No abstract

CHD mortality is extremely low in Japan, particularly in rural districts, when compared with that in Western countries. This has been partly attributed to the difference in dietary lifestyle. We investigated the factors influencing CHD mortality in a rural coastal district of Japan, comprising mercantile, farming, and fishing areas with distinct dietary habits. We prospectively examined the incidence of CHD from 1994 to 1998, as well as coronary risk factors and serum fatty acid concentrations. The incidence of angina pectoris was significantly (P=0.01) lower in the fishing area than in the mercantile and farming areas. Blood pressure, physical activity, prevalence of diabetes, serum levels of uric acid and HDL-cholesterol were similar between the three areas. Total- and LDL-cholesterol levels were significantly lower but the smoking rate was markedly higher in the fishing area than in the other two areas. Serum levels of saturated fatty acids and n-6 polyunsaturated fatty acids (PUFA) were lowest in the fishing area, but n-3 PUFA did not differ significantly. The n-6:n-3 PUFA ratio was lowest and eicosapentaenoic:arachidonic acid was highest in the fishing area. Although many previous studies have emphasized the beneficial effect of n-3 PUFA in preventing CHD, the present study indicated that a lower intake of n-6 PUFA and saturated fatty acids has an additional preventive effect on CHD even when the serum level of n-3 PUFA is high because of high dietary fish consumption.

In ApHCM, sustained CO is an important pathophysiologic condition as well as hypertrophy, ischemia, and prolonged QTc, which are considered jointly related to the development of aneurysm through interactions.

Our data suggested that CI in patients without structural heart disease was mainly caused by a pathophysiological condition in which sympathetic activation was not well translated into heart rate increase. Further study is needed to determine the post-synaptic sensitivity of the beta-adrenergic receptor pathway in relation to CI.

Objective: To determine whether the Bezold-Jarisch reflex or enhancement of vagal nerves, which are preferentially distributed in the inferoposterior myocardium, results from exercise induced ischaemia in this region. Methods: On the basis of exercise myocardial scintigraphy and coronary angiography, 145 patients were classified as follows: group I, 34 patients with inferoposterior ischaemia; group A, 32 with anterior ischaemia; and control, 79 without ischaemia. The relation between ischaemic areas and ECG leads with ST segment changes and vagal modulation assessed by heart rate variability (HRV) (high frequency (HF) component (0.15-0.40 Hz) and coefficient of HF component variance (CCV HF ), which is the square root of HF divided by mean RR interval) were assessed. Results: The rate of ST segment depression in any lead did not differ between group I and group A. HF and CCV HF were similar before exercise but higher in group I than in group A and the control group after exercise (mean (SEM) HF: 94 (17) ms 2 , 41 (7) ms 2 , and 45 (6) ms 2 , respectively, p = 0.021; CCV HF : 1.18 (0.09)%, 0.81 (0.07)%, and 0.89 (0.05)%, p = 0.0053). Furthermore, the percentage change in CCV HF before and after exercise was higher in group I than in group A or controls (mean (SEM) 22 (10)%, 224 (4)%, and 221 (3)%, p , 0.0001). The optimal cut off for diagnosis of inferoposterior ischaemia was 25% with a sensitivity of 74%, specificity 75%, and accuracy 75%. Conclusions: Vagal modulation as assessed by HRV analysis was enhanced in association with exercise induced inferoposterior ischaemia. Exercise ECG testing combined with HRV analysis would increase accuracy in the diagnosis of ischaemic areas in selected patients with angina pectoris.A cute myocardial infarction in the left ventricular (LV) inferoposterior wall is often associated with transient hypotension along with sinus bradycardia.