Sarcolemmal Ca2+ transport activities in cardiac hypertrophy caused by pressure overload

To examine Ca2+ transport activities in sarcolemmal membrane in cardiac hypertrophy caused by pressure overload, rats were subjected to aortic banding for 28 days. Heart-to-body weight ratio was increased by 46% in aortic-banded animals in comparison with the sham-operated rats. Ouabain-sensitive Na+-K+-ATPase activity in sarcolemma (SL) from hypertrophied hearts was not different from that in the control preparation. The initial rate of Na+-dependent Ca2+ uptake in SL vesicles from the hypertrophied hearts was stimulated by 53% compared with the control vesicles. ATP-dependent Ca2+ uptake and Ca2+-stimulated adenosinetriphosphatase (ATPase) activities in SL from hypertrophied hearts were increased by 35%. The number of Ca2+ channels estimated by [5-methyl-3H]nitrendipine binding was decreased by 33% in SL from hypertrophied hearts. Total and individual phospholipid contents in the hypertrophied heart preparations were not different from those in the control, except that phosphatidylcholine and phosphatidylethanolamine contents were significantly increased. Sarcolemmal preparations from hypertrophied hearts from the 22-wk-old spontaneously hypertensive rats exhibited changes in Na+-Ca2+ exchange and Ca2+-pump activities (similar to those observed in banded hearts), whereas the Na+-K+-ATPase activity decreased, [3H]nitrendipine binding increased, and phospholipid contents were not different. Thus, although differences were defined between two types of hypertrophy, these results suggest alterations in the sarcolemmal Ca2+ transport activities that may serve as an adaptive mechanism for the removal of Ca2+ from the myocardial cells during the development of cardiac hypertrophy.

Frequency characteristics of the heart rate variability produced by Cheyne-Stokes respiration during 24-hr ambulatory electrocardiographic monitoring

Spectral analysis of heart rates during 24-hr ambulatory electrocardiographic monitoring has been carried out to characterize the heart rate spectral components of Cheyne-Stokes respiration (CSR) by using fast Fourier transformation (FFT). Eight patients with congestive heart failure were selected for the study. FFT analyses have been performed for 614.4 sec. Out of the power spectrum, five parameters were extracted to characterize the CSR. The low peak frequencies in eight subjects were between 0.0179 Hz (56 sec) and 0.0081 Hz (123 sec). The algorithms used to detect CSR are the followings: (i) if the LFPA/ULFA ratios were above the absolute value of 1.0, and (ii) the LFPP/MLFP ratios were above the absolute values of 4.0, then the power spectrum is suggestive of CSR. We conclude that the automatic detection of CSR by heart rate spectral analysis during ambulatory ECG monitoring may afford a tool for the evaluation of the patients with congestive heart failure.

[Analysis of EEG, respiration, and ECG by 24-hour polygraphic study in a case of aortitis syndrome associated with epilepsy]

The relationships between electroencephalographic changes and cardio-respiratory responses were analysed by using 24 hour ambulatory simultaneous monitoring of EEG, respiration, ECG in a patient with aortitis syndrome. Circadian changes of "absence" attacks, effects of anti-convulsive drugs on epileptic attacks, and respiratory arrest and abnormalities of the cardiorespiratory integration were clarified.

Modulation of Na+-Ca2+ exchange in cardiac sarcolemmal vesicles by Ca2+ antagonists

The purpose of this study was to examine the effect of three classes of Ca2+ antagonists, diltiazem, verapamil and nifedipine on Na+-Ca2+ exchange mechanism in the sarcolemmal vesicles isolated from canine heart. Na+-Ca2+ exchange and Ca2+ pump (ATP-dependent Ca2+ uptake) activities were assessed using the Millipore filtration technique. Sarcolemmal vesicles used in this study are estimated to consist of several subpopulations wherein 23% are inside-out and 55% are right side-out sealed vesicles in orientation. The affect of each Ca2+ antagonist on the Na+ dependent Ca2+ uptake was studied in the total population of sarcolemmal vesicles, in which none of the agents depressed the initial rate of Ca2+ uptake until concentrations of 10 microM were incubated in the incubation medium. However, when sarcolemmal vesicles were preloaded with Ca2+ via ATP-dependent Ca2+ uptake, cellular Ca2+ influx was depressed only by verapamil (28%) at 1 microM in the efflux medium with 8 mM Na+. Furthermore, inhibition of Ca2+ efflux by verapamil was more pronounced in the presence of 16 mM Na+ in the efflux medium. The order of inhibition was verapamil greater than diltiazem greater than nifedipine. These results indicate that same forms of Ca2+-antagonist drugs may affect the Na+-Ca2+ exchange mechanism in the cardiac sarcolemmal vesicles and therefore we suggest this site of action may contribute to their effects on the myocardium.

Effect of a new calcium antagonist, nilvadipine, on variant angina pectoris evaluated by 24-hour Holter electrocardiography

The clinical effect of nilvadipine, a new calcium antagonist, was investigated in a single blind trial in 19 patients with variant angina pectoris. The efficacy of the drug was evaluated on the basis of frequency of anginal attacks and Holter electrocardiographic findings during observation periods and during two treatment periods when the drug was given in doses of 4 mg twice a day or 4 mg 3 times a day. The frequency of anginal attacks and the consumption of sublingual nitroglycerin tablets decreased significantly in both treatment periods in comparison with those in the observation period before treatment, but in the observation period after treatment tended to increase in comparison with those during the second treatment period. The frequency and duration of ST-segment elevation and the maximum ST-segment elevation confirmed by Holter electrocardiography also improved significantly in both treatment periods, compared with those in the observation period before treatment. Our findings show that nilvadipine is effective for variant angina pectoris at doses of 4 mg twice a day.

Role of the suprachiasmatic nuclei of the hypothalamus on diurnal rhythm in cardiac arrhythmias

Ambulatory EGG and EEG recordings were recorded under a 14/10-h light-dark illumination schedule using rats. The rats consisted of two groups: a suprachiasmatic (Sch) lesioned group (n = 5) and a normal control group (n = 5). Bilateral Sch nuclei were lesioned electrically (DC, 2.5 mA, 30 s for each) using a pair of platinum electrodes 0.3 mm in diameter. After recovery from surgery, recordings of ECGs (leads I, II, and III) and EEGs from the cortex and the left dorsal hippocampus were continued for 6 days. Diurnal periodicity in bradyarrhythmia (sinoatrial block, atrioventricular block) and heart rate was analyzed by the least square fit of 24-h cosines. Significant diurnal rhythm was observed in control rats, whereas Sch-lesioned rats showed no significant diurnal rhythm. The integrity of the Sch nuclei, therefore, is necessary for the generation and/or the expression of diurnal periodicity in bradyarrhythmia in rats.

[Pituitary hormone responses to exercise at high altitudes]

The secretory responses of the anterior pituitary hormone to physiological stress were studied in healthy male volunteers. Measurements of blood LH, FSH, Prolactin, GH, ACTH, lactate, pyruvate and hematocrit were made from blood samples taken at rest, after 15 minutes at sea level, and at an altitude of 4000 m and 5500 m modulated in a climate-controlled room. The results are summarized as follows: Blood levels of Prolactin and ACTH were increased after exercise at a high altitude. Blood levels of LH and FSH after exercise at each altitude were not significantly different from those at rest. Blood GH level was increased after exercise at any altitude. Blood levels of lactate and pyruvate were increased after exercise at any altitude. These results suggest that the secretory response of the anterior pituitary hormone to physiological stress is prominent in Prolactin, GH and ACTH but not in FSH and LH.

Influence of glucocorticoids on brain serotonin metabolism in rats

It has been suggested brain serotonin (5HT) plays a role in regulation of the hypothalamic-pituitary-adrenal system, although none of the experimental approaches so far reported has produced unequivocal results, mainly on account of the static tissue 5HT level or the known effects of drugs being employed in interpretation of their data. The present study in rats of the possible feedback influence of glucocorticoids on the brain 5HT was designed to analyze the dynamic turnover of its metabolism. Intracisternal injection of corticosterone (COR) caused no significant changes in 5HT content but increased its turnover dose-dependently in the cortex-cerebellum and the rostral brain stem including the hypothalamus, and lowered the serum COR level at doses less than 5.0 micrograms/kg, reducing its effect with increasing doses. Intracisternal or intraperitoneal administration of miliary doses of dexamethasone (DEX) decreased 5HT turnover in the same brain portions. The effects of glucocorticoids on the brain 5HT metabolism were more potent when injected intracisternally, especially onto the rostral brain stem. Although COR and DEX played controversial roles, the present results suggest that adrenal glucocorticoids may directly act on brain 5HT metabolism and there may be a feed-back relation between adrenal glucocorticoid and brain 5HT.

Well-controlled comparative study of the clinical effectiveness of intravenous mexiletine and procainamide on ventricular premature contraction

In a well-controlled study the clinical efficacy of a single intravenous injection of mexiletine (3 mg/Kg) on ventricular premature contractions was compared with that of procainamide (10 mg/Kg) using continuous electrocardiographic recordings. Of the 56 subjects studied, 55 were analyzed. These consisted of 28 cases in the mexiletine group and 27 in the procainamide group. The backgrounds of both groups were considered to be equivalent. Effectiveness on VPC ("marked and moderate improvement", as judged by the subcommittee) was seen in 88% of the mexiletine group and 84.6% of the procainamide group. This difference was not significant. The duration of efficacy was almost the same in the 2 groups. Overall improvement was the same as improvement in VPC. No significant difference was observed in the incidence of side effects. Five patients in the mexiletine group and 3 in the procainamide group reported side effects. The main side effect was light-headedness in the mexiletine group and a decrease in blood pressure in the procainamide group. A decrease in blood pressure was observed in 1 case in the mexiletine group but this was restored by an intravenous infusion of noradrenaline. Mexiletine had little effect on blood pressure, while procainamide induced a drop in the systolic pressure. This difference was significant. Overall utility ("markedly and moderately useful", as judged by the subcommittee) was seen in 84.0% of the mexiletine group and 84.6% of the procainamide group. There was no significant difference between the 2 groups. From the above results, it is concluded that mexiletine (3 mg/Kg) is as efficacious as procainamide (10 mg/Kg) in the treatment of VPC but that, unlike procainamide, mexiletine has little effect on blood pressure.

Studies of arrhythmias by 24-hour polygraphic recordings: relationship between atrioventricular block and sleep states

The relationship between AV conduction disturbances and sleep states was investigated using continuous polygraphic recordings for one full night. The results were as follows: (1) In the case of first-degree AV block, the phasic shortening of the PQ interval was observed during rapid eye movement (REM) sleep. (2) In the case of second-degree AV block (Wenckebach type), the conduction ratio increased transiently during REM sleep and significant relationships were observed between the number of nonconducted P waves and the mean heart rate in each sleep stage. (3) In the case of advanced AV block, complete AV block was observed less frequently during REM sleep and the period of falling asleep. Since the reproducibility of these results from night to night has not yet been investigated, additional evaluation is required.

The usefulness of Holter monitoring in the evaluation of antiarrhythmic drug efficacy for tachycardia

Using Holter monitoring tachycardia was found in 145 out of 2058 patients suffering from various underlying diseases. Three thousand seven hundred and forty monitorings were performed. The mean age of patients was 54.5 years with a range of 19 to 83 years. The observed tachycardia was classified into three types: tachycardia with short duration, tachycardia with long duration and tachycardia with complex form. The attacks of tachycardia were more frequently observed during periods of physical activity than during sleeping periods. The relationship of the number of tachycardia with short duration between 24-hour Holter monitorings was examined in order to establish day to day variability of the attacks. The 95% confidence interval about the resultant regression line was calculated and the percent reduction required for the evaluation of drug efficacy to avoid the chances of interference of spontaneous variation was found to be about 44.0, 55.0 and 82% when the total number of attacks during a 24-hour period were 50, 100 and 1,000, respectively. Holter monitoring showed higher positive results as compared to exercise testing for detection of tachycardia. Higher correlation coefficients between numbers of premature ventricular contractions (PVCs) and the plasma concentrations of procainamide or N-acetylprocainamide were observed in 3 or more successive PVCs than in individually occurring PVCs. Using repeated 24-hour Holter monitorings a significant reduction in the number of tachycardia was observed when the therapeutic concentration was reached after the combined or single administration of the drug. These results suggest that repeated Holter monitorings, exercise testing and determination of plasma level of the drug may be useful for the evaluation of antiarrhythmic drug efficacy for tachycardia.

Sleep and night-type arrhythmias

The relationship between arrhythmias and sleep states was investigated in patients with night-type arrhythmias, which were detected by 24-hour electrocardiogram recordings using the Holter Avionics system. These patients were examined using all-night polygraphic recordings and sleep states were divided in to 5 groups according to the standard sleep stage scoring manual as stage I, II, III, IV, and REM sleep. Patients were divided into 5 groups: (1) grade 2 ventricular premature contractions (VPCs), (2) grade 4a VPCs, (3) grade 4b VPCs, (4) supraventricular premature contractions, and (5) paroxysmal tachyarrhythmias such as paroxysmal atrial fibrillation or paroxysmal supraventricular tachycardia. The paroxysmal tachyarrhythmia group showed a significant increase in arrhythmia incidence during REM sleep (p less than 0.05). However, the subjects with other arrhythmias showed no significant increase during REM sleep, but grade 2 VPCs showed a tendency to increase in sleep stage IV (0.05 less than p less than 0.1). These results suggest that there are 2 types of arrhythmias influenced by sleep. The first type is affected by a phasic increase in sympathetic nervous tone during REM sleep and the second type is related to an increase in vagal tone during the night.