Comparison of Recurrence Rate Based on the Frequency of Preceding Symptoms in Patients With Neurocardiogenic Syncope or Presyncope

BACKGROUND AND OBJECTIVES: In patients with neurocardiogenic syncope or presyncope, symptoms developed unpredictably and intermittently. The purpose of this study was to determine whether there was any significant difference in the recurrence rate of symptoms during the follow-up period between patients with many episodes of symptoms and those with fewer episodes of symptoms before diagnosis, as well as to assess the clinical significance of previous episodes of symptoms during treatment. SUBJECTS AND METHODS: A total of 100 patients with neurocardiogenic syncope or presyncope were divided in two groups (high episode group, n=54; low episode group, n=46) according to the frequency of symptoms before the head-up tilt test. We retrospectively analyzed the recurrence of symptoms using telephone interviews and medical record reviews. RESULTS: The clinical characteristics were not significantly different between the two groups. However, the recurrence rate was significantly lower in the high episode group than in the low episode group (5.6% vs. 19.6%, p=0.001). In the high episode group, patients treated with medication showed higher recurrence of symptoms than those without medication. In the lower episode group, a similar result was observed. CONCLUSION: The frequency of previous symptoms at the diagnosis of neurocardiogenic syncope or presyncope did not predict the occurrence of symptoms during the follow-up period. Therefore, to continue drug treatment based on the frequency of symptoms in patients with neurocardiogenic syncope or presyncope may not be the best option.

The Use of an Implantable Loop Recorder in Patients With Syncope of Unknown Origin

BACKGROUND AND OBJECTIVES: Possible mechanisms of syncope often remain unknown despite the performance of extensive cardiological and neurological tests. An implantable loop recorder (ILR) has been introduced to monitor the heart rhythm continuously over a year. We evaluated the diagnostic value of the use of the ILR for unexplained syncope. SUBJECTS AND METHODS: Between 2006 and 2007, an ILR was implanted in 9 patients (7 male, 2 female, mean age 55+/-17 years) where syncope remained unexplained after extensive diagnostic tests. We analyzed the recorded electrocardiogram signal in the memory of the ILR. RESULTS: During a follow-up period of 8.8+/-7.3 months, arrhythmia was detected in five patients. Two patients had a sinus pause and received a permanent pacemaker, and one patient had sustained ventricular tachycardia and fibrillation and received an implantable cardioverter defibrillator. One patient had micturition syncope with sinus pause and is waiting for permanent pacemaker implantation, and one patient had symptomatic paroxysmal atrial fibrillation and was administered anticoagulation therapy. Inappropriate auto-activations such as a pseudopause or a decreasing signal were also noted. CONCLUSION: ILR monitoring seems to be a useful diagnostic tool to identify the arrhythmic cause in patients with unexplained syncope.

Long-term Follow-up Results of Tilt Training in Patients with Neurocardiogenic Syncope

BACKGROUND AND OBJECTIVES: Tilt training as a non pharmacological therapy was recently introduced to treat the patients with neurocardiogenic syncope. Tilt training has been known to prevent neurocardiogenic syncope by desensitizing abnormal autonomic reflex. Herein, the early effect of tilt training and the preventive effect on the relapse of syncope were studied during a long-term follow-up period. SUBJECTS AND METHODS: Fifteen patients (11 males) who experienced recurrent syncope, despite drug treatment or were intolerant to drug treatment, among those diagnosed as neurocardiogenic syncope by the head-up tilt test at Samsung Medical Center between March 2000 and May 2003 were recruited. Each patient underwent tilt training after admission and was educated to continue self-tilt training after discharge. Data for recurrences after discharge were obtained via questionnaires on outpatient visits or by telephone interviews. RESULTS: Eleven (73%) of the 15 who underwent tilt training on admission showed therapeutic effects. The mean follow-up period was 21+/-10 months (5-40 months). Only one patient was excluded due to follow-up loss. Ten of the above patients underwent training by themselves for an average of 4 months after discharge, and experience no relapse of syncope during the follow-up period. CONCLUSION: Tilt training maintained its therapeutic effect during long-term follow-up. This could be a new treatment for patients non responsive or intolerant to medical therapy.

Safety of One-Day Admission Transradial Coronary Intervention

BACKGROUND: Recent advances of percutaneous coronary intervention (PCI) and transradial coronary intervention (TRI) have made it possible to reduce the local complication rate and the time until a return to ambulation. The aim of this study is to assess the safety and the patient satisfaction of the TRI-based one-day admission program for PCI. METHODS: Total 230 consecutive patients underwent TRI on the day of admission, according to pre-determined inclusion criteria, from May 2001 to October 2003. The subjects were examined for clinical and angiographic characteristics. The patients having a same-day discharge were telephone-interviewed one day and seven days after discharge to assess late complications and the patients' satisfaction. RESULTS: The mean age of the subjects was 59+/-9 years and 77.4% were male patients. 169 (73.4%) had stable angina and 37 (16.1%) had unstable angina. Stents were implanted in 178 cases (69.3%). Of the 230 patients who underwent TRI, 206 patients (89.6%) could discharge on the same day after the procedure. The procedure was successful in 98.5%. The average hospital stay for them was 9.4+/-1.4 hours. Two subjects reported hematoma near the puncture site within 24 hours after discharge, and one reported this problem 7 days after discharge. During the follow-up, there were no cases reporting chest pain needing rehospitalization or such complications as subacute vessel closure. No deaths, myocardial infarctions or revascularization were noted during the follow-up period. The majority of the patients (n=197, 95.6%) were satisfied with the same-day admission and discharge. CONCLUSIONS: Same day admission and discharge after TRI seems to be safe as well as satisfactory for not low-risk patients.

The Joint Multicenter Study on the Atrial Fibrillation in Korea

BACKGROUND: Atrial fibrillation (AF) is one of the most common clinical arrhythmia. AF may cause disabling symptoms and serious adverse effects, such as impairment of cardiac function or thromboembolic events. Until now, there were no study about the clinical characteristics of atrial fibrillation throughout this nations. The purpose of this study is a establishment of epidemiologic database of patients with atrial fibrillation in this nations. METHODS: 867 patients from 12 university hospitals were involved in this study. Atrial fibrillation were diagnosed with documented ECG in all patients. Medical history, physical findings, basic Laboratory finding, ECG, echocardiography and 24-hour Holter monitoring of these patients were evaluated. Chronic atrial fibrillation were defined as the duration of AF longer than 72 hours regardless of intervention. RESULTS: In patients with chronic atrial fibrillation, the most common symptom was dyspnea and the most common associated diseases were valvular heart disease, hypertension and ischemic heart disease. 2) In patients with paroxysmal atrial fibrillation, the most common symptoms were palpitation, dizziness and chest pain, and the most common associated diseases were hypertension, ischemic heart disease and valvular heart disease. 3) left atrial size, systolic and diastolic left ventricular size in patients with chronic atrial fibrillation were significantly increased as compared those in patients with paroxysmal atrial fibrillation (p<0.001). 4) cardiomegaly and pulmonary edema were more common in patients with chronic atrial fibrillation (p<0.0001). CONCLUSIONS: This study is first large multicenter study about atrial fibrillation in this nations. These data can be used as basic data for follow up and management of atrial fibrillation.

Study of 24 Hour Ambulatory Blood Pressure Monitoring in Acute Stroke Patients

OBJECTIVE: Appropriate evaluation of hypertension is important in the patients with a stroke because hypertension is a major cause of a stroke. Blood pressure may be falsely elevated or depressed immediately after a stroke, depending on the severity of neurological deficit, mobility, and physical activity, and the level of consciousness. To overcome this problem, ambulatory blood pressure monitoring (ABPM) has been proposed as a method of obtaining a more accurate clinical assessment. SUBJECTS AND METHODS: The present study was performed in an acute stage of stroke patients to assess the manifestation of 24 hour ambulatory blood pressure, to observe the nocturnal blood pressure fall and to evaluate the relationship of blood pressure degree on admission and nocturnal blood pressure dip. Thirty four patients admitted within 24 hours after onset of acute stroke were involved in this study. 24 Hour blood pressure monitoring device was installed on an independent arm by oscillometric method as soon as brain imaging study was performed. ABPM readings were obtained each 30 minutes during daytime and each 1 hour during nighttime with electrocardiography. Each patients were classified as the presence or absence of hypertension. We examined nocturnal blood pressure dip and mean pressure of 24 hour ambulatory blood pressure. RESULTS: 1)This study demonstrated that comparing daytime with nighttime 24 hour ambulatory blood pressure, 20 of 24 patients (83%) with acute stroke with hypertension, did not show nocturnal blood pressure dip, and there was sustained high nocturnal blood pressure in patients with acute stroke with hypertension. 2)There were significant differences between 24 hour ambulatory mean daytime blood pressure and mean nighttime blood pressure in patients with acute stroke without hypertension, so was lower in nighttime (p<0.05). 3)It is likely that in acute stroke patients with hypertension, patients with higher blood pressure on admission had more abnormality of nocturnal blood pressure dip. CONCLUSION: These results suggest that in patients with acute stroke, 24 hour ABPM is useful method to assess diurnal variation and evaluate hypertension in acute stage of stroke patients, and suggest that patients with acute stroke with hypertension trend to loss of nocturnal blood pressure dip.

A Case of an Dilated Cardiomyopathy Combined with Guillain-Barre Syndrome

Many neuromuscular disorders involve the heart and may produce dilated or hypertrophic cardiomyopathy. Guillain-Barre Syndrome is an inflammatory polyradiculoneuropathy in which the autonomic nervous system is sometimes involved. ST-segment and T-wave abnormalities have been reported in which the autonomic nervous system is involved, and sudden death can be attributed to fatal arrhythmic or malignant hypertension, but cardiomypathy have been reported rare. 58-year-old woman who complained of pitting edema and exertional dyspnea was admitted. Dilated cardiomyopathy was diagnosed by transthoracic echocardiography. Guillain-Barre syndrome was diagnosed by clinical manifestation, EMG, and CSF tapping. T-wave inversion in electrocardiogram was noted, and left ventricular end-diastolic diameter and ejection fraction were 69.2mm and 37.5% respectively in transthoracic echocardiography. Coronary angiograms were normal and ergonovine test was negative. Plasmapheresis has been used as mainstay of treatment in patient with Guillain-Barre syndrome. She was treated with diuretics and digoxin. Motor paralysis improved gradually by plasmapheresis and left ventricular dysfunction improved after 8 months.

A Clinical Study of Pulmonary Tuberculosis in Diabetics / 결핵

BACKGROUND: An association between diabetes and tuberculosis has long ken implied. The severity of diabetes appears to correlate with the degree of tuberculous activity. METHODS: A retrospective chart review of 82 patients with active pulmonary tuberculosis in diabetics(DMTB) and 83 patients with active pulmonary tuberculosis in nondiabetios (Non-DMTB) admitted to the Kyung Hee Medical Center between January 1995 and December 1996 was undertaken. RESULTS: The sex ratio of DMTB was 58 : 24, and that of Non-DMTB was 62 : 21. Male patients predominated in both groups. The highest incidence of DMIB was 6th and 7th decades and that of Non-DMTB was 3rd and 4th decades. In case which the tuberculosis developed after diagnosis of diabetes, the prevalence of pulmonary tuberculosis was the highest in diabetes for 5 -10 years. On chest X-ray findings, the moderate advanced tuberculosis cases were the most common (60.9% in DMTB and 50.6% in Non-DMTB). There was no relation between the degree of tuberculosis activity on chest x-ray(minimal, moderata awl far advanced tuberculosis) and presence of diabetes. The incidence of lower lung field tuberculosis in DMTB was significantly higher than Non-DMTB(p<0.05). The multiple lobe involvement was the predominant chest roentgenograpflc finding in both groups. There was no significant difference of treatment response between DMTB and Non-DMTB. There was no relationship between initial HbA1c and the stverity of pulmonary tuberculosis on chest X-ray. During treatmenu of pulmonary tuberculosis in excellently and well controlled diabetes, the cure rate of pulmonary tuberculosis was sigrificantly higher than the pcorly controlled diabetes and the rate of treatment failure was significantly lower than poorly controlled diabetes. (p<0.05). CONCLUISON: Poor control of blood glucose is related with increased rate of treatment failure in pulmonary tuberculosis with diabetes mellitus. Further investigation will be needed to study the mechanisms of treatment failure in poorly controlled diabetics with pulmonaiy tuberculosis.

A Case of Congenital Long QT Syndrome Associated with Deafness and Syncope

Congenital long QT syndrome (LQTS) is an inherited disease characterized by prolonged QT intervals and polymorphic ventricular tachycardia. The clinical manifestations vary from sudden cardiac death by ventricular arrhythmia to asymptom throughout life. In 1957, Jervell and Lange-Nielsen reported a syndrome of congen-ital sensory deafness associated with a prolonged QT interval in four children. The affected children had multiple syncopal episodes, and three died suddenly. The mode of inheritance is autosomal recessive. Affected persons are susceptible to recurrent syncope, and they have a high incidence of sudden death and short life expectancy. We report a case and review the literature on long QT syndrome diagnosed in a 30-year-old female with a history of convulsion and loss of consciousness during delivery.

Correlationn of the ultrasonic PCO-like multicystic ovaries with clinical, hormonal and ultrasonic findings / 대한산부인과학회잡지

No abstract available.