Two factors of the ventricular function, systolic contractile and diastolic relaxing functions, cooporate in pumping the adequate blood volumes to suffice bodily demands. In some hypertensive patients with marked left ventricular hypertrophy, the intact systolic function of the ventricle associated with clinical symptom of congestive heart failure(CHF), which is considered to be a consequence of diastolic dysfunction. In this study 10 hypertensive patients(group A) complaining of exertional dyspnea or chest pain with increased left ventricular mass index and normal systolic function and 6 normotensive controls(group B) were examined by cardiac catheterization and echocardiography to assess the left ventricular systolic and diastolic function and ventricular responses to constant infusion of nitroprusside. Various systolic and diastolic function indices were measured by cardiac catheterization and echocardiography. 1) The ejection fraction(EF), fractional fiber shortening, mean velocity of circumferential fiber shortening, left ventricular(LV) peak+dp/dt, change of slope of LV peak systolic pressure-volume and pressure-dimension relations in group A were not different from those of group B in the resting states. 2) Diastolic dysfunction was evidenced by prolonged A2D time, decreased OR slope, decreased peak negative dp/dt and increased diastolic time constant 'T' in group A. 3) Cardiac index by thermodilution method was negatively related to left ventricular mass index(LVMI) measured by echocardiography, whereas time constant T was positively related to LVMI. 4) With constant infusion of nitroprusside, LV systolic pressure, LV end-diastolic pressure and pulmonary arterial pressure were decreased, and left ventricular end-systolic stress and stroke work index(SWI) derived from left ventricular pressure-volume loop area were decreased, EF was increased, but time constant T was prolonged and cardiac output(CO) by thermodilution method was decreased in group A. 5) In group B, with constant infusion of nitroprusside, EF, SWI and CO were pratically unaffected and time constant T was not prolonged significantly. These reults suggest that patients with hypertensive hypertrophic left ventricle is associated with diastolic dysfunction, which could further be exacerbated by a vasodilator such as nitroprusside.
Arterial Pressure ; Blood Pressure ; Blood Volume ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Dyspnea ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart Diseases* ; Heart Ventricles* ; Heart* ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Nitroprusside* ; Stroke ; Theophylline ; Thermodilution ; Ventricular Function

Cardiac output depends on the ability of systolic ejection and diastolic filling of the heart. M-mode echocardiography can provide accurate clinical assessment of left ventricular systolic and diastolic functions. To see whether there are changes of the left ventricular function in asymptomatic hypertensives and if any kind of dysfunction and whether any relationship between the pattern of the ventricular hypertrophy and type of ventricular dysfunction exists, the authors examined the systolic and diastolic function indices of the left ventricle in 50 normotensives and 88 hypertensives composed of 18 patients without left ventricular hypertrophy(group 1), 40 patients with disproportionate septal thickening (group 2) and 30 patients with concentric left ventricular hypertrophy(group 3). Obtained results were as follows : 1) Blood pressure & left ventricular mass index were increased significantly in each hypertensive group compared to normal control. 2) Ejection fraction & fractional shortening in the hypertensive groups were not different from the normotensive control group. 3) Left ventricular isovolumic relaxation time(A2D time) was prolonged in each hypertensive group, especially in group 3. 4) Left atrial emptying index (AEI) was decreased in each hypertensive group. 5) Left ventricular percent ventricular A wave (% VAW) was increased in all hypertensive groups. Above study suggested that the left ventricular diastolic function could be impaired in the hypertensives without associated systolic dysfunction, and the degree of the diastolic dysfunction was not much affected by the type of left ventricular hypertrophy, but the more prolonged A2D time in the concentric hypertrophy group.
Blood Pressure ; Cardiac Output ; Echocardiography ; Heart ; Heart Ventricles ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Relaxation ; Ventricular Dysfunction ; Ventricular Function, Left

This study was made to evaluate the effect of oral atenolol, a cardioselective beta-adrenergic blocking agent without intrinsic sympathomimetic activity, on left ventricular function in patient with essential hypertension. Atenolol, 100mg/day, was given to 11 hypertensive patients for 4 weeks, and its effects on arterial pressure, pulse rate, left ventricular dimensions and ejection phase indices of myocardial performance were examined by echocardiography. Echocardiographic studies were performed before treatment and after 4 weeks of atenolol therapy. Arterial pressure fell form 145/90 mmHg to 138/84mmHg after 4 weeks. Pulse rate fell significantly from 69/min to 58/min(p<0.05). Left ventricular end-diastolic and end-systolic dimensions and mean rate of circumferential fiber shortening(mVcf) did not change significantly. Ejection fraction increased significantly from 0.66 to 0.72(p=0.01). This results indicate that atenolol in the resting state has no depressant effect on left ventricular function in patients with essential hypertension.
Arterial Pressure ; Atenolol* ; Echocardiography ; Heart Rate ; Humans ; Hypertension* ; Ventricular Function, Left*

Myocardial bridge is not a rare congenital malformation of the coronary artery which takes an intramural course. Most of the lesions are found in proximal half of the left anterior descending coronary artery, but one which occurs in the left circumflex artery is extremely rare. During systole, the intramural coronary artery is compressed by contraction of over bridging ventricular muscle, therefore blood flow distal to the lesion in impaired and angina pectoris or acute myocardial infarction may occur. We experienced a 54-year-old man who complained of severe precordial pain during exercise and at rest for several months, and was diagnosed as myocardial bridging in the left circumflex coronary artery by coronary arteriography. Thus we report this case with literature review.
Angina Pectoris ; Angiography ; Arteries ; Coronary Vessels* ; Humans ; Middle Aged ; Myocardial Bridging ; Myocardial Infarction ; Systole

For the evaluation of the left ventricular diastolic function in mild to moderate hypertensive patients without left ventricular hypertrophy, 15 hypertensive patients (group A) and 15 normotensive subjects (group B) were examined by 2-D guided M-mode echocardiography. Various systolic and diastolic indices were derived from computer-assissted analysis of differential curves of left ventricular dimension and posterior wall thickness. The systolic and diastolic function indices of each of the two groups were compared. The results were as follows : 1) There were no significant differences in ejection fraction, left ventricular peak ejection rate and posterior wall thickening rate between two groups. 2) There were no significant differences in % ventricular A wave, left ventricular peak filling rate and posterior wall peak relaxation rate between two groups. 3) One third filling rate was 2.07+/-0.41 EDD/sec in group A and which was significantly lower than 3.29+/-0.88 EDD/sec of group B. Above result suggests that computer-assisted analysis of differential curves of left ventricular dimension and posterior wall thickness could be helpful in the early detection of diastolic dysfunction, and that left ventricular diastolic dysfunction in its early filling period may develop in the mild to moderate hypertensive patients even before left ventricular hypertrophy develops.
Echocardiography ; Humans ; Hypertrophy, Left Ventricular* ; Relaxation

A 15 year-old boy who was supposed to have had rheumatic myocarditis manifested acute heart failure and transient left ventricular hypertrophy in the early phases of the disease process. Serial echocardiographic examination was very helpful to follow the clinical course and observe the anatomic and functional changes of the heart in conjunction with the clinical status.
Adolescent ; Echocardiography ; Heart ; Heart Failure ; Humans ; Hypertrophy, Left Ventricular* ; Male ; Myocarditis*

The hypotensive effect of tripamide(Normonal(R)) were evaluated in 31 cases of essential hypertension. Fifteen to thirty mg of tripamide per day were administered continuously for 8 weeks. The results were as follows; 1) The systolic blood pressure was significantly lowered from 175+/-15 mmHg(Mean+/-SD) before treatment to 144+/-17 mmHg after treatment(p<0.01), and the diastolic blood pressure was significantly lowered from 106+/-11 mmHg before treatment to 90+/-12 mmHg after treatment(p<0.01). 2) The systolic blood pressure was lowered 20 mmHg or more in 25 out of 31 cases(80.7%), and the diastolic blood pressure was decreased 10 mmHg or more in 25 out of 31 cases(80.7%) at the end of 8 weeks treatement. 3) There was no significantl differences in the level of SGOT, serum cholesterol, serum electrolytes(Na+, K+, Cl-), BUN, creatinine and urinc acid before and after treatment with tripamide. 4) In most cases the subjective symptoms disappeared or became easier after tripamide treatment. 5) Profound weakness was developed in 2 cases during tripamide administration.
Aspartate Aminotransferases ; Blood Pressure ; Cholesterol ; Creatinine ; Hypertension*

The antianginal effect of oral nicorandil was examined on 15 subjects with angina pectoris who had not been improved by previous treatment with beta blocker and/or calcium antagonists. Nicorandil, 5mg tid, was added to their previous regimen which were composed of beta blocker and/or calcium antagonists, and patients were followed up at least for 6 weeks. The following results were obtained; 1) Frequences of anginal attack were markedly reduced in 11(73%) of 15 patients after the use of nicorandil. 2) After the use of nicorandil, ST segment depression and T wave inversions were improved in 10(66.7%) of 15 patients. 3) In 10 patients who had been taken nicorandil over 12 weeks, 9 patients showed sustained improvement in clinical status, but no significant side effect was noted. 4) In two patients who had undergone exercise tolerance test, significant prolongation in exercise duration were noted. 5) The adverse effects of nicorandil were as follows; headache in 3, insomnia in 3, excessive perspiration, dizziness, thirst, constipation and facial fiushing in 1, respectively.
Angina Pectoris* ; Calcium ; Constipation ; Depression ; Dizziness ; Exercise Tolerance ; Headache ; Humans ; Nicorandil* ; Sleep Initiation and Maintenance Disorders ; Thirst

Fistula between the right renal artery and the infereior vena cava is a rare disorder, of which only 7 cases were reported in so far as the authors have reviewed. A 34-year-old man, who had got a stab wound on the abdomen and undergone an abdominal surgery 12 years ago during his military service, visited the hospital because of occipital headache and known hypertension for 5 years. On examination, his blood pressure was 200/140mmhg, and a thrill and loud continuous vascular bruits over the paraumbilical and right loin region were noted. his blood pressure was refractory to usual antihypertensive regimens. The chest X-ray film showed cardiac enlargement and pulmonary congestion. With the aids of abdominal ultrasonogram, static and dynamic renal scanning with (99m)T-DTPA, excretory urogram, aortogram and selective right renal angiogram, he was diagnosed as right renal artery inferior vena cava fistula. After fistulectomy and repair of walls of both vessels, his blood pressure was successfully controlled with drugs.
Abdomen ; Adult ; Arteriovenous Fistula* ; Blood Pressure ; Estrogens, Conjugated (USP) ; Fistula ; Headache ; Humans ; Hypertension ; Hypertension, Renovascular ; Military Personnel ; Renal Artery* ; Thorax ; Ultrasonography ; Vena Cava, Inferior* ; Wounds, Stab ; X-Ray Film

BACKGROUND: Purinergic and cholinergic agonists elicit negative-inotropic and chronotropic effects, anticip-ating their protective action from the damage of overloaded myocardium. However, the actions of the agents during the ischemic insults are not yet clearly informed. The aim of this study was to investigate the role of the purinergic and cholinergic agonists on the simulated ischemic myocardium of the rat atrial fiber preparations. METHOD: Various action potential parameters (maximum diastolic potential MDP;action potential amplitude APA;velocity of phase 0 depolarization dV/dtmax;action potential duration APD90) were measured and compared in electrically paced, normal (NPSS) and modified physiological salt solution (MPSS) superfused rat atrial fibers in vitro, using conventional 3M-KCl microelectrode technique. Ischemia-simulated modified physiologic solutions were prepared by changing the solution's composition. RESULTS: Hypoxic-and/or hyperkalemic-MPSS decreased all the action potential (AP) variables. However, no significant changes of the AP variables were developed by the acidic-or glucose-free MPSS. Adenosine (Ado) and cyclopentyladenosine (CPA) only decreased the APD90 in a dose-dependent manner. Acetylcholine (Ach) and carbachol (Cch) hyperpolarized the MDP, increased the dV/dtmax with certain doses, and decreased the APD90 dose-depen-dently. The potency for APD90-decrease was greater in order, CPA>Cch>Ach>Ado. Ado and CPA did not affect the hypoxic, hypokalemic MPSS-induced dV/dtmax-decrease. On the other hand, Ach and Cch sig-nificantly inhibited the dV/dtmax-decrease by the hypoxic hypokalemic-MPSS. Ado, CPA, Ach and Cch sig-nificantly augmented the hypoxic, hypokalemic MPSS-induced APD90-decrease. The inhibition by the Ach and Cch on the MPSS-induced dV/dtmax-decrease was not affected by DPCPX, but atropine significantly attenuated the inhibition by the cholinergic agonists. DPCPX inhibited the augmentation by the Ado and CPA on the MPSS induced APD90-decrease, and atropine inhibited the effect of the cholinergic agonists. CONCLUSION: Both purinergic and cholinergic agonists not only shorten the AP duration by themselves but also enhance the AP-shortening effect elicited by the ischemia, and therefore, it is inferred that both agonists prevent further tissue damage from the ischemic insults.
Acetylcholine ; Action Potentials ; Adenosine ; Animals ; Atropine ; Carbachol ; Cholinergic Agonists* ; Hand ; Ischemia ; Microelectrodes ; Myocardium* ; Rats*