Yukiko Tsuchioka

Abnormal systolic blood pressure response during exercise recovery in patients with angina pectoris

OBJECTIVES This study was conducted to clarify the mechanisms of the abnormal systolic blood pressure response after exercise in patients with angina pectoris. BACKGROUND An abnormal systolic blood pressure response in patients with angina pectoris has been observed not only during exercise but also during the recovery period after exercise. However, the mechanisms of this abnormal response during recovery have not been elucidated. METHODS Thirty-five patients with angina pectoris and 17 control subjects underwent bicycle ergometric studies after insertion of a Swan-Ganz catheter. RESULTS In control subjects, all hemodynamic variables decreased rapidly after exercise. In 7 of the 35 patients, systolic blood pressure increased after exercise. The patients with angina were classified into two groups. In group I (17 patients), changes in systolic blood pressure during recovery were smaller than those in control subjects. In group II (18 patients) recovery of systolic blood pressure was normal. Changes in stroke index from rest to peak exercise were smaller in group I than in group II. Stroke index in both patient groups increased paradoxically during recovery. The increase in systemic vascular resistance index during recovery and the ratio of plasma norepinephrine concentration to cumulative work load were greater in group I than in group II. CONCLUSIONS An abnormal systolic blood pressure response after physical exercise in patients with angina pectoris is indicative of severe myocardial ischemia during exercise and may be caused by an increase in stroke volume due to recovery from myocardial ischemia and increased systemic vascular resistance secondary to exaggerated sympathetic nervous activity.

Intralymphocytic sodium and free calcium and plasma renin in essential hypertension.

Intraceilular sodium, potassium, and free calcium concentrations were investigated in lymphocytes of 30 patients with essential hypertension and 30 normotensive controls. All subjects were placed on a diet containing 8 to 10 g of sodium chloride per day. Lymphocyte sodium concentration was higher in hypertensive patients than in normotensive controls (19.8 ± 1.8 vs 18.4 ± 1.8 mmol/kg wet weight; p < 0.01), whereas lymphocyte potassium concentration was similar in both groups. Lymphocyte free calcium concentration was also higher in hypertensive patients than in normotensive controls (134.6 ± 13.2 vs 120.2 ± 16.4 nmol/L; p < 0.01). There was a positive correlation between lymphocyte sodium and free calcium concentrations in normotensive controls, in hypertensive patients, and in the subjects combined (r = 0.59, p < 0.01; r = 0.71, p < 0.001; and r = 0.70, p < 0.001, respectively). Lymphocyte potassium concentration was not related to lymphocyte sodium or free calcium concentration in each group. In patients with essential hypertension, intraceilular sodium and free calcium concentrations were negatively correlated with plasma renin activity (r = −0.66, p < 0.001; r = −0.60, p < 0.001, respectively), but they were not related to age, mean blood pressure, serum electrolyte concentration, or plasma norepinephrine concentration. These results suggest that a considerable relationship exists between intraceilular sodium and free calcium in lymphocytes and that, in essential hypertension, the alteration in cellular metabolism of sodium and calcium may be linked to the renin system but not to blood pressure, age, or adrenergic activity.

Periarteritis of coronary arteries with severe eosinophilic infiltration. A new pathologic entity (eosinophilic periarteritis)

A 40 year-old male presented symptoms of angina pectoris for about nine years and expired with symptoms of unstable angina, changing pattern at the terminal stage. At autopsy, both right and left coronary arteries of the subepicardial region were grayish white and elastic hard. Histologically, inflammatory infiltration was localized in adventitia of coronary arteries located in the subepicardial region. Inflammatory cells infiltrated into the adventitia were mostly eosinophiles. The medial smooth muscle cells were well preserved and the intima showed irregular thickening with fibrosis. Vascular obstruction or recanalization could not be observed. As a result of these findings, it was considered that these inflammatory changes of the coronary arteries could be termed eosinophilic periarteritis. These inflammatory changes could not be found in the intramural coronary arteries. Rather extensive fibrosis could be seen in the muscle layer centering about the posterior wall of the left ventricle. No findings of angiitis could be detected in the blood vessels except subepicardial coronary arteries.

Assessment of supra-valvular abnormal signal with color Doppler flow mapping in patients with aortic regurgitation

A supra-aortic abnormal flow signal (proximal acceleration) was studied in 62 patients with aortic regurgitation with the use of color Doppler flow mapping. The proximal acceleration signal was detected in 28 of the 62 patients and was shaped like a V or a teardrop. In the 29 patients who underwent aortography, a proximal acceleration signal was observed in all 18 patients with severe and moderate regurgitation and in only one of the 11 patients with mild regurgitation. The sensitivity for the diagnosis of severe regurgitation from the existence of a proximal acceleration signal was 100%, specificity 50%, and predictive accuracy 47%. A close correlation between the area of the proximal acceleration signal and the width of the aortic regurgitant jet signal was observed (r = 0.81). An acceleration area of 45 mm2 or more was observed in eight of the nine patients with severe regurgitation, in four of the nine patients with moderate regurgitation, and in none of the patients with mild regurgitation. Sensitivity for the diagnosis of severe regurgitation from an area of proximal acceleration of more than 45 mm2 was 89%, specificity 80%, and accuracy 67%. These results suggest that evaluation of the area of the supra-aortic abnormal signal may be a useful auxiliary aid in estimating the severity of aortic regurgitation.

Transvenous mitral commissurotomy examined with transesophageal echocardiography

SummaryTransvenous mitral commissurotomy (TMC) was conducted with transesophageal echocardiography (TEE) in two patients with mitral stenosis. It was possible to see clearly not only the intracardiac structures to be examined by TMC, such as the right and left atria, interatrial septum, and mitral valve, but also the instruments used in TMC, such as the catheter, guidewire, and balloon. It was possible to determine the positional relation between the intracardiac structures and instruments. We could observe all procedures other than Brockenbroughs procedure by both TEE and fluoroscopy at the same time. Although safety and reliability cannot be confirmed from just the two present cases, TEE appears to be applicable to TMC.

Histopathological observation of the heart with diffuse and abnormal proliferation of mitochondria in myocardial cells (mitochondrial cardiomyopathy): Report of an adult case

SummaryAn autopsy case of idiopathic dilated cardiomyopathy with abnormal proliferation of mitochondria in the myocardial cells is reported. The case is that of a 39-year-old male with congestive heart failure. The heart was 700 g and showed marked dilatation of all cardiac chambers with myocardial fibrosis of the left ventricular myocardium and interventricular septum, especially in the basal portion of the left ventricular posterior wall. Myocardial cells were hypertrophied with a marked increase of fine-granular sarcoplasm, containing numerous mitochondria, seen by electron microscopy. The mitochondria were usually round or oval and ranged in size from 0.3 to 1.2 µm in diameter. The cristae of these mitochondria frequently showed a concentric lamellar or reticular configuration. Myofibrils were unusually scarce, but the sarcomere structure and arrangement of myofilaments were well-preserved. Epicardial and intramural coronary vessels were almost normal. From these findings, we consider this to be an adult case of mitochondrial cardiomyopathy.

Effect of salt loading on intracellular sodium concentration in erythrocytes and lymphocytes of patients with essential hypertension.

本態性高血圧症患者50例を対象に赤血球およびリンパ球の細胞内Na濃度を,減塩食および増塩食摂取下に測定し,両者の変化の関係および血圧変化との関係を検討した.血圧と赤血球およびリンパ球内Na濃度は,増塩により有意に増加した.赤血球とリンパ球の細胞内Na濃度は減塩期,増塩期とも相関しなかったが,増塩による両者の変化率は有意の正相関を示した.平均血圧の変化率は赤血球およびリンパ球の細胞内Na濃度変化率とおのおの有意の正相関を示した.以上より,増塩による細胞内Na濃度変化は異なる細胞においても共通であること,および本態性高血圧症患者の食塩感受性には細胞内Na濃度変化が関与していることが示唆された.