Circadian variation in acute myocardial infarction

BACKGROUND: TAn increased occurrence of morning time acute myocardial infarction(AMI) based on subjective self-reports and objective confirmation has been reported in the USA and Europe. We tried to see if the same circadian pattern is found among Korea patients in the regard. We have also studied how various modifying factors such as age, gender, history of congestive heart failure, previous angina pectoris, hypertension and smoking may affect the circadian pattern. METHODS: The onset of chest pain was studied in 471 patients with AMI admitted to four teaching hospitals in Taegu. Korea. We categorized the patients according to the modifying factors described above. RESULTS: The patients with AMI indeed showed bimodal variation at the onset of myocardial infarction with the primary peak between 6 A.M. and 12 noon. The frequency of the onset of pain occurred during this 6 hour period was 1.8 times higher than the average of the remaining period(p<0.001). The secondary peak occurring in the evening was barely noticeable. On the other hand. the sub-group(n=96) with a history of congestive heart failure demonstrated its peak(30%) in the evening(6 pm~12 midnight) and the sub-group with a history of hypertension(n=177) demonstrated its peak(37%) in the afternoon(12noon-6P.M.). However. the rest of the sub-groups smokers, patients with previous angina and patients over the age of 70 revealed typical circadian rhythm with a pronounced primary morning peak. CONCLUSIONS: This study clearly showed that Korean patients with AMI revealed a remarkably similar circadian pattern, primary morning peak of onset of myocardial infarction and that the marked differences in diurnal patterns of myocardial infarction onset occur in sub-groups of patients with modifying factors, particularly previous congestive heart failure and hypertension.

The Upper Gastrointestinal Mucosal Lesion / 대한소화기내시경학회지

Clinical and endoscopic features on 86 patients with acute upper gastrointestinal mucosal lesien were evaluated. Males were predaminant about 3 times of female. Most of patients were in 4 th to 6 th decade. The prevalent locations were proximal part of the stomach and dodenal bulb. Most,freqent chief camplaints was epigastric pain. Eeloscopieally aoute ulcers were characterized by shallow in depth, variant size and shape, rather clear ulcer margin without mucosal fold eonvergence and multiple lesions rather than sigle. The inducing factors of the acute mucosal lesiona whiah were noted were alcohol, HCI, analgesics, herb drug, steroid, antibiotlies and orgaaie ipheephorus.

Bleeding Gastric Ulcer - Clinical Observation of 120 Cases of Bleeding Gastric Ulcer) / 대한소화기내시경학회지

Analyses were done on one hudred and twenty caaes of bleeding gastric ulcers diagnosed by emergency endoscopy for the past five years. The reaults are as the following: Much more cases were found in male than female and the most prevalent age group was 6th decade. The body of stomach along the lesser curvature was the most common bleeding site. No age related difference was noted in bleeding sites. Most common type of ulcer was in the round and shallow form. Five of six cases with exposed vessels showed atrophic changes in surrounding mucosa. Among the probable precipitating factors, analgesica, alcohols and certicosteroids were found in such order,