This study was designed in order to reexamine the changes in the ECG findings among the patients with so-called neurocirculatory asthenia (NCA). Analyses of ECG were done not only with those conditions at rest and/or at the episodes of heart attack, but also with those taken after Master's two step test as well as Mirror Drawing Test (MDT). 50 cases with NCA were picked up according to its characteristic subjective symptoms and compared with 84 control subjects. During mental stress loading by MDT, changes in heart rate, blood pressure, serum FFA levels and urinary excretion levels of catecholamines(CA)were determined simultaneously.MDT revealed some abnormal patterns of ECG such as ST-T changes and /or various arrhythmias, the frequency of which was rather higher than that of exercise test. Of all the 50 cases with NCA, abnormal ECG findings were frequently seen by MDT loading in as many as 56%, while the controls showed only 9.7% abnormalities. According to the ECG findings, our own criteria of abnormal ECG in psychological stress loading were established. An attempt was then made to classify these patients with NCA into two groups, A and B. Group A was designated as cardiac neurosis, where no abnormal ECG finding was obtained. In contrast, group B which we named "latent functional coronary insufficiency" was further divided into three subgroups, B_1 (physical type), B_2 (etmotional type) and B_3 (mixed type).Especially, groups B_2 and B_3 shoewd more hyperresponses of endogenous adrenaline, of blood pressure and of heart rate than group A and controls in MDT. These results suggest that the abnormal ECG findings in these groups are caused by cardiac hyperfunctions due to an easier increase in sympathetic tone after stress loading. Hence, the two groups of A and B may psychophysiologically differ from each other. However, whether or not they have quite a different etiological origin is still obscure. On account of some cases in groups B_2 and B_3 with relatively low response of CA levels in MDT, it seems plausible that these groups havea a closely similar pathogenesis to that of "hyperdynamic beta-adrenergic circulatory state".

View full abstract

This report presents the analysis of somatic and psychic factors in the coronary patients (240 of angina pectoris, 363 of acute myocardial infarction) treated at St. Luke's International Hospital, Tokyo, Japan, since 1952.The physical factors were studied about following matters : age at onset of symptoms, sex, ratio of males to females, body physique, body weight, incidence of diabetes mellitus and of hypertension, and fundal findings.Laboratory studies included serum cholesterol, triglyceride and glucose tolerance test.To investigate psychological and emotional factors in these patients, author utilized primary personal interviews, behavior pattern of Fredman, Rosenman's and Yatabe-Guiford personal inventry scale.Environmental factors were also studied with personal interviews.Results : (1) Male and female ratio of acute myocardial infarction shortened in recent years (2.4 : 1 during 1965〜1974,6 : 1 during 1952〜1964) which suggested increasing social acitivity of Japanese women.(2) Psysical factors such as obesity (female only), diabetes mellitus, hypertension, retinal angiosclerosis, hypertriglyceridemia and hypercholesterolemia were predominantly demonstrated.(3) Emotional factors were divided in two types such as acute, transient emotional stress and long standing tension.(4) Specific personality in these Japanese coronary patients were such as honest, strict with social responsibility and an emotionalist. They used to have no hobby. These factors seemed to resemble Dunber's coronary personality. Neurotic patients were rare.Conclusion : It is obvious such factors as physical, emotional and environmental factors tend to produce coronary arteriosclerosis and coronary heart disease in certain specific personalities.

View full abstract

To elucidate various cardiac complaints in the nighttime, ECGs were taken through the night on hospitalized patients, and the relations between complaints and abnormal ECG findings were analyzed. Of 146 patients whose all-night ECGs were recorded. 66 cases were selected for detailed analyses. These were 37 patients with clinical diagnosis of angina pectoris and 29 patients who had neurocirculatory complaints in the night such as chest discomfort, palpitation, breathlessness, sensation of uneasiness, etc.Using Frank's lead system, ECG was continuously recorded in the magnetic tape through the night and reproduced later by use of an oscilloscope and amingograph recorder. In some cases, all-night polygrahic recordings including electroencephalogram, electrooculogram and electrocardiogram were also performed, and the relationship between an ischemic attack and the sleep stage was studied.In the total of 17 cases in which ischemic attacks in the night were recorded, attacks occurred in the following 2 types ; a repetitive type and a sporadic type. In repetitive type, more than 3 episodes occur in succession or 2 episodes occur in more than 2 trains, with the onset of the train often associated with the REM period. Attacks of sporadic type were much less associated with the sleep pattern. Out of 9 cases with varioant angina, 6 cases belonged to repetitive type, while all of the 8 cases with ST depression pattern were of sporadic type.A comparison made between the number of chest pain and the number of ischemic changes in individual patients, disclosed that the patients who showed a few ischemic changes in ECG became aware of most of their attacks, while the patients who had many ischemic changes complained only part of their attack.One such extreme case, whose ECGs were recorded for 3 successive nights, and who showed a marked repetition of ischemic attacks of variable degrees at various intervals throughout recording, complained only 7 attacks during the same periods.In one case with neurocirculatory asthenia, T wave changes occurred frequently, but not with regular repetition or in close relation to REM sleep. Nineteen out of 29 patients with neurocirculatory distress in the night, showed transient abnormal ECG findings which would explain their complaints. Four such cases are presented.

View full abstract

We studied changes in blood pressure and pulse rate during a respiratory exercise in the control as well as hypertension groups, and applied a respiratory biofeedback method to the patients with hypertension. In addition, and attempt was mede in blood pressure control by means of the breathing exercises.The results of our study were summarized as follows : 1) Patients with hypertension showed more pronounced responses to exertions such as holding of breath, deep breathing, mental calculation than the normal control group. This finding indicates the instability of the cardiovascular system in the hypertensives and, at the same tiem, suggests a possibility of blood pressure control by way of the voluntary control of respiration in such patients.2) There occurred a significant diminution of the respiratory rate and an increase in the amplitude of respiratory movement when abdominal breathing and "susokkan" were introduced. The practice of biofeedback, nevertheless, had no conspicuous effect.3) As compared with the control group, the patient group, with programmed respiratory exercises (abdominal breathing and "susokkan") exhibited a notably greater degree of hypotensive response. This fact suggests a possiblity of lowering blood pressure by respiratory exercises in hypertensive patients.

View full abstract

It is well known that exposure of man to various psychological stress leads to an increase of plasma free fatty acid, so we investigated the lipids (free fatty acid) metabolism in psychosomatic diseases of the cardiovascular system. The psychosomatic patients who showed abnormal test results, such as CMI type IV and high MAS points, have higher fasting plasma free fatty acid level (706±63μEq/l n=12) than the normal (CMI type I, low MAS points) control group (473±40μEq/l n=13). Among these patients, especially the cardiac neurosis group, plasma FFA and blood glucose increased more markedly after infusion of low doses of norepinephrine (0.2μg/kg/min for 15 min.) than the noraml control. This difference in response does not seem to be the effect of aging, obesity and hyperlipidemia. In both groups, the increase in plasma FFA and glucose after norepinephrine infusion was not completely suppressed by the pretreatment with propranolol infusion. In animal experiments, during a hemorragic shock, plasma FFA of anesthetized dogs gradually decreased, instead of marked increase of blood lactate and catecholamines. From these results, it is tempting to speculate that a certain group of psychosomatic patients may have metabolic hyperresponse (ex. hyper-free-fatty-acidemia) to distressing stimuli, but the variety, intensity and duration of stress may cause variable metabolic responses.

View full abstract

Peptic ulcer is considered to be one of the representative psyhosomatic diseases in the digestive organ, for psychological stress is involved in its etiology, treatment and pathophysiology. From the accmulated data on the psychosomatic investigation of peptic ulcer which was conducted at the Third Medical Department of the Tohoku University School of Medicine, the following conclusions were obtained.1) Etiology Although psychological stress acts as a causal factor in the occurrence of peptic ulcer, it is important to take into consideration such factors as the organological weakness, patient's character, mode of life and living techniques, etc. By which the patient reacts to the said stress.2) TherapyIt is very important to understand the necessity of a psychosomatic approach to the treatment of peptic ulcer. For this aim, it is mandatory for the psysician to be able to establish and maintain a trustful relationship with the patient.3) Recurrence and flare-up of peptic ulcerPsychological stress is involved in the recurrence and flare-up of peptic ulcer. Therefore, it is important to be aware of the nature of the psychological stress and to educate the patient so as not to make the stresser to be stressful in his daily life.

View full abstract