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An 80-year-old man remained conscious due to vigorous deep breathing during 100 s of ventricular arrest which was recorded on a Holter ECG. Arterial blood flow is considered to have been maintained by changes in intrathoracic pressure produced by deep respiratory movements. This case may represent a pure model of the "thoracic pump" mechanism.

A 68-year-old man was admitted with congestive heart failure. He was treated with diuretics and digitalis; thereafter, the two-dimensional echocardiogram suggested a pedunculated and mobile left ventricular thrombus. He underwent surgical thrombectomy because of the high risk of systemic embolization. To our knowledge, this is the first case of dilated cardiomyopathy with a mobile left ventricular thrombus that was attached to ruptured false tendons.

A 62-year-old women had a history of cyanosis and easy fatigability from school age but had refused medical examinations. She was admitted to our department with exacerbation of dyspnea at the age of 59. Laboratory tests showed hypoxia complicated with polycythemia with 35 mmHg of PaO2, 8.5 x 10(6) erythrocytes per mm3. The systolic pressure of the right ventricle was 155 mmHg. RI angio demonstrated a high degree of the right-to-left shunt at the ventricular level. The patient was given oxygen therapy at home without diagnosis of tetralogy of Fallot (TOF) and eventually died at the age of 62. Tetralogy of Fallot was diagnosed at autopsy. Pulmonary stenosis of this case was located in infundibulum. The lining of the infundibular inlet was constituted of the thick fibrous tissue which remarkably augmented the pulmonic stenosis. Although the autopsy findings were considered to be relatively mild TOF, the death was presumed to be caused by development of the infundibular stenosis due to formation of fibrous tissue. This is the oldest patient in Japanese medical literature to be identified by cardiac catheterization and autopsy finding as a case of TOF.

Out of 330 patients with acute myocardial infarction (AMI) admitted to our institution, 256 patients entered our 3-week rehabilitation program and discharged from the hospital. Through the execution of the program, its feasibility and safety were examined, and guidelines for the progress of the program were re-evaluated. The state of outpatient community life and its determining factors were also investigated by a questionnaire. The following results were obtained: 1) Over 90% of patients with uncomplicated MI could complete the rehabilitation nearly on schedule, indicating the feasibility of the program. 2) Mortality after ambulation and serious complications related to rehabilitative activities were very few, indicating the safety of our rehabilitation program. 3) Among guidelines for the progression of the program generally accepted, the case for an elevation of blood pressure as well as an ST depression was found to be especially important in order to prevent serious complications. 4) Age, discharge exercise capacity, left ventricular function and the severity of coronary disease were important factors influencing the patients' returning to work.

The relation between changes in left ventricular systolic time intervals with amyl nitrite (AN) inhalation and the severity of coronary artery disease (CAD) was evaluated in 77 patients who underwent catheterization because of chest pain. In 25 subjects with normal coronary angiograms (control group), AN inhalation increased the ejection time (ET), shortened the preejection period (PEP) and increased the ET/PEP markedly. In the 52 patients with CAD (CAD group), the ET/PEP changed insignificantly after AN. The difference between the 2 groups was significant (p less than 0.001). At cardiac catheterization, the increase of left ventricular dP/dt after AN in the control group was significantly larger than that in the CAD group. Although a positive correlation between changes in ET/PEP with AN and ejection fraction at rest was noted in patients with 1-vessel CAD, no such correlation was noted in those with multivessel CAD. This suggests that factors in addition to pump function, such as the degree of CAD, influence the effect of AN inhalation on systolic time intervals. When an increase of less than 30% in ET/PEP occurs with AN inhalation, the presence of significant CAD can be detected with a sensitivity of 92%, a specificity of 84% and the predictive value of 92%. The AN inhalation test is safe and simple, and thus could serve as a stress test for evaluating the presence and severity of significant CAD.

The response of the mean circulatory pressure (MCP), an index of the tone of the systemic capacitance vessels, to the infusion of an alpha-adrenergic receptor stimulant (phenylephrine) and a beta-adrenergic receptor stimulant (isoproterenol) was studied in anesthetized, open-chest dogs. Provided that the blood volume (particularly, extra volume) remains constant, an increase in the MCP indicates an increase in the tone of the capacitance vessels ("venoconstriction") and a decrease in the MCP indicates a decrease in the tone of the capacitance vessels ("venodilation"). It was almost definitely concluded that the stimulation of the alpha-adrenergic receptor led to the increased tone of the systemic capacitance vessels and the stimulation of the beta-adrenergic receptor did not decrease the tone of the systemic capacitance vessels in anesthetized, open-chest dogs, but the stimulation of the beta-adrenergic receptor decreased the tone of the systemic capacitance vessels, when the tone had been previously elevated by angiotensin-II.

Two patients with left recurrent laryngeal nerve paralysis in association with pulmonary artery hypertension are described. One had primary pulmonary hypertension and the other had patent ductus arteriosus. The greatly dilated pulmonary artery in these patients resulted in compression of the left recurrent laryngeal nerve and produced a cardiovocal (Ortner's) syndrome. The pathogenesis of the vocal cord palsy was documented by cross-sectional computed tomography. In conclusion, computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension.