A Case of Ventricular Fibrillation Aassociated with Hyperthysoidism / 대한내분비학회지

The cardiovascular manifestations in hyperthyroidism are sinus tachycardia, paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation, atrioventricular block, bundle branch block(especially right bundle branch block), angina pectoris, heart failure and cardiomyopathy. Of these, angina pectoris is commonly seen in hyperthyroidism with coronary artery disease and the potential mechanisms have been attributed to the increased metabolic demand and consequently increased cardiac work which result in the more demand of coronary blood flow than that can be delivered via a fixed atherosclerotic coronary artery stenosis. Hyperthyroidism associated anginas without underlying coronary artery stenosis have also been reported where the mechanism of these was suspected to be the coronary vasospasm. Ventricular fibrillation may occur in the thyrotoxic patients due to myocardial ischemia such as variant angina, but it is very rare in the condition without previous heart disease. A 30-year-old male was admitted to the hospital because of palpitation, weight loss and proptosis for the previous 3 months. There was no history of effort related chest pain, syncope, drug abuse or medical illnesses such as diabetes mellitus, hypertension. The laboratory results were, TSH: 0.38uU/mL(0.4~5,0 uU/mL), free T4: 8.9ng/dL(0.8~1.9ng/dL), TSH receptor antibody: 43.6%(-15~15%), antiTPO antibody: 5000 IU/mL(0~100 IU/mL). The initial EKG showed normal sinus rhythm. He was diagnosed as Graves disease with ophthalmopathy, class 3a and was put on propylthiouracil 200 mg po tid, propanolol 40 mg po tid and started solumedrol pulse therapy for the exophthalmos on the first day of admission. He was found to have generalized tonic seizure with apnea attack on second hospital day and twice thereafter. Ventricular fibrillation was documented at that time. DC cardioversion was performed with successful response. After the attack, he was treated as accelerated hyperthyroidism namely with increased dosage of propylthiouracil, dexamethasone and Lugols solution, The echocardiogram, treadmill test, ergonovine echocardiography, coronary angiography and electrophysiologic study disclosed no abnormalities. Further episodes of ventricular fibrillation didnt occur after being euthyroid state. In conclusion, we report a case of ventricular fibrillation associated with hyperthyroidism itself without underlying coronary artery disease with brief review of literatures.

Late Clinical Outcome after Intracoronary Palmaz-Schatz Stenting with High Pressure Balloon Dilatation without Anticoagulation

BACKGROUND: The intracoronary stent implantation is accepted as the treatment modality to reduce restenosis in comparison with balloon angioplasty in patients with coronary artery disease. In recent studies, the technique of high pressure balloon dilation for stent optimization has been shown to improve procedural success and to reduce the subacute closure after stenting. The late clinical outcome, however, is still uncertain after stenting with high pressure balloon dilation. Therefore, we evaluated the effect of high pressure balloon dilation on subsequent clinical courses after intracoronary stenting. METHOD: One hundred sixty nine patients with 176 lesions were treated with Palmaz-Schatz stent implantation. Intracoronary stenting without high pressure balloon dilation was perforned in 55 patients with 55 lesions(phase 1), whereas intracoronary stenting with high pressure balloon dilation was done in 114 patients with 121 lesions(phase 2). We compared the angiographic and clinical results immediately and at late follow-up period after atenting between phase 1 and phase 2. RESULTS: Coronary angiography was repeated at 6 months in 135 patients, 138 lesions(78%). The overall incidence of restenosis was 25%(31% in phase 1 and 22% in phase 2). The restenosis occurred in 18% of elective stenting on de novo lesions(23% in phase 1 and 15% in phase 2). The restenosis rate was significantly reduced after using high pressure balloon dilation in infarct-related artery, final luminal diameter>/=4.0 mm after stenting and bail-out procedure(p<0.05). In phase 2, the restenosis rate was significantly higher in the lesions that had been previously dilated(43% in restenotic lesion vs 15% in de novo lesion, p<0.05) and in type C lesion compared with the others(type A, type B1, type B2 and type C ; 22%, 22%, 15% and 57%, respectively, p<0.05). According to the final luminal diameter, the restenosis rate was 7% in case of final luminal diameter greater than 4.0 mm which was significantly lower than that of final luminal diameter less than 3.5mm(p<0.05). At univariate anaysis, factors affecting restnosis were post-stent minimal luminal diameter, balloon-to-vessel ratio, acute gain and restenotic lesion. However multivariate analysis showed post-stent minimal luminal diameter was the only factor affecting restenosis. CONCLUSION: As intracoronary stenting using high pressure balloon dilation technique without anticoagulation has a good immediate results, negligible stent thrombosis and has a tendency of lower rate of restenosis.

Congenital Coronary Artery Fistula

No abstract available.

Three Cases of Single Ventricle with Asplenia

No abstract available.

Clinical Effects of Nicorandil on Angina Pectoris

The effects of oral nicorandil were evaluated in 32 patients with angina pectoris who were diagnosed by typical chest pain and postitive treadmill exercise test from December 1986 throught May 1987. The effects were measured by clinical improvement rating at 4 and 8 weeks after administration of nicorandil, and by repeated treadmill exercise test in 16 patients. The results were as follow's: 1) Clinical improvement was observed in 23(71.5%) and 25(78%) of 32 patients at 4 and 8 weeks after oral nicorandil. 2) Repeated treadmill exercise test of 16 patients showed significant prolongation of exercise duration (464+/-148 seconds vs. 526+/-174, p<0.05). 3) Hemodynamic data like blood pressure or heart rate were independent of nicorandil administration. 4) Three patients complained of headache, and one of them discontinued nicorandil. Mild indigestion was also found in another one patient.

Properties of Dual AV Nodal Pathways in Patients with Paroxysmal AV Nodal Reentrant Tachycardia

Anterograde and retrograde conduction properties of dual AV nodal pathways were analyzed in 15 patients having no accessory pathway and showing dual AV nodal pathways during extrastimulation. Four patients in whom the supraventricular tachycardia of common type (common type SVT) was induced during electrophysiological study were classified into group A. The remained 11 patients in whom the common type SVT was not induced were classified into group B. There was a history of paroxysmal supraventricular tachycardia(PSVT) in all of group A but none of group B. Among the properties of dual AV nodal pathways, effective refractory period (ERP) of anterograde fast pathway (FP) and retrograde FP were not different in both group. Maximal AH interval of anterograde slow pathway (SP) was significantly shorter in group A than in group B (P<0.01). In group A, all patients had intact ventriculoatrial (VA) conduction, but in group B, 5 patients had no VA conduction. The paced atrial cycle length producing Wenckebach block (WBCL) and the paced ventricular cycle length producing retrograde VA block (VABCL) were significantly shorter in group A the in group B (p<0.05). There were two patients showing retrograde dual AV nodal pathways. The common type SVT was not induced in both of them probably due to long ERP of retrograde FP. In conclusion, in patients with anterograde dual AV nodal pathways, the occurrence of common type SVT is highly related to anterograde slow pathway refractoriness (WBCL) and retrograde fast patway refactoriness (VABCL).