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Cardiac hemangioma is extremely rare. We encountered two patients with cardiac hemangioma detected by thoracic echocardiography during a medical checkup. In the first case, transthoracic echocardiography revealed a pedunculated tumor in the left ventricle. Selective left coronary angiography demonstrated that the main feeding artery of the tumor arose from the third diagonal branch of the left anterior descending coronary artery. In the second case, thoracic and transesophageal echocardiography showed an oval tumor arising from the right atrium. Both tumors were successfully resected. Histopathological examination revealed that one of the tumors was a capillary hemangioma and the other was a mixed capillary and cavernous hemangioma. After operation, both patients had an uneventful recovery without any complications.

on behalf of the J-RHYTHM Registry Investigators* Background--To clarify the influence of hypertension and blood pressure (BP) control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J-RHYTHM Registry was performed.

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To clarify the clinical and electrophysiological characteristics of atrial standstill (AS) we studied 11 patients (7 males and 4 females), whose average age was 62 years and who were followed over a period of 4-179 months. Underlying heart disease was present in nine patients and two cases were idiopathic. Major clinical symptoms in the 11 cases included Adams-Stokes attacks, and dyspnea on exertion. In the standard 12-lead ECGs obtained on admission, the P wave was absent in six cases. Atrial flutter (AF) was noted in 3, atrial fibrillation (Af) in 1, and multifocal atrial tachycardia in 1. In some cases, the ECG initially showed AF or Af, and was transformed after several years into ectopic atrial tachycardia or an ectopic atrial rhythm with a markedly decreased amplitude of the P wave. Finally, the P wave disappeared over a prolonged period. When intracardiac mapping was performed, the atrial electrograms tended to diminish at the site of high, mid-lateral right atrium (RA). Electrograms were remained present in the vicinity of the tricuspid valve (TV) annulus. A repeated mapping and pacing study conducted in two patients revealed that the "silent" area spread toward the lower site of RA. During the average follow-up period of 64 months, four patients died. The interval until death in one patient with myocarditis was 6 months, and in another with dilated cardiomyopathy (DCM) it was 8 months. It appears that the atrial muscular lesion starts in the high lateral RA and progresses toward the lower RA, then to the vicinity of the TV annulus. A diffuse and progressive disturbance may occur not only in the atrial muscle, but also in the atrioventricular conduction system in patients with AS who had progressive myocarditis or DCM.

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hysical and mental activities can be triggers for acute myocardial infarction or myocardial ischemia, [1][2][3] and these exogenous factors are closely related to the daily distribution of the onset of acute cardiovascular diseases, 4 such as acute aortic dissection (AAD), which is a serious cardiovascular catastrophe. The circadian variation in the onset of AAD has a peak in the morning, 5 but the activities that trigger AAD and their relation to the time of onset have not been clarified, so the present study aimed to clarify those aspects of AAD. MethodsThe study group comprised 444 consecutive patients referred to 3 institutions (Juntendo University Hospital, Juntendo Izunagaoka Hospital, and Juntendo Urayasu Hospital) between January 1979 and March 2000 for spontaneous AAD. Data were retrospectively collected from the hospital medical records. The diagnosis of AAD was based on clinical symptoms and signs (severe chest pain, abdominal pain, back pain, and/or acute neurologic signs), typical findings on computed tomography or magnetic resonance imaging, observation at surgery and/or postmortem examination. Classification of the aortic dissection was based on anatomical location. Stanford type A dissections involved the ascending aorta and type B dissections occurred distal to the left subclavian artery. Patients with AAD secondary to trauma were excluded. To assess the influence of age, we divided the patients into 2 groups: younger (≤60 years old) and older (≥61 years old) patients. Statistical AnalysisContinuous variables are presented as mean ± SD. Categorical variables were compared by the chi-square test. The day was divided into twelve 2-h periods to evaluate the distribution of onset of AAD. For the subgroup analysis of age, the day was divided into eight 3-h periods. Chi-square goodness-of-fit testing was used to determine whether AAD uniformly occurred during the day. A p value <0.05 was considered statistically significant.