Neurocirculatory Asthenia Research Articles

Da Costa Syndrome Revisited

The referred to in 1864 by Hartshorne 1 as muscular exhaustion and in 1871 by Costa 2 as irritable heart syndrome, has undergone so many name changes that it is almost possible to date a physician by the name he selects. To an old-timer it may still be Da Costa syndrome; to a later graduate it may be neurosis, disordered action of the heart, soldier's heart, effort syndrome, or neurocirculatory asthenia; to a new arrival it can be Holmgren's 3 vasoregulatory asthenia, Gorlin's 4 hyperkinetic heart syndrome, or Frohlich's 5 hyperdynamic β-adrenergic circulatory state. One wonders whether the doctor's choice of the appropriate label can serve as his screening test for recertification. Whatever its label, the symptom-complex characterized by palpitation, dyspnea, precordial pain, fatigue, exaggerated emotional responses with increased cardiac awareness, and occasionally, systolic hypertension, often presents a diagnostic and therapeutic dilemma, as well as a

Study on Myocardial Carbohydrate and Energy Metabolism During Exercise in Patients with Circulatory Diseases

Many authors have reported the changes of myocardial lactate metabolism during angina or coronary insufficiency induced by exercise or atrial pacing. However, a precise correlation of myocardial carbohydrate metabolism with electrocardiographic changes during exercise has not been studied for various circulatory diseases. The purpose of this paper is to clearify the aspect of myocardial carbohydrate metabolism and its role for the myocardial energy source under the condition in which the exercise load is so intensive that the appearance of ischemic ECG changes can detect the coronary insufficiency. Methods and Subjects: The arterial blood taken from brachial artery and coronary sinus sampled by coronary sinus catheter was analised. The sampling was carried out three times, immediately after the insertion of coronary sinus catheter, after keeping rest before exercise and ten minutes after starting exercise. Blood glucose was determined by glucose oxidase method, lactate by hydroxybiphenyl method according to Barker and Summerson and pyruvate by dinitrophenylhydrazine method according to Friedemann and Haugen. Coronary blood flow was measured by the nitrous oxide method. Exercise was performed in the supine position at a level of fifty watts for fifteen minutes with bicycle ergometer. Thirty six patients with circulatory diseaes who were fasting for six to eighteen hours were studied, consisting of 5 with neurocirculatory asthenia (NCA), 8 with hypertension without coronary insufficiency (HT), 7 with hypertensive coronary failure (HTC), 7 with normotensive coronary heart disease (CHD) and 9 with the other heart diseases (HD) such as valvular disease etc. All subjects were also classified into 3 groups according to the electrocardiographic changes before and after the exercise test, namely, 17 cases of the negative test group before and after Master's double two-step test or bicycle ergometry, 16 cases of the positive test group whose ECG showed ischemic changes after the exercise tests or also before exercise and 3 cases of the improved group whose ischemic ECG changes were partly normalized after exercise.

Transient S-T elevation detected by 24-hour ECG monitoring during normal daily activity

Seven out of 174 patients subjected to continuous 24-hour ECG monitoring because of atypical chest pain and/or palpitations were found to have transient S-T elevation. Two were diagnosed as suffering from neurocirculatory asthenia, three had myocardial infarction, and two suffered, most probably, from Prinzmetal's variant angina pectoris. We believe that the finding of transient S-T elevation is of special significance, because of the pathological and therapeutic implications, and that continuous ECG monitoring during unrestricted daily activities provides a unique opportunity to detect this condition more frequently.

Abnormal respiration and unusual movements of the diaphragm in patients with neurocirculatory asthenia.

Abnormal respiration and unusual movements of the diaphragm in patients with neurocirculatory asthenia.

Myocardial lipid metabolism in man during exercise (with special reference to coronary artery diseases)

The exercise is useful both for the diagnosis and the treatment of coronary heart disease. In recent years, there are many articles treated with myocardial carbohydrate metabolism, but rarely with lipid metabolism during exercise. This paper reports a study of myocardial lipid metabolism during exercise in clinical cases. Materials and Methods Coronary sinus catheterization was performed by Bing's method in 19 clinical cases including 8 cases of coronary heart disease, 5 of hypertension, 4 of neurocirculatory asthenia and 2 others, after fasting for 6-18 hr. Patients were exercised for 15 minutes in the supine position on a bicycle ergometer with which 50 watts were loaded. Sampling both from coronary sinus and brachial artery was done at rest and during the 10th minutes of the period of exercise. Samples were analyzed in non-esterified fatty acid (NEFA) by Dole's method, in ketone bodies by Green-berg-Lester's modification, in triglyceride (TG) by Van Handel Zilversmidt's method. The catheter was kept patent by the slow infusion of the fluid which 1, 000 units heparine was added to 100 ml normal saline. The data of coronary blood flow, myocardial oxygen consumption, carbohydrate metabolism and left ventricular work, which obtained simultaneously by coraboraters, were used to the consideration of myocardial metabolism during exercise. Results and Comments 1. Arterial concentration and myocardial extraction of lipids ' a) NEFA; The arterial NEFA level showed a tendency to rise by influence of heparine infusion, but almost constant after two hours. At that time the exercise was performed. The arterial level showed decrease in 16 of 19 cases. Significant correlations were found between the arterial level and the myocardial extraction both at rest (r=0.05, n=19, p<0.02) and during exercise (r.67, n=19, p<0.01). The mean value of myocardial extraction was decreased, but of the usage was not so changed by exercise. b) Ketone bodies; There was a significant correlation (r=0.52, n=38, p<0.001) between the myocardial extraction and the arterial level through rest and exercise.

Coronary Circulation, Myocardial Oxygen Metabolism and General Hemodynamics during Exercise and the Relation to Electrocardiographic Changes in Patients with Circulatory Diseases

Recent many investigations have been demonstrated the changes of coronary circulation, general hemodynamics and myocardial metabolism during exercise and the relation between ECG changes. This report is one of these studies, but in which the bicycle loading is so intensive that the ischemic ECG changes appear in the patients with coronary diseases, and the balance of myocardial oxygen utilization to cardiac performance is studied at the same time. Methods and Subjects The systemic hemodynamic parameters were determined by right heart catheterization with direct Fick's method and coronary circulation was measured by coronary sinus catheterization with N20 desaturation technique and blood gas analyzing were made with Van Slyke-Neill method before and during exercise. Exercise was performed in the supine position with a bicycle ergometer for 15 minutes at a level of 50 watts. Thirty-three patients with circulatory diseases were subjected, consisting of 5 with neurocirculatory asthenia (NCA), 8 with hypertension (HT), 6 with hypertensive coronary failure (HTC), 7 with coronary heart disease (CHD) and 6 with than heart disease (HD). All subjects were divided also into 3 groups according to the electrocardiographic changes before and after the exercise test, namely, 16 cases of group 1 whose ECG has never shown ischemic finding before and after the Master's double two step test or ergometer, 14 cases of group 2 whose ECG has shown ischemic changes after the exercise tests or before exercise also and 3 cases of group 3 whose ECG has normalized partly in ischemic changes after exercise. Results Continuous measurement of oxygen and carbon dioxide in expired air of 17 patients with Metabolar made in Fukuda and Co. demonstrated that the bicycle ergometry at a rate of 50 watts demanded 4.4 Cal./min. and it takes about 66 calories for for 15 minutes, which is about 2.5 times of calories demanded for Master's double two step test. In spite of the observation, in 31 cases out of 33 patients, the electrocardiographic changes after bicycle ergometer evaluated by Master's criteria were quite same with the result of Master's double two step test which was done as the pretest. Characteristic findings of various circulatory diseases Heart rate increased in all groups equally during exercise. The cardiac index and stroke index were the lowest in CHD at rest, however the rate of increase during exercise was the highest. Systemic vascular resistance was the highest in CHD at rest. During exercise systemic vascular resistance decreased in all groups and the rate of decrease in CHD was significantly greater than that of NCA. Mean blood pressure increased slightly in HT and HTC during exercise. Left ventricular work was the highest in HT at rest and increased in all groups. Myocardial tension was the highest in HT and the lowest in CHD at rest and increased significantly in all groups during exercise. Coronary blood flow showed no significant difference among the diseases at rest.

The fate of women with normal coronary arteriograms and chest pain resembling angina pectoris

The clinical and laboratory findings and subsequent fate of 100 women with unexplained chest pain, having some or all of the features of angina pectoris, and normal selective coronary arteriographic findings were studied. Some basis for the chest pain was discovered in only 14 percent (14 of 100) and included the unusual conditions of systolic click syndrome, primary myocardial disease, rheumatic heart disease and a cystic duct neuroma. Of the remaining 86 patients with no readily apparent cause for their symptoms, the average age was 44 years. Atypical angina was noted in 76 percent (65 of 86); 46 percent (40 of 86) gained relief of pain from nitroglycerin, and 40 percent (34 of 86) manifested anxiety neurosis. Of 44 patients who exercised, 16 had a positive electrocardiographic response of S-T segment depression of more than 1 mm, yet this group did not differ significantly from those with a negative response to exercise. Follow-up study of these 86 patients from 6 months to 2 1 2 years revealed that 50 percent had a decrease or disappearance of pain. More important, there was no instance of sudden death or myocardial infarction. It is suggested that chest pain with normal coronary arteriographic findings should be clearly distinguished, especially as to its benign prognosis, from the angina pectoris associated with large vessel obstructive atherosclerosis and that it most likely is related to neurocirculatory asthenia, although other possible explanations are discussed.

Adrenergic beta-receptor blockade in neurocirculatory asthenia

Twenty patients with neurocirculatory asthenia (NCA) have been investigated. They suffered from at least three out of seven defined symptoms and the severity of the symptoms prevented an ordinary daily activity. The patients were classified according to physiological variables and psychiatric (interview) criteria. They were treated with Aptin®, an adrenergic beta-blocking agent, and placebo in a double-blind cross-over design. From objective and subjective assessment of symptomatic improvement and drug preference, eight patients were classified as Aptin-responders and eleven as placebo responders. Physiological characteristics of hyperkinetic circulation due to increased activity of the sympathetic nerves was found in seven Aptin-responders but only in four placebo-responders. Six Aptin-responders were classified as anxiety states but only four placebo-responders. — The trial illustrates how therapy with a specific drug can reveal differences of probably etiological character in patients constituting a symptomatic entity. Adrenergic beta-blocking therapy in NCA seems to be of value predominately in patients with signs of hyperkinetic circulation and/or anxiety states.

The hemodynamic effects of beta-adrenergic blockade in patients with neurocirculatory asthenia.

The hemodynamic effects of beta-adrenergic blockade in patients with neurocirculatory asthenia.

Harlow brooks on neurocirculatory asthenia in World War I

Harlow brooks on neurocirculatory asthenia in World War I

Study of the effects of Valsalva's maneuver on the electrocardiogram and its clinical significance in patients with chronic respiratory diseases

There have been already many investigations on the circulatory effects of Valsalva maneuver, and especially with regard to the change of pulmonary circulation it has been made clear that the venous return to right heart during straining is blocked by the increased intrathoracic pressure, and then by the sudden fall of the intrathoracic pressure after release of straining the blood remaining stagnant in the face and extremities suddenly flows into the right heart and the stroke volume of the right ventricle increases compared with that at rest and there is a transient rise of the pulmonary arterial pressure and the net pulmonary capillary pressure. The purpose of this report is to present the electrocardiographic changes by the Valsalva maneuver in patients of chronic broncho-pulmonary diseases in an attempt to detect any specific electrocardiographic changes in pulmonary hypertension or latent cor pulmonale and to discuss their clinical significance. Materials and Methods: (1) One hundred and eleven cases have been chosen for this study, including 76 cases of chronic respiratory diseases, 15 cases of non-cardiopulmonary diseases, 5 cases of neurocirculatory asthenia and 15 cases of healthy adults. The 76 cases of respiratory diseases consists of 35 cases of pulmonary tuberculosis (including 12 cases of after operation and 6 cases of severe pleural involvement), 10 cases of pulmonary emphysema, 8 cases of bronchiectasis, 20 cases of chronic bronchitis and bronchial asthma and 3 cases of lung tumor. (2) First the routine electrocardiogram at rest was recorded, and then, during and following the Valsalva maneuver at lead I, II, III, V1 and V5. The Valsalva maneuver was performed by having each subject maintained an expiratory pressure of at least 40mm.Hg for about 10 seconds by blowing into a aneroid sphygmomanometer. Next, of 20 cases including 10 cases taken at random out of the patients of severe broncho-pulmonary diseases and another 10 cases of healthy adults and in-patients without cardiopulmonary diseases, the author recorded their electrocardiogram at rest and following Valsalva maneuver at a speed of 50mm per second, photographically enlarged it, and observed the changes in the ventricular activation time and QRS amplitude at V1, studying the measured values of both groups in comparison. The respiratory function was judged from the ventilatory function measured with a 9.0 L or 13.5 L Bendict-Roth type respirometer.

THE ORIGIN OF THE TERM NEUROCIRCULATORY ASTHENIA.

ON reading the letter by Dr. Calvin P. Leeman in the April 23, 1965, issue of the Journal I was struck by the thought that few physicians would know the origin of the term neurocirculatory asthenia, — how, where and when it was first used. Since I may be the only living person who might know, it appears appropriate to record the actual facts. During the early months of American participation in World War I a small group of young American medical officers were attached to the British Medical Corps, working at the British Heart Hospital in Colchester, England. This . . .

Studies on the Electrocardiogram in Exercise

The disease of coronary vascular origin has been increasingly calling our attention in recent years in Japan, and it has played a prominent part in the diseases of circulation. Although various clinical examinations have been in use in the early detection of the coronary sclerosis resulting in the myocardial infarction or coronary insufficiency, none of them seem to be satisfactory for a diagnostic method of choice. The electrocardiographic examination after exercise had been found to be useful in the diagnosis of the latent coronary sclerosis, and many studies have been reported on this subject, however, no critical evaluation has yet been made on the change in the electrocardiogram after exercise test. The author has made the studies on the changes in the electrocardiogram after Master's exercise test with the one group suspected of the latent coronary sclerosis from their anginal symptoms or clinical examinations ; the other group showing normal electrocardiogram was chosen as the control. From these results, an attempt has been made to establish the clinical evaluation of the exercise test. In addition, the exercise test has been tried on patients with neurocirculatory asthenia simulating coronary sclerosis with the subjective complaints requiring differential diagnosis, and the comparative studies of electrocardiograms were made. Although practice of the exercise test was usually for healthy adults at rest demonstrating normal electrocardiographic tracings, the present investigation stressed in patients with abnormal electrocardiogram at rest and the results were evaluated by comparing between the exercise test in group with normal and abnormal electrocardiograms at rest together with the subjective complaints corroborated with clinical laboratory findings. Materials and Methods of Observation All subjects were classified into the following 4 groups. Group 1, 81 normal adults over 40 years of age. Group 2, 110 patients over 40 years of age who were suspected of coronary sclerosis from their subjective symptoms and the laboratory examinations, showing normal electrocardiogram in resting time. Group 3, 61 patients with the neurocirculatory asthenia. Group 4, 107 patients with the coronary sclerosis whose electrocardiograms showed coronary insufficiency with the symptoms, signs and laboratory examinations, revealing the characteristic findings.

NEUROCIRCULATORY ASTHENIA; STILL A COMMON AND IMPORTANT CLINICAL CONDITION.

ONE of the great causes of disability in World War I was not structural disease and not a simple neurosis or malingering. This condition was called by the British Medical officers the "irritable heart of soldiers," as it had been called by Da Costa, a surgeon in the Northern armies in the American Civil War, and later "effort syndrome." Thomas Lewis's American colleagues who studied this condition in Colchester, England, during World War I changed its name to "neurocirculatory asthenia," a term that has been used ever since.By definition this disease — for it is a disease — is . . .

Circulation times in patients with neurocirculatory asthenia

Synchronous photoelectric measurements of the arm-to-ear and arm-to-foot times were made in two comparable groups: one group of normal individuals (n = 20) and another group of patients with neurocirculatory asthenia (n = 20). The mean arm-to-ear times did not differ significantly, whereas the mean arm-to-foot times (“peripheral circulation times”) demonstrated a marked divergence which proved to be significant on statistical evaluation (p smaller than 0.01). This abnormal slowing of the blood flow should be considered to be characteristic of neurocirculatory asthenia. To what extent the pathophysiologic behavior does explain the symptomatology of that disease must be investigated further.

Lymphocyte reaction after physical stress in neurocirculatory asthenia

Es wird uber einen signifikanten Anstieg der absoluten und relativen Lymphocytenwerte bei 70 Fallen von neurozirkulatorischer Asthenie, nach kleiner korperlicher Belastung, berichtet. 110 Kontrollpersonen wiesen keine Veranderungen des weisen Blutbildes nach der gleichen Belastung auf. Die Ergebnisse werden kurz besprochen.

False Impression of Equilibrium Associated with Neurocirculatory Asthenia and Allied Diseases, with Special Reference to "Neck Vertigo" : Conference on Neurocirculatory Asthenia &amp; Allied Diseases and Orthostatic Hypotensive Diseases

False Impression of Equilibrium Associated with Neurocirculatory Asthenia and Allied Diseases, with Special Reference to "Neck Vertigo" : Conference on Neurocirculatory Asthenia &amp; Allied Diseases and Orthostatic Hypotensive Diseases

Postural hypotension and shock. Mechanisms and treatment.

Postural hypotension and shock. Mechanisms and treatment.

Diagnosis and treatment of NCA.

In Europe and America a high incidence of NCA was found in the battle field in men who were drafted but in Japan there have been no reports on large numbers of NCA neither in the battlefield nor in the home front in the past wars. Although it is believed that the aeroneurosis which occured in the Japanese Air Force during the Pacific War was a chronic anoxia which resulted in NCA. During peace and in war there have been cases of beriberi in the Japanese Army since it is difficult to differentiate between NCA and beriberi. It is believed that there were NCA cases mixed in with those diagnosed as beriberi. To the practitioner a ERG is important for a active diagnosis of NCA. There are many cases of NCA with no pathological findings in the ERG but on the other hand it is possible to see many kinds of abnormal findings. It is of importance to see through the unbalance of the ERG findings and the subjective and objective complaints. When there are changes in the ST-T it is difficult to differentiate between NCA and cardiomyopathia in such cases the leucocyte count, ESR, GOT and GPT are of help and the course must be followed up. In NCA the outstanding point is that there is no specifiic treatment' This is only natural because it is a syndrom which has different causes. In our department we are using Eserine and Trancopal as an aid.

Measurement of cardiac output from precordial dilution curves using a radioisotope.

In 124 subjects consisting of normal controls and patients with various diseases, 203 determinations of cardiac output were performed by precordial dilution technic using I131 labeled human serum albumin. 1) Our standard technic was determined to direct the scintillation detector toward the apex of the heart from the left lateral to see the left heart predominantly and to take a blood specimen for calibration 5 minutes after the RISA injection, since the values obtained under these conditions revealed the best approximation to those obtained by direct arterial sampling method. 2) The values determined by our standard technic demonstrated a satisfactory reproducibility and a reasonable agreement with those determined by Fick method. Superiority of the digital type recording to the conventional analog ratemeter recording was described. 3) Orthostatic decrease in cardiac output was more marked in patients with neurocirculatory asthenia and in those with hyperthyroidism than in control cases. 4) After lifting the legs in recumbent position, cardiac output decreased in some patients with heart disease, while it remained unchanged in control cases and slightly increased in patients with hyperthyroidism. 5) Aminophylline increased the cardiac output in patients with heart failure, but not in control cases and in patients with compensated heart disease. Cedilanid increased the cardiac output in one patient with heart failure but no significant changes were found in the other patients and in control cases within a relatively short period of observation.