Japanese Heart Journal
Online ISSN : 1348-673X
Print ISSN : 0021-4868
ISSN-L : 0021-4868
Volume 34, Issue 2
Displaying 1-13 of 13 articles from this issue
  • Masanori OKABE, Keisuke FUKUDA, Yoshiyuki NAKASHIMA, Tadayuki HIROKI, ...
    1993 Volume 34 Issue 2 Pages 121-129
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    The purpose of the present study is to elucidate the difference in extent of myocardial infarction (MI) between those cases with and those without right bundle branch block (RBBB) occurring during the course of acute MI. We examined postmortem hearts from 20 patients with acute anteroseptal MI; 10 with (group A) and 10 without RBBB (group B). The extent of MI was studied pathologically in the interventricutar septum (IVS) and reconstructed. The longitudinal extent of MI did not distinctly differ between groups A and B. In 5 hearts of group B, the anterior limit of the MI extended as high, or as close to the cardiac base, as in group A hearts. Transmural MI was relatively common and seen more frequently in group A than in group B. However, the MI did not always extend evenly to the left and right ventricular sides in the IVS. Leftsided predominance in extent of the MI was more frequently observed in group B than in group A. Right-sided predominance in the extent of septal MI was relatively rare and was seen in 5 cases at the portion where the right bundle branch came down. Four of these were group A patients. Thus, involvement of the right bundle branch might partly depend on the unevenness of the mural extent of the MI as well as the height of extension of the MI in the IVS.
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  • Chung-Yin CHEN, Wei-Kung WANG, Tsair KAO, Beverly C. Yu, Benjamin C. C ...
    1993 Volume 34 Issue 2 Pages 131-143
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    The aim of this study was to examine the frequency spectrum of arterial pulses in 17 patients with acute, uncomplicated myocardial infarction. Recordings of right radial pulses were taken from these patients immediately after their arrival at the emergency room. This information was considered as baseline data and was monitored at the same time each day for up to 7 days. These serial recordings of radial pulses were then analyzed together with recordings from 3 control groups of patients not suffering from myocardial infarction. These included subjects who underwent coronary arteriography (n=24), coronary angioplasty (n=18), and mitral valvuloplasty (n=13). The method of analysis involved a discrete Fourier transformation of radial pulses recorded from an external pulsation transducer to obtain "power spectra" for pulse waves. There was no significant change in the power spectrum for each of the 3 control groups although significant clinical and hemodynamic improvement was observed in the coronary angioplasty and mitral valvuloplasty patients. In sharp contrast, the intensity of the frequency moduli C2 and C3 in the target group fell on arrival at the emergency room and then gradually increased while the average pulse energy (frequency modulus C0) decreased simultaneously with stable recovery from the acute myocardial infarction. In order to investigate the changes in C2 and C3 in the target group, the effective renal plasma flow (ERPF) was first determined for 10 of the 17 patients using intravenous I-131 labelled iodo-ortho-hippurate. A second reading was taken a week later. Eight of the 10 patients were found to have a relatively "higher" ERPF at the onset of acute myocardial infarction with an average reading of 450.1±168.9ml/min, compared with the data obtained a week later (374.1±130.4ml/min, p<0.02). An inverse correlation existed between the percentage of "initial drop" in frequency moduli C2 and C3 in the power spectra of the radial pulses and the percentage of "initially higher" ERPF (r=-0.66 and -0.70, respectively, p<0.05). It is concluded that there was a specific change in the power spectrum of the radial pulses which were recorded and analyzed noninvasively in patients with acute, uncomplicated myocardial infarction. Changes in the ERPF may exert an influence on the frequency moduli C2 and C3 of the power spectra of the radial pulses after heart attack, suggesting that the aorta and the closely organs may cause coupled oscillation. Theoretically this structure is equivalent to a resonance circuit.
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  • Ahmet ALPMAN, Muharrem GÜLDAL, Çetin EROL, Günes AKG& ...
    1993 Volume 34 Issue 2 Pages 145-157
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    To determine the immediate and remote prognostic significance of bundle branch block (BBB) associated with acute myocardial infarction (AMI), 40 patients with AMI and BBB were studied. One hundred forty-four patients with AMI but without BBB were evaluated during the in-hospital phase and 45 of them were taken as a control group. These patients were followed for an average of 15 months (3-28 months). Arrhythmias and left ventricular function were investigated with 24-hr Holter monitoring and echocardiography, respectively.
    The hospital mortality was significantly greater in patients with BBB than in the control group (32.5% vs 10.4%, p<0.001). The main cause of mortality was pump failure in the group with BBB (76.9%) and ventricular fibrillation in the control group (53.3%). The peak creatine kinase level was significantly higher in the group with BBB than in the control group (2094.8±288.4IU/L vs 416.7±30.5IU/L, p<0.001).
    In patients with BBB prophylactic temporary pacemaker insertion was not found to improve the hospital mortality rate. In the hospital phase, although 32% of the patients with BBB had complicated arrhythmias (multiform, paired VPB, runs, R-on-T) the cause of death in 10 of the 13 patients who died was pump failure but not arrhythmia. In patients with BBB the wall motion index and the number of patients who had a left ventricular aneurysm were greater than in patients without BBB (9.5±0.9 vs 6.3±0.6, p<0.01 and 52.0% vs 14.3%, p<0.01, respectively).
    In patients with BBB follow-up mortality (12.0%) was lower than hospital mortality (32.5%). During the follow-up period there was no significant difference between patients with BBB and those without with regard to complicated arrhythmias (14.8% vs 15.6%).
    These results indicate that the main cause of poor prognosis during the hospital period in patients with AMI and BBB was not arrhythmia or conduction disturbance but severe pump failure due to extensive myocardial necrosis. Prophylactic temporary pacemaker insertion did not improve the hospital mortality rate of these patients, and patients with AMI and BBB who survive the in-hospital phase after infarction have a good prognosis during the following 15 months.
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  • Yüng-Zu TSENG, Chuen-Den TSENG, Huey-Ming Lo, Fu-Tien CHIANG, Kwa ...
    1993 Volume 34 Issue 2 Pages 159-170
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    Body surface potential maps were obtained in 50 normal adults using the heart potential map system designed by Yamada. Group A (younger adult group) consisted of 30 persons whose ages ranged from 20 to 39 years. Group B (middle-aged group) included 20 persons whose ages ranged from 40 to 59 years.
    Although there were slight variations in the pattern of isopotential distribution among the subjects studied, a consistent pattern with a similar sequence was observed in both study groups. However, there were some parameters which significantly differed between groups A and B, including the earliest appearance time of the anterior negative potential (p<0.05), the anterior potential minimum (p<0.001), the posterior positive potential (p<0.001), the midsternal minimum (p<0.001), the largest potential minimum (p<0.05), the largest potential maximum (p<0.005), the "reversal" pattern (p<0.001), the multipolar potential distribution in the upstroke (p<0.001) and the amplitude of potential minimum in the periods 50msec (p<0.005) and 60msec (p<0.01) of ventricular depolarization.
    Accordingly, the data obtained regarding the time relationship between the bipolar and multipolar phases, the distribution and time course of the potential as well as the dynamic changes in potential voltage, particularly the age-related potential pattern will serve as a basis for further study of BSPM.
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  • Ken-ichi WATANABE, Takayuki INOMATA, Yasushi MIYAKITA, Minoru TAKAHASH ...
    1993 Volume 34 Issue 2 Pages 171-182
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    A total of 38 patients with syncope in whom a cause was not assigned or suggested by the initial history, physical examination and electrocardiography (ECG) were studied. Twenty-four patients underwent cardiac examination with Holter ECG, electrophysiologic testing with programmed ventricular stimulation (EPS) and/or coronary arteriography including ergonovine provocation (ergonovine CAG). The study with Holter ECG, EPS and ergonovine CAG yielded a presumptive diagnosis in 36 patients (36/38=95%), 11 with vasospastic angina, 7 with ventricular tachycardia, 4 with ischemic heart disease, 9 with sick sinus syndrome (SSS), 1 with drug induced SSS, 3 with A-V block, 1 with supraventricular tachycardia, 1 with hypertrophic cardiomyopathy, 1 with aortic valve stenosis and 1 with carotid sinus syndrome (included are 1 patient with ventricular tachycardia+ischemic heart disease, 1 with SSS+vasospastic angina and 1 with ventricular tachycardia+vasospastic angina). Therapy based on these findings provided complete symptomatic relief in all patients during a mean follow up of 25±10 months (range 5-45 months).
    In conclusion, EPS and ergonovine CAG are useful in the diagnosis and therapy of unexplained syncope.
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  • Hiroshi AKITA, Suguru MATSUOKA, Yoshiyuki TAGUCHI, Masahiro KUBO, Yasu ...
    1993 Volume 34 Issue 2 Pages 183-192
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    It is important to distinguish proximal right bundle branch block (RBBB) from distal RBBB because patients with both proximal RBBB and left bundle branch block may progress to a late atrioventricular conduction disturbance. Signal-averaged electrocardiograms (SAECGs) were investigated in 35 patients with RBBB following surgical correction of tetralogy of Fallot or ventricular septal defect in order to determine the block site of RBBB noninvasively using a SAECG. The site of RBBB was first identified by a body surface map; 12 patients had proximal RBBB (group 1), and 23 had distal RBBB (group 2). The control groups consisted of 8 patients with RBBB without congenital heart disease (group 3) and 20 normal subjects (group 4). The mean of the filtered QRS duration in the group 1 patients was significantly longer than in the other 3 groups (p<0.01). The number of fragmented signals in group 1 was significantly greater than that in the other 3 groups (p<0.01). A filtered QRS pattern was divided into 4 different types (whole, early, late, and normal) according to the successive fragmented signals; the "whole" type was the most common in group 1 (83%). SAECG is successful in identifying those patients with proximal RBBB according to the following indices: a filtered QRS duration equal to or longer than 160msec, a fragmented signal number greater than 10 and a "whole" type filtered QRS pattern. In conclusion, SAECG is a useful tool for distinguishing proximal RBBB from distal RBBB.
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  • Complications, Electrical Performance, and Longevity of 561 Right Ventricular Leads
    Shigeru KAZAMA, Kiyotaka NISHIYAMA, Masato MACHII, Katsuhiko TANAKA, T ...
    1993 Volume 34 Issue 2 Pages 193-200
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    Five hundred and sixty-one endocardial pacing leads implanted in the right ventricle of 502 patients between 1971 and 1990 were followed for up to 17 years regarding their complications, stimulation threshold behavior, and overall longevity.
    Lead tip dislodgement occurred in 16 leads (2.9%), in 14 of which dislodgement occurred within 2 months after implantation. The incidence of dislodgement was significantly smaller in tined leads than in nontined leads. Lead conductor fracture occurred in 19 leads (3.4%), in 15 of which fracture occurred within 5 years after implantation. Two particular sites of lead fracture were identified; i.e., one within the pacemaker pocket and the other at a particular point in the subclavian vein between the clavicle and the first rib. Fixation ligature in the former site and the venopuncture point for lead insertion in the latter site are thought to be related to lead fracture.
    Other complications included insulator break in 3 leads (0.5%), exit block in 7 leads (1.2%), and poor sensing in 2 leads (0.4%).
    The cumulative survival of leads was 94.1±2.7% (mean±95% confidence interval) at 5 years, 86.3±6.3% at 10 years, and 74.2±14.0% at 15 years after implantation.
    The minimal stimulation threshold, lead impedance and R wave amplitude were all found to be stable for up to 10 years, and there were no tendencies toward higher stimulation threshold during the observation period of this study.
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  • A Retrospective Study
    Makoto NAKAZAWA, Satoshi YASUKOUCHI, Masashi SEGUCHI, Kotaro OYAMA, Ka ...
    1993 Volume 34 Issue 2 Pages 201-211
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    The afterload to the left ventricle increases following valve replacement in chronic mitral regurgitation (MR), yet there has been no study taking into account left ventricular (LV) afterload. In 43 patients with isolated chronic MR undergoing mitral valve replacement (MVR), we calculated LV wall stress using preoperative LV end-diastolic dimensions and diastolic aortic pressure (predictive LV wall stress=pWS). This value would represent LV wall stress at the instant of aortic valve opening immediately after MVR, assuming that LV end-diastolic dimensions and the aortic pressure did not change after operation. We also calculated end-systolic wall stress/volume index (ESS/ESVI) ratio, an index of myocardial function. None of 15 patients with the ESS/ ESVI ratio>1.6 had postoperative mortality or morbidity, whereas among the 26 patients with the ESS/ESVI ratio<1.6, 12 patients had mortality (3 patients) and/or morbidity requiring intraaortic balloon pumping or prolonged catecholamine support. Three patients who died had pWS>200 kdynes/cm2. Including these 3, all 5 patients whose pWS>200 had mortality or severe morbidity immediately after surgery. In contrast, among the 38 patients with lower pWS, none died and only 7 patients (18%) had morbidity. Thus, patients who had a low contractility index and a high predictive afterload value had high mortality and morbidity. We conclude that the prediction of postoperative mortality and morbidity is improved by combined assessment of myocardial function and the hypothetical postoperative LV afterload.
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  • Keisuke SATOH, Yoshinori SATOH, Jun-ichi IMAGAWA, Norio TAIRA
    1993 Volume 34 Issue 2 Pages 213-219
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    The cardiotonic effect of pimobendan was studied in 6 dog heart-lung preparations in which cardiac function had been severely depressed by pentobarbital. Pimobendan in doses of 1-10mg improved cardiac function in a dose-dependent manner and at 10mg improved it beyond the control. These doses of pimobendan, however, produced neither a significant increase in heart rate nor arrhythmias. The results indicate that the drug may be of use in the treatment of heart failure.
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  • Muharrem GÜLDAL, Remzi KARAOGUZ, Hakki AKALIN, Mustafa BAYAR, Tur ...
    1993 Volume 34 Issue 2 Pages 221-226
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    The interaction between amiodarone and the defibrillation threshold (DFT) is still controversial. We present a case with dilated cardiomyopathy and recurrent sustained monomorphic ventricular tachycardia who received an automatic implantable cardioverter defibrillator (AICD) while under long-term amiodarone treatment. AICD implantation was performed without thoracotomy. The transvenous lead was inserted via a left subclavian vein puncture and the patch was placed on the lateral chest wall, submuscularly. At the time of implantation a 35J shock was not successful in converting ventricular fibrillation to sinus rhythm, but a 40J rescue shock was successful. After discontinuation of amiodarone, DFT measurements were repeated. Sixteen days later DFT was still higher than 34J, but 71 days later it decreased to 20J.
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  • Masaomi CHINUSHI, Yoshifusa AIZAWA, Yoriko KUSANO, Hitoshi KITAZAWA, T ...
    1993 Volume 34 Issue 2 Pages 227-234
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    In a patient with sustained ventricular tachycardia (VT), we observed two different conduction times through the reentry circuit at the critical paced cycle length. The cycle length of the VT was 420msec and overdrive pacing initially performed at a paced cycle length of 400msec and repeated at decrements of 10msec until the VT was interrupted at a paced cycle length of 320msec. During rapid pacing, constant fusion and progressive fusion were confirmed. The first post-pacing return cycle was identical to each paced cycle length. The conduction time between the stimulus artifact and the orthodromically captured electrogram at the left ventricle was constant at 350msec in each paced cycle length. However, only at a pacing cycle length of 360msec two conduction times were alternatively observed, one of 350msec and the other of 365msec. When the conduction time changed from 350msec to 365msec, morphological alternation both in the surface QRS complex and in the orthodromically captured electrogram was evident. Dual slow pathways or a single slow pathway with plural exits from the reentry circuit is a likely mechanism of the alternation.
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  • Mohammad J. HASHEMI, Ali Andon PETROSSIANS
    1993 Volume 34 Issue 2 Pages 235-238
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    A 40-year-old male with known hypertrophic cardiomyopathy was admitted for catheterization. At catheterization and angiography the septum was hypertrophied to about 5.5cm and diffuse coronary artery aneurysms were revealed. We found no previous report of coronary artery aneurysm associated with hypertrophic cardiomyopathy.
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  • Semra ATALAY, Ayse ÖNER, Y.K. Yavuz GÜRER, Selmin KARADEMIR
    1993 Volume 34 Issue 2 Pages 239-243
    Published: 1993
    Released on J-STAGE: December 09, 2008
    JOURNAL FREE ACCESS
    Carbamazepine (CBZ) has been reported to have an antidiuretic action, though it is not known how it produces this effect. This is a well recognized complication of CBZ therapy in adults. However this syndrome has been rarely observed in childhood. We present an epileptic child with fluid overload due to CBZ treatment who was referred with chest pain and cardiomegaly. Our patient developed fluid retention with cardiomegaly during treatment with CBZ alone at a normal dose and for a short time. To our knowledge this is the first case of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) due to CBZ therapy which has been observed to be associated with cardiomegaly.
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