Signal Averaged Electrocardiography Using Holter Tape in Patients without Heart Disease

BACKGROUND: Ventrlcular tachyarrhythmias are major cause of sudden cardiac death in patients after myocardial infarction and their accurate detection seems to be important in prevention of sudden cardiac death. Clinical findings, treasmill test, holter monitoring and coronary angiography have been used to search for high risk group in sudden cardiac death. Recently electrographysiologic stimulation has been to this, but it is not practical, because of high cost and invasiveness. Signal averaged electrocardiogram(SAECG) may be helpful in prediction of high risk group in sudden cardiac death. So we try to know the values of SAECG in Korean patients without heart disease. RESULTS: 1) The mean value and standard deviation of Time domain analysis is as follows ; fQRS : 106.8+/-12.3ms, RMS : 36.2+/-21.5(micro)V, LAS : 27.2+/-8.1ms. 2) The mean value and standard deviation of Spectral turbulence analysis is a follows ; LSCR : 58.6+/-3.9, ISCM : 95.2+/-0.8, ISCSD : 71.8+/-15.7, SE : 6.9+/-1.8. CONCLUSION: There was no significant difference between male and female. Time domain analysis shows significant differences among each hour but spectral turbulence analysis did not. Spectral turbulence analysis shows high specificity.

Apoptosis in Ischemia-Reperfused Myocardium of Rabbit

BACKGROUND: Apoptosis, as opposed to necrosis, is a active and regulated mode of cell death. Persistent myocardial ischemia results in necrosis. The most effective method to limit ischemic myocardial injury is reperfusion, however, reperfusion itself may be associated with tissue injury. The pathophysiologic findings of myocardial ischemia-reperfusion are well known. However, involvement of apoptosis, as a form of tissue damage, has not neen well defined. Recently apoptosis has been suggested as a specific feature of myocardial reperfusion injury leading to late cell death. This study was performed to investigate whether reperfusion induces apoptosis irrespective of reperfusion time, and the pattern of distribution and the extent of apoptosis in rabbit myocardium. METHOD: New Zealand white rabbits weighing 1.8-2.9kg underwent 20 or 30 minutes left anterior descending(LAD) or left circumflex coronary artery occlusion followed by reperfusion for 30 minutes(n=1), 1 hour(n=1), 3 hours (n=2), and 4 hours (n=3). Ventricles were excised immediately after intervention. Tissues were fixed in 10% buffered formalin and embedded in paraffin. Apoptosis was examined by hematoxylin and eoisin(H & E) staining, in situ nick end labeling, and transmission electron microscopy. Number of apoptotic cells was evaluated semiquantitatively on H & E stained section. Myocardial tissues of ischemia only(LAD occlusion for 30 minutes, n=2) and normal rabbits(n=2) were also examined. RESULTS: Evidence of apoptosis was detected in every ischemia-reperfused myocardium irrespective of reperfusion time of 30 minutes to 4 hours. Apoptotic cells were found in the non-necrotic myocardium near necrotic areas and in islets of the non-necrotic myocarium inside necrotic areas. In the areas where apoptotic cells were distributed, the average number of apoptotic cells ranged from 1.0(30 minutes and 1 hour reperfused myocardium) to 1.1(3 hours and 4 hours reperfused myocardium) per high power field(X400)(the proportion ; less than 1% of cardiomyocytes at specific time point of reperfusion). Apoptotic cells were not detected in ischemia only and normal myocardium. CONCLUSION: These fingings suggest that apoptosis is involved as a form of cell death and it may contribute to cardiomyocyte loss not to a large extent in ischemia-reperfusion injury of rabbit myocardium.

Three Cases of Vibrio cholerae Serogroup Non-O1 Septicemia / 감염

Non-O1 V. cholerae usually causes endemic disease. Common clinical manifestations of this infection involve gastroenteritis, sepsis, and wound infection. In Korea, six cases of infection with this pathogen have been reported. From 1995 to 1996, non-O1 V. cholerae was isolated from blood of three patients of sepsis in this hospital. Two of them had liver cirrhosis as an underlying disease. One patient died of progressive sepsis and another two patients recovered. The isolates were identified by API 20E(API system, BioMerieux, France) and their biochemical properties were characterized. The serotypes of two isolates were determined to be O2 and O24. These cases, with the previous reports, suggest that non-O1 V. cholera should be considered as a pathogen causing septicemia in patients who have underlying disease of liver cirrhosis during summer.

Outbreak of Multi-resistant Acinetobecter baumannii in Intensive Care Unit of a Newly Opened Hospital / 병원감염관리

BACKGROUND: A sustained outbreak of multi-resistant Acinetobacter baumannii has been noticed in intensive care unit (ICU) of a newly opened hospital. METHODS: We retrospectively studied 72 patients in the ICU whose specimen grew A. baumannii from March to December 1995. To identify risk factors for infection, a case control study was conducted. Comparing clinical characteristics of 19 infected patients with those of 53 colonized cases. Environmental culture was performed in January 1996 to identify the source of infection. We analyzed antibiotic susceptibility of the isolates, and ribotyping was performed with 52 isolates. RESULTS: Nineteen out of 72 patients developed disease: primary sepsis 2, catheter related infection 2, catheter related infection and pneumonia 2, wound infection 5, wound infection and sepsis 2, pneumonia 6. On comparison of clinical characteristics between the infected and colonized groups, central venous catheterization was a significant risk factor for development of disease by A. baumannii (P<0.05) and duration of lCU stay was a factor independently associated with A. baumannii infection by logistic regression analysis. An epidemiologic investigation failed to identify the source of infection, but we found 2 of 3 sinks in lCU were heavily contaminated by the organism. Antibiogram of the isolates showed a multi-drug resistance including amikacin, which was found to increase gradually during the course of the outbreak. Ribotyping showed 3 major subtypes: 2A (18 isolates) 2B (16) 2B'(13) and other types (5). CONCLUSION: The findings from this study support the reports from many parts of the world that A. baumannii plays an increasingly important role as one of the major nosocomial pathogens.

Outbreak of Multi-resistant Acinetobecter baumannii in Intensive Care Unit of a Newly Opened Hospital / 병원감염관리

BACKGROUND: A sustained outbreak of multi-resistant Acinetobacter baumannii has been noticed in intensive care unit (ICU) of a newly opened hospital. METHODS: We retrospectively studied 72 patients in the ICU whose specimen grew A. baumannii from March to December 1995. To identify risk factors for infection, a case control study was conducted. Comparing clinical characteristics of 19 infected patients with those of 53 colonized cases. Environmental culture was performed in January 1996 to identify the source of infection. We analyzed antibiotic susceptibility of the isolates, and ribotyping was performed with 52 isolates. RESULTS: Nineteen out of 72 patients developed disease: primary sepsis 2, catheter related infection 2, catheter related infection and pneumonia 2, wound infection 5, wound infection and sepsis 2, pneumonia 6. On comparison of clinical characteristics between the infected and colonized groups, central venous catheterization was a significant risk factor for development of disease by A. baumannii (P<0.05) and duration of lCU stay was a factor independently associated with A. baumannii infection by logistic regression analysis. An epidemiologic investigation failed to identify the source of infection, but we found 2 of 3 sinks in lCU were heavily contaminated by the organism. Antibiogram of the isolates showed a multi-drug resistance including amikacin, which was found to increase gradually during the course of the outbreak. Ribotyping showed 3 major subtypes: 2A (18 isolates) 2B (16) 2B'(13) and other types (5). CONCLUSION: The findings from this study support the reports from many parts of the world that A. baumannii plays an increasingly important role as one of the major nosocomial pathogens.

Diagnostic Significance of Pseudonormalization during Treadmill Exercise Test in Ischemic Heart Disease

BACKGROUND: The interpretation of electrocardiographic change in treadmill exercise test is difficult when the test is performed in patients with abnormal resting electrocardiography. In patients with primary nagative T wave, normalization of primary negative T wave(pseudonormalization)is not uncommon finding during treadmill exercise test. The mechanism of pseudonormalization is uncertain and the interpretation is difficult. Thus this study was performed to evaluate the diagnostic significance of pseudonormalization during treadmill exercise test. METHODS: 200 cases who showed primary negative T wave at rest were included in this study. The results were classified as positive, borderline positive, borderline negative, negative, non-diagnostic and pseudonormalization. RESULTS: Pseudonormalization during treadmill exercise test was oberved in 78(39%) of the 200 cases who had primary negative T wave at rest. Coronary angiography and left ventriculography were performed in 13(mean age 56+/-7 year, male vs. female 1:2.25) of 78 cases who showed pseudonormalization during exercise. They had no history of acute myocardial infarction and no abnormalities such as abnormal Q wave, left ventricular hypertrophy,bundle branch block,right ventricular hypertrophy and QRS widening above 0.1ms in resting electrocardiography. There were significant stenosis in only 3 cases; 2 cases in left anterior descending coronary artery and 1 case in right coronary artery. CONCLUSION: In treadmill exercise tests, pseudonormalization appears as non-specific finding for the diagnosis of ischemic heart disease becuase it is observed in either patients with or without coronary artery stenosis.

Increased Expression of Phospholipase C-gamma1 in Phenylephrine Induced Cardiac Hypertrophy of Rats

BACKGROUND: Cardiac hypertrophy is an adaptive mechanisms in response to an increased cardiac work load. Alterations in gene expression play an important role in this adaptive process. Recent investigations have indicated that the alpha-1 adrenergic stimulation in vitro induces hypertrophic change of neonatal cardiomyocytes. The signalling mechanisms of this alpha-1 agonist induced cardiomyocyte hypertrophy are largely unknown. however, recent evidence favors an effector pathway that involves phospholipase C(PLC) mediated hydrolysis of phosphatidylinositol 4,50 bisphosphate. It should be recognized that the demonstration of enhanced phosphoinositol turnover in the presence of alpha-1 adrenergic agonist in vitro does not necessarily imply that a similar response is operative in vivo. Furthermore, the role of subtypes of phospholipase C in this system should be determined. In this context, we produced in vivo cardiac hypertrophy by repeated injection of alpha-1 adrenergic agonist, phenylephrine, and tried to evaluate any change of phospholipase C subtypes by immunohistochemistry and immunoblotting technique and also measured the phosphatidylinositol hydrolyzing activity of the enzyme. METHOD: To produce cardiac hypertrophy, we injected phenylephrine 12mg/kg i.p. to the 28 female S-D rats weighing 150-250g daily for 5 days. This measures produced 22% increase of heart weight/body weight ratio. After 5 days. rats were sacrificed and hearts were rapid excised and freezed for next procedure. The immunohistochemical stainings of myocardium were carried out using monoclonal antibodies against PLC-beta1,-gamma1,-delta1 with Avidine-Biotin Complex method. Immunoblotting was done with monoclonal anti-PLC-gamma1 antibody after immnoprecipitation. The activity of PLC-gamma1 was determined in the assay mixture containing [3H] phosphatidylinositol of 20,000 cpm. The reaction was performed by incubating with resuspended immunoprecipttol of 20,000 cpm. The reaction was performed by incubating with resuspended immunoprecipitate for 10 min and supernatant was collected for -scintillation counting. RESULTS: Immunohistochemical staining demonstrated increased staining of PLC-gamma1 in the phenylephrine induced hypertrophied heart as compared with normal control heart. PLC-beta1 and-o1 did not showed any change. Elghteen out of 20 hypertrophied cardiac tissue(90%) demonstrated increased expression of the PLC-gamma1 compared with control heart tissue in immunoblotting. [3H] PI hydrolyzing activity of PLC-gamma1 in the immunoprecipitates of the hypertrophied hearts(4650+/-614 cpm) were increased consistently in 6 samples as compared with control normal hearts (2387+/-651 cpm). CONCLUSION: In the present experiments we demonstrated that Phospholipase C-gamma1 was overexpressed compared with control normal heart of rat by immunohistochemistry and immunoblotting technique and showed that the activity of this isoenzyme was elevated. Our findings of increased PLC-gamma1 expression in the alpha1-adrenergic agonist induced cardiac hypertrophy tissue suggest that the phosphatidylinositol signalling pathway is important in the genesis of cardiac hypertrophy and the isoenzyme of PLC-gamma1 may play a central role in this mechanism.

The Effect of Non-Ionic Contrast Media on Q-T Interval and ST-T Wave of ECG during Coronary Angiography

BACKGROUND: During coronary angiography, some electrocardiographic changes occured due to contrast media, which do life threatening influences. METHODS: We compared the electrocardiographic changes which were induced by injection of three radiopaque contrast media during selective coronary angiography in 49 patients with chest pain. One of the contrast media was high osmolar ionic(Urografin_76) and the another was low osmolar ionic(Hexabrix) and the last was non-ionic(Ioversol). Electrocardiograms were obtained before, during and after selective coronary angiography. RESULTS: The changes of S-T segment or T were decreased in non-ionic group rather than high osmolar or ionic group. And there was significant Q-Tc interval prolongation among all three groups except comparision of low osmolar ionic contrast dye and non-ionic contrast dye in left coronary angiography. CONCLUSION: Non-ionic low osmolar contrast media was safer than high osmolar or ionic contrast medial because of lesser change of Q-Tc interval during selective coronary angiography.

The study of 24-hour holter monitoring in patients with coronary artery disease

BACKGROUND: Patients with ischemic heart disease have many episodes of ischemic attack which is presented as ST-T change in electrocardiogram during ordinary daily life. The purpose of this study was to confirm the presence of a significant circardian variation in transient myocardial ischemia and the difference of the incidence of ischemia according to involved vessel. METHODS: Twenty two patients with angiographically significant coronary stenosis were evaluated. The ambulatory electrocardiography(Holter monitoring) was performed in each patients. RESULTS: One hundred twenty-eight episodes of ischemic ST-T changes occured in 18(82%) of 22 patients and 65(51%) episodes of ischemic ST-T changes occured between 6 A.M. and 12 noon(p<0.005). The mean frequency per patient according to involved vessel was 9 in double vessel disease, 4.5 in diffuse sclerosis with old myocardial infarction, 2.9 in single left anterior descending, 2.3 in single right coronary and 1 in single left main coronary artery disease. The only one episode of T wave change was observed in patients with lesion of left circumflex artery. The mean frequency of ST changes per patient according to type of angina was 4.8 in postinfartion angina, 3.5 in unstable angina and 2.1 in stable angina and the mean frequency of T change was 4.7 in stable angina, 2 in unstable angina and 0.3 in postinfarction angina. CONCLUSIONS: The significant circardian variation of ischemic activity was found in patients with ischemic heart disease. The mean frequency of ST change was higher in double vessel disease and diffuse sclerosis with old myocardial infarction than in other coronary artery lesion. And the episode of ST change was more frequent in postinfarction angina and unstable angina pectoris and the episodes of T change in stable angina pectoris. Also this study suggest 24-hour Holter monitoring has a low detectability of ischemic episodes in patient with lesion of left circumflex artery.

Complications for implanted cardiac permanent pacemaker / 대한내과학회지

No abstract available.

A Clinical Study on the Antihypertensive Effect of Nipradilol

beta-receptor antagonist as antihypertensive agent has adverse effect such as vasoconstriction, bronchoconstriction and aggravation of atherosclerosis. So beta-receptor antagonist with alpha-receptor blocking property has been studied for avoidance of adverse effects of beta-receptor antagonist. Nipradilol, a new beta-receptor antagonist with alpha-receptor blocking property was administrated in 30 essential hypertensive patients for 10 week in order to evaluate the antihypertensive effects and adverse effects. The results were as follows: 1) Nipradilol was effective in 20 patients(67%) on systolic blood pressure 22 patients (73%) on diastolic blood pressure at the end of 10 weeks treatment. 2)Before medication, mean systolic and diastolic blood pressure in sitting position were 160+/-14mmHg and 102+/-18mmHg,and after 10 weeks of medication, mean systolic and diastolic blood pressure were significantly declined to 143+/-22mmHg and 89+/-12mmHg(p<0.001). 3) There was no significant change in pulse rate, from 78+/-12 beats per minute the beginning of the treatment to 75+/-11 beats per minute after 10 week of treatment. 4) There was no significant changes in sodium, potassium, GOT, GPT, bilirubin, alkalin ephosphatase, BUN, creatinine, LDH, CPK and lipid. 5) The adverse effects of nipradilol were bradycardia(7%), dyspnea(3%), chest discomfort(3%) and headache(3%). In summary, nipradilol seemed to be effective antihyertensive drug in treating mild to moderate hypertension.

A Case of Viral Myocarditis Presenting as Acute Extensive Myocardial Infarction

Viral myocarditis is a inflammatory process of the heart caused by virus. Its manifestation ranges from asymptom to acute fulminent congestive heart failure and often mimics acute myocardial infarction. A 22 year old man was admitted to the hospital because of prolonged anterior chest pain. 15 days before entry, anterior chest pain with cough and fever brought him to the another hospital. At that time, the LDH level was 1160U/L, the CPK level was 659.7U/L and MB band was 16.1%. The ECG revealed acute inferior wall infarction. And 3 days later, extensive anterior wall infarction findings appeared. 2D-Echo findings showed proximal septal hypokinesia. On admission time to this hospital, physical examination was negative. The ECG showed no interval change. 2D-Echo findings showed increased echogenicity of anterior and inferior wall. Treadmill test did not evoked chest pain or change of ECG. The LDH, CPK levels returned to normal range. The antibody titers of Coxsackievirus type A-16 was positive. Coronary angiography showed normal findings. 3 months later, antibody's titer of Coxsackievirus A-16 was increased. A diagnosis of acute viral myocarditis was made.

Differential Diagnosis between Dilated Cardiomyopathy and Ischemic Heart Failure with Post-Exercise Echocardiography

BACKGROUND: Ischemic cardiomyopathy and dilated cardiomyopathy may be clinically indistinguishable and cardiac catheterization is often required to differentiate between them. And many nonivasive methods including myocardial Thallium scan have showed nonspecific results in differentiating between them. METHODS: We studied the change of echocardiographic ejection fraction after exercise in 8 patients with ischemic heart failure and 9 patients with dilated cardiomyopathy and have assessed the usefulness of this noninvasive technique in distinguishing between the two groups. RESULTS: All patients with ischemic cardiomyopathy displayed the significant decrease of ejection fraction at 5 minutes after exercise(p28.75+/-7.89%-->34.38+/-8.50%). Respectively, all patients with dilated cardiomyopathy showed the significant increment of ejection fraction at 5 minutes(p46.33+/-11.93%-->35.00+/-5.68%). CONCLUSION: Our results suggest that echocardiographic ejection fraction at post-exercise 5 minutes, will be the adjunctive method to differentiate between ischemic cardiomyopathy and dilated cardiomyopathy.

Risk Factors For Subtypes of Cerebrovascular Disease in Korea

With a purpose to difine risk factors of respective subtypes of cerebrovascular disease, a case-control study was performed in 1,251 cases with cerebrovascular disease who were admitted to twelve large institutions over the country during the year of 1988. All cases were subtype-proven by computerized tomography. Three hundred and eighty three patients were selected as control among the patients who were admitted to the same hospitals during the same period. The variables were collected prospectively and the data were processed by univariate and multiple logistic regression analyses and the significance was tested by chi-square methods. In the univariate analysis, female sex, being a physical worker, history of hypertension either treated or not and previous stroke history were significantly related with cerebral hemorrhage. Male sex, being aged 60 or more, living in city area, being a mental worker, history of hypertension either treated or not, history of stroke, being a diabetic and positive family history of stroke were significantly related with cerebral infarction. In multiple logistic regression analysis hypertension and alcohol drinking were strong independent risk factors for cerebral hemorrhage. Hypertension, being aged 60 or more, and living in urban area were also independent risk facrots for cerbral infarction. Of the other variables analyzed, socioeconomic class, smoking history or body mass index did not constitute significnat risks for either cerebral hemorrhage or cerebral infarction.

The Comparison of Renal Handling of Sodium and Potassium According to Salt Intake between Control and Hypertensive Group

The salt-sensitivity has been generally accepted as a mechnism of high blood pressure in elderly hypertensive patients, and so it may result in a difference of renal handling of sodium and potassium between normal healthy control and elderly hypertensive patient. So to evaluate an lbove difference, the amount of 24 hours' urinary excretion of Na+ & K+ were measured in healthy normotensive control (10 case) and elderly hypertensive group(10 case) according to normal diet (12-15gm of NaCl) for first 3 days and low salt diet (3~5)gm of NaCi) for next 3 days, also blood rewwure was mintored. The results were followed : 1) 24 hours' urinary excretion of NA+ was increased in hypertensive group more than control group at first day of normal diet and low salt diet significantly. 2) After a replacement of normal diet to low salt diet, a maximal decrement of 24 hours' urinary excretion of Na+ was 25% at first day in control but 40% at second day in hypertensive group only. 3) There was a similar pattern of urinary excretion of K+ as Na+ in hypertensive group, but it was not stastically significant. 4) There was no significant changes of blood pressure, serum electrolyte and BUN/creatinine according to salt intake in both group. From above findings. We can conclude that a urinary excretion of sodium is delayed in elderly hypertensive group, and it is suggested that a delayed excretion of sodium. is associated with retention of sodium in body. So a persistent restriction of sodium is recommended in elderly hypertensive patient.

The Evaluation of Position of Interventricular Septum Measured by Transitional Zone of EKG

The position of interventricular septum, which was measured by transitional zone of EKG, was compared with that measured by 2-D echocardiography in 51 patient. 1) The position of interventricular septum measured by 2-D echocardiography was very similar to that measured by transitional zone of EKG. 2) Extensive AMI (Anterior Myocardial Infarction) and LBBB showed moderate differences between two method. 3) RBBB and replaced mitral valve state showed severe differences between two methods. Transitional zone of EKG was helpful to define the position of interventricular septum except extensive AMI, bundle branch block and replaced mitral valve state.

The Comparison of Antihypertensive Effects among Hydralazine, Clonidine and Nifedipine in Hypertensive Emergency

If hypertensive emergencies are left untreated, multiple damages on heart, brain and kindney can develop. So rapid control of blood pressure within safty with effective antihypertensive agents is mandatory. For the comparison of antihypertensive effects among hydralazine (IV or IM), clonidine (IV), and nifedipine (sublingual) in hypertensive emergency, which were frequently used in our hospital, we performed propective study with hypertensive emergency patients(243 cases) who visited emergency room from Oct. 1986 until Aug. 1987. The results are as follows ; 1) For 58 patients who recieved hydralazine (IV or IM), initial mean arterial blood pressure(MAP) was 167.2+/-21.5mmHg and 15 minutes later 138.9+/-24.4mmHg, 45 minutes later 141.7+/-21.1mmHg, 90 minutes later, 133.9+/-26.6mmHg and, respectively. For 55patients who recived clonidine(IV), initial MAP was 164+/-21.9mmHg and 15minytes later 137.4+/-18.9mmHg, 45 minutes later 127.5+/-34.9mmHg, respectively. For 130 patients who recived nifedipine(sublingual), initial MAP was 159.8+/-21.4mmHg and 15 minutes later 143.0+/-22.8mmHg, 45 minutes later 127.5+/-21.1mmHg, 90 minutes later 119.3+/-20.0mmHg, respectibely. 2) Pulse rate showed 12.9% increase afer administration of hydralazine, 15.8% decrease in clonidine, 5.6% increase in nifedipine, respectively. 3)Severe reduction of blood pressure(systolic BP<130mmHG) after administration of following antihypertensive agents was found. i.e., hydralazine 5.2%, clonidine 1.8%, nifedipine 1.5%, respectively. 4) In 4 cases(6.9%) out of the 58 cases using hydralazine, 3 cases(5.5%) out of the 55 cases using clonidine, 9 cases(6.9%) out of the 130 cases using nifedipine, acute paradoxic hyertensive effects were observed.

Uinical Observation on Antihypertensive Effects of Nitrendipine

1) Daily dose was 10-20mg Q.D. for 12 weeks. 2) Mean systolic and diastolic pressure were decreased by 49mmHg(25.9%), and 18mmHg(16.8%) respectively. But there was no significant change in heart rate before and after treatment. 3) Systolic and diastolic blood pressure were stably maintained on the whole day. 4) There were no significant side effects except two cases of aggravated congestive heart failure and hypertension. 5) There were no significant changes on hematologic & biochemical parameters before and after treatment.

The frequency distribution of cardiovascular diseases in 13 hospital admitted patients in Korea: Korean Society of Circulation

The frequency distribution of cardiovascular disease are changing recently due to the development of living environment. Unfortunately there are few epidemiological studies of cardiovascular diseases in general population, we tried to estimate the recent trend of cardiovascular diseases studying hospitalized patients in nationwide 13 large hospitals during a year of 1985. The hypertensive disease (24.1%) was the most common cardiovascular disease and the next were cerebrovascular disease (15.8%), arrhythmias (12.2%), ischemic heart disease (9.7%), congenital heart disease (9.1%), and rheumatic heart disease (5.4%) in order. This results showed that hypertensive disease and cerebrovascular disease are still the major cardiovascular disease and ischemic heart disease and arrhythmias are increased. But chronic rheumatic heart disease is declined compared with previous studies in hospitalized patients.

A Clinical Study on Hypertensive Encephalopathy

Hypertensive encephalopathy is an acute clinical syndrome that shows central nerve dysfunction with sudden and marked elevation in blood pressure. But its pathophysiologic mechanisms, clinical courses and prognosis are still not clear. In order to study clinical manifestations and response to treatment in patients with hypertensive encephalopathy, we reviewed 45 patients with hypertensive encephalopathy who were admitted in Dept. of Internal Medicine, National Medical Center, from January 1975 to December 1984. The following results were obtained: 1) The ratio of male to female was 1.1:1. The peak age of incidence was in the 6th and 7th decade with mean age of 57.5 years. 2) Among 45 patients, only 29 had known history of hypertension and the average duration of hypertension was 8.1+/-3.6 years. 3) The most common sympotm was severe headache (68.9%). And altered consciousness, nausea and/or vomiting, focal neurologic signs and visual disturbance were also common symptoms in decreasing order of frequency. 4) Funduscopic examination showed hypertensive retinopathy in 20 of 24 (91.7%) patients and lumbar puncture revealed increased CSF pressure in 12 of 20 (60%) patients. 5) In most patients, the mean interval to symptomatic improvement was 2.1 days after administration of anti hypertensive agents, but in 6 patients with initial mean arterial blood pressure above 170mmHg, 4 patients showed delayed response and 2 patients were expired.