibrillation was reduced and PQ interval prolonged, while PP interval, QT interval and QRS duration showed little changes. Ectopic tachycardia occurred at an average dose of 56.9γ/Kg of AS. The indices of mechanical properties, dp/dt/IIT, max dp/dt and dp/dt (50), began to increase as soon as AS infusion was started and continued to increase during the administration of AS. The dp/dt (50) and PP interval or ventricular rate during atrial fibrillation did not change in parallel. Inotropic activity was not depressed even during ectopic tachycardia. The administration of K eliminated ectopic tachycardia, but caused no changes in the other electrophysiological and mechanical properties of the digitalized heart.
The following conclusions were derived from the experiment. 1) The 2 actions of digitalis, mechanical and electrophysiological ones, are not necessarily related to each other. 2) Digitalis intoxication, represented by ectopic tachycardia, does not mean the depression of the inotropic activity. 3) The administration of K does not affect the inotropic activity of digitalis

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An unusual case of pheochromocytoma is described in this communication. Besides a chain of typical clinical pictures and laboratory findings which suggested a catecholamine-producing tumor, the left renal artery stenosis was demonstrated by an aortography and the plasma renin activity was consistently elevated, Surgery revealed the left renal artery was embedded in the tumor mass, originated from the left adrenal gland, resulting in a high degree of constricture of the vessel. Following the removal of the tumor, blood pressure immediately returned to normal, however, plasma renin activity remained elevated as long as 9 months of the follow-up study. The second aortography performed 14 months after the operation failed to demonstrate the left renal artery stenosis and subsequent studies revealed that plasma renin activity was gradually declining to upper normal levels. It is suggested that an excess of catecholamines secreted by the tumor was responsible for hypertension in this case, and that another factor, probably renal artery stenosis, was involved in the elevation of plasma renin activity, although this high renin activity was maintained for more than 9 months following the tumor extirpation

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A 13-year-old girl was admitted with congestive heart failure, edema, ascites, and jaundice. There was an apical pansystolic murmur of mitral insufficiency and marked cardiomegaly. Her venous pressure was ele-vated. Despite medical treatment her condition deteriorated, hepatic and renal failure as well as disseminated intravascular coagulation ensued, leading to her death.
At post mortem she was found to have rheumatic mitral valvulitis and constrictive pericarditis. The pathologic picture of pericarditis was nonspecific, but in presence of a positive skin test for tuberculosis the latter is considered to be the most likely cause of the pericarditis, nevertheless, rheumatic etiology of pericarditis in this case cannot be excluded. The presence of rheumatic heart disease and cardiomegaly may have led to the exacerbation of symptoms and signs of constrictive pericarditis and severe right heart failure

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