Coronary circulation and myocardial gaseous metabolism were studied on 25 patients by means of coronary sinus catheterization. These patients were classified into following three groups, according to the blood pressure and ECG. findings.: Group I; hypertension only (5 cases), Group II; hypertension with depressed ST·T (10 cases), Group III; coronary sclerosis without hypertension (10 cases). 1) From the data previously reported concerning normal subjects and patients with hyperthyroidism and mild anemia, it was found that myocardial oxygen consumption were well correlated with cardiac work or with myocardial oxygen availability. As for coronary blood flow it was also found that it correlated fairly well with cardiac output or cardiac index. 2) In groups I and II, coronary blood flow, myocardial oxygen consumption and its availability were increased, as compared with the normal value. These results were related to the increased cardiac work. In group II, coronary arterio-sinus oxygen difference and oxygen extraction ratio tended to increase, while these values were normal in group I. 3) In group III, myocardial (xygen availability and oxygen consumption were slightly increased and coronary arterio-sinus oxygen difference and myocardial oxygen extraction ratio seemed to increase. 4) Immediately after the exercise, coronary arterio-sinus oxygen difference and myocardial oxygen extraction ratio tended to increase in almost all cases in groups II and III, but in group I and normal subjects remained unaltered. From the data mentioned above, the author discussed on the increased coronary arterio-sinus oxygen difference and myocardial oxygen extraction ratio in coronary sclerosis, and concluded that they indicate the relatively diminished coronary blood flow and insufficiency of myocardial oxygenation.
The effects of coronary dilator drugs upon the coronary circulation and myocardial metabolism were studied by coronary sinus catheterization in a total of 35 cases with hypertension, coronary sclerosis and various kinds of vulvular diseases. Results thus obtained were as follows: 1) Following the intravenous administration of theophylline-ethylendiamine, both coronary blood flow (C.B.F.) and myocardial oxygen consumption (M.O.C.) increased in average 14 and 9.4 per cent respectively. Coronary arterio-sinus oxygen difference (ΔO2) was significantly increased and myocardial oxygen extraction ratio was also elevated. In carbohydrate metabolism, glucose extraction showed tendency to increase, whereas lactate and pyruvate extraction tended to decrease. Thus, it is able to be concluded that theophylline-ethylendiamine not only dilatate coronary vascular bed, but also stimulate directly the myocardium, simultaneously. 2) After the sublinguar administration of nitroglycerine, C.B.F. and M.O.C. were decreased in parallel with diminished cardiac work, whereas C.B.F./cardiac output was increased, and additionally ΔO2 as well as myocardial oxygen extraction ratio were decreased. Concerning the myocardial metabolism, lactate extraction increased or remained unchangable. These facts suggest that nitroglycerine have a coronary vasodilatating action and increases the myocardial oxygenation. 3) In three cases examined with papaverine hydrochloride, ΔO2 and myocardial oxygen extraction ratio were increased and myocardial lactate metabolism was directed to the normal extraction in one case. 4) As a comparative study, the effects of high oxygen inhalation were studies in three cases. Of these, disturbed lactate metabolism were improved up to the normal extraction in two cases, indicating the improvement of the myocardial hypoxia by oxygen inhalation.
The disturbances of acid-base balance in 32 patients with pulmonary emphysema were studied. Respiratory acidosis was found in 10 patients and the ratio of residual volume to total lung capacity was above 50% in all of these 10 patients. Positive correlation between arterial carbon dioxide pressure and pulmonary arterial pressure was found. The serial gas analyses of the forced expired air indicated the disturbances of intra-pulmonary gas-mixing in the patients. Influences of the induced hypoxia and hyperoxia were studied. The patients reacted as well as normal subjects to the induced hypoxia. Their acidosis became worse during the inhalation of 100% oxygen. During the exercise test, arterial carbon dioxide pressure markedly increased in some patients who were suffering from severe disturbances of ventilation. The effects of carbonic anhydrase inhibitor were studied on 3 patients with respiratory acidosis. And their acidosis was improved only during the administration of the drug. The several factors concerning the development of the respiratory acidosis in pulmonary emphysema were discussed.
It is well known that incomplete right bundle branch block (I.R.B.B.B.) appears in the heart diseases with right ventricular hypertrophy, and recently it was suggested by Cabrera that diastolic overloading of the right ventricle produces frequently I.R.B.B.B., and an intermediary factor of the relation between I.R.B.B.B. and diastolic overloading is a dilatation of the right ventricle. In order to ascertain this theory, the comparison was made between E.C.G. and Xray in mitral valvular disease and the following were the results: 1. Electrocardiographic polyphasic QRS patterns in V1 lead which were encountered statistically more frequently in mitral valvular disease than control group, were difined as I.R.B.B.B. pattern. 2. Among 535 cases of mitral valvular disease, while heart-lung ratios were not so great so far as the patients with electrocardiographic right ventricular hypertrophy (R.V.H.), they were remarkably great concerned with the patients of I.R.B.B.B. patterns. 3. The value of the longest distance between right phrenicocardiac angle and left third arch of cardiac silhouette divided by thorathic transverse diameter was difined as right ventricular index (R.V.I.). R.V.I. of the patients with I.R.B.B.B. patterns was statistically greater than that of the patients with R.V.H. patterns. 4. During clinical course, I.R.B.B.B. patterns appeared hand in hand with the enlargement of cardiac silhouette and disappeared following the reduction of the enlargement in several cases.
In 19 dogs, E.C.G. of experimental acute dilatation of right ventricle produced by mechanical compression of pulmonary artery was studied by means of simultaneous epicardial, differential and right intraventricular leads. The following results were obtained: 1. Remarkable changes of E.C.G. were not seen in 5 dogs whose pericards were not opened and whose right ventricles were dilated by mechanical compression of pulmonary artery. 2. As to 12 dogs whose pericards were cut opened, rsRS′ pattern appeared in conus arteriosus in all cases, but in some cases there was no change of ventricular activation time (V.A.T.). With respect to its reason the following could be suggested that appearance of rsR′S′ pattern was not due to the conduction disturbance, but to the right ventricular dilatation itself. 3. In many cases, the changes of ventricular activation time of epicardial lead were most remarkable in conus arteriosus, but in some cases extroadinary prolongation of V.A.T. in middle and basal epicardial regions of right ventricle was more pronounced than that in conus artericsus. These changes were reversible in most of cases.
Myocardial metabolism was studied on 39 patients with hypertension and 14 patients with coronary sclerosis by means of the coronary sinus catheterization. These patients were classified into the following three groups, according to the values of blood pressure and ECG findings. Group I: 13 cases. The average value of mean blood perssure measured 127mmHg, and enlargement of left ventricle was observed in all the patients except for 2 cases. Group II: 26 cases. Hypertensives that denote depressed ST, flat or inverted T wave, or the combination of these abnormalities on ECG. The average value of mean blood pressure measured 133mmHg in height. All patients except for 2 cases showed the enlargement of left ventricle, including 4 cases with marked enlargement. Group III: 14 cases. Coronary sclerosis without hypertension. Mean blood pressure averaged 93mmHg. Enlargement of left ventricle was noticed in 6 cases. Following results thus obtained were compared with the normal data previously reported. 1) In group I, myocardial O2 extraction and O2 extraction coefficient were normal, while myocardial lactate and pyruvate extraction coefficient ratios were decreased. These results indicate the disturbance of myocardial carbohydrate metabolism in this group. 2) In group II, abnormalities of myocardial gaseous and carbohydrate metabolism were remarkable; i.e., O2 extraction coefficient was increased, myocardial RQ was below normal, and in a few cases O2 partial pressure of coronary venous blood was decreased. Moreover, myocardial lactate and pyruvate extraction coeffecient ratios were reduced s gnificantly, and myocardial O2 extraction ratio as well. In addition, coronary venous blood pH was measured on 12 of the patients examined and four of these showed increased coronary venous difference of pH. 3) In group III, O2 extraction and O2 extraction coefficient of cardiac muscle inclined to diminish, and marked reduction of O2 partial pressure of coronary venous blood was noticed in all 4 cases. Abno malities of myocardial lactate and pyruvate metabolism were also observed in this group. 4) From the data above mentioned, it is inferred that myocardial hypoxia is the major cause of these metabolic disturbances, and that, in group I, contributing factor of the hypoxia was myocardial hypertrophy, and that in group III, it is the relative limitation of coronary blood flow due to coronary sclerosis. Accordingly, group II, influenced by these two facters, exhibited the most severe changes, and the myocardial metabolism got worse, parellel with the clinical grades of hypertension and ECG findings. In some cases of group III whose ECG were normal in resting state, the increase of myocardial O2 extraction coefficient was noticed. This suggests the existence of myocardial hypoxia in these cases. 5) Hexamethonium (C6) and hydralazine (HY) were administered intravenously on ten hypertensive patients. HY decreased myocardial O2 extraction coefficient in all four cases, but C6 did in only two cases out of six examined. As to myocardial lactate and pyruvate extraction coefficient ratios, C6 increased them. Some discussion concerning the different actions of these two agents on coroanry circulation were attempted.
In order to clarify the mechanism of exercise proteinuria, acute exercise for a short time and repeated exercise for long periods were loaded to 54 healthy adult students; and exercise proteinuria resulted was investigated, with reference to renal hemodynamics measured by clearance methods. The results obtained were as follows. 1) An average 1.01 (0.10-3.12)mg/min. of urinary protein excretion, accompanied with marked decrease in renal blood flow (-16.4--43.0%), glomerular filtration rate and K-and Na-clearance, was observed by loading an average 4300kgm of momentum, which was measured by ergometer. These effects of exercise on renal hemodynamics were observed to disappear in 80 minutes after exercise. Arterial O2 saturation showed no significant changes during exercise, wheras arterial CO2 content showed marked decrease. 2) Exercise proteinuria was observed to appear in most subjects by acute loading with over 3000kgm of momentum and urinary protein excretion was shown to increase in proportion to momentum of exercise. 3) The effects of exercise on renal function were observed to be generally more slight in trained subjects than in non-trained ones. 4) The effects of exercise on renal hemodynamic are similar to those of stimulation of sympathetic nervous system, and it is presumed that the effects of exercise observed here may be reffered to excitement of sympathetic nervous system during exercise. 5) During 7 to 17 days of repeated daily exercise, protein excretion up to 70.2mg/min. was observed to appear in early morning urine. 6) In rest periods, during 7 days of repeated daily exercise, proteinuria accompanying remarkable decrease in renal blood flow (-17.8--50.6%) was found to appear. 7) The appearance of proteinuria, accompanied with decrease in renal blood flow, in the early morning or in the rest after exercise during training term seems to be one of manifestations indicating accumulated fatique and to be an important sign in physical training. 8) In the above-mentioned experiments on exercise proteinuria, the glomerular permeability to protein was observed to increase during exercise, and close correlation was demonstrated between appearance of proteinuria and duration of decrease in renal blood flow. However, no correlation was found between exercise proteinuria and mean blood pressure or filtration fraction. 9) From the presented observations, it was presumed that the increased glomerular permeability to protein, due to the decreased renal blood flow caused by excitement of sympathetic nervous system, might play an important rôle in the pathogenetic mechanism of exercise proteinuria.