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In a placebo-controlled, randomized, crossover, double-blind study of 17 normal volunteers, we examined the effects of captopril on the concentration of opioid peptides during bicycle exercise and on quality of life after a 2-week treatment period. Two exercise tests (progressive exercise and constant work rate exercise) were performed. Maximum oxygen uptake and blood lactata concentrations were measured in progressive exercise tests. The exercise intensities corresponding to a 12 lactate threshold, a lactate threshold, and a 4 mmol/L lactate concentration were determined. Constant work rate exercise at selected work loads for 20 minutes was carried out to measure the concentrations of opioid peptides and other hormones. Quality of life was assessed after the 2-week treatment period. Captopril treatment had no effect on the exercise response of blood pressure, heart rate, maximum VO 2 , and maximum work loads. The plasma concentrations of lactate, epinephrine, norepinephrine, and aldosterone increased during exercise and captopril did not change them. β-Endorphin levels and plasma renin activity also increased during exercise, and the increases were greater with captopril treatment. Met-enkephalin and leu-enkephalin concentrations did not increase during exercise. According to responses in the quality of life questionnaires, administration of captopril improved the physiologic state more than the placebo did. These findings suggest that captopril may act on the central nervous system involving an increase in the β-endorphin level.

It has been consistently shown that the total blood leukocyte count is an independent risk factor for coronary artery disease. Few studies, however, have addressed the relation between differential leukocyte counts and coronary artery disease. We investigated the relation of total and differential leukocyte counts to angiographically determined coronary atherosclerosis. The study included 486 subjects (335 men, 151 women) who underwent coronary angiography for suspected coronary artery disease. Band neutrophil count was significantly positively related to coronary atherosclerosis (p = 0.004) after adjustments for age, sex, body mass index, cigarettes per day, serum total cholesterol, and hypertension. Although sex and age-adjusted total blood leukocyte count was significantly positively related to coronary atherosclerosis (p = 0.04), this relation did not reach significant levels (p = 0.08) after adjusting for other risk factors. The positive association with band neutrophil counts was at least as strong as that with serum total cholesterol concentrations. This study indicates that band neutrophil counts serve as an independent risk factor for coronary atherosclerosis.

The relation of serum glycoproteins and C-reactive protein (CRP) to severity of coronary atherosclerosis was examined in 133 men and 92 women undergoing coronary angiography. The following serum glycoproteins were determined: alpha 1-antitrypsin, alpha 1-acid glycoprotein, alpha 2-macroglobulin, ceruloplasmin, haptoglobin, fibrinogen, C4b binding protein, and lipoprotein (a) [Lp(a)]. Sex- and age-adjusted levels of alpha 1-antitrypsin, alpha 1-acid glycoproteins, alpha 2-macroglobulin, ceruloplasmin, Lp(a) and CRP were significantly associated with the severity of coronary atherosclerosis as determined by the Gensini score; these associations remained significant even after adjustment for body-mass index, smoking history, hypertension, and total cholesterol, except for Lp(a) (p = 0.075). These findings suggest that certain serum glycoproteins and CRP can serve as independent indicators for the progression of coronary atherosclerosis.

The purpose of this study was to determine the feasibility and efficacy of terminating atrial flutter/fibrillation using low-energy synchronous shocks delivered through a transesophageal catheter in dogs with talc-induced pericarditis. Atrial flutter/fibrillation was induced by employing the pulse train method. The minimum effective cardioversion energy level was compared for three different methods--method A, delivery between a distal esophageal electrode and a proximal esophageal electrode; method B, delivery of shocks through a distal esophageal electrode and a plate placed on the chest; method C, transthoracic cardioversion. The minimum effective cardioversion energy level did not differ significantly between methods A and B (1.30 +/- 0.46 joules versus 1.29 +/- 0.35 joules). Transesophageal cardioversion decreased the defibrillation threshold three- to fourfold from that of conventional transthoracic cardioversion. There were no complications of heart block, ventricular fibrillation, or any pathologic evidence of esophageal injury. Thus transesophageal low-energy synchronous cardioversion is considered a feasible and effective method for the treatment of atrial flutter/fibrillation.

We report three patients with a particular form of myocarditis characterized by numerous clusters of lymphocytes. Their common clinical manifestation was progressive and fatal heart failure with a 3- to 6-year duration. Atrioventricular and intraventricular conduction disturbances were observed in two patients. At necropsy, the hearts weighed 480, 530, and 430 gm, respectively, and showed marked dilatation of the bilateral ventricles and atria, with frequent mural thrombi. Histologic examination revealed numerous lymphocytic clusters and scattered foci of acute myocardial cell damage on a background of extensive fibrosis. We propose the term "chronic active myocarditis" to denote clinicopathologic characteristics of the present cases.

La contribution de HLA a la pathogenie de la cardiopathie rhumatismale pourrait etre assez faible comparativement a d'autres maladies comme la pelvispondylite ankylosante (HLA-B27), la polyarthrite rhumatoide (HLA-DRY) la maladie de Takayasu (HLA-Bw 52) et le diabete sucre insulino-degradant (HLA-Bw 54) chez les japonais, HLA-B8 et B95 chez les Blancs). Les efforts doivent donc se tourner vers le streptocoque hemolytique et/ou certains virus afin de prevenir la cardiopathie valvulaire

A potent vasoconstrictive action and the hemodynamic consequences of angiotensin, selective to the systemic circulatory system, were applied in functional phonocardiography in place of methoxamine or phenylephrine. As with methoxamine or phenylephrine, regurgitant murmurs occurring in the left heart increased significantly with angiotensin while right-sided heart murmurs remained unchanged. Angiotensin, however, is much more advantageous than methoxamine, because of the much sharper action of only a few minutes' duration without any untoward effect, making it useful even in the outpatient clinic. Furthermore, angiotensin intensified the mitral opening snap in several cases of mitral-valve failure, not significantly affecting the II a -opening snap interval and the heart rate, and is indicated to be useful as a new device for detecting opening snap.