During admission for investigation of dysphagia, an 82-year-old woman suddenly complained of dyspnea, which was followed by cardiogenic shock. Her symptoms, electrocardiogram, echocardiogram and laboratory data were compatible with an extensive acute anterior myocardial infarction. Emergency cardiac catheterization showed no atheromatous narrowing in any coronary artery. However, the contractions of the left and right ventricles were diffusely and severely impaired, except for some hyperkinesis of the basal area. The asynergy, as well as the abnormalities on the ECG, improved almost to normal by the 35th hospital day. An endomyocardial biopsy from the right ventricle during the acute phase showed atypical myocardial damage with proliferation of fine collagen fibers and small round-cell infiltration including polymorphologic leukocytes. This type of transient cardiac disorder has recently been described in Japan, and is called 'Tako-tsubo cardiomyopathy' because of the characteristic appearance of the left ventricular asynergy. In the present case, ventricular asynergy was not limited to the left ventricle, but was also present in the right ventricle.

Diastolic mitral regurgitation (MR) may be induced by prolonging atrioventricular (AV) delay, and a significant negative correlation has been described between the critical PQ interval for the appearance of diastolic MR and pulmonary capillary wedge pressure (PCWP) in patients with DDD pacemakers. We report the relationship between the critical PQ interval for the appearance of diastolic MR and the optimal PQ interval in 11 patients (69.1 +/- 12.6 years). Cardiac output (CO) and PCWP were measured by Swan-Ganz catheter and transmitral blood flow was recorded by pulsed-Doppler echocardiography. AV delay was prolonged stepwise by 0.025 seconds starting from 0.065 seconds. The pacing rate was fixed at 70 beats/min. CO was highest when the PQ interval was 0.18 +/- 0.04 seconds. There was a significant positive correlation between the critical PQ interval for the appearance of diastolic MR and the PQ interval at which CO was the highest (r = 0.91, P < 0.01). The PQ interval at which CO was the highest was 0.02 +/- 0.02 seconds shorter than the critical PQ interval for the appearance of diastolic MR (P < 0.05). When the PQ interval was increased by 0.025 seconds from the critical PQ interval for the appearance of diastolic MR, CO decreased from 4.3 +/- 0.6 L/min to 4.1 +/- 0.6 L/min and PCWP increased from 7.5 +/- 6.4 mmHg to 8.5 +/- 7.3 mmHg (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

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A noninvasive method was developed for measuring the digital arterial pressure and the compliance by using a fingertip pneumoplethysmograph and a pneumatic cuff. The compliance (C) of the digital artery was obtained from the peak amplitude of the volume pulse wave (deltaVp-a) under the effect of the cuff pressure (Po-a) by the equation: C = deltavp-a/(Ps - P-o-a) during the dicrotic phase defined in this study. The normal mean value was 11.37 +/- 0.59 X 10(-5) cm3/mmHg. On lowering of the cuff pressure, the moment when the deltaVp value becomes positive is regarded as the systolic pressure (Ps). At the end of the dicrotic phase, the mean amplitude (deltaVss') of the pulse wave during one pulse cycle (SS') and the ratios (deltaVss'/deltaVsd), where deltaVsd is the mean amplitude of the wave during the systolic period (SD), of successive waves after a particular wave fail to increase at the same rate when the cuff pressure decreased below the diastolic pressure. The cuff pressure corresponding to this particular wave is regarded as the diastolic pressure (Pd). The mean value of the mean digital pressure of normotensive subjects was 80.6 +/- 1.2 mmHg.

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