Journal of cardiology
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Journal of cardiology · Jan 1990
[Left ventricular asynergy and myocardial necrosis accompanied by subarachnoid hemorrhage: contribution of neurogenic pulmonary edema].
One hundred-thirty patients with acute subarachnoid hemorrhages were investigated to examine the relationship of neurogenic pulmonary edema to cardiac lesions. Abnormal electrocardiograms were observed in 99 of these patients. Left ventricular asynergy was detected in nine of the 99 patients by two-dimensional (2D) echocardiography. ⋯ Biopsy findings were available in three and demonstrated severe fragmentation at the sites of left ventricular asynergy. Pulmonary edema, electrocardiographic abnormalities and left ventricular asynergy improved markedly during the courses of hospitalization. We concluded that left ventricular asynergy and myocardial necrosis may occur during the acute stage of subarachnoid hemorrhage and could produce neurogenic pulmonary edema rather than or in addition to permeability edema.
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Journal of cardiology · Sep 1989
Comparative Study[Out-of-hospital sudden cardiac death: a comparative study spanning 10 years].
Incidence, etiology and time zones of sudden cardiac deaths were compared for 1986 and 1976. Totals of 1,140 cases of acute endogeneous deaths, 590 in 1986 and 550 in 1976, were sent for coroner's inquest in Kanagawa Prefecture. These were the materials for the present study. ⋯ In ischemic heart disease, deaths most frequently occurred about midnight (from 12 a.m. to 1 a.m.) or in the evening (from 5 p.m. to 6 p.m.), and deaths due to acute cardiac failure occurred during sleep. Time zones of evening deaths in ischemic heart disease corresponded to the report of Muller et al., but, the peak about midnight was not reported. This difference may be explained by the circadian rhythm theory, however, heavy alcohol intake and spasmogenicity in the Japanese people may also play roles in midnight deaths.
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Journal of cardiology · Sep 1989
[The relationship between mitral regurgitation and asynergy of the left ventricle in old myocardial infarction].
To elucidate the mechanism of mitral regurgitation (MR) in patients with old myocardial infarction, two-dimensional (2D) and 2D Doppler echocardiographic examinations were performed in 92 patients. According to the sites of asynergy in the short-axis view of the left ventricle at the papillary muscle level, the patients were classified in three groups; i.e., anteroseptal (AS) group (49 cases), inferoposterior (IP) group (29 cases), and the AS + IP group (14 cases). The existence and severity of MR were evaluated by 2D Doppler echocardiography and the presence of mitral valve prolapse (MPV), by 2D echocardiography. ⋯ In these groups, mitral valve ring diameters were significantly larger in patients with MR than in those without MR (AS group: 32 +/- 3 mm with MR vs 24 +/- 2 mm without MR; p less than 0.01, IP group: 26 +/- 2 mm with MR vs 25 +/- 2 mm without MR; NS, AS + IP group: 30 +/- 3 mm with MR vs 24 +/- 1 mm without MR; p less than 0.05). Mitral valve ring diameters in the IP group with MR (26 +/- 2 mm) were smaller than in those in the AS and AS + IP groups with MR, and did not differ from those in the IP group without MR (25 +/- 2 mm). In conclusion, posterior papillary muscle dysfunction was mainly responsible for MR in the inferoposterior infarction and the dilatation of the mitral valve ring in the infarction involving the anteroseptal wall.
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Journal of cardiology · Jun 1989
Case Reports[Precordial ST segment depression in acute inferior myocardial infarction: the importance of posterolateral wall infarction].
To determine whether precordial ST segment depression during acute inferior myocardial infarction indicates posterolateral wall ischemia, anatomical predominance of coronary circulation was examined by coronary angiography and evaluated in 43 patients who experienced first acute inferior myocardial infarction. Among patients who underwent intracoronary thrombolysis within six hours from the onset of symptoms, the infarct-related artery was the right coronary artery (RCA) in 35. In addition, their early 12-lead electrocardiographic features were compared with those in eight patients having the infarct-related left circumflex coronary artery (group Cx). ⋯ On thallium-201 scintigraphy, additional perfusion defects of the posterolateral wall were present in all eight patients in group Cx and in ten of the 21 patients in groups SR and RI. Thus, precordial ST segment depression during acute inferior myocardial infarction seemed to be affected by the pattern of coronary circulation. It was concluded that this ST depression represents more extensive involvement of the posterolateral wall in patients with right predominant coronary circulation as well as in those with left circumflex artery obstruction.
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Journal of cardiology · Dec 1988
[The significance of early coronary reperfusion in patients with acute myocardial infarction assessed by regional wall motion].
Left ventricular ejection fraction, regional wall motion, hospital mortality rate, and reocclusion rate of the infarct-related coronary artery after thrombolytic therapy were examined in 164 consecutive patients who were admitted within 12 hours of the onsets of their symptoms of acute myocardial infarction. The patients were divided into three groups based on the findings of initial coronary angiography before and after administration of urokinase: (1) stenosed (the infarct-related coronary blood flow was visualized at initial angiography) (n = 41); (2) successfully thrombolysed (n = 82); and (3) unsuccessful (n = 41). The patients in each group were also subdivided into three subgroups based on the recanalized time (hours): within three, three to six hours and six hours or longer. ⋯ Regional wall motion in patients with the recanalized coronary artery within 12 hours was better than that of the unsuccessful group. The area of improved wall motion was wide in patients with early recanalization in the stenosed and thrombolysed groups. Thus, early recanalization within three hours is mandatory for reducing mortality and for improving ejection fraction and wall motion.