The relationship between left ventricular thrombus and left ventricular dynamics in dilated cardiomyopathy (DCM) was studied by echocardiography and postmortem examination
The subjects were 57 patients with DCM, 40 were survival patients examined by echocardiography and 17 were autopsy patients. Systemic or pulmonary embolism occurred in 10 of 57 patients, 4 of 40 survival patients and 6 of 17 autopsy patients. Intracardiac thrombus was detected in 11 of 40 survival patients and was found in 8 of 17 autopsy patients
Left ventricular segmental wall motion abnormalities were observed in all 40 patients examined by two-dimensional echocardiography and apical dyskinesis or akinesis was observed more frequently in patients with left ventricular thrombus than in patients without left ventricular thrombus. Of 33 patients examined by pulsed Doppler echocardiography, Doppler ejection flow signals in the apical long axis view were recorded in 9% at the apex, in 17% at the middle portion and in 57% at the portion near the interventricular septal center. The signals at the portion near the interventricular septal center were recorded in only 2 patients with left ventricular thrombus but in 66% of patients without left ventricular thrombus
Systemic or pulmonary embolism and intracardiac thrombus occurred less frequently in patients treated with warfarin than in patients without warfarin
These results indicate that endomyocardial and blood flow disorders of the left ventricle play important roles in the occurrence of left ventricular thrombus and that anticoagulant therapy is useful for the prevention of systemic or pulmonary embolism and cardiac thrombus

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To evaluate whether the effect of nifedipine on left ventricular function relates to the severity of coronary artery disease (CAD) or not, supine graded ergometer exercise testing was performed before and after sublingual administration of 10mg nifedipine in 24 patients with stable effort angina. To minimize the effect of nifedipine on myocardial oxygen consumption, exercise before and after nifedipine was discontinued at the same target rate pressure product. Percent (%) left ventricular ejection fraction (EF) [EF during exercise/EF at rest•100] was measured before and after nifedipine by radionuclide angiocardiography. The angiographic degree of CAD was defined by Gensini's CAD scoring as follows: severe CAD:_??_50, moderate: <50>20 and mild:_??_20
After nifedipine, left ventricular function (%EF) was improved in all 6 patients with mild CAD, but was worsened in all 9 patients with severe CAD. Maximal ST segment depression during exercise was improved in 5 of 6 patients with mild CAD, while improvement was induced in 5 of 9 patients with moderate CAD and in 3 of 9 patients with severe CAD. Jeopardy of coronary collateral vessels may have an influence on the effect of nifedipine
It is suggested that the effect of nifedipine on left ventricular function is influenced by the severity of CAD when most of its effect on myocardial oxygen consumption is eliminated

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The risk factors for ischemic heart disease (IHD) in 35 Tibetan highlanders were investigated and compared with those in 30 age-and sexmatched healthy Japanese controls. Although Tibetans had remarkably high hematocrit values, and a decrease of eicosapentaenoic acid in both serum total lipids and serum phospholipid (PL) possibly due to their diet, they were considered to have a low incidence of IHD from our door-to-door study. These positive risk factors are likely counteracted by other negative risk factors as follows; Tibetans rarely exhibited systolic hypertension, and had lower levels of serum cholesterol and serum apolipoprotein (apo) B, and apo B/apo A-I ratio. In addition, Tibetan highlanders showed a decreased level of palmitic acid and an increased level of linoleic acid in serum PL which may protect against atherosclerosis

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The purpose of this study was to analyze the cardiovascular effects induced by mental stress evoked by different stressors in patients with recent uncomplicated myocardial infarction. Twenty four males, aged 52±10 years, were studied 45±22 days after uncomplicated myocardial infarction in the absence of specific cardiovascular drugs. During electrocardiographic and hemodynamic monitoring with a Swan-Ganz catheter the patients underwent 4 different stressors: mental arithmetic, Sacks test, Raven progressive matrices, white noise. All hemodynamic parameters were significantly (p<0.001) modified by 3 of the 4 stressors, while noise significantly affected (p<0.005) only blood pressure. Mental arithmetic was more powerful in inducing hemodynamic effects than either the Sacks test or the Raven matrices. Thus, experimentally induced mental stress challenges the recently infarcted patient's cardiovascular system to a quantifiable extent, causing important increments in left ventricular filling pressure. Hemodynamic response is different depending on the stressor employed

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When left bundle branch block (LBBB) is present on the electrocardiogram, the diagnosis of left ventricular hypertrophy (LVH) may be difficult. The left ventricular mass in 70 patients with LBBB was estimated by echocardiography, and was compared to the QRS configuration on the electrocardiogram. We found that there was agreement between a monophasic R pattern in lead 1 or V₆ (sensitivity 79.3%, 70.7%) and left ventricular hypertrophy. We suggest that a monophasic R pattern in L₁ and V₆ may provide a useful simple index of left ventricular hypertrophy in the presence of left bundle branch block

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In this paper, we report the results of experimental and clinical studies of the pulmonary vein with Doppler echocardiography in 188 cardiac patients and normal controls
1. The diameter of the right superior pulmonary vein (RSPV): The diameter of the RSPV was 9.8±0.2mm in normals and significantly dilated in the groups with passive or active pulmonary hypervolemia and decreased in the group with pulmonary hypovolemia (p<0.001)
2. Blood flow velocity of RSPV: The blood flow velocity of the RSPV measured in normal controls by Doppler echocardiography was 35.7±3.2cm/s and significantly decreased in the groups with passive pulmonary hypervolemia and pulmonary hypovolemia (19.6±7.8cm/s and 25.2±9.4cm/s, respectively) and increased in the group with active pulmonary hypervolemia (49.6±19cm/s, p<0.001)
3. Blood flow of RSPV: Blood flow of the RSPV was 2.3±1.5L/m in normals, 3.4±2.4L/tn in the group with passive pulmonary hypervolemia, 6.2±2.9L/m in the group with active pulmonary hypervolemia and 0.7±0.5L/m in the group with pulmonary hypovolemia. Blood flow in the active pulmonary hypervolemic group was higher than that in the passive pulmonary hypervolemic group and the hypovolemic group. There was a high correlation between the pulmonary blood flow measured by Fick's method (Qp) and RSPV flow (RSPVF) measured by echocardiography (Qp=1.96, RSPVF 0.92, r=0.81, p<0.05)
4. The relationship among the blood flow velocity of the RSPV, pulmonary flow and pulmonary arterial pressure: By left-sided heart contrast echocardiography, it was confirmed that the larger the Qp/Qs is, the higher the blood flow velocity of the RSPV; there was no correlation between the blood flow velocity of the RSPV and the pulmonary arterial pressure

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The activities of three enzymes concerned with collagen metabolism 4-prolyl hydroxylase, UDP-glucose: collagen glucosyltransferase and glucosyl-galactosyl-hydroxylysine glucohydrolase and 4-hydroxyproline content have been studied in the cardiac ventricles of spontaneously by pertensive rats (SHR) during prehypertensive, hypertensive and sustained hypertensive stages (respectively 4.5, 12 and 19 weeks of age). They were compared with values observed in age-matched normotensive Wistar Kyoto rats (WKY). The same studies have been performed in parallel on aortic-constricted rats (ACR) 8 days after suprarenal constriction of the abdominal aorta. The most striking finding was a significant increase in cardiac prolyl hydroxylase specific activity in the ACR but not in the SHR. No variation in 4-hydroxyproline concentration was found in the hearts of ACR. In contrast, a decrease in 4-hydroxyproline concentration was found in the hearts of SHR at 19 weeks. Cardiac glucosyltransferase specific activity was significantly elevated only in the SHR at 12 weeks. No variation in glucohydrolase specific activity was detected in the hearts of either SHR or ACR. The cardiac enzyme activities all decreased with age. These data show that the alterations in cardiac collagen metabolism are different in SHR and ACR. The patterns of the alterations found in the heart mirror those observed in the aorta in both models under the same experimental conditions

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Modulation of intracellular Ca²⁺ concentration ([Ca²⁺]_i) is a signal for the contraction of vascular smooth muscle cells responding to vasoreactive substances. We prepared confluently cultured smooth muscle cells from rat aorta, loaded them with Ca²⁺ sensitive fluorescent dye, fura-2, and measured the [Ca²⁺]_i transient by microscopic spectrofluorometry. The [Ca²⁺]_i was distributed heterogeneously in cytosol. Angiotensin II (10nM) transiently doubled the [Ca²⁺]_i. It was also increased by arginine-vasopressin (10nM), even after stimulation by angiotensin II was saturated. In contrast, acetylcholine (10μM) or rat atrionatriuretic peptide (10nM) did not change the [Ca²⁺]_i in the same detecting field of the same cell, contradicting previous reports

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In order to investigate the peripheral neuroeffector functions of renal hypertension, norepinephrine release from the sympathetic nerve endings and vascular responsiveness were evaluated in the mesenteric vasculatures from two-kidney, one-clip Goldblatt hypertensive rats (2K, 1G-HT). Norepinephrine release and pressor responses during periarterial nerve stimulation (40V, 5msec rectangular pulses for 1min, 5, 10 and 15H_z) were unchanged during the acute phase (3 weeks after surgery), and were rather reduced during the chronic phase (7-8 weeks after surgery) in 2K, 1G-HT compared to sham-operated normotensive control rats. By contrast, the vasoconstrictor responses to exogenously applied norepinephrine were significantly greater in 2K, 1G-HT than in the normotensive controls. From these observations, it seems unlikely that peripheral adrenergic function in the blood vessels plays an important role in the pathogenesis of 2K, 1G-HT. However, the increased sensitivity of vascular smooth muscle cells to norepinephrine may contribute to the maintenance of high blood pressure in the face of reduced vascular sympathetic tone in this form of hypertension

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Three cases of isolated right ventricular infarction resulting from thrombotic occlusion of a hypoplastic right coronary artery were found in 4, 000 consecutive autopsies performed at Tokyo Metropolitan Geriatric Hospital. The incidence of isolated right ventricular infarction was 0.08%. The clinical profile of the first case was characterized by shock, pulmonary congestion, pleural effusion, decreased V₁R and V₂R on ECG, a small elevation of CPK and transaminase, elevation of fibrin degenerative products and decreased platelet count. The patient responded to volume expansion, heparin and catecholamines. One year later she died from cerebral bleeding. In the second case, mild aortic regurgitation and atrial fibrillation were present. He died suddenly during an episode of pneumonia. In the third case, there was chronic obstructive lung disease, atrial fibrillation and lung cancer. He died of respiratory failure. On autopsy, the coronary arteries revealed a marked left dominant and right hypoplastic pattern in all cases. The right coronary artery perfused only the free wall of the right ventricle. Complete occlusion of the hypoplastic right coronary artery resulted in isolated right ventricular infarction. In addition, chronic pulmonary disease and arrhythmia may be contributory

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A 46 year old woman with hypertension and left ventricular hypertrophy accompanied by an atrial septal defect is reported. Hemodynamic changes induced by balloon occlusion and concomitant nifedipine were studied. Left ventricular failure appeared after balloon closure of the defect. Nifedipine decreased the increment in left ventricular enddiastolic pressure induced by balloon occlusion. After the reduction of systemic vascular resistance, the ratio of intracardiac shunt flow was still larger. Surgical closure of the defect was performed and the postoperative course was good with the use of vasodilators

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The case of a 9 year old boy with acute renal failure and myocarditis as complications of mumps is reported. The cardiac rhythm and conduction disorders which appeared after admission were refractory to treatment and the outcome was fatal. On necropsy, minimal interstitial nephritis and myocarditis were seen, confirming the clinical diagnosis

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