Congenital coronary arterial aneurysm without arteriovenous fistula resulting in myocardial infarction--case report and review of the literature.

A 38-year-old woman with coronary arterial aneurysm, which resulted in myocardial infarction, was reported. By coronary arteriography, an aneurysm of the left anterior descending branch was found, but no arteriovenous shunt could be revealed. The patient has neither clinical history of severe febrile inflammatory disease nor any coronary risk factors. The etiology of her coronary arterial aneurysm was considered to be congenital. The patient underwent aorto-coronary saphenous vein bypass graft surgery successfully. We believe that this is the first case report in Japan on congenital aneurysm of the coronary artery without arteriovenous fistula, which was diagnosed during life by coronary arteriography.

Treatment of severe hypertension and hypertensive emergency with nifedipine, a calcium antagonistic agent.

Nifedipine, the Ca++ antagonistic coronary vasodilator, was administered by oral, sublingual and enema routes. 1) In 6 severe hypertensive patients (systolic pressure greater than or equal to 200 mmHg, diastolic greater than or equal to 120 mmHg), nifedipine, administered orally, induced prompt and reliable fall of arterial pressure (systolic pressure: -28% of control level, diastolic: -27%). 2) In 10 patients with hypertensive emergencies, including malignant hypertension, intracranial bleeding, hypertensive encephalopathy and acute hypertensive heart failure, sublingual and enema administration of nifedipine were performed with excellent hypotensive efficacy. 3) Pressure began to fall within 5--15 min, 30 min and 30--60 min after sublingual (or dissolved), enema and oral (capsule), respectively, and reached its lowest levels in the next 10--20 min. The fall of pressure lasts for 2--4 hours. 4) In the combination of nifedipine with alpha-methyldopa, antihypertensive response in short-term was increased about +11% over nifedipine alone and lasted for 8 hours. In combination with beta-blocker (propranolol), hypotensive efficacy increased +39% over nifedipine alone, but the effective duration of this combination was the same as nifedipine alone. 5) Side effects, including dryness of the mouth and burning sensation in face and legs, were observed in few patients.

Hemodynamic effects of sublingual nifedipine in congestive heart failure.

Hemodynamic response of nifedipine in 11 patients with congestive heart failure was examined. Thirty minutes after sublingual administration of nifedipine, CI and SVI were increased together with a decrease in PAEDP and TSVRI. The increase in CI was proportional to the decrease in TSVRI. Twenty-four hours after continuous administration of nifedipine, however, six of 11 patients did not show the improvement of left ventricular function. These results indicate that sublingual administration of nifedipine is effective in the short-term therapy of the patients with a markedly decreased cardiac output and an increased systemic vascular resistance.