In order to elucidate the hemodynamic significance of exerciseinduced ST-segment shifts in ischemic heart disease, left ventricular cineangiography was carried out in 41 patients at rest and during supine bicycle ergometer exercise.
These patients were divided into 2 groups, that is, a normal coronary artery group (6 patients), having neither significant coronary artery stenosis nor exercise-induced ST-segment shifts, and a diseased group (35 patients) having significant coronary artery stenosis (inner-diameter stenosis _??_75%). The latter was further divided into 3 subgroups according to exercise-induced ST-segment shifts: ST-unchanged group (17 patients), ST-depression group (11 patients) and ST-elevation group (7 patients).
In the normal coronary artery and ST-unchanged groups, exercise produced an increase in left ventricular end-diastolic volume index (LVEDVI), a decrease in left ventricular end-systolic volume index (LVESVI) and increases in stroke index and ejection fraction. In the ST-depression group, the appearance or aggravation of left ventricular wall motion abnormality was induced at the site of coronary artery stenosis by exercise in 9 patients. Both LVEDVI and LVESVI increased, stroke index remained unchanged, and ejection fraction decreased during exercise. In the ST-elevation group, ST-segment elevation was induced in leads with abnormal Q waves. In 2 patients, exercise induced aggravation of wall motion abnormality at the infarctional segment. LVESVI increased, but LVEDVI showed little increase, and stroke index and ejection fraction tended to decrease during exercise.In the ST-depression group, exercise-induced left ventricular pump dysfunction was due to lowered contractility (increased LVESVI) caused by transient myocardial ischemia.
In the ST-elevation group, exercise-induced pump dysfunction was mainly due to lowered contractility, and in some of them, the findings suggested that transient myocardial ischemia at or around the region of infarction might be the cause of pump dysfunction. In addition, a poor compensatory effect of the Frank-Starling mechanism seemed to play a role in the onset of such dysfunction in this group.

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This study was undertaken to determine the diagnostic feasibility of detecting both qualitatively and quantitatively stenotic wall abnormalities in the left main coronary artery (LMCA) and its bifurcation. Adequate two-dimensional echocardiographic (2DE) images of the LMCA were obtained in 18 of 20 patients with angiographically proven coronary artery disease (CAD). In 15 of 18 patients the LMCA was completely imaged but in different 2DE-planes in most of the cases. Only in 4 of 18 patients could adequate images of the bifurcation, including the central parts of left anterior descending and circumflex branches, be demonstrated. On the contrary, the 2DE detected calcification of the LMCA identified by fluoroscopy in only 2 of 5 patients.
As to quantitative analysis, the correlation of luminal diameters in stenotic and non-stenotic coronary artery obtained from 2DE and coronary angiography was satisfactory (r=0.69, p<0.01).
These results suggest that 2DE can be useful for the follow-up study of LMCA disease. However, this method is not indicated for the detection of more distal left coronary artery stenosis occurring beyond the bifurcation.

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The optimal surgical management of ventricular septal defects (VSD) in infancy and particularly in small babies, still remains controversial.
Seventy-six infants with VSD as the major cardiac lesion were operated upon from March 1978 to December 1981. Forty-three underwent primary repair with a 9.3% mortality rate. Pulmonary artery banding (PAB) was performed in 33 infants without mortality. Sixteen of them had subsequent debanding and VSD closure, also without mortality.
Based on our own experience, our current recommendations are as follows: PAB in severely ill infants under 3 months of age, in infants with multiple or "Swiss-cheese type VSD" and in some cases of VSD with associated anomalies. Early debanding and correction, except in cases with multiple VSDs. Primary repair in infants aged more than 3 months and in some selected younger cases, according to the anatomical location of the defect.

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We studied the hemodynamic response to orally administered hydralazine (30mg) and examined the changes in neurohumoral factors in 16 aged patients with chronic congestive heart failure. After a single 30mg dose, 9 patients (Group I) demonstrated a greater than 30% decrease in systemic vascular resistance (SVR) and a significant increase in the cardiac index (CI); 7 patients, whose SVR was decreased by less than 30% (Group II), showed a less marked increase in CI. After 3 days of drug administration (90mg/day), the CI decreased in Group I (p<0.05) while it tended to increase further in Group II. Pretreatment plasma norepinephrine was lower in Group I than Group II (p<0.05). However, in Group I, it increased after 3 days of therapy, with a concomitant increase in plasma renin activity (p<0.01) and total plasma volume (p<0.025).
We conclude that the higher pretreatment plasma norepinephrine level in Group II, suggestive of more severe derangement of left ventricular function, may be associated with a less pronounced dilatory response of the peripheral vasculature after a single dose of hydralazine, and that the increase in norepinephrine in Group I after 3 days of treatment may limit these patients' late hemodynamic responses to the drug.

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We examined the haemorheological determinants in a group of 52 hypertensives (diastolic basal pressure>100mmHg) subdivided in relation to the clinical stage (I and II or III according to the WHO classification) and in a group of 50 normal controls, matched for age and sex.
From this study, it is evident that only plasma viscosity, fibrinogen and the fibrinogen/albumin ratio are able to distinguish normals from hypertensives. It is also clear that the clinical stage does not influence the haemorheological findings. These haemorheological factors were also measured in 3 groups of hypertensives treated with either timolol (20mg/day), metoprolol (200mg/day) or oxprenolol (160mg/day). After a basal evaluation, measurements were performed, at regular intervals of 10 days, for a period of 30 days. The only significant changes were obtained using timolol; metoprolol and oxprenolol, did not affect these haemorheological parameters.

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Indapamide, a sulphonamide derivative, was prescribed for 8 weeks at low dose (2.5mg once a day) to 14 hypertensive patients in order to investigate its effects on systolic and diastolic blood pressure (SBP, DBP), cardiac function and peripheral arterial resistance (PAR). During treatment we observed decreases in both SBP and DBP without any change in HR in the supine and standing positions and on exercise. As a result cardiac work was significantly reduced. Slight changes in pre-ejection period (PEP) and left ventricular ejection time (LVET) along with a more significant decrease in rate of rise of left ventricular pressure (DBP to PEP ratio) were observed during treatment. An increase in RBF and a decrease in PAR were also detected in the peripheral circulation.
These findings may indicate that indapamide antagonizes the cardiovascular effects of catecholamines.

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A unique case of variant angina is described in which cyclic S-T segment elevation was reproducibly induced by exercise. The treadmill test revealed cyclic S-T segment elevation to occur from the first minute onward, recurring with a cycle length of 2 min throughout the exercise while the work load was being increased. Similar cyclic episodes were also induced by the cold pressor test, and the ambulatory electrocardiogram demonstrated spontaneous episodes of S-T segment elevation with a similar cycle length in early mornings. Coronary arteriography revealed a fixed lesion in the mid-portion of right coronary artery with a 90% narrowing associated with coronary spasm leading to subtotal occlusion. The cyclic episodes were abolished by the administration of the calcium antagonist diltiazem. The spontaneous phasic activity of coronary arterial muscle is discussed as a possible cause or mechanism.

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A 61-year-old man with variant angina underwent bypass surgery to the left anterior descending artery (LAD) which had a 90% narrowing in the proximal segment. The postoperative course was favorable, but 6 months after surgery, the calcium antagonist, diltiazem, with which the patient had been continuously treated since surgery, was stopped because of hepatitis. Immediately after discontinuation of the calcium antagonist, the patient had an acute anterior myocardial infarction. An angiogram demonstrated a patent graft and an anteroapical infarction.
The infarction is thought to have been caused by a severe, prolonged spasm of the LAD distal to the graft or diffuse spasm of the LAD throughout its entire length.
Thus, after bypass surgery calcium antagonists should be given continuously to patients with variant forms of angina pectoris.

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An infant with idiopathic hypertrophic obstructive cardiomyopathy, presenting as severe right ventricular outflow obstruction, is described. The nonspecific clinical features and an unexpected angiocardiographic appearance made determining the correct diagnosis difficult. This infant was mistakenly diagnosed as having severe pulmonary stenosis. Attempted surgical correction was unsuccessful and at necropsy this diagnosis was confirmed. It is suggested that cross-sectional echocardiography may be diagnostic for infants with idiopathic hypertrophic obstructive cardiomyopathy.

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The main metabolic alterations in the hypothalamus of SHRSP that the endogenous vaso-dilating prostaglandin I₂ biosynthesis was not so enough adaptively enhanced as in SHRSR and that not only the vaso-constricting thromboxane A₂ biosynthesis but also the edema-causative leukotriene C formation elevated much higher than in SHRSR would reasonably contribute to a cause of malignant hypertension prior to stroke.

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Characteristics of M-SHRSP and M-SHRSP crossbred offspring were examined and the following results were obtained: 1. M-SHRSP are a suitable most severe hypertensive animal model. 2. Various crosses or backcrosses using M-SHRSP, WKY, and their hybrids, results in rat colonies with blood pressure levels of from 135 to 250mmHg. 3. The severe hypertensive factors in M-SHRSP diminish as a result of 3 or 4 backcrosses with WKY. 4. Stroke lesions disappear through crossing MSHRSP with WKY.

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1) Specific arterial runways (recurrent branchings, right-angular branchings, loopings and/or sharp turnings, etc.) were found in the adrenals, heart and mesenterium as well as in the brain and kidneys of SHRSP.
2) Most of the vascular changes were observed in the peripheral areas of the arteries and arterioles with these specific runways.
These morphological specificities in blood circulation seem to be very close to the functional specificities of each organ and to cause circulatory disturbances under conditions of hypertension as well as play a role in the high incidence of vascular changes in SHRSP.

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The hypotensive substances in bamboo leaf extract were separated by dialysis, salting out, ultrafiltration and gel filtration. The most effective fraction was further fractionated by density-gradient isoelectric focusing. The isoelectric point of the fraction exhibiting a potent hypotensive effect on SHR and SHRSP was focused around a pH range from 4 to 5. On the basis of chemical analysis, this purified substance was considered to be either a glycoprotein or a phenolic substance with a molecular weight of 5, 000 to results of tests using isolated aortae, this substance's hypotensive mechanisms may be ascribable to a direct effect upon the blood vessels.

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We attempted separation, purification on the hot water extractionsolvent extraction-precipitation by basic lead tetraacetate-gel filtration by TSK gel HW-40-column chromatography on silica gel by a characteristic solvent system. Six flavonoid glycosides [4], [5], [6], [7], [11] and [12] were isolated and thestructures were determined on the basis of their spectral and chemical evidence. apigenin-6, 8-di-C-glucoside [4] and Limocitrol-3-β-D-glucoside [5] showed especially marked falls of blood pressure after intravenous administration.

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It was found that arterial aneurysms were formed near the optic disc of SHRSP of more than 6 months of age. Marked circulatory disturbances were observed in the peripheral vessels distal to the aneurysm.

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