Complete Atrioventricular Block-Induced Torsade de Pointes, Manifested by Epilepsy

Complete atrioventricular (AV) block is frequently regarded as a cause of informed syncopal attacks, even though the escape rhythm is maintained. Torsade de pointes (TdP) may be a significant complication of AV block associated with QT prolongation. Here, we report the case of a 42-year-old female who was referred to our hospital due to recurrent seizure-like attacks while taking anti-convulsant drugs at a psychiatric hospital. TdP with a long QT interval (corrected QT = 0.591 seconds) was observed on an electrocardiogram (ECG) taken in the emergency department. The patient's drug history revealed olanzapine as the suspicious agent. Even after the medication was stopped, however, the QT interval remained within an abnormal range and multiple episodes of TdP and related seizure-like symptoms were found via ECG monitoring. A permanent pacemaker was thus implanted, and the ventricular rate was set at over 80 beats/min. There was no recurrence of tachyarrhythmia or other symptoms.

A Case of Isoniazid Induced Gynecomastia / 결핵및호흡기질환

No abstract available.

A case of congenital bilateral coronary-to-right ventricle fistula coexisting with variant angina

A coronary arteriovenous (AV) fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common anomaly that can affect coronary perfusion. Yet bilateral involvement of a coronary fistula, constitutes an uncommon subgroup of coronary AV fistulas. We herein report on a case of bilateral coronary AV fistula that was coexistent with variant angina originating from the distal right ventricular branch of the right coronary artery and the distal septal branch of the left anterior descending artery, and the latter drained into the right ventricle.

Prospective, Randomized, Preliminary Clinical Trial with Low-Molecular-Weight Heparin or Unfractionated Heparin as Periprocedural Anticoagulant during Elective Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: LMWH as a periprocedural anticoagulant during PCI has not yet been extensively studied. The aim of this study is to compare the clinical outcomes of enoxaparin to those of unfractionated heparin (UH) during elective PCI. SUBJECTS AND METHODS: The eligible patients were randomized 1:1 into two treatment arms, either a single IV bolus of enoxaparin (75 IU/kg) or UH (100 IU/kg). The patients who had received any anticoagulants at therapeutic doses were excluded in this study. Data on patient characteristics, angiographic complications, laboratory variables and the in-hospital and 1-month clinical outcomes were compared between the two groups. RESULTS: Of the 139 patients enrolled in this study, 68 received enoxaparin and 71 received UH. The patients' demographic and angiographic characteristics (gender, weight, creatinine and the PCI target vessel) were not different except for age between the groups. Multi-vessel angioplasty was performed in 59 (42.4%) patients. At least one stent was implanted in 130 (93.5%) patients. The sheath was removed immediately after PCI, except for one case, and then a collagen plug was applied in all the cases. There were no significant differences in angiographic complications like no reflow, thrombus at the treated lesion site, occlusion of collateral branches, distal embolism, dissection, coronary rupture or abrupt closure. Cardiac markers including CK (6 [8.8%] in the LMWH group vs 8 [11.3%] in the UH group), CK-MB (6 [8.8%] vs 8 [11.3%], respectively), and troponin-I (6 [8.8%] vs 10 [14.1%], respectively) were slightly increased after PCI compared to the last value obtained before the procedure in both groups, but the differences were not statistically significant. One patient in the enoxaparin arm and 2 patients in the UH arm developed NSTEMI during their admission. Four patients from the UH arm and 3 from the enoxaparin arm experienced hematoma at the puncture site. After discharge, no other events were reported at the 1-month follow-up. CONCLUSION: The use of enoxaparin (75 IU/kg) during elective PCI was effective and safe as using UH. Enoxaparin could be used like UH as a periprocedural anticoagulant in the elective PCI setting.

Prospective, Randomized, Preliminary Clinical Trial with Low-Molecular-Weight Heparin or Unfractionated Heparin as Periprocedural Anticoagulant during Elective Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: LMWH as a periprocedural anticoagulant during PCI has not yet been extensively studied. The aim of this study is to compare the clinical outcomes of enoxaparin to those of unfractionated heparin (UH) during elective PCI. SUBJECTS AND METHODS: The eligible patients were randomized 1:1 into two treatment arms, either a single IV bolus of enoxaparin (75 IU/kg) or UH (100 IU/kg). The patients who had received any anticoagulants at therapeutic doses were excluded in this study. Data on patient characteristics, angiographic complications, laboratory variables and the in-hospital and 1-month clinical outcomes were compared between the two groups. RESULTS: Of the 139 patients enrolled in this study, 68 received enoxaparin and 71 received UH. The patients' demographic and angiographic characteristics (gender, weight, creatinine and the PCI target vessel) were not different except for age between the groups. Multi-vessel angioplasty was performed in 59 (42.4%) patients. At least one stent was implanted in 130 (93.5%) patients. The sheath was removed immediately after PCI, except for one case, and then a collagen plug was applied in all the cases. There were no significant differences in angiographic complications like no reflow, thrombus at the treated lesion site, occlusion of collateral branches, distal embolism, dissection, coronary rupture or abrupt closure. Cardiac markers including CK (6 [8.8%] in the LMWH group vs 8 [11.3%] in the UH group), CK-MB (6 [8.8%] vs 8 [11.3%], respectively), and troponin-I (6 [8.8%] vs 10 [14.1%], respectively) were slightly increased after PCI compared to the last value obtained before the procedure in both groups, but the differences were not statistically significant. One patient in the enoxaparin arm and 2 patients in the UH arm developed NSTEMI during their admission. Four patients from the UH arm and 3 from the enoxaparin arm experienced hematoma at the puncture site. After discharge, no other events were reported at the 1-month follow-up. CONCLUSION: The use of enoxaparin (75 IU/kg) during elective PCI was effective and safe as using UH. Enoxaparin could be used like UH as a periprocedural anticoagulant in the elective PCI setting.

Cecal rupture by Anoplocephala perfoliata infection in a thoroughbred horse in Seoul Race Park, South Korea

A 7-year-old Thoroughbred horse was admitted to the Equine Hospital, Korea Racing Association with signs of colic. Based on the size of impactions, the clinical signs, the results of abdominal paracentesis and medical treatment, the prognosis was poor. The horse died 3 hours later following hopeless discharge. At necropsy, the caecum and large colon were fully filled with fecal contents and there was a rupture (10 cm in dia) in the latero- ventral caecum. The mucosa of the ileo-caecal and caeco- colic valves appeared to the hyperemic, edematous and ulcerous. There were many tapeworms in the affected mucosa. Histopathologically, lesions included hyperaemia, a deep necrotic inflammatory lesion and ulcers in the mucosa and submucosa of ileo-caecal and caeco-colic valves. One hundred thirty four faecal samples were obtained from 16 stables and submitted to parasitic examination. A total of 4 genera of eggs were recovered: Stongylus spp (82.1%), Anoplocephala perfoliata (10.5%), Bovicola equi (0.7%) and Parascaris equorum (1.5%). The major findings in this study are the presence of A perfoliata and its suspected association with the colic which led into an eventual caecal rupture. This study indicates the needs for an epidemiological survey of colic that is associated with Anoplocephala.