Incidence of amiodarone-induced thyroid dysfunction in Korean / 대한내과학회지

BACKGROUND: Amiodarone is an effective antiarrhythmic agent, but it is used restrictively due to several side effects. Amiodarone has been caused thyroid dysfunction, thyroid hyperfunction or hypofunction in several clinical studies. In this study, we assessed the clinical features, frequency and nature of thyroid dysfunction in patients with amiodarone therapy METHODS: A total of 150 patients (Male;n=71, Female;n=79) was assessed. They had never had the history of thyroid disease and had been received amiodarone therapy. All the patient's medical records on therapeutic dose and duration, body weight, height, body mass index and thyroid function test were reviewed. Patient's underlying diseases were supraventricular arrhythmia (n=54) and ventricular arrhythmia (n=96). The dose of amiodarone was between 100 mg and 400 mg, and the mean duration of therapy was 36 months. We defined decreased TSH with elevated T3 and T4 as thyrotoxicosis, and elevated TSH as hypothyroidism RESULTS: Thyroid dysfunction was observed in 56 (37.3%) patients and their mean body mass index (BMI) was 23.6 kg/m2. Of them, thyrotoxicosis and hypothyroidism were observed in 5 (3.3%) patients and 51 (34%) patients, respectively. The difference of sex in hypothyroidism was almost not visible (male;n=24, female;n=27), also the correlation with BMI and thyroid function was not (mean BMI=23.7 kg/m2). Amiodarone was maintained for 46 months in hypothyroidism patients, that was more longer duration than normal thyroid patients (30 months). CONCLUSION: In korean patients with amiodarone therapy, one third patients presented thyroid dysfunction and most of them were hypothyroidism. No correlation was found between thyroid dysfunction and sex and BMI. Hypothyroidism prevalances in patients with long duration of amiodarone therapy, but high dose therapy may induce thyrotoxicosis.

Huge Left Ventricular Aneurysm With Normal Coronary Artery

No abstract available.

Comparison between Nicorandil and Adenosine in the Measurement of Coronary Flow Reserve Using a Doppler Guide Wire

BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) is the capability of coronary arteriolar bed to dilate in response to increased cardiac metabolic demand. Nocorandil, a hybrid of ATP-sensitive K+ channel opener and nitrates, causes coronary vasodilation of both epicardial and resistance vessels. We investigated the feasibility and safety of nicorandil as compared to adenosine in the measurement of CFR using a Doppler guide wire. SUBJECTS AND METHODS: We measured CFR in 26 consecutive patients (mean age 52+/-19 years, M:F=16:10) during coronary intervention with a 0.014-inch Doppler guide wire. We recorded the baseline average peak velocity (APV) and the hyperemic APV induced by intracoronary adenosine or nicorandil. The heart rate, mean aortic pressure and the time interval from maximal APV to baseline APV were also recorded. RESULTS: There were no significant differences between APV, diastole/systole velocity ratio and CFR induced by adenosine and those induced by nicorandil (44.4 +/- 17.3 vs 45.5 +/- 17.6, p=0.78, 1.59 +/- 0.51 vs 1.57 +/- 0.52 p=0.78, 2.22 +/- 0.89 vs 2.27 +/- 0.94, p=0.36). The CFR and diastole/systole velocity ratio induced by nicorandil showed a strong positive linear correlation with those by adenosine (r2=0.77, p=0.0001, r2=0.83, p=0.0001). Adenosine significantly decreased the heart rate as compared to nicorandil =-25.5 +/- 9.7 vs -8.7 +/- 4.9 bpm, p=0.001). There were no differences in the changes of mean aortic pressure between adenosine and nicorandil (-7 +/- 9 vs -2 +/- 3 mmHg, p=0.17). Nicorandil prolonged the time interval from maximal APV to baseline APV compared to adenosine (194 +/- 62 vs 37 +/- 12 sec, p=0.001). CONCLUSION: Nicorandil is feasible and safe for use in measuring CFR using a Doppler guide wire and may replace adenosine.

Effect of Low Dose External Irradiation on MMP-2 Expression in Rat Carotid Artery Injury Model

BACKGROUND AND OBJECTIVES: Brachytherapy is one of the promising therapeutic strategy for the prevention of restenosis. The effects of low dose irradiation (<10 Gy) on neointimal hyperplasia, and on the expression of MMP-2 are unknown. MATERIALS AND METHODS: Sprague-Dawley rats were subjected to a balloon injury to the common carotid artery. An external irradiation dose of 10 Gy was performed on the irradiated group at 24 hours following the balloon injury. The index of neointima, such as the percentage area of stenosis, maximal intimal thickness and intima/media area ratio in the H/E stain, were measured, as was the MMP-2 positivity (100xMMP-2(+) cell number/total cell number) from the immunohistochemical staining, at 15 and 29 days following injury. Western blotting for the MMP-2 were performed at 2, 4, 9, 15 and 29 days following injury. RESULTS: The percentage area of stenosis (22.3+/-10.9% vs. 40.2+/-12.1%), maximal intimal thickness (0.11+/-0.06 mm vs. 0.30+/-0.12 mm) and intima/media area ratio (61.7+/-25.8% vs. 127.4+/-65.8%) were lower in the irradiated group at 15 days following injury (p<0.05). At 29 days following injury, there were no differences between the two groups for the above mentioned indices: 57.4+/-14.0% vs. 45.5+/-2.1%; 0.45+/-0.11 mm vs. 0.41+/-0.12 mm and 158.1+/-24.5% vs. 187.8+/-101.9%, respectively (p=NS). The MMP-2 levels in the control group were higher than those in the irradiated group at 15 days (1.03+/-0.69 vs. 1.61+/-0.55, p<0.05), but the levels in the irradiated group were higher than those in the control group at 29 days following injury (1.16+/-0.28 vs. 0.72+/-0.28, p<0.05). There were no differences in MMP-2 positivity between the two groups at 15 days following injury (95.6+/-4.4% vs. 93.1+/-3.5%, p=NS). At 29 days after injury, the MMP-2 positivity was higher in the irradiated than the control group (69.4+/-9.0% vs. 24.6+/-9.9%, p<0.05). CONCLUSION: 10 Gy of external irradiation transiently inhibited the neointimal hyperplasia, partly due to the transient inhibition of the MMP-2 activity in our rat carotid artery injury model.

Two cases of severe cholesterol embolism after coronary angiography : Proven by skin biopsy / 대한내과학회지

Cholesterol embolism is due to dislodgment of cholesterol crystals from the atheromatous aorta resulting in an occlusion of small arteries. Cholesterol emboli may occur spontaneously but usually develops as a complication of vascular procedures. The organs most frequently involved are the skin and the kidneys but any organ can be affected. Cutaneous manifestations include livedo reticularis, indurated firm violaceous painful plaques and noduli tending to show central necrosis and tender blue toes. We report two cases of cutaneous cholesterol embolization of lower extremities with the impairment of renal function after coronary angiography, proven by skin biopsy.

A Case of Left Circumflex Coronary Artery Arising as a Terminal Extension of Right Coronary Artery

No abstract available.

Assessment of change of coronary artery flow using corrected TIMI frame count following abciximab adminstration during primary angioplasty for acute myocardial infarction

BACKGROUND: In spite of the successful reperfusion therapy, coronary blood flow in infarcted myocardium was known to decrease for a long time. Abciximab is known to inhibit the final pathway of platelet aggregation and maintenance the large vessel patency. But abciximab may have another important effect beyond the these effect. TIMI frame count method is simple, reproducible, objective and quantitative index of coronary flow. We tried to define the effect of abciximab that used with primary angioplasty on the coronary blood flow using TIMI frame count methods. METHODS: We consecutively studied 30 patients who admitted for acute myocardial infarction without cardiogenic shock from September 1997 to August 1999. We analyzed the changes of corrected TIMI frame count(CTFC) between the baseline(immediate after the angioplasty) and follow-up(post-op 7th day) coronary angiogram and compared the results between the group of primary angioplasty with abciximab(abciximab group, n=1) and the group of primary angioplasty without abciximab(non-abciximab group, n=9). RESULTS: There were no differences between abciximab group and non-abciximab group in baseline characteristics, treatment modalities and angiographic results. According to the results of the comparison of deltaCTFC, changing rate of CTFC, deltavelocity and changing rate of velocity, there were significant improvement of the coronary blood flow in infarct related artery in the abciximab group than non-abciximab group. But there were no differences in the changes of coronary blood flow in non-infarct related artery between two groups. The frequency of major adverse coronary events during follow up periods(mean 6 months) were similar(9.1% and 5.2% each other, p>0.05). CONCLUSIONS: Abciximab used with primary angioplasty in acute myocardial infarction improved the coronary blood flow significantly in infarcted myocardium. This finding may be related that abciximab enhance the perfusion and function of microvasculature in infarcted myocardium.

Evaluation of Left Ventricle Diastolic Function by Color M-Mode Doppler Echocardiography in Coronary Artery Disease

PURPOSE: The aims of this study were to evaluate the usefulness of the propagation velocity (Vp) measured by transthoracic color M-mode Doppler in patients with coronary artery disease and compare Vp with conventional diastolic function index using transmitral and pulmonary vein flow. METHODS: Study subjects were classified into two groups according to the presence of coronary artery disease (CAD): 44 subjects (M:F=22:22, mean age 63+/-12 yrs) with CAD (AMI; n=13 , unstable angina; n=5, stable angina; n=26); 31 normal subjects (M:F=13:18, mean age 43+/-15 yrs). Vp of early flow into left ventricular cavity measured by color M-mode Doppler was proposed as an index of left ventricular diastolic function. Vp was compared with conventional diastolic function index. RESULTS: 1. Vp in CAD patients (32.8+/-9.1 cm/sec) was lower than control (63.6+/-14.1 cm/sec)(p>0.01). Among CAD patients, Vp in CAD patients (30.1+/-8.6 cm/sec) with left ventricular hypertrophy (LVH) was lower than Vp in CAD patients without LVH (35.9+/-8.9 cm/sec)(p>0.01). 2. Vp was correlated with left ventricular ejection fraction (r=0.602, p>0.01), with D wave of pulmonary vein flow (r=0.540, p>0.01) and with E/A velocity ratio of mitral inflow (r=0.517, p>0.01) and negatively correlated with left ventricular mass index (r=-0.576, p>0.01). CONCLUSION: The propagation velocity measured by color M-mode Doppler is a useful index for evaluation of diastolic function of left ventricle in the patients with coronary artery disease.

Transthoracic Echocardiographic Assessment of Adriamycin-induced Cardiomyopathy in Rats with a 15 MHz Transducer

BACKGROUND: Adriamycin (doxorubicin) is one of the widely used drugs in the treatment of a variety of solid and hematologic malignancies. However, the adriamycin-induced cardiomyopathy limits the prolonged use of this effective drug. Transthoracic echocardiography is the excellent tool in early detection and follow-up studies of adriamycin-induced cardiomyopathy. The aim of this study was to assess the cardiac function and morphology using a 15 MHz high-frequency imaging in rats. METHODS: Adriamycin was administrated intraperitoneally by six equal injections at a dose of 2.5 mg/kg over a period of 2 weeks for total cumulative dose of 15 mg/kg body weight in 12 male Sprague-Dawley rats (weight 367+/-39 g). Transthoracic echocardiography with a 15 MHz linear-array transducer was performed at baseline and additionally at 3 weeks to measure the left ventricular wall thickness and dimension from the parasternal short axis view with 2D guided M-mode and pulsed Doppler signals of mitral inflow. Within 2 days of echocardiography, the heart was harvested for electron microscopic evaluation after potassium-induced cardiac arrest. RESULTS: 1) The mortality rate during the experimental period was 0%. 2) Transthoracic echocardiography provided adequate 2D guided M-mode images and pulsed Doppler signals of mitral inflow in all rats. 3) In follow-up echocardiography, pericardial effusion was detected in 7out of 12 rats (58%). 4) Compared to baseline, end-diastolic dimensions were increased from 7.01+/-0.69 to 7.74+/-1.25 mm (p<0.001), end-systolic dimensions were increased from 4.13+/-0.69 to 5.22+/-1.12 mm (p<0.05), and interventricular septal and posterior wall thickness at end-systole and end-diastole were significantly decreased (p<0.05, respectively). 5) Fractional shortening was decreased from 43.0+/-6.8 to 32.7+/-8.0%, compared to baseline (p<0.05). 6) E/A ratio of mitral inflow changed significantly from 1.63+/-0.36 to 2.78+/-1.0, compared to baseline (p<0.05). CONCLUSION: Adriamycin administration at total cumulative dose of 15 mg/kg body weight over 2 weeks creates a reliable model of non-ischemic dilated cardiomyopathy in rats with a high success rate. Transthoracic echocardiography using a 15 MHz transducer provides adequate images for assessing the cardiac function and morphology in follow-up studies in adriamycin-induced cardiomyopathy of rats. These results suggest that transthoracic echocardiography using a 15 MHz Transducer is a promising tool for an assessment of adriamycin-induced cardiomyopathy in small animals.

The Effect of L-arginine on Neointima Formation in a Rat Vascular Injury Model

BACKGROUND: The inhibitory effects of nitric oxide(NO) on platelet adhesion and vascular smooth muscle cell(VSMC) proliferation may have a possible role inhibiting development of neointima following balloon catheter induced injury. We tested the hypothesis that L-arginine, the precursor of NO, would attenuate neointima formation following balloon catheter induced injury via regulation of antagonistic balance between proliferation and apoptosis of VSMC. METHODS: Adult, male Sprague-Dawley rats(300 to 400g) were anesthetized with ketamine (100mg/kg intraperitoneally). The left common and external carotid artery were exposed. For endothelial denudation, 2mm angioplasty catheter was introduced through the left external carotid artery into the left common carotid artery. The catheter was inflated at I atm. and withdrawn three times. Animals were randomized to receive 2.25% L-arginine in their drinking water(n=14) or placebo(n=16) from 2 days prior to and 9 days following denudation. VSMC proliferation was quantified by immunohistochemical staining with an antibody to the proliferating cell nuclear antigen(PCNA). The cells undergoing apoptosis were identified by terminal nucleotidyl transferase-mediated nick end labeling(TUNEL) method and morphologic changes by computerized planimetry and transmission electron microscopy. RESULTS: 1) The neointimal area in injured arteries were significantly reduced in L-arginine supplemented animals compared with placebo group(p<0.05). 2) L-arginine administration significantly reduced the number of PCNA positive cells in neointima when compared with placebo at 9 days(p<0.05). 3) Positive TUNEL cells were not influenced by L-arginine supplementation. 4) On transmission electron microscopy, there were no cells showing characteristics of apoptosis in neointima. CONCLUSION: These results suggested that the inhibitory effect of L-arginine on neointima formation is due to reduced VSMC proliferation, but is not due to increased VSMC apoptosis at the early time period after initmal injur .

Pheochromocytoma with Unusual Electrocardiographic Changes and Having Clinical Features of Angina Pectoris : A Case Report

A 50 year old female presented unusual electrocardiographic changes including AV block, accelerated idioventricular rhythm, ventricular premature systole with severe fluctuation of blood pressure and clinical features of angina pectoris. Deep ST segment depression was demonstrated in spite of the normal coronary arteriogram and the negative coronary artery spasm study. Urinary excretion of catecholamines and their metabolites were elevated and a huge pheochromocytoma was found in the left adrenal glandd. After removal of the pheochromocytoma, the electrocardiographic abnormalities and the blood pressure were normalized and teh aptient became asymptomatic.

Correlation between Coronary Risk Factors and Severity of Coronary Artery Disease

BACKGROUND: Coronary artery disease(CAD) has been related to a number of factors, including diabetes, smoking,hypertension, blood lipids, and family history of CAD. However, a few studies have examined the correlation between these factors and severity of CAD. In the present study, we aimed to define the correlation between risk factors and the severity of CAD. METHODS: The study population was 309 consecutive patients who underwent coronary angiography in Kang Nam St. Marys hospital between Mar. 1992 and Aug. 1994. We analyzed risk factors of CA ; age, total cholesterol(TC), triglyceride, high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol cholesterol(LDL-C), the ratio of TC to HDL-C, Lp(a), uric acid, fibrinogen, diabetes, hypertension, smoking, and family history of CAD. All films were reviewed without specific knowledge of blood laboratory results. Significant occlusive disease was defined as >50% diameter obstruction of a major coronary vessel. Extent of disease was defined as the number of major coronalry arteries with significant occlusive disease. RESULTS: 1) Statistically significant risk factors between one vessel disease group and multivessel disease group are age, TC, LDL-C, and diabetes in total patients and age, LDL, and diabetes in male patients. But there is no significant difference in female patients. 2) In patients with multivessel disease, age, HDL-C level are significantly lowere, and TG level and the percentage of smkoing are significantly higher, in male than female. 3) There is increase in four major risk factors(diabetes, hypertension,smoking,hypercholesterolemia) with the increased number of diseasesd coronary arteries; normal coronary group has 1.07 risk factors, one vessel disease group 1.30, two vessel disease group 1.49, and three vessel disease group 1.78. 4) In total and male patients, three independent variables are significantly associated with severity of CAD. These variables are age, smoking, and diabetes. In female patients, diabetes in only significant independent risk factor. CONCLUSION: The significant independent risk factors associated with severity of CAD are age, diabetes, and smoking in total and male patients. Whereas in female patients, diabetes is only significant independent risk factor.

A Case of Single Coronary Artery with Bicuspid Aortic Valve

Single coronary artery is one of coronary artery anomalies, which originates from single aortic ostium and distributes blood to whole myocardium and is reported to occur in about 0.02 percent of general population. Although this condition does not produce severe clinical complications, it is often combined with other congenital cardiac anomaly and may produce angina pectoris, arrythmia, and sudden cardiac death syndrome rarely. Bicuspid aortic valve is anomalous aortic valve which consists of two commisure and two cusps and is said to occur in about 2 percent of the population. In some cases, the valve may function normally for many decades, but in others, it may produce aortic stenosis and/or aortic regurgitation frequently. We report here a case of single coronary artery combined with bicuspid aortic valve.

Clinical Value of Exercise TI-201 SPECT in Patients with Chest Pain and Normal Coronary Angiogram

BACKGROUND: The interest of patients with chest pain and normal coronary arteries has been increased since 1960. From the year 1973, the syndrome representing these characteristics has been classified as syndrome X. Treadmill test and exercise TI-201 SPECT are important in the diagnosis of syndrome X. This study was designed to evaluate the clinical value of exercise TI-201 SPECT and the difference of clinical characteristics between exercise TI-201 SPECT positive(Group A) and negative (Group B) in patients with chest pain and normal coronary angiogram. METHODS: Twenty seven patients with chest pain and normal coronary angiogram underwent echocardiogram and exercise TI-201 SPECT. Patients received 2 mCi of thallium intravenously during exercise, redistribution images were performed 4 hour later and second dose of 1 mCi of thallium was injected at rest immediately thereafter. These three sets of image(stress, redistribution and reinjection) were analyzed. RESULTS: 1) 12 of 16 patients in Group A, none of 11 patients were positive on exercise treadmill test(p<0.005). 2) The incidence of systemic hypertension in Group A was significant greater than Group B(p<0.05). 3) The left ventricular end diastolic pressure was significantly higher in Group A than in Group B (p<0.05). CONCLUSION: The exercise TI-201 SPECT is a useful method to evaluate the patients with chest pain and normal coronary angiogram and the reversible perfusion defects on the exercise TI-201 SPECT might be related to systemic hypertension and elevated left ventricular end diastolic pressure.

Pericardial effusion in malignant cancer patients / 대한암학회지

No abstract available.

Echocardiographic Findings in Systemic Lupus Erythematosus

BACKGROUND: Systemic lupus erythematosus(SLE) frequently has cardiovascular complications. Pericardial inflammation and effusion. ventricular dysfunction, valvular disease and coronary atherosclerosis may result in morbidity. While the pathologic findings in SLE have been well described, the antemortem documentation of the cardiac complications has been less frequent than the postmortem findings would support, we therefore sought to study how echocariography may improve the clinical assessment of cardiac involvement in 40 consecutive patients with SLE. SUBJECTS AND METHODS: This study began in 1990 with a prospective design. An appointment was scheduled with all patients whose SLE was diagnosed at the outpatient clinic and during the admission of the internal medicine service at the Kang Nam St Mary's hospital These were 40 female patients, with a mean age of 32+/-11 years(+/-SD). The average duration of disease was 37+/-32months, the average dosage of prednisolone per day was 20+/-17mg. M-mode and 2-D echocardiogram were carried out to the 40 SLE patients. RESULT: Seventeen(43%) of the SLE patients had pericardial effusion. Reduced left ventricular contractility was evident in 8 patients(20%). Abnormality of diastolic dysfunction to be checked by A/E ratio was in 3 patients(8%). No patients had echocardiographic evidence of pulmonary arterial hypertension. Clinical findings of myocardial dysfunction in these patients included dyspnea(30%), jugular venous distension(20%), rales(10%) and S3 gallop(8%). Valvular abnormality of SLE patients included mitral regurgitation in five patients(13%) and aortic regurgitation in two patients(5%). Electrocardiogram showed myocardial ischemia, atrial fibrillation and sick sinus syndrome in 3, 1 and 1 patients respectively. CONCLUSION: In this study, pericardial effusion were the most common echocardiopraphic abnormalities in Patients with SLE. The incidence of valvular and myocardial disease were relatively common.

A case of acute myocardial infarction with polycythemia vera / 대한혈액학회지

No abstract available.