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Tsujimoto Y, Kobayashi M, Oku T, Ogawa T, Yamadera S, Tsukamoto M, Matsuda N, Nishihira M, Terauchi Y, Tanaka T, Kawabata Y, Miyamoto Y, Morikami Y. Outcomes in novel hospital-at-home model for patients with COVID-19: a multicentre retrospective cohort study. Fam Pract 2023; 40:662-670. [PMID: 36723907 PMCID: PMC10745271 DOI: 10.1093/fampra/cmad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hospital-at-home (HaH) care has been proposed as an alternative to inpatient care for patients with coronavirus disease (COVID-19). Previous reports were hospital-led and involved patients triaged at the hospitals. To reduce the burden on hospitals, we constructed a novel HaH care model organized by a team of local primary care clinics. METHODS We conducted a multicentre retrospective cohort study of the COVID-19 patients who received our HaH care from 1 January to 31 March 2022. Patients who were not able to be triaged for the need for hospitalization by the Health Center solely responsible for the management of COVID-19 patients in Osaka city were included. The primary outcome was receiving medical care beyond the HaH care defined as a composite outcome of any medical consultation, hospitalization, or death within 30 days from the initial treatment. RESULTS Of 382 eligible patients, 34 (9%) were triaged for hospitalization immediately after the initial visit. Of the remaining 348 patients followed up, 37 (11%) developed the primary outcome, while none died. Obesity, fever, and gastrointestinal symptoms at baseline were independently associated with an increased risk of needing medical care beyond the HaH care. A further 129 (37%) patients were managed online alone without home visit, and 170 (50%) required only 1 home visit in addition to online treatment. CONCLUSIONS The HaH care model with a team of primary care clinics was able to triage patients with COVID-19 who needed immediate hospitalization without involving hospitals, and treated most of the remaining patients at home.
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Affiliation(s)
- Yasushi Tsujimoto
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Koraibashi 1-7-7-2302, Chuo-ku, Osaka, Japan
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoecho, Sakyo-ku, Kyoto, Japan
| | | | - Tomohisa Oku
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
| | - Takahisa Ogawa
- Oku Medical Clinic, Shimmori 7-1-4, Asahi-ku, Osaka, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Koraibashi 1-7-7-2302, Chuo-ku, Osaka, Japan
| | | | | | | | | | - Yu Terauchi
- Terauchi Clinic, Dotonbori 1 Chomehigashi 5-5, Chuo-ku, Osaka, Japan
| | - Takahiro Tanaka
- Minato Clinic, Nagarahigashi 1-4-24-102, Kita-ku, Osaka, Japan
| | | | - Yuki Miyamoto
- Yoshiki Home Care Clinic, Yamada Yonotsubocho 12-2, Nishikyo-ku, Kyoto, Japan
| | - Yoshiki Morikami
- Yoshiki Home Care Clinic, Yamada Yonotsubocho 12-2, Nishikyo-ku, Kyoto, Japan
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Miyamoto Y, Matsumura Y, Sumiyoshi S, Morikami Y, Nagao M. Hospital-at-home care for immunodeficient patients with COVID-19: Approach to persistent COVID-19 infection. Clin Case Rep 2023; 11:e7294. [PMID: 37151938 PMCID: PMC10160423 DOI: 10.1002/ccr3.7294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/10/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Key Clinical Message Patients with COVID-19 who have undergone B-cell depletion therapy could have prolonged SARS-CoV-2 infection; therefore, even in the hospital-at-home setting, primary care physicians should carefully consider the treatment regimen and the timing of ending isolations in such cases, and should not hesitate to consult with infectious disease specialists if necessary. Abstract We presented the first reported case of hospital-at-home care for a patient with persistent COVID-19 who had undergone B-cell depletion therapy. He received hospital-at-home care, including two courses of remdesivir; however, he ultimately failed to recover and was transferred to the hospital.
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Affiliation(s)
- Yuki Miyamoto
- Department of Emergency MedicineKyoto Prefectural University of MedicineKyotoJapan
- Yoshiki Home Care ClinicKyotoJapan
| | - Yasufumi Matsumura
- Department of Clinical Laboratory MedicineKyoto University Graduate School of MedicineKyotoJapan
| | | | | | - Miki Nagao
- Department of Clinical Laboratory MedicineKyoto University Graduate School of MedicineKyotoJapan
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Fernandes J, Ribeiro S, Garrido P, Sereno J, Costa E, Reis F, Santos-Silva A, Hirata M, Tashiro Y, Aizawa K, Endo K, Fujimori A, Morikami Y, Okada S, Kumei M, Mizobuchi N, Sakai M, Claes K, Di Giulio S, Galle J, Guerin A, Kiss I, Suranyi M, Winearls C, Wirnsberger G, Farouk M, Manamley N, Addison J, Herlitz H, Visciano B, Nazzaro P, Riccio E, Del Rio A, Mozzillo GR, Pisani A, Gupta A, Ikizler TA, Lin V, Guss C, Pratt RD, Stewart VM, Anthoney A, Blenkin S, Ahmed S, Yasumoto M, Tsuda A, Ishimura E, Ohno Y, Ichii M, Nakatani S, Mori K, Fukumoto S, Uchida J, Emoto M, Nakatani T, Inaba M, Joki N, Tanaka Y, Kubo S, Asakawa T, Hase H, Ikeda M, Inaguma D, Sakaguchi T, Shinoda T, Koiwa F, Negi S, Yamaka T, Shigematsu T, Inaguma D, Suranyi MG, Claes K, Di Giulio S, Galle J, Kiss I, Winearls C, Wirnsberger G, Farouk M, Manamley N, Addison J, Herlitz H, Guerin A, Groenendaal-Van De Meent D, Den Adel M, Rijnders S, Essers H, Golor G, Haffner S, Schaddelee M, Hirata M, Tashiro Y, Yogo K, Aizawa K, Endo K, Choukroun G, Hannedouche T, Kessler M, Laville M, Levannier M, Mignon F, Rostaing L, Rottembourg J, Jeon J, Park Y, Karanth S, Prabhu R, Bairy M, Nagaraju SP, Bhat A, Kosuru S, Parthasarathy R, Kamath S, Prasad HK, Kallurwar KP, Nishida H, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Wan Q, Cana Ruiu DC, Ashcroft R, Brown C, Williams J, Mikhail A. CKD ANAEMIA. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hori T, Okada N, Nakauchi M, Hiramoto S, Kikuchi-Mizota A, Kyogoku M, Oike F, Sugimoto H, Tanaka J, Morikami Y, Shigemoto K, Ota T, Kaneko M, Nakatsuji M, Okae S, Tanaka T, Gunji D, Yoshioka A. Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery. World J Gastrointest Surg 2013; 5:272-277. [PMID: 24179626 PMCID: PMC3812442 DOI: 10.4240/wjgs.v5.i10.272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/07/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
Sister Mary Joseph’s nodule (SMJN) is a rare umbilical nodule that develops secondary to metastatic cancer. Primary malignancies are located in the abdomen or pelvis. Patients with SMJN have a poor prognosis. An 83-year-old woman presented to our hospital with a 1-month history of a rapidly enlarging umbilical mass. Endoscopic findings revealed advanced transverse colon cancer. computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon, umbilicus, right inguinal lymph nodes, and left lung. The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels. Imaging findings of the left lung tumor allowed for identification of the primary lung cancer, and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was made. The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection. Intra-abdominal dissemination to the mesocolon was confirmed during surgery. Histopathologically, the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma. We suspect that SMJN may occur via a hematogenous pathway. Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled, the patient and her family desired home hospice. Seven months after surgery, she died of rapidly growing lung cancer.
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Yano M, Natsuaki M, Morimoto T, Yamamoto E, Morikami Y, Kimura T. Antiplatelet therapy and stent thrombosis after sirolimus-eluting stent implantation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Morikami Y, Higashi T, Isomura T, Hirano A, Tanaka K, Hisatomi K, Ohishi K. Cardiac lipoma with changes of ST segment and T wave on electrocardiogram. Jpn Circ J 1994; 58:733-6. [PMID: 7967018 DOI: 10.1253/jcj.58.733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a case of cardiac lipoma found by chance as a cause of ST-T changes which suggested left ventricular hypertrophy. A 38-year-old man was completely asymptomatic and was incidentally found to have an abnormal electrocardiogram during a regular physical examination. Echocardiography revealed an oval mass located in the inferior wall of the left ventricle near the apex, and there was no finding of left ventricular hypertrophy. Computed tomography and magnetic resonance imaging, rather than echocardiography, were useful in determining the characteristics of the lipoma in this case. The tumor was resected by operation and the histology showed lipoma with no evidence of malignancy.
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Affiliation(s)
- Y Morikami
- Division of Cardiology, Arao City Hospital, Japan
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Okumura K, Yasue H, Matsuyama K, Ogawa H, Morikami Y, Obata K, Sakaino N. Effect of acetylcholine on the highly stenotic coronary artery: difference between the constrictor response of the infarct-related coronary artery and that of the noninfarct-related artery. J Am Coll Cardiol 1992; 19:752-8. [PMID: 1545069 DOI: 10.1016/0735-1097(92)90513-m] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To examine the constrictor response of the infarct-related stenotic coronary artery in comparison with that of noninfarct-related stenotic arteries, acetylcholine in maximal doses of 100 micrograms for the left and 50 micrograms for the right coronary artery was injected into the 16 infarct-related coronary arteries of 16 patients with previous myocardial infarction (group 1) and into 19 stenotic coronary arteries of 16 patients with stable angina without myocardial infarction (group 2). Acetylcholine's effects on lumen diameter and area were quantitatively analyzed at the stenotic segment and its proximal segment without significant stenosis. Acetylcholine decreased lumen diameter and area at the stenotic segments from 0.72 +/- 0.18 to 0.18 +/- 0.33 mm and from 0.45 +/- 0.22 to 0.10 +/- 0.22 mm2, respectively, in group 1 (both p less than 0.01) and from 0.75 +/- 0.22 to 0.49 +/- 0.30 mm and 0.48 +/- 0.29 to 0.26 +/- 0.23 mm2, respectively, in group 2 (both p less than 0.01). Acetylcholine decreased the diameter and area at the proximal segment from 2.71 +/- 0.75 to 2.38 +/- 0.6 mm and from 6.18 +/- 3.4 to 4.71 +/- 2.23 mm2, respectively, in group 1 (both p less than 0.01) and from 2.31 +/- 0.67 to 1.95 +/- 0.59 mm and from 4.5 +/- 2.97 to 3.22 +/- 1.96 mm2, respectively, in group 2 (both p less than 0.01). The changes in diameter and area at the stenotic segment in group 1 were significantly greater than those in group 2 (both p less than 0.01); there were no significant differences between groups in the changes at the proximal segment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Okumura
- Division of Cardiology, Kumamoto University Medical School, Japan
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Abstract
To evaluate the efficacy of slow-release nifedipine (a single dose of 20 mg given at 10 P.M. or 2 doses of 20 mg at 10 P.M. and 6 A.M.) on ischemic episodes in patients with variant angina, a single-blind crossover study with ambulatory electrocardiographic monitoring was performed in 15 patients (13 men and 2 women, mean age 63 years). In all, there were 646 ischemic episodes detected with ambulatory electrocardiographic monitoring during the study period, and 618 episodes of them occurred during placebo periods with a circadian variation. Sixty-nine percent of the episodes in placebo periods were asymptomatic. The number of anginal attacks, nitroglycerin tablets taken, ST-segment elevation and the total ischemic duration significantly decreased during nifedipine therapy compared with results after the placebo therapy period, respectively (p less than 0.01 or 0.05). Twenty-eight ischemic episodes occurred during nifedipine therapy when the plasma level of nifedipine was low. Thus, asymptomatic ischemic episodes more frequently occur than symptomatic episodes and the administration of slow-release nifedipine is highly effective in suppressing not only symptomatic but also asymptomatic myocardial ischemia in patients with variant angina. The timing of the administration of slow-release nifedipine is an important factor in suppressing ischemic episodes.
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Affiliation(s)
- Y Morikami
- Division of Cardiology, Kumamoto University Medical School, Kumamoto City, Japan
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Okumura K, Yasue H, Matsuyama K, Matsuyama K, Morikami Y, Ogawa H, Obata K. Effect of H1 receptor stimulation on coronary artery diameter in patients with variant angina: comparison with effect of acetylcholine. J Am Coll Cardiol 1991; 17:338-45. [PMID: 1991889 DOI: 10.1016/s0735-1097(10)80096-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
It has been suggested that histamine is involved in the pathogenesis of coronary spasm but its exact role remains unclear. H1 receptor stimulation of the coronary artery was performed with a selective intracoronary infusion of histamine (2 micrograms/min) in 21 patients with variant angina after blockade of the H2 receptor with cimetidine (25 mg/kg) and its effect on the coronary artery diameter was examined. Intracoronary injection of acetylcholine was also performed in 19 of the 21 patients. Ergonovine (0.2 mg) was intravenously administered in one patient. The coronary artery diameter was measured with cinevideodensitometric analysis. A mean plasma histamine concentration in the coronary sinus increased from 4 x 10(-9) to 7 x 10(-8) M 5 min after histamine infusion into the left coronary artery (n = 18). Coronary spasm was induced in 6 patients (29%) with histamine, in 18 (95%) with acetylcholine and in 1 with ergonovine. The effect of histamine on the luminal diameter was analyzed at the site of spasm in the 26 coronary arteries in which spasm was induced by acetylcholine or ergonovine. Of the 20 coronary arteries with a normal arteriogram or a fixed stenosis less than or equal to 50% of luminal diameter, histamine decreased the diameter in 4, increased it in 14 (70%) and caused no change in 2; of the 6 coronary arteries with a fixed stenosis greater than or equal to 75%, histamine decreased the diameter in 5 and increased it in 1. In the coronary arteries in which spasm was not induced by either acetylcholine or ergonovine, histamine increased the diameter, especially in those without advanced atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Okumura
- Division of Cardiology, Kumamoto University Medical School, Japan
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10
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Abstract
We examined the effects of slow-release nifedipine on ischemic attacks in eight patients with variant angina. The study period was divided into four parts: placebo I period; nifedipine I period, when 20-mg slow-release nifedipine was given once a day at 10:00 p.m.; placebo II period; and nifedipine II period, when 20-mg slow-release nifedipine was given twice a day at 10:00 p.m. and 6:00 a.m. Each period consisted of 4 days, and 48-hour Holter monitoring was done at the end of each period. There was a significant decrease in the number of the episodes per 48 hours during the nifedipine I and nifedipine II periods as compared with the placebo I period (2.4 +/- 2.2 vs. 25.7 +/- 12.3, p less than 0.01; and 0.1 +/- 0.1 vs. 25.7 +/- 12.3, p less than 0.01, respectively). The total duration of episodes of ST-segment elevation per 48 hours decreased significantly during the nifedipine I period and the nifedipine II period as compared with the placebo I period (2.4 +/- 2.2 vs. 87.6 +/- 30.2 minutes, p less than 0.01; and 0.3 +/- 0.3 vs. 87.6 +/- 30.2 minutes, p less than 0.01, respectively). The total duration of the episodes also decreased significantly during the nifedipine II period as compared with the placebo II period (0.3 +/- 0.3 vs. 31.6 +/- 20.1 minutes, p less than 0.05). We concluded that 20-mg slow-release nifedipine given once a day at 10:00 p.m., or twice a day at 10:00 p.m. and 6:00 a.m., is highly effective in suppressing ischemic episodes in patients with variant angina.
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Affiliation(s)
- H Yasue
- Division of Cardiology, Kumamoto University Medical School, Japan
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Yasue H, Ogawa H, Morikami Y. [Circadian variation of myocardial ischemia]. Kokyu To Junkan 1990; 38:637-40. [PMID: 2402563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- H Yasue
- Division of Cardiology, Kumamoto University Medical School
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Yasue H, Matsuyama K, Matsuyama K, Okumura K, Morikami Y, Ogawa H. Responses of angiographically normal human coronary arteries to intracoronary injection of acetylcholine by age and segment. Possible role of early coronary atherosclerosis. Circulation 1990; 81:482-90. [PMID: 2105173 DOI: 10.1161/01.cir.81.2.482] [Citation(s) in RCA: 208] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We examined the response of left coronary arteries to intracoronary injection of acetylcholine (ACh) 50 micrograms in 74 patients by measuring the diameter changes with a videodensitometric analysis system. Patients with angiographically normal coronary arteries were subdivided into a younger group of 26 patients (age, 9-29 years) and an older group of 23 patients (age, 31-68 years). In the younger group, the diameter at the distal segment of the left anterior descending artery (LAD) and at the proximal, middle, and distal segments of the left circumflex artery (LCx) increased significantly (16.7 +/- 19.3%, p less than 0.01, for LAD and 8.0 +/- 18.8%, p less than 0.05; 11.0 +/- 16.1%, p less than 0.01; and 19.8 +/- 17.5%, p less than 0.01, for LCx segments, respectively) in response to ACh. In the older group, on the other hand, the diameter at the proximal and middle segments of LAD and LCx decreased significantly (-20.8 +/- 16.9%, p less than 0.01; and -17.9 +/- 28.4%, p less than 0.01, for LAD segments and -14.6 +/- 17.4%, p less than 0.01; and -11.3 +/- 21.4%, p less than 0.05, for LCx segments, respectively). The dilator response to ACh in the younger group was significantly greater in the distal segment than in the proximal segment in both LAD and LCx (p less than 0.01 for LAD and p less than 0.05 for LCx). The constrictor response to ACh in the older group was significantly greater in the proximal than the distal segment in both LAD and LCx (p less than 0.05 for LAD and LCx, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Yasue
- Division of Cardiology, Kumamoto University Medical School, Japan
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Matsuyama K, Yasue H, Okumura K, Matsuyama K, Ogawa H, Morikami Y, Inotsume N, Nakano M. Effects of H1-receptor stimulation on coronary arterial diameter and coronary hemodynamics in humans. Circulation 1990; 81:65-71. [PMID: 2297849 DOI: 10.1161/01.cir.81.1.65] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Effects of H1-receptor stimulation on coronary arterial diameter and coronary hemodynamics were examined in 11 patients with angiographically normal coronary arteries and without variant angina or resting angina. Selective H1-receptor stimulation was achieved by infusing histamine into the left coronary artery at a rate of 2.0 micrograms/min for 5 minutes after pretreatment with cimetidine (25 mg/kg). Plasma histamine concentration in the coronary sinus, coronary sinus blood flow, heart rate, and aortic pressure were measured before, during, and after the histamine infusion. Coronary arterial diameter was measured by cinevideodensitometric analysis of coronary arteriograms performed before and immediately after the histamine infusion. During the histamine infusion, plasma histamine concentration in the coronary sinus increased from 0.33 +/- 0.06 to 5.86 +/- 0.71 ng/ml (p less than 0.01); coronary sinus blood flow increased from 98 +/- 12 to 124 +/- 13 ml/min (p less than 0.01), and coronary vascular resistance decreased from 1,113 +/- 117 to 851 +/- 91 mm Hg.min/l (p less than 0.01). Heart rate and aortic pressure remained unchanged. The mean luminal diameters of the proximal, middle, and distal left anterior descending artery increased by 9.4 +/- 3.6% (p less than 0.05), 19.2 +/- 3.8% (p less than 0.001), and 31.5 +/- 5.6% (p less than 0.001), respectively, after the histamine infusion. The mean luminal diameters of the proximal, middle, and distal left circumflex artery increased by 15.2 +/- 3.6% (p less than 0.01), 17.5 +/- 5.2% (p less than 0.01), and 20.6 +/- 4.3% (p less than 0.001), respectively, after the histamine infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Matsuyama
- Division of Cardiology, Kumamoto University Medical School, Japan
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Fujii H, Yasue H, Okumura K, Matsuyama K, Morikami Y, Miyagi H, Ogawa H. Hyperventilation-induced simultaneous multivessel coronary spasm in patients with variant angina: an echocardiographic and arteriographic study. J Am Coll Cardiol 1988; 12:1184-92. [PMID: 3170961 DOI: 10.1016/0735-1097(88)92598-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Left ventricular wall motion abnormalities during an attack of coronary spasm induced by hyperventilation were examined with use of two-dimensional echocardiography in 27 patients with variant angina. Transient abnormal wall motion (asynergy) confined to one coronary artery region was found in 18 of the 27 patients and transient abnormal motion extending over more than one coronary artery region in the remaining 9 patients. Spasm of more than one major coronary artery was demonstrated separately by coronary arteriography during an attack induced by injection of acetylcholine or ergonovine in seven of the nine patients who manifested asynergy in more than one coronary artery region. In one patient, spasm was demonstrated in one major coronary artery, and the other coronary arteries were severely stenosed or occluded organically. In the remaining patient, acetylcholine was not injected into both arteries; however, the attack was sometimes associated with ST segment elevation in the anterior leads and at other times in the inferior leads. Therefore, simultaneous multivessel coronary spasm seems to have occurred in eight of the nine patients who exhibited asynergy in more than one coronary artery region. The 8 patients with simultaneous multivessel coronary spasm had a higher degree and longer duration of ST segment elevation and a higher incidence of arrhythmias during the attack induced by hyperventilation than did the 19 patients with single vessel coronary spasm, and all of them had no significant organic stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Fujii
- Division of Cardiology, Kumamoto University Medical School, Japan
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Okumura K, Yasue H, Horio Y, Takaoka K, Matsuyama K, Kugiyama K, Fujii H, Morikami Y. Multivessel coronary spasm in patients with variant angina: a study with intracoronary injection of acetylcholine. Circulation 1988; 77:535-42. [PMID: 3342484 DOI: 10.1161/01.cir.77.3.535] [Citation(s) in RCA: 172] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Multivessel coronary spasm has been described but its incidence in patients with variant angina still remains unclear. Thirty-three patients with variant angina were studied during coronary angiographic examination with selective intracoronary injection of acetylcholine (ACh). In all but three patients, the location of ischemia during attack was determined by the electrocardiographic findings, by exercise 201Tl myocardial scintigraphy, and by two-dimensional echocardiography during a hyperventilation test, and the coronary artery (or arteries) responsible for the attack was predicted before the study. ACh induced spasm of at least one coronary artery in all but one patient. ACh induced spasm of both the left and right coronary arteries (i.e., multivessel coronary spasm) in 24 patients: in two of the four patients who were predicted to have spasm of the left coronary artery, in six of the 11 predicted to have spasm of the right coronary artery, in 13 of the 15 predicted to have spasm of both the left and right coronary arteries, and in three of the three in whom coronary artery responsible for attack had not been predicted. This ACh-induced spasm of the left and right coronary arteries occurred separately and no patients showed hemodynamic instability during attack. In one patient in whom multivessel coronary spasm had been predicted and ACh failed to induice coronary spasm, ergonovine maleate (0.2 mg) induced spasm of both the left and right coronary arteries simultaneously, resulting in severe prolonged hypotension. Nineteen of the 25 patients in whom multivessel coronary spasm was documented showed angiographically normal or nearly normal coronary arteries after administration of nitroglycerin.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Okumura
- Division of Cardiology, Kumamoto University Medical School, Japan
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Morikami Y, Yasue H, Okumura K, Horio Y, Fujii H, Matsuyama K. Effects of phentolamine and atropine on angina pectoris induced by handgrip test in patients with variant angina. Am J Cardiol 1988; 61:71-6. [PMID: 3337019 DOI: 10.1016/0002-9149(88)91307-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In 19 patients with variant angina, handgrip test as an isometric exercise was performed in 3 conditions on different successive days in the early morning: in the control, after administration of phentolamine (0.3 mg/kg) and after administration of atropine sulfate (0.04 mg/kg). Angina associated with ST-segment elevation on the electrocardiogram was induced in 5 patients (26%) in the control condition, in 14 (74%) after phentolamine and in 5 of 16 (31%) after atropine. All anginal events but 1 occurred after the cessation of the exercise and were not associated with the significant increase of rate-pressure products. These attacks were considered to be due to coronary spasm. The frequency of the induction of angina was significantly higher after phentolamine than in the other 2 conditions (p less than 0.01). It is concluded that the attack can be induced by the handgrip exercise in a sizable number of patients with variant angina, and that the administration of phentolamine increases the incidence of angina induced by handgrip exercise. The mechanism or mechanisms by which coronary spasm is induced by handgrip exercise remains to be elucidated.
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Affiliation(s)
- Y Morikami
- Division of Cardiology, Kumamoto University Medical School, Japan
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Yasue H, Horio Y, Nakamura N, Fujii H, Imoto N, Sonoda R, Kugiyama K, Obata K, Morikami Y, Kimura T. Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation 1986; 74:955-63. [PMID: 3769179 DOI: 10.1161/01.cir.74.5.955] [Citation(s) in RCA: 382] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We injected acetylcholine (ACh), the neurotransmitter of the parasympathetic nervous system, into the coronary arteries of 28 patients with variant angina. Injection of 10 to 80 micrograms ACh into the coronary artery responsible for the attack induced spasm together with chest pain and ST segment elevation or depression on the electrocardiogram in 30 of the 32 arteries of the 25 of the 27 patients. The injection of 20 to 100 micrograms ACh into the coronary artery not responsible for the attack in 18 patients resulted in various degrees of constriction in most of them, but no spasm in any of them. After intravenous injection of 1.0 to 1.5 mg atropine sulfate, the injection of ACh into the coronary artery responsible for the attack did not induce spasm or attack in any of the nine coronary arteries injected in eight patients. We conclude that the intracoronary injection of ACh induces coronary spasm and attack in patients with variant angina and that the activity of the parasympathetic nervous system may play a role in the pathogenesis of coronary spasm. We also conclude that the intracoronary injection of ACh is a useful test for provocation of coronary spasm.
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Kugiyama K, Yasue H, Horio Y, Morikami Y, Fujii H, Kimura T. Possible role of parasympathetic nervous system in the pathogenesis of exercise-induced coronary artery spasm. Am Heart J 1986; 112:605-6. [PMID: 3751870 DOI: 10.1016/0002-8703(86)90527-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Kugiyama K, Yasue H, Horio Y, Morikami Y, Fujii H, Koga Y, Kojima A, Takahashi M. Effects of propranolol and nifedipine on exercise-induced attack in patients variant angina: assessment by exercise thallium-201 myocardial scintigraphy with quantitative rotational tomography. Circulation 1986; 74:374-80. [PMID: 3488140 DOI: 10.1161/01.cir.74.2.374] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To examine the effects of propranolol and nifedipine on exercise-induced attack in patients with variant angina, exercise 201Tl myocardial scintigraphy with quantitative analysis by emission-computed tomography was performed in 20 patients with variant angina after oral propranolol (80 mg), nifedipine (20 mg), and placebo. Exercise-induced attack occurred in 11 patients on placebo, in 14 on propranolol, and in none on nifedipine. The exercise duration was significantly shorter in those on propranolol (p less than .05), but significantly longer in patients on nifedipine (p less than .05) than in those on placebo. The peak rate-pressure product was significantly lower in patients on propranolol (p less than .01), but did not change in those on nifedipine, as compared with that in patients on placebo. The size of the perfusion defect as measured by 201Tl tomography was significantly greater in patients on propranolol (p less than .05), but significantly less in those on nifedipine (p less than .01) than in those on placebo. In conclusion, propranolol does not suppress but rather may aggravate exercise-induced attack in patients with variant angina, while nifedipine suppresses it. This unfavorable effect of propranolol on exercise-induced attack in patients with variant angina is likely to be due to a reduction of regional myocardial blood flow.
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Horio Y, Matsuyama K, Morikami Y, Rokutanda M, Hirata A, Okumura K, Takaoka K, Uchida H, Kugiyama K, Araki S. Blocking effect of verapamil on conduction over a catecholamine-sensitive bypass tract in exercise-induced Wolff-Parkinson-White syndrome. J Am Coll Cardiol 1984; 4:186-91. [PMID: 6736448 DOI: 10.1016/s0735-1097(84)80340-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
By intravenous administration of isoproterenol, 0.5 micrograms/min, a catecholamine-sensitive bypass tract was confirmed in two patients with exercise-induced Wolff-Parkinson-White syndrome. In a 24 year old woman, an intravenous bolus injection of 5 mg of verapamil suddenly blocked conduction over a catecholamine-sensitive bypass tract. In a 62 year old man, the exercise-induced Wolff-Parkinson-White syndrome disappeared after 3 days of oral administration of verapamil (120 mg/day). These observations suggest that a slow inward calcium current plays an important role in conduction over a catecholamine-sensitive bypass tract in exercise-induced Wolff-Parkinson-White syndrome.
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Horio Y, Matsuyama K, Rokutanda M, Hirata A, Okumura K, Takaoka K, Uchida H, Ito H, Kugiyama K, Morikami Y. Electrophysiologic effects of atropine and isoproterenol on the cardiac conduction system in familial amyloid polyneuropathy. Jpn Circ J 1984; 48:474-83. [PMID: 6727027 DOI: 10.1253/jcj.48.474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In ten patients with familial amyloid polyneuropathy (FAP), the effects of atropine and isoproterenol on the cardiac conduction system were studied using surface electrocardiogram (ECG) and His bundle electrograms. Intravenous administration of atropine sulfate, 1 mg, prolonged the sinus cycle length ( SNCL ) in 6 of 8, sinus node recovery time (SNRT) in 3 of 6, automaticity recovery time of the atrioventricular (A-V) node in one, A-H interval in 4 of 7, effective refractory periods of the atrium and A-V node in 4 of 6 and in 3 of 7 patients, respectively. Continuous intravenous administration of isoproterenol, 0.5 micrograms/min, shortened the SNCL , SNRT, A-H interval and refractory periods of the atrium and A-V node in all patients. We conclude that the therapeutic doses of atropine may be useless or potentially detrimental for bradyarrhythmias or conduction blocks in some patients with FAP, but that isoproterenol may have beneficial effects on those arrhythmias in FAP.
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