Junzo Nagashima

Acute Myocardial Infarction Induced by Alternating Exposure to Heat in a Sauna and Rapid Cooling in Cold Water

We describe a patient with acute myocardial infarction, which was thought to result from plaque rupture or thrombosis because of coronary artery spasm. The vasospasm was most likely induced by stimulation of the α-adrenergic receptors during alternating heat exposure during sauna bathing and rapid cooling during cold water bathing. This report emphasizes the dangers of rapid cooling after sauna bathing in patients with coronary risk factors.

Three-month exercise and weight loss program improves heart rate recovery in obese persons along with cardiopulmonary function.

OBJECTIVE Heart rate recovery (HRR) after exercise is an independent risk factor for cardiovascular disease and mortality, and it is well known to be modifiable by weight loss. We investigated whether HRR was mainly improved by better cardiopulmonary function or by alteration of the metabolic profile. METHODS The weight loss program included 2h of group exercise per week and individual dietary instruction by a qualified dietician every week. Clinical assessment (including HRR) was done before and after the 3-month program. PATIENTS The subjects were 125 obese persons without a past history of stroke, cardiovascular events, or use of medications who participated in and completed our exercise plus weight loss program. RESULTS HRR (35.61+/-12.83 to 45.34+/-13.6 beats/min, p<0.0001) was significantly faster after the program. The change in HRR was significantly correlated (p<0.05) with the changes in body weight, body mass index, percent body fat, waist circumference, hip circumference, resting heart rate, peak exercise heart rate, exercise time, maximal work load, physical working capacity divided by body weight (PWC75%HRmax/weight), subcutaneous fat area, visceral fat area, low-density lipoprotein cholesterol, and leptin. Multivariate analysis showed that the change in HRR was significantly correlated (p<0.05) with the changes in resting heart rate, peak exercise heart rate, and PWC75%HRmax/weight. CONCLUSIONS Our data demonstrated that HRR can be improved in obese subjects by a 3-month exercise and weight loss program. Improvement in cardiopulmonary function by exercise seems to be the main contributor to the increment of HRR.

Alterations in echocardiographic and electrocardiographic features in Japanese professional soccer players: comparison to African-Caucasian ethnicities.

Background: Scarce data are available regarding the electrocardiographic (ECG) and echocardiographic changes in athletes of Asian origin. Design: We investigate the ECG and echocardiographic patterns in Japanese (J) compared with African-Caribbean (AC) and Caucasian (C) athletes. Methods: A total of 282 professional soccer players (68 J, 96 AC and 118 C) matched for age, gender, sport and level of achievement was examined. Results: ECGs were without alterations in 62% of J (versus 69% of C, p = non significant and 44% of AC, p < 0.001). The most common alterations in J were sinus bradycardia (69%), incomplete right bundle branch block (RBBB; 43%), early repolarization (18%), isolated increase in R/S-wave (10%), Q-waves (9%). Remarkably, no J athlete showed deeply T-wave inversion, in contrast to 6% of AC (p < 0.05). Occasionally, J showed J-point upward/domed ST-elevation with inverted/biphasic T-wave (6% versus 16.5% in AC, p < 0.01). J demonstrated larger left ventricular (LV) cavity compared with AC and C players (55.2 ± 3.3 versus 52.2 ± 3.8 and 53.9 ± 3.7 mm, respectively, p < 0.01), with an important subset ( > 4%) presenting a markedly enlarged cavity (>60 mm), in the presence of normal systolic/diastolic function and no segmental abnormalities. Therefore, J showed a more eccentric remodelling compared with AC and C (relative wall thickness: 0.31 ± 0.05, 0.38 ± 0.06 and 0.36 ± 0.06, respectively, p < 0.01). Conclusion: J players show the most eccentric LV remodelling compared with C and AC players. In association, certain training-related ECG patterns, i.e. sinus bradycardia and isolated increase in R/S-wave voltage, are present in a larger proportion of J players than previously described in C players. Conversely, no J athlete showed deeply T-wave inversion, as commonly found in AC and occasionally in C.

Myocardial injury in a 100-km ultramarathon

Abstract Impaired cardiac function after strenuous exercise, such as an ultramarathon or triathlon, has been ascribed to “cardiac fatigue.” However, a reduction of cardiac function in strenuous sports in the absence of coronary artery disease might also be based on myocardial injury because of excess catecholamines. We studied the cardiac injury in runners of a 100-km ultramarathon by determination of levels of serum troponin T, which is highly specific for myocardial injury. Blood was collected from 13 healthy adult men before, immediately after, and the next morning after participation in a 100-km ultramarathon. Creatine kinase (CK), isozyme of CK with muscle and brain subunits (MB), and cardiac troponin T levels were determined. Creatine kinase levels were 207 ± 108 IU/L before the marathon, 10,313 ± 10,273 IU/L immediately after, and 10,799 ± 6593 IU/L on the next day. Creatine kinase MB levels at the same time points were 12 ± 14 IU/L, 197 ± 170 IU/L, and 166 ± 108 IU/L, respectively. Cardiac troponin T level was ⩽0.1 ng/mL in all subjects before the marathon and increased significantly to a mean of 0.68 ± 0.73 ng/mL immediately after, exceeding the normal limit in seven subjects. It then returned to normal (0.15 ± 0.07 ng/mL) on the next day, while CK, which referred to skeletal muscle damage, was still elevated at a high level. Because cardiac troponin T levels increased after the ultramarathon, myocardial injury was considered to have occurred.

A case of coronary artery ectasia with thrombus detected by transthoracic two-dimensional echocardiography.

Coronary artery aneurysm, or ectasia, is an uncommon disease with a reported incidence of 1.2%-1.4% in coronary angiograms.1,2 Previous reports have described rupture, thrombus with distal embolization with subsequent myocardial infarction, and spasm as complications of coronary artery aneurysm.2,3 In this report, we present a rare case of coronary artery ectasia with thrombus detected by transthoracic twodimensional echocardiography.

Assessment of reflection pulse wave in patients with cardiomyopathy: evaluation of noninvasive measurement of wave intensity.

Objective —We assessed the reflection pressure wave using noninvasive measurement of wave intensity (WI) in patients with cardiomyopathy. Methods and results — Subjects included 8 patients with hypertrophic cardiomyopathy (HCM group) and 10 patients with dilated cardiomyopathy (DCM group).Twelve healthy subjects were used as a control group. By using a combined Doppler and echo-tracking system, changes in vascular diameter (dD) and blood flow velocity (dV) were recorded simultaneously at the common carotid artery and dD x dV was measured as WI. In the components of WI, the positive component of early systolic phase (FE) and the negative component following FE (B) were significantly reduced in the DCM group. There was a significant positive correlation between FE and B in all 3 groups.The appearance time of B was significantly shorter in the HCM group and significantly longer in the DCM group compared with the control group. Conclusions — It was suggested that the value of the reflection pressure wave was influenced by the left ventricular contractility, and that the effect of the reflection pressure wave appeared earlier in patients with HCM and later in patients with DCM compared with the control subjects.

Dynamic component of sports is an important determinant factor of heart rate recovery

OBJECTIVE It is usually suggested that life expectancy of top athletes especially in endurance sports is longer than that of sedentary people. On the other hand, heart rate recovery (HRR) after exercise is an independent risk factor for cardiovascular disease and mortality, but differences in HRR between various top athletes are unclear. We examined HRR in various top athletes to clarify a role of HRR that may affect their life expectancy. METHODS HRR was defined as the difference between the heart rate at peak exercise and that at 2 min after the finish of exercise using symptom-limited maximal graded bicycle ergometer exercise testing. The relationships between HRR with the grade of static and dynamic component of classification of sports, age, and body mass index (BMI) were estimated. SUBJECTS The subjects were 720 male athletes participating in the National Sports Festival Japan in 2005-2008 and age-matched 28 sedentary controls. RESULTS HRR was significantly correlated (p<0.0001) with the higher grade of dynamic component of sports, younger age, and lower BMI in both univariate and multivariate analysis. CONCLUSIONS HRR of top athletes is predicted by increased dynamic component of sports, younger age, and lower BMI.

70歳まで良好な経過を示している高齢者 Eisenmenger 症候群の1例

We report a 70-year-old women with Eisenmengers syndrome. Eisenmengers syndrome with ventricular septal defect was diagnosed at another hospital when she was 32 years old. Then, she was referred to our hospital at age 60 old and she now is according to the out patient in over clinic. She have mild cardiac function, NYHA classification, was II-M, polycythemia cell blood count 535 x 10(4) and 17.2 g/dl in hemoglobin. Echocardiography suggested serious Eisenmengers syndrome. The left ventricle was compressed, the blood pressure of the right ventricle exceeded 105 mmHg, and the onset of the right to left shunt flow was thought to be 250 msec bored on the electrocardiogram Q wave. The reason why the progression of complicated obstructive pulmonary artery disease was slow may have been become of the mildness of her polycythemia, and this is presumed to be the reason for her long survival to age 70.