Heart sounds and murmurs are studied in 18 proved cases of rheumatic valvular aortic stenosis and an attempt is made to correlate their characteristics to pathologic and hemodynamic changes.
The 1st sound may be normal. Alternation is a rare finding. Faintness and low pitch are encountered in the greatest percentage of cases. Accentuation and splitting are usually due to marked exaggeration of the last component of the 1st sound (early systolic click, ejection sound).
The systolic murmur, practically constant, may be alternans. It is loudest at the 2nd and 3rd right interspaces and it radiates mostly to the suprasternal notch and to the neck; however wide differences may be found both in its location and propagation. A diamond-shaped configuration, a high frequency range, and its ending a few hundredth of a second before the aortic (or first) component of the 2nd sound are characteristic features.
The 2nd sound may have a very different amplitude; as a rule its faintness or absence are in favor of severe constriction. As the lesion progresses, left ventricular systole extends and aortic closure is delayed so that the aortic component of the 2nd sound successively draws closer to, coincides with, and occurs after the pulmonic component (reversed or paradoxical splitting).
A faint diastolic murmur is occasionally present and it is due to a minimal aortic regurgitation. When paradoxical splitting of the 2nd sound occurs and aortic closure is silent, the systolic murmur may extend beyond the pulmonic component and it can be mistaken for an early310 CALO jap. Heart J. July, 1962diastolic murmur.
Gallop sounds, either presystolic or early diastolic, may be present.

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Investigations were made on the relation between regional difference in the mortality from apoplexy, a characteristic of Japanese death from this disease and the dietary life, and the following results were obtained.
(1) Salt was named first as a nutritive element relating to the regional difference. It was found that regional difference in the salt intake was marked, and large amounts (more than 20Gm.) of salt were taken in the north-eastern district where the mortality from apoplexy and the level of blood pressure of the inhabitants were high.
(2) It was clarified that the Japanese salt intake was influenced by the Japanese dietary habit to eat rice with miso soup and pickles and to use soy-sauce as a seasoning. Regional difference in the salt intake was due to regional difference in salt contained in miso and pickles.
(3) Investigations were made on the relation with K, a factor to give influences to the relation between high blood pressure and the salt intake. The fact that the mortality from apoplexy and blood pressure were comparatively low in the. apple producing regions of Aomori Prefecture, though it was also in the north-eastern district, suggested that eating apples containing abundant K had something to do with this phenomenon, and the author emphasized the necessity to give consideration to balance between Na and K in the daily dietary life.

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Relatively high incidence of the involvement of the heart in patients with rheumatoid arthritis was reported, Abnormal electrocardiographic findings were found in 36.8% of 95 patients. Heart murmur was heard in 19.7% of 117 patients. An average of cardio-thoracic index was greater than that of normal persons.
Relationship between abnormalities of ST segment and/or T wave and other laboratory data did not reveal the higher incidence of the pathological changes in the patients with dysproteinemia.
Six autopsied cases of rheumatoid arthritis were presented and all of them showed anatomical heart lesions.

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In 60 patients with or without renal disease, I¹³¹-Hippuran or I¹³¹-Diodrast was injected in a dose of 30 to 50μc. and elimination rates of the radioactive compounds from the circulation were measured by means of serial blood sampling and external counting on the body surface. The elimination constant was calculated from the slowly and exponentially declining part of the curve which began about 20 minutes after an injection. When I¹³¹-Hippuran was injected, the elimination rate with the external measurement at the head showed the close agreement with that obtained by serial blood sampling. And it had a close correlation with RBF and rough correlations with RPF and 15-minute excretion of PSP test. On the other hand, when I¹³¹-Diodrast was administered, the K values obtained in the same way did not indicate such a good correlation with results of those conventional kidney function tests. The elimanation rates of I¹³¹-Hippuran obtained by repeated external measurements were observed to show a good reproducibility, and not influenced by varying the dosage within a range from 10 to 80μc.

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(1) We have studied on the electrocardiogram and the histology of the hearts of the underfed and unfed rats. As we found that there were no electrocardiographic changes and myocardial degenerations in these rats, we believe that there could be no electrocardiographic changes caused by undernourishment (mere calorie deficiency) without thiamine deficiency. In other words, the various electrocardiographic changes which were observed in the thiamine deficient rats were due to thiamine deficiency only and not to starvation.
(2) We have studied the vagal effect on the electrocardiographic changes of thiamine deficient rats. Worsening of bradycardia and arrhythmia by Neostigmine injection and improvement of arrhythmia by Atropine were observed but both injections showed no effect on the complexes of electrocardiogram. From these findings the authors found out that bradycardia and arrhythmia of thiamine deficient rats are related with vagus and that the changes of electrocardiographic comprexes are not related with it.

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The electrical activities of the S-A node regions of the rabbits' and canine hearts were studied by means of the microelectrode technique.
The entire area suspected to be the S-A node region was explored at intervals of 1mm.
(1) The membrane action potential from the S-A node region was characterized by the presence of the slow diastolic depolarization.
The features of the membrane action potentials from the S-A node region could be classified into 2 types.
One type is characterized by a moderately sloped slow diastolic depolarization, a gentle upstroke of the action potential, and rather small membrane resting and action potentials. The transition from the slow diastolic depolarization to the upstroke of the action potential was smooth. (refered to as Type A)
The other type is characterized by a very slightly sloped slow diastolic depolarization, a steep upstroke of the action potential, and by larger membrane resting and action potentials than those of Type A.
The transition from the slow diastolic depolarization to the upstroke of the action potential was abrupt. (refered to as Type B)
(2) Type A tracings were recorded from a narrow area in the venous wall. This area was about 4mm. in length and lay parallel to the crista terminalis at a distance of from 1 to 1.5mm.
Type B tracings were recorded from the area surrounding the region exhibiting the Type A potential, but not necessarily from the area of the S-A ring bundle as described by Hoffman et al.
The S-A ring bundle could not be observed during the present experiment.
The true pacemaker was located in some part of the area exhibiting the Type A potential.
(3) The conduction rate of excitation in the S-A node region in general was observed to be late (about 0.02M./sec.).
The sinus activation was transmitted rapidly in only one direction from the true pacemaker to the crista terminalis (about 0.08M./sec.).

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A case of isolated extraordinary dilatation of the right atrium was observed which was removed by the aid of total cardiopulmonary bypass. The etiology of the disease could not be clarified and we are of the opinion to call it "idiopathic enlargement of the right atrium".

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