The effects of the intravenous administration of 100mg of trapidil on systolic and diastolic left ventricular functions and coronary sinus blood flow, as well as on myocardial lactate metabolism and platelet aggregation, were investigated before and after pacing in 12 patients with coronary artery disease.
Pacing without administration of trapidil provoked angina in 6 of these patients. During rest, trapidil decreased the mean blood pressure by an average of 5mmHg (from 112±15 to 107±8mmHg, p<0.05) and the left ventricular end-diastolic pressure by an average of 4mmHg (from 10±3 to 6±2mmHg, p<0.05). Trapidil also caused both the max dp/dt and the coronary sinus blood flow to increase slightly, although it had no significant effect on diastolic function, myocardial lactate metabolism, or platelet aggregation.
During the pacing that followed trapidil administration, chest pain was not provoked in the same 6 patients who had previously experienced chest pain on pacing. The extent of ST-segment depression also improved from -1.6±0.3 to -0.9±0.7mm (p<0.05) and there was a significant suppression of the production of myocardial lactate. When pacing was terminated, trapidil caused a decrease in left ventricular systolic pressure from 173 to 156mmHg (p<0.05), and also caused a decrease of the left ventricular end-diastolic pressure, from 16±4 to 8±2mmHg (p<0.05).
Trapidil had no significant effect on platelet aggregation activity with either a 1μM or a 2μM dose of ADP (adenosine diphosphate). However, the beta-TG level was suppressed, decreasing from 119±14 to 99±19ng/ml in the arterial blood (p<0.1) and from 114±9 to 103±17ng/ml (p<0.1) in the coronary sinus blood.
Reductions in the preload and afterload by trapidil were of far greater magnitude than either its coronary dilatory or positive chronotropic effects in patients with coronary artery disease.
Thus trapidil, a new antianginal agent appears to inhibit the production of platelet derived growth factors and may, therefore, protect the arteries from atherosclerosis as it promotes beneficial systemic hemodynamics in patients with depressed ventricular function.

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The clinical effects of nitrendipine, a new calcium antagonist, were investigated in a single-blind test on 21 patients with variant angina pectoris. The efficacy of the drug was evaluated on the basis of frequency of anginal attacks and Holier electrocardiographic findings during different treatment periods at doses of 10mg once a day (period I) and 20mg once a day (period II). The number of anginal attacks decreased significantly from a pretreatment level of 2.1±0.3 per day to 0.7±0.2 per day in treatment period I and 0.3±0.1 per day in treatment period II (p<0.01, p<0.001, respectively). The consumption of sublingual nitroglycerin tablets decreased significantly in both treatment periods in comparison with the observation period before treatment (p<0.01, p<0.001, respectively). In 20 patients with continuous ECG monitoring, the frequency of ST-segment elevation was 4.5±1.0 per day during the pretreatment period; it decreased significantly to 0.9±0.6 per day in treatment period I and 0.5±0.3 per day in treatment period II (p<0.01, p<0.001, respectively). The duration and the maximum magnitude of ST-segment elevation also improved significantly in both treatment periods. These results demonstrate the efficacy of nitrendipine in the treatment of variant angina at a single daily dose of 10mg.

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The chronic antihypertensive effect of the combination of ketanserin (KET) 40mg+hydrochlorothiazide (HCTZ) 12.5mg was evaluated in 20 patients with arterial hypertension of mild to moderate degree. After a 2-week wash-out period, patients were prescribed a single oral dose of KET 40mg or HCTZ 25mg in a randomized order at 2-day intervals and blood pressure and heart rate were measured during the following 24hrs by an automatic recorder. Thereafter patients were given the combination of KET 40mg+HCTZ 12.5mg for 6 weeks and 24hrs blood pressure was recorded after the first dose of the combination and at the end of treatment. Ketanserin induced a significant fall in systolic and diastolic pressures for up to 8hrs; thiazide did not induce any change in these parameters. The combination of KET+HCTZ in the acute study reduced significantly systolic (SBP) and diastolic (DBP) blood pressures for up to 10hrs. After 6 weeks of treatment with KET+HCTZ, blood pressure showed a further fall at each time period and was normalized (BP>160/80mmHg) for 8hrs after dosing. The results of this study indicate that once daily oral administration of the combination of KET 40mg+HCTZ 12.5mg in mild to moderate primary hypertensives significantly reduces blood pressure over 24hrs. Fairly good control of BP, i.e. BP<160/90mmHg, was, however, achieved only up to 8hrs after drug administration, indicating that this combination given once daily is not able to normalize BP over the following 24hrs.

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One hundred and 15 hospitalized patients with acute pericarditis were analyzed retrospectively for their etiology, management and longterm prognosis. It was found that most of the patients had either idiopathic or viral etiologies (60%), collagen disease (16.4%) or malignancy (6.9%). Most of the patients were treated with non-steroidal anti-inflammatory drugs (NSAID). Twenty-six patients (22%) required corticosteroids following NSAID treatment failure. Only one patient underwent pericardiocentesis for tuberculous pericarditis. The long-term prognosis was good, although 21.9% of the patients suffered from recurrent episodes of pericarditis.
It is concluded that in hospitalized patients with pericarditis, an extensive workup may not reveal the major etiologies, and the disease may be more complicated than previously thought.

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The surgical, clinical and radiological importance of the diagonal artery in the human heart and the extreme variability in its description prompted us to undertake its study. The investigation was performed in 150 hearts, dissected after injection of colored substance in the coronary arteries. The following results were obtained: The left coronary artery presented 3 types of division: bifurcation (54.7%), trifurcation (38.7%) and quadrifurcation (6.7%); the latter 2 patterns produced a diagonal artery. The trunk of the left coronary artery bifurcated more frequently in hearts of female Caucasians (57.1%) and male Caucasians (54.9%). It trifurcated more frequently (60%) in hearts of female non-Caucasians. The ramus diagonalis was found in 45.3% of the hearts. The incidence of a ramus diagonalis did not differ significantly between male Caucasians (45%), male non-Caucasians (42.8%) and female Caucasians (37%). However, it occurred more frequently in female non-Caucasians (66.5%). The length of the ramus diagonalis varied from 20.1 to 50mm (79.3%) and its relative length varied from 21 to 50% of the length of the left ventricle (75.3%). The ramus diagonalis was classified as short, medium and long types, the former 2 types were most frequent.

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A thick-walled elastic cylinder contracting symmetrically is used as a model for the myocardium. The active force generated by the myocardium during systolic contraction is represented by body force (force/unit volume of myocardium). A mathematical formalism previously developed and based on large deformation analysis is used to derive a quadratic equation to represent the non-linear pressure volume (P-V) relation in the left ventricle in the Suga-Sagawa model. Experimental application of the results obtained confirms the consistency of the mathematical formalism developed to describe the P-V curve in the Suga-Sagawa model.

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The chronic effects of tolbutamide on myocardial contractility of the diabetic heart during ischemia and reperfusion were evaluated in perfused, isolated rat hearts. Five experimental groups were used: (1) control rats (C), (2) insulin dependent diabetic rats (IDDM; single intravenous injection of 60mg/kg streptozotocin (STZ) in male Sprague-Dawley rats), (3) non insulin dependent diabetic rats (NIDDM; single subcutaneous injection of 90mg/kg STZ in 5 day neonates), (4) tolbutamidetreated IDDM and (5) NIDDM (T-IDDM, T-NIDDM; giving tolbutamide 100mg/kg/day for 6 weeks via an orogastric tube every day, respectively). At 14 weeks of age, experiments were performed using a Langendorff perfused heart preparation. After equilibration, T (myocardial developed tension), +dT/dt (contraction velocity), -dT/dt (relaxation velocity) and RT (resting tension) were measured during a 15min period of global ischemia, followed by reperfusion for 20min. Basal values of T increased in both T-IDDM and T-NIDDM, compared to IDDM and NIDDM, respectively. The percent recovery rate of +dT/dt in TIDDM increased significantly during both ischemia and reperfusion, but the change in T-NIDDM was not significant. The recovery rates of -dT/dt in T-IDDM and T-NIDDM were significantly higher throughout reperfusion than in IDDM and NIDDM, respectively. On the other hand, that of T in T-IDDM and T-NIDDM were significantly higher than IDDM and NIDDM throughout ischemia and reperfusion, respectively. The RT was significantly higher in IDDM than in C and NIDDM throughout ischemia and reperfusion. The RT was significantly lower during ischemia in IDDM, but it did not differ significantly from IDDM during reperfusion. These results indicate that chronic oral administration of tolbutamide directly improved myocardial contractility throughout ischemia and reperfusion regardless of the improvement of glycemia. The improvement was also greater in IDDM than in NIDDM.

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The effects of hypoxia and reoxygenation on regular contractions and postrest contractions (PRC) of papillary muscle of rats were studied. Isometric tension was measured during two cycles of hypoxia and reoxygenation. Trains of 80 externally continuous stimulations at 40/min were applied. PRCs were evoked by a stimulus train after a 60sec resting interval.
After 90min of hypoxia (the first hypoxia period), regular contractions and PRCs decreased to 5.6±2.0% and 23.4±2.4% of baseline values, respectively (p<0.001; n=18). After 90min of reoxygenation, the recovery of the PRCs (44.4±3.4%) was better than that of the regular contractions (23.3±3.3%) (p<0.01; n=18). After 30min of hypoxia (the second hypoxic period), regular contractions and PRCs decreased to 2.2±0.6% and 13.6±1.6% of baseline values, respectively (p<0.001; n=18). However, the recovery from the second hypoxic injury was not significant for either regular contractions or PRCs. The % diastolic tension, which was normalized to the baseline for regular contractions, increased to 113.2±6.9% and 133.6±8.4% at the end of the first and the second hypoxic periods, respectively. There was statistically significant correlation between the % diastolic tension and the % hypoxic injury of PRCs (p<0.002; n=18). There was no significant relationship between % diastolic tension and % hypoxic injury of regular contractions. There was no statistically significant correlation between % diastolic tension and % recovery from the hypoxic injury of either regular contractions or PRCs.
Since the PRCs are thought to be more dependent on calcium stored in the sarcoplasmic reticulum (SR) than regular contractions, SR function seems to be resistant to transient hypoxia. The marked increase in diastolic tension during repeated hypoxia may indicate SR dysfunction, leading to irreversible myocardial damage. Thus, both hypoxia and reoxygenation may regulate the recovery from hypoxic dysfunction.

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Three groups of rats were studied in an investigation to determine the influence of alcohol on myocardial electrolytes and the ventricular fibrillation threshold (VFT) levels. Drinking water was provided ad libitum; the control group received water while the other 2 groups drank a water-ethanol solution, constituted in a ratio of 75:25, for periods of 3 and 9 months, respectively. Two rats from each of the experimental groups, together with a control rat were killed on each experimental day. One heart was studied on the Langendorff preparation and the other used for tissue electrolyte analysis. The mean myocardial Mg²⁺ levels (233±28μg/g vs 148±23μg/g and 233±28μg/g vs 107±15μg/g; p<0.0001), K⁺ levels (3260±437μg/g vs 1779±312μg/g and 3260±437μg/g vs 1195±205μg/g; p<0.0001) and Zn²⁺ levels (32.7±6.8μg/g vs 14.0±4μg/g and 32.7±6.8μg/g vs 4.2±3.4μg/g; p<0.0001) were significantly lower in alcohol fed rats than the controls. In addition, a significant fall in the mean VFT levels (10.1±1.94mA vs 6.27±2.17mA, p<0.001) was noted in rats given water: alcohol solution for 9 months. This study reveals that chronic exposure to alcohol induces a deficiency of myocardial Mg²⁺, K⁺ and Zn²⁺, and an increase in myocardial irritability in laboratory rats.

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Prostaglandins have been reported to play an important role in endotoxic shock. However, the beneficial effects of prostaglandin synthesis inhibitors for the treatment of newborn endotoxic shock have been controversial. This study was performed to evaluate the effects of indomethacin on the hemodynamics during fulminant endotoxic shock in newborn dogs. After E. coli lipopolysaccharide (LPS) injection, mean arterial pressure was maintained for the first 60min, and then declined from 53±2 to 27±2mmHg at 120min. Cardiac output dropped from 0.37±0.03 to 0.24±0.03L/min/kg 5min after LPS injection and continued to decline to 0.12±0.01L/min/kg at 120min. Indomethacin treatment 20min prior to LPS injection attenuated the hypotension (50±3mmHg at 120min, p<0.05) and the decrease of cardiac output (0.18±0.02L/min/kg at 120min, p<0.05). Indomethacin treatment 5min after LPS injection also attenuated the hypotension (55±4mmHg at 120min, p<0.05) and the decrease of cardiac output (0.21±0.02L/min/kg at 120min, p<0.05). Survival times were increased by the indomethacin treatments. Thus, indomethacin appears to be beneficial for the treatment of fulminant hemodynamic deterioration in newborn endotoxic shock.

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Primary cardiac tumors are quite rare in the newborn period. Prior to surgery, cardiac catheterization and angiocardiography have been performed to confirm the two-dimensional echocardiographic findings. In this report a 2-day-old baby with the clinical impression of severe cyanotic congenital heart disease diagnosed by two-dimensional echocardiography as multiple rhabdomyoma and confirmed by surgery is presented. It is emphasized that two-dimensional echocardiography is a very useful technique for the diagnosis of primary cardiac tumors. By means of this method severely symptomatic newborns may be taken directly to surgery without prior cardiac catheterization, thus minimizing complications.

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Two cases of extracardiac malignancies presenting with cardiac tamponade are reported. One patient had adenosquamous carcinoma of the lung. Such a manifestation of this tumor has never been reported previously. The second patient had an adenocarcinoma and is the youngest case of carcinoma presenting with tamponade. The English literature has been reviewed.

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In right ventricular cardiomyopathy the relationship between the progression of structural abnormalities and arrhythmia development is not yet well known. This report describes a case in which severe ventricular arrhythmias appeared 3 years after the demonstration of right ventricular (RV) structural and dynamic abnormalities. In this interval of time structural changes were not detectable with the commonly used diagnostic methods, but endocavitary RV late fractionated QRS potentials appeared suggesting the development of an arrhythmic component of the disease.

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A 35-year-old female who presented with features of mitral valve disease showed mitral stromal deposits which were acidophilic in nature and brilliantly red by Masson trichrome. Stromal GAG (glycosaminoglycan) alterations are considered responsible for the deposits.

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Staphylococcus epidermidis (SE) is the leading pathogen of prosthetic valve endocarditis. At the same time it is a very rare cause of native valve endocarditis and it follows a clinical course and outcome similar to Streptococcal viridans endocarditis. We report here the case of a 41-year-old man with a community acquired SE endocarditis of a native aortic valve. Despite early surgical intervention, the case followed an acute and fatal course.

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Infections occurring after aortic valve surgery, whether valvuloplasty or replacement, commonly affect the valve itself. However infection of the aortic suture line alone is extremely rare. Such cases with endarteritis can be diagnosed at autopsy or by angiocardiography.
In this report a patient with a vegetation at the aortic suture line which was diagnosed by echocardiography is presented. By two-dimensional echocardiography, a very mobile and echo-dense mass protruding from the ascending aorta was observed on the recordings through the suprasternal notch. This diagnosis was surgically confirmed and the patient was treated.

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