A Case of Severe Coronary Spasm Associated with 5-Fluorouracil Chemotherapy

Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.

Acute Idiopathic Hemorrhagic Pericarditis with Cardiac Tamponade as the Initial Presentation of Acquired Immune Deficiency Syndrome

This paper presents a case of cardiac tamponade with idiopathic hemorrhagic pericarditis as the initial symptom of human immunodeficiency virus (HIV) infection. A 29-year-old male came to the emergency room with a sudden onset of dizziness. Upon arrival, he was hypotensive although not tachycardic, and his jugular venous pressure was not elevated. His chest X-rays revealed a mild cardiomegaly. Transthoracic echocardiography revealed a large amount of pericardial effusion with a diastolic collapse of the right ventricle, a dilated inferior vena cava with little change in respiration, and exaggerated respiratory variation of mitral inflow velocities, representing echocardiographic evidence of cardiac tamponade. After pericardiocentesis, his blood pressure improved to 110/70 mmHg without inotropics support. Serial 12-lead electrocardiograms during hospitalization revealed upwardly concave diffuse ST-segment elevation followed by a T-wave inversion suggestive of acute pericarditis. Pericardial fluid cytology and cultures for bacteria, mycobacteria, adenovirus, and fungus were all negative. HIV enzyme-linked immunosorbent assay (ELISA) was positive and confirmed by Western blot. The CD4 cell count was 168/mm3. Finally, the diagnosis of cardiac tamponade due to HIV-associated hemorrhagic pericarditis was made. It was concluded that HIV infection should be considered in the diagnosis of unexplained pericardial effusion or cardiac tamponade in Korea.

A Case of Fabry Cardiomyopathy

In the absence of hypertension, hypertrophic cardiomyopathy is the most common cause of left ventricular hypertrophy (LVH). However, it has been reported that up to 3% of males with unexplained LVH have Fabry disease, an X-linked disorder of glycophospholipid metabolism that is due to a deficiency in the lysosomal enzyme alpha-galactosidase A (alpha-Gal A). A 44-year-old man was admitted to our hospital with palpitations. He had a history of chronic renal failure diagnosed at age 33 followed by kidney transplantation performed at our institution 2 years later, as well as long-standing hypohidrosis. His medications included prednisolone (5 mg daily), mycophenolate mofetil (1,000 mg, bid), and cyclosporine (150 mg, bid). On hospital day two, an echocardiogram demonstrated increased left ventricular wall thickness (septal wall thickness of 28 mm, posterior wall thickness of 20 mm). Diastolic dysfunction was noted on transmitral flow patterns and tissue Doppler imaging. The patient was found to have low plasma alpha-Gal A activity. A previously reported H46R missense mutation was detected in his alpha-Gal A gene and the patient was subsequently diagnosed with Fabry disease.

A Case of Hemolytic Anemia Following Mitral Valve Repair

Hemolytic anemia is one of the findings representative of prosthesis dysfunction after valve surgery. A 67-year-old man, who underwent mitral annular ring plasty one week ago, was admitted with shortness of breath and fatigue. Hematological studies revealed a Coombs'-negative hemolytic anemia with a hemoglobin 7.9 g/dl, hematocrit of 17.1%, haptoglobin of 1.0 mg/dl, LDH 5148 U/L, total bilirubin of 3.1 mg/dl (direct of 0.71 mg/dl), and a peripheral blood smear demonstrating mechanical hemolysis with red cell fragmentation. Transesophageal echocardiogram revealed a turbulent jet of mitral regurgitation hitting the annuloplasty ring. The patient returned to the operating room for mitral valve replacement, and thereafter which the hemolytic anemia resolved.

Cardiac tamponade complicated by chronic recurrent pancreatitis / 대한내과학회지

Chronic pancreatitis causes a variety of complications such as glucose intolerance, pancreatic pseudocyst and duodenal obstruction. However pericardial effusion is very rarely complicated with chronic pancreatitis and life-threatening. The hypothesis of the development of pleuropericardial effusion in chronic pancreatitis has been variously proposed; fistula formation through esophageal or aortic hiatus, local transfer of pancreatic enzyme. Recently, we experienced a case of pleuropericardial effusion complicated by chronic recurrent pancreatitis causing cardiac tamponade. There was a contrast leakage appearing from the pancreatic duct to the mediastinum in endoscopic retrograde pancreaticography. The transpapillary pancreatic stent insertion led to the disappearance of pleuropericardial effusion on the radiography. We report this unusual manifestation of chronic recurrent pancreatitis with the review of literature.

A Case of Huge Ovarian Tumor Associated with Hypothyroidism / 대한산부인과학회잡지

In adult women, hypothyroidism has significant effect on reproduction. Hypothyroidism is associated with oligomenorrhea, amenorrhea, anovulation, hypermenorrhea, menorrhagia, infertility, spontaneous abortion, stillbirth or preterm delivery. It can cause ovarian tumor, which clinically resembles ovarian hyperstimulation syndrome or multicystic ovarian tumor. We have experienced a case of spontaneously regressed huge ovarian tumor which was found in patient. With hypothyroidism. So we report this case with a brief review of literature.

A Case of Peripartum Cardiomyopathy / 대한산부인과학회잡지

Peripartum cardiomyopathy is relatively uncommon form of heart failure that occurs from one month before, to 5 months after delivery. The causes of this disease are unknown and mortality rate may be as high as 20-50%. We recently experienced one case of this disease and summarized here with brief review of literatures.

Impact on Long-term Adverse Cardiac Events of Troponin T or Creatine Kinase-MB Release after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND AND OBJECTIVES: The impact on long-term adverse cardiac events of troponin T (TnT) or creatine kinase-MB (CK-MB) release after percutaneous transluminal coronary angioplasty (PTCA) is not well defined. The purpose of the study is to evaluate the effect of elevated TnT or CK-MB on the late major adverse cardiac events [MACE ; Q wave myocardial infarction (MI), revascularization, or cardiac death]. SUBJECTS AND METHODS: Study population were 207 consecutive patients (M : F=148 : 59, mean 60.8+/-9.2 years) who underwent PTCA. Patients with acute MI, unstable angina with abnormal levels of TnT or CK-MB, or newly developed Q MI after PTCA were excluded. Cardiac enzyme levels were measured before and 8, 24 hours after PTCA for CK-MB, and before and 16 hours after PTCA for TnT. Group I (n=181, 87.4%) had normal levels of both after PTCA. Group II (n=26, 12.6%) had abnormal levels of CK-MB (>or=16 U/L) and/or TnT (>or=0.2 ng/mL). 1-year follow-up was available in 201 (97.1%) patients. RESULTS: Incidence of non-Q MI after PTCA was 26/207 (12.6%). Major complications such as acute coronary occlusion, side branch occlusion, and major dissection were significantly associated with elevation of TnT or CK-MB after PTCA (p=0.01). However, elevation of CK-MB or TnT was not significantly associated with late MACE by Kaplan-Meier survival curve (p=0.46). During 1-year follow-up, event free rate of group I and II were 76.6% and 69.2%, respectively. CONCLUSION: Acute coronary occlusion, side branch occlusion, or major dissection can increase the level of TnT or CK-MB after PTCA. But, elevation of CK-MB or TnT after PTCA dose not significantly influence on late MACE.

Determinants of White Coat Effect in Essential Hypertension

BACKGROUND: White coat effect (WCE) and white coat hypertension (WCH) are relatively prevalent in clinical situation (20 - 57% of WCH in the hypertensive population). The aim of this study was to analyze the determinant factors of WCE. METHODS: A prospective study was carried out in outpatient clinic in a consecutive hypertensives without receiving pharmacologic treatment. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed following more than two resting blood pressure (BP) determinations carried out with the interval of 1 - 2 weeks by mercury sphygmomanometer. WCE was calculated for systolic and diastolic BP as the difference between a clinic BP (CBP) and an average daytime ambulatory BP (ABP). WCH was defined as;BP in the clinic > or = 140/90 mmHg with a mean daytime BP by ABPM < or =137/< or =89 mmHg. RESULTS: 1) Two hundred thirty-five patients (mean age 49.7 years, females 74%) were studied. Thirty-seven percent in male and forty-six percent in female patients fulfilled WCH criteria. 2) CBP was significantly correlated to daytime ABP (systolic BP;r=.47, p<.001 and diastolic BP;r=.65, p<.001). 3) The magnitude of WCE was greater in the group of WCH (28.9+14.6/19.3+6.9 mmHg) than ambulatory hypertensives (15.1+15.7/13.0+8.2 mmHg) (p<.001). 4) The magnitude of WCE is significantly correlated with female (r2=.12, p<.001) and the stage of CBP according to JNC-V (r2=.23, p<.001) in systolic BP, the stage (r2=.08, p<.001) in diastolic BP, and the stage (r2=.09, p<.001) and weight (r2=.15, p<.01) in mean BP. CONCLUSIONS: The magnitude of WCE in essential hypertension diagnosed at the clinic is significantly correlated with female, the magnitude of clinic BP, and weight.

Problems in Measuring Blood Pressure

No abstract available.