Acute Proximal Aortic Dissection Associated with ST Segment Elevation on Electrocardiography

Inappropriate administration of thrombolytic agents to acute type A aortic dissection patients with acute myocardial infarction could result in catastrophic outcomes. A 38-year-old female patient without any previous cardiac history visited the emergency room due to a severe acute onset of retrosternal chest pain. The ECG showed a complete heart block with a junctional escape rhythm at 33 beats/min and more than 2 mm of ST elevation in the inferior and anterior precordial leads. Because of an acute myocardial infarction, prompt thrombolytic agent (tPA) was administered. The patient had cardiogenic shock and persistent chest pain after the thrombolytic therapy. We performed the transthoracic echocardiography (TTE). The TTE showed a dissection flap just above the aortic valve and akinesia of the inferior wall of the left ventricle. She underwent an emergency surgical correction. However, the patient died due to the failure of weaning from the cardiopulmonary bypass machine.

Assessment of Diastolic Function using Mitral Annulus Velocity by Doppler Tissue Velocity in the Patients with Hypertension

BACKGROUND AND OBJECTIVE: Mitral annulus velocity measured by doppler tissue imaging (DTI) has been used as a method of evaluation of the left ventricular diastolic function. This study was aimed to evaluate the left ventricular diastolic function using the mitral annulus velocity measured by DTI in the patients with hypertension. METHODS AND SUBJECTS: One hundered twenty nine patients with blood pressure above 140/90mmHg and age sex matched 123 normotensive subjects were studied. For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical four chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocities were easily obtained from all subjects. In the hypertension group, mitral annulus E'velocity was significantly lower than normotensive controls (5.4 1.3 cm/sec vs 6.5 1.8 cm/sec, p<0.001) and mitral annulus A' velocity was significantly higher than normotensive controls (8.6 1.4 cm/sec vs 7.9 1.1 cm/sec, p<0.001). In comparison with patients with normal LVML(IV mass index in hypertension group and subjects with normal LVMI in normotensive controls, mitral annulus E'velocity was reduced in patients with normal LVMI in hypertension group compared with subjects with normal LVMI in normotensive controls (5.6 1.4 cm/sec vs 6.7 1.8 cm/sec, p<0.001). CONCLUSION: Mitral annulus velocity measured by DTI could be used as one of the parameters in evaluating the early changes of left ventricular diastolic function in the patient with hypertension.

A Case of Lymphangioleiomyomatosis Looked Like Miliary Tuberculosis / 결핵

We experienced one case of pulmonary lymphangioleiomyomatosis in 26-year-old female patient. She had taken antituberculous medication under the impression of miliary tuberculosis on simple chest X-ray at peripartum period. On outpatient follow-up she complained of progressive exertional dyspnea in spite of medication. Through careful history taking and physical examination, high resolutional CT, and open lung biopsy she was diagnosed as pulmonary lymphangioleiomyomatosis combined with incomplete type of tuberous sclerosis. So, we presented the case with the brief review the literatures.