A 65-year-old man was admitted with chest pain. A diagnosis of spastic angina was made because of symptoms of recurrent anginal attacks associated with ST-segment elevations in the electrocardiogram. A selective coronary arteriogram revealed a 90% diameter narrowing of the proximal left anterior descending coronary artery (LAD). No angiographically visible collaterals from the right coronary artery to the LAD were observed. The ventriculogram showed normal contraction of the left ventricle with an ejection fraction of 65%. Percutaneous transluminal coronary angioplasty (PTCA) failed resulting in total occlusion of the stenosis. Repeat PTCA at a higher pressure and of longer duration failed to redilate the artery. Reperfusion with the blood from the femoral artery through the balloon catheter, which was used for the PTCA, was carried out until coronary artery bypass grafting (CABG). Blood flow rate of perfusion was approximately 25 ml/min. Reperfusion through the balloon catheter reduced chest pain and ST-segment elevations in the electrocardiogram. The patient tolerated the operative procedure well and his post-operative course was uncomplicated. The interval between the acute occlusion and revascularization by CABG was approximately 4 1/4 h. The ventriculogram taken 56 days after the CABG demonstrated normal contraction of the anterior wall of the left ventricle with an ejection fraction of 63%. Abnormal Q waves did not appear in precordial leads of the electrocardiogram after the surgery. The thallium scintigram showed no perfusion defects.

The present study was conducted to determine whether or not there is diurnal variation in the hemodynamic responses to stimuli that increase myocardial oxygen demand, and the effects of such variation on electrocardiograms (ECG). Fifteen patients with angina pectoris, 17 patients with old myocardial infarction, and 8 healthy controls were examined in this study. Graded exercise stress testing was conducted in the supine position, once in the morning and once in the afternoon, using a bicycle ergometer. A standard 12-lead ECG was recorded before, immediately after, and 3, 5, and 10 min after the end of the exercise. The exercise ECG and blood pressure changes were compared among the groups and, within each group, the results after morning and afternoon exercise were compared. Hemodynamic responses, including heart rate, blood pressure, and the pressure-rate product, showed greater increases in the morning than in the afternoon in angina patients and controls, in association with greater depression of the electrocardiographic ST-segment. In contrast, patients with old myocardial infarction exhibited no difference in hemodynamic responses or the ST-pattern from morning to afternoon. The results suggest that diurnal variation of hemodynamic responses to increased oxygen demand may explain, at least partly, why myocardial ischemia of effort angina is more severe in the morning than in the afternoon.

肥大型心筋症41例を対象に, 肥大部位の違いがフランク法ベクトル心電図に与える影響について検討した.肥大部位は断層心エコー図およびMRIを用いて判定し, 最大肥厚部位によりSeptal (S) , Anterior (A) , Lateral (L) , Posterior (P) およびApical (AP) の各群に分類した.最大ORSベクトルの大きさには各群間に差が認められなかったが, 最大QRSベクトルの方向ではS-群は-180～-60°の範囲に, P-およびL-群は-60～0°に, AP-群は0～+90°の範囲に, それぞれ約70%の症例が分布し, S-群を除いて肥大部位と最大QRSベクトルの方向は一致した.QRS環はS-群では複雑な回転を示す例が多かったが, 他の群ではほぼ正常な回転を示した.最大Tベクトルは, P-群が他の群よりも前方に位置し, AP-群は他の群よりも大きかった.以上より肥大型心筋症の肥大部位は主として最大QRSベクトルの方向に反映されていることが明らかになるとともに, 中隔肥大群は他の群よりも不均一な群であることが推測された.

We report a case of a papillary fibroelastoma originating from the left ventricular endocardium in the outflow tract which was discovered by echocardiography in an asymptomatic patient. Two echocardiographic features were observed: (1) the tumor surface was smooth, and characteristic papillary formation was not detected; and (2) the outline of the mass was clearly defined as a dense echo, with the central, radiolucent, portion surrounded by a highly refractive linear echo at the level of the maximum diameter of the mass. The excised tumor was covered with a gelatinous substance that masked multiple papillae on the surface, but its echolucent center could not be explained by the pathology of the tumor which was solid centrally. Our case indicates that a papillary fibroelastoma may sometimes show echocardiographic findings similar to those of a myxoma, although other investigators have not noted the smooth surface and the echolucent center makes it indistinguishable from a myxoma. Thus, in some cases, it is difficult to distinguish papillary fibroelastoma from myxoma by echocardiography.

Clinical significance of body surface mapping (mapping) for estimating the ventricular hypertrophy was reviewed mainly based on the reports from the Department of Laboratory Medicine, Okayama University Medical School. First, the normal pattern of the maps was determined on 296 normal subjects. Then, the maps of the patients with aortic regurgitation, essential hypertension and hypertrophic cardiomyopathy were compared with each other and with the normal maps. The results showed that the maps are useful for diagnosis of the left ventricular hypertrophy, but failed to elicite the pathophysiological base of the hypertrophy. However, for the right ventricular hypertrophy, mapping was shown to be useful for estimating the right ventricular systolic pressure, i.e., systolic pressure of the pulmonary artery. Therefore, mapping is useful for diagnosis of ventricular hypertrophy, especially for estimating the right ventricular overloading.

We reported a case of primary cardiac lipoma in a 74-year-old woman who had a 23-year history of cardiomegaly. The chest roentgenogram showed an enlargement of the cardiac silhouette. The electrocardiogram showed slight abnormalities including mild low voltage of R wave in V6 and flat T wave in V5 and V6. M-mode and cross-sectional echocardiography revealed a low echoic mass which mainly situated between left ventricular posterior wall and the pericardium. The left and right ventricular wall motion was not affected. Computed tomography of the heart revealed a large mass backward of the left ventricle and right side of the right atrium. The attenuation values of the mass ranged around-118HU and was compatible to lipoma. We diagnosed as a lipoma of the heart possibly arising from the pericardium. Computed tomography may be of use for a very specific diagnosis of cardiac lipoma.

Reactive hyperaemia, the cardiovascular response to transient occlusion of a vessel, was examined and compared in the right coronary artery (RCA) and the left anterior descending coronary artery (LAD) in the same heart of an open-chest dog. First, to study the relationship between reactive hyperaemia and occlusion time in the RCA and LAD, respective flows were measured and reactive hyperaemia was induced with different occlusion times. Occlusion time required for half the maximum peak percentage reactive hyperaemic flow (%PRH), t1/2, for the RCA was approximately twice that of the LAD: 11.4±2.3 s versus 5.9±1.4 s. Maximum %PRH of the RCA was significantly greater than that of the LAD while the percentage repayment of the RCA was lower than that of the LAD. Augmentation of right ventricular oxygen consumption shortened t1/2 and increased percentage repayment significantly. Second, to determine “critical pressure”, which was defined as the perfusion pressure below which reactive hyperaemia was abolished completely, the RCA and LAD were perfused through a shunt from the carotid artery, perfusion pressure was varied in the range of 100 to 20 mmHg and reactive hyperaemia was induced. Critical pressure in the RCA was significantly lower than in the LAD: 32.2±5.7 mmHg versus 41.5±5.0 mmHg. These results suggest that the RCA has a greater flow reserve than the LAD. These results were consistent with the difference of oxygen metabolism between the right and left ventricles. The difference of oxygen metabolism between the two ventricles would, at least partly, account for these results.

Experiments were conducted to study autoregulatory responses of the right and left coronary arteries in dogs with open chests. The right and left circumflex coronary artery were cannulated and perfused with blood from the femoral artery via a pressurized reservoir. The perfusion pressure was varied in steps over a wide range and coronary blood flow rates were measured. Both the right and left coronary arteries exhibited autoregulation but the pressure at the lower end of the autoregulatory range was lower in the right (39.8±9.1 mm Hg) than in the left circumflex coronary artery (57.6±14.5 mm Hg). The slope of the pressure-flow relationship in the autoregulatory range was less steep in the right than the left circumflex coronary artery. The closed-loop gain when the perfusion pressure was less than 100 mm Hg was greater in the right than in the left circumflex coronary artery. Increases in the right ventricular afterload produced by pulmonary artery constriction decreased the closed-loop gain, shifted the autoregulatory range upward and to the right, and made the slope steeper. These results indicate that more effective autoregulation is carried out by the right than the left circumflex coronary artery.

Isointegral maps (area maps) were recorded for 262 normal adults aged 20 to 81, and sex and age differences in the maps were analyzed.Men showed significantly larger QRS, QRST and STT area maps than women in the region from the left anterior to the left lateral chest. Age differences in the STT and QRST area maps were observed in men but not in women: younger men had larger maps in the region of the left anterior chest when compared with older males.

A retrospective study of 166 cases of cerebral infarction who were treated at the Takamatsu Red Cross Hospital from 1983 to 1986 was conducted.1) There was no significant relationship between cases of cerebral infarction deaths and smoking, alcohol consumption, high blood cholesterol levels, high blood neutral fat levels or diabetes.2) Those cases of cerebral infarction which were complicated by heart disease or atrial fibrillation demonstrated a significantly higher mortality rate.3) From among a total of 20 cases of cerebral infarction complicated with heart disease, 12 cases had a simultaneous complication of atrial fibrillation. The most common type of heart disease observed was cardiac valve disease, which was present in 7 of the cases.4) All 4 cases of cardiac infarction were not complicated by atrial fibrillation.5) All of the cases of death due to cerebral infarction complicated by heart disease were also complicated by atrial fibrillation.These finding indicate the importance of atrial fibrillation in cases of cerebral infarction.A study of the clinical picture of cases of cerebral infarction complicated with atrial fibmillation was conducted.1) The clinical picture of cases of cerebral infarction complicated by atrial fibrillation frequently involved cerebral embolism and the site of infarction was frequently observed to be the dendriform cerebral cortex. In addition, these cases were usually quite severe, even resulting in consiousness disorders and also involved a high mortality rate.2) In comparison to cases which were not complicated by atrial fibrillation, there was no significant difference observed between such cases nd survivors of cerebral infarction complicated by atrial fibrillation in terms of their function of movement and social life style.Based on the above, atrial fibrillation is believed to be a major risk factor of cerebral infarction irrespective of the presence or absence of underlying disorders.