Type 4 dual left anterior descending coronary artery

No abstract available.

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 ST-Segment Elevation Myocardial Infarction Mimicking Stress-Induced Cardiomyopathy

ST-segment elevation myocardial infarction (STEMI) is a disease decribed by typical chest pain, ST-segment elevation on eletrocardiogram, elevated cardiac enzymes, along with wall motion abnormality under echocardiographic findings, and it is caused by vulnerable plaques. However, stress induced cardiomyopathy (SICM) may show similar clinical symptoms, but specific echocardiographic findings (i.e. transient left ventricular regional wall motion abnormalities with peculiar apical ballooning appearance) and normal coronary angiography may differentiate it from STEMI. Therefore, one may mistake STEMI for SICM, and lead to serious error in diagnosis and treatment of the disease. We report a case of STEMI mimicking SICM, and suggest an idea to approach the patient with SICM.

A Case of Multifocal Pyomyositis by Staphylococcus aureus

Pyomyositis, the suppurative infection of skeletal muscle, is rarely found in areas of temperate climates unless the patients have immune suppressing conditions such as diabetes, human immunodeficiency viral infection, or chemotherapy. Most reported pyomyositis cases in Korea showed localized involvement in only one or two muscles. Previously, no case of pyomyositis with multifocal metastatic dissemination has been reported in Korea. This case of pyomyositis in 51 year old man involved multiple muscles including the chest wall muscles, abdominal muscles and pelvic muscles. Pus culture results revealed Staphylococcus aureus as the causative organism. Delayed diagnosis and prior treatment of two months before visiting our hospital were considered as the causes for the metastatic dissemination of the organism. After 1 month of treatment with aggressive surgical drainage and intravenous cefazolin the patient fully recovered.

A Case of Multifocal Pyomyositis by Staphylococcus aureus

Pyomyositis, the suppurative infection of skeletal muscle, is rarely found in areas of temperate climates unless the patients have immune suppressing conditions such as diabetes, human immunodeficiency viral infection, or chemotherapy. Most reported pyomyositis cases in Korea showed localized involvement in only one or two muscles. Previously, no case of pyomyositis with multifocal metastatic dissemination has been reported in Korea. This case of pyomyositis in 51 year old man involved multiple muscles including the chest wall muscles, abdominal muscles and pelvic muscles. Pus culture results revealed Staphylococcus aureus as the causative organism. Delayed diagnosis and prior treatment of two months before visiting our hospital were considered as the causes for the metastatic dissemination of the organism. After 1 month of treatment with aggressive surgical drainage and intravenous cefazolin the patient fully recovered.

A Case of Stress-Induced Cardiomyopathy Related with the Postpartum Period

Stress-induced cardiomyopathy is a relatively rare, unique entity that has only recently been widely appreciated. It characterized by transient left ventricular regional wall motion abnormalities (with a peculiar apical ballooning appearance), chest pain or dyspnea, ST-segment elevation and/or T wave inversion and minor elevations of the cardiac enzyme levels. The patients in the previous series were usually women over 50 years of age and a triggering event was identified in most cases; these included severe emotional distress or an acute medical illness. Although reports of single episodes of stress-induced cardiomyopathy are not infrequent in the recent medical literature, we report here on a case of stress-induced cardiomyopathy in a young women, and this was related with the post-partum period as a stressful condition.

Brain Tumor is a Rare Cause of both Bradycardia and Seizure

The association between brain tumors and cardiac asystole has rarely been reported in the medical literature. This potentially life-threatening symptom has usually been observed to arise from left temporal lobe brain tumors. Yet previously published papers have shown that cardiac asystole and bradycardia, as manifestations of epilepsy, originate from the frontal lobe of the brain. Although syncope is a common presenting symptom of a brain tumor, bradycardia and complete atrioventricular (AV) block, as the first signs of a brain tumor, have been only sporadically documented in the literature. We report here on a patient with recurrent complete AV blocks that were followed by syncope as an expression of seizures that may have arose from a brain tumor; this tumor was most likely a meningioma in the right frontal lobe. The patient required the subsequent placement of a permanent pacemaker. In conclusion, cardiac asystole may be a potentially life-threatening symptom of frontal lobe lesion of the brain. The frontal lobe may play a role in the autonomic regulation of cardiovascular responses.