Hereditary protein S deficiency presenting acute pulmonary embolism / 영남의대학술지

Protein S deficiency is one of the several risk factors for thrombophilia and can cause blood clotting disorders such as deep vein thrombosis and pulmonary embolism. A 54-year-old man was admitted with the complaint of dyspnea and was diagnosed with pulmonary embolism. The patient had very low level of free protein S, total protein S antigen, and protein S activity (type I protein S deficiency). In history taking, we found that his mother, 78 year old, had a history of same disease 10 years ago, and confirmed the pronounced low level of protein S. The patient's son also had very low level of protein S, however there had not been any history of pulmonary embolism yet. This case study suggests that asymptomatic persons with a family history of protein S deficiency and pulmonary embolism should be checked regularly for early detection of the disease, as protein S deficiency can be suspected.

Physician's Awareness and Education for Patient on Life Style Modification and Home Blood Pressure Monitoring Recommended in Hypertension Guideline

BACKGROUND: It is important to understand physicians' awareness and knowledge on hypertension guideline to comprehend physician oriented barrier against proper hypertension management. Current guidelines emphasize on the role of home blood pressure monitoring. The aim of this study is to investigate the level of awareness and knowledge of Korean physicians on home blood pressure monitoring recommended in current guideline. METHODS: A questionnaire survey asking home blood pressure measurement, as well as prehypertension and life style modification, was conducted among 36 primary physicians and 25 residents of a tertiary medical center. RESULTS: Except the limitation alcohol intake (80.3%), the physicians demonstrated above 90% of agreement with other contents of life style modification recommended by published guidelines (salt restriction, stop smoking, weight loss, and regular aerobic exercise). Majority (77.7%) of primary physicians recommend home blood pressure measurement to their patients. Significantly primary physicians were likely to recommend home blood pressure monitoring than residents (48% vs. 77.7%, p = 0.027). But both physicians and residents show poor compliance to home blood pressure monitoring guideline in the point of blood pressure measuring (12% vs. 19.4%, p > 0.05). But most of participants are aware of adverse effect of prehypertension (88.5%) and the need of its treatment (96.7%). CONCLUSIONS: This result suggest screening alcohol use disorder and brief counseling by physicians should be encouraged as a part of hypertension management and promoting physicians to equip the correct knowledge of home blood pressure measuring recommended in guideline is warranted.

Clinical Utility and Accuracy of Coaguchek(R) XS, a Reliable Alternative to Laboratory International Normalized Ratio Monitoring in Korean Patients With Atrial Fibrillation

BACKGROUND AND OBJECTIVES: To evaluate the accuracy and the clinical utility of the Coaguchek(R) XS, a portable point-of-care coagulometer, compared to standard laboratory methods in Korean patients. SUBJECTS AND METHODS: We included 107 patients with atrial fibrillation on long-term oral warfarin therapy. The prothrombin time as expressed by the international normalized ratio (INR) was measured by the portable Coaguchek(R) XS system as well as standard laboratory methods. Agreement between the two methods was defined as a difference of less than 0.3 between the INR values. RESULTS: The INR determined by the portable Coaguchek(R) XS had excellent correlation with the values obtained by standard methods (r=0.984, p3.0). There was a 91.6% agreement between the two methods. Only nine cases (8.4%) had a difference of more than 0.3; this was mainly noted in the high INR group. CONCLUSION: The portable self-testing of the INR by the Coaguchek(R) XS might be a reliable alternative to hospital based laboratory testing in Korean patients.

Changes in Left Ventricular Systolic Function According to Thrombolysis in Myocardial Infarction Frame Count Immediately After Coronary Intervention in Patients With Obstructive Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Some reports have suggested that coronary microvascular dysfunction plays a role in the recovery of myocardial function in patients with obstructive coronary artery disease. Thrombolysis in myocardial infarction (TIMI) frame count (TFC) is regarded as a simple, reliable method for evaluating microvascular function. We evaluated microvascular function using TFC immediately after coronary intervention and compared TFC with left ventricular systolic function eight months later. SUBJECTS AND METHODS: We studied 68 patients with obstructive coronary artery disease who underwent coronary intervention. Just after intervention, TFC was calculated with the standard method. Left ventricular systolic function was assessed with left ventricular diastolic dimension (LVEDd), ejection fraction (EF), and wall motion score index (WMSI). Eight months after intervention, we completed follow-up coronary angiography and echocardiography. We defined high TFC (HTFC) as a TFC greater than 18. RESULTS: Ten patients were in the HTFC group, and 58 patients were in the low TFC (LTFC) group. There was no difference between the two groups with regard to baseline cardiovascular characteristics and angiographic findings. Just after intervention, the HTFC group showed significantly higher LVEDd (56.6+/-8.9 mm) and WMSI (1.60+/-0.65) compared to the LTFC group (50.3+/-5.9 mm, p0.05). Eight months after intervention, there was also a significant decrease in the WMSI in the LTFC group (1.23+/-0.25, p0.05). CONCLUSION: Increased TFC immediately after coronary intervention is an important poor prognostic factor related to myocardial systolic function eight months after coronary intervention. Coronary microvascular dysfunction may influence myocardial recovery in the setting of obstructive coronary artery disease.

Usefulness of Korean Guideline for Grading Disability in Patient with Congestive Heart Failure

BACKGROUND AND OBJECTIVES: The increased prevalence of congestive heart failure (CHF) and disabled population with heart diseases has led, in 2000, to the establishment of Korean guidelines for grading disability in patients with CHF, but its usefulness has not been tested. The purpose of this study is to investigate the usefulness of the guidelines in grading disability and predicting the prognosis of patients with CHF. SUBJECTS AND METHODS: Between January, 1999 and March, 2003, 546 consecutive CHF patients were enrolled. Of these 546 patients, only 240 completed one year of follow up before the severity of disability was graded. They were classified into either the disabled or non-disabled groups according to the Korean guidelines for grading disability. They were also subdivided into severe CHF or non severe groups. Severe CHF was defined as a status greater than New York Heart Association class III or to those requiring frequent hospitalization, i.e. more than twice. The mortality and frequency of severe CHF between the disabled and non-disabled groups were evaluated. RESULTS: The prevalence of the disabled with CHF was 7.1% (17/240); one patient was graded in the severe disabled (grade 1), 4 in the moderate (grade 2) and 12 in the mild disabled (grade 3) groups. The mortality within the disabled group was higher than that in the non disabled group (8/17 vs. 1/223, 47.6% vs. 0.4%, p<0.001), but there was no difference according to the severity of disability (p=0.26). All survivors (9 patients) in the disabled group were classified with severe CHF, but 15 from 222 (6.8%) patients not classified in the disabled group also showed severe CHF stati. Half (8 patients, 50%) of the 16 whose total disability scores ranged between 15 and 19, 7 (21.2%) of the 33 with total scores between 10 and 14 were classified with severe CHF stati. CONCLUSION: The current Korean guidelines for grading of disability were able to relatively well predict the prognosis of CHF between the disabled and non disabled groups, but appeared too strict, in that some severe patients cannot be classified into the disabled group. Therefore, the current guidelines will either require modification following a large scaled study or the disability grades will have to be classified into more than 4 categories.

Change of Plasma Atrial Natriuretic Peptide(ANP) before and after Percutaneous Ballon Mitral Valvuloplasty(PMV)

To evaluate the effect of alteration of left atrial pressure. volume and wall tension on the circulating plasma level of atrial natriuretic peptide(ANP), 15 patients with left atrial hypertension due to mitral stenosis were studied at the time of percutaneous balloon mitral valvuloplasty(PMV). Hemodynamic measurements and plasma atrial natriuretic peptde levels were obtained before, immediately(5-10min) after and 24h after valvuloplasty, and echocardiographic left atrial size, wall tension and mitral valve area were measured bdfore and 24h after valvuloplasty. 1) Immediately after valvuloplasty, left atrial pressure, pulmonary atrial pressure and mean diastolic pressure gradient across the mitral valve decreased, and the mitral valve area by Gorlin's method increased, significantly. Plasma atrial natriuretic peptide level(atright and left atrium, pulmonary artery and aorta) rose significantly after balloon inflation. This rising may reflect a transient increase in left atrial pressure and volume expansion associated with mitral valve occlusion by balloon. 2) Twenty four after valvuloplasty, mitral valve area increased, and left atrial volume and wall tension decreased, significantly. Plasma atrial natriuretic peptide level(at right atrium, pulmonary artery and aorta) fell significantly, too. In conclusion, change of plasma atrial natriuretic peptide le.vel before and after percutaneous balloon mitral valvuloplasty reflect hemodynamic alteration of right and left atrium.

Change of Plasma Atrial Natriuretic Peptide(ANP) before and after Percutaneous Ballon Mitral Valvuloplasty(PMV)

To evaluate the effect of alteration of left atrial pressure. volume and wall tension on the circulating plasma level of atrial natriuretic peptide(ANP), 15 patients with left atrial hypertension due to mitral stenosis were studied at the time of percutaneous balloon mitral valvuloplasty(PMV). Hemodynamic measurements and plasma atrial natriuretic peptde levels were obtained before, immediately(5-10min) after and 24h after valvuloplasty, and echocardiographic left atrial size, wall tension and mitral valve area were measured bdfore and 24h after valvuloplasty. 1) Immediately after valvuloplasty, left atrial pressure, pulmonary atrial pressure and mean diastolic pressure gradient across the mitral valve decreased, and the mitral valve area by Gorlin's method increased, significantly. Plasma atrial natriuretic peptide level(atright and left atrium, pulmonary artery and aorta) rose significantly after balloon inflation. This rising may reflect a transient increase in left atrial pressure and volume expansion associated with mitral valve occlusion by balloon. 2) Twenty four after valvuloplasty, mitral valve area increased, and left atrial volume and wall tension decreased, significantly. Plasma atrial natriuretic peptide level(at right atrium, pulmonary artery and aorta) fell significantly, too. In conclusion, change of plasma atrial natriuretic peptide le.vel before and after percutaneous balloon mitral valvuloplasty reflect hemodynamic alteration of right and left atrium.