Unstable angina and old myocardial infarction in a patient with thrombocythemia

Essential thrombocythemia is a kind of myeloproliferative disorder characterized by primary elevation in the number of platelet and by multiple episodes of bleeding or thrombotic complications. Rarely, thrombocythemia itself causes coronary arterial occlusion and leads to ischemic heart disease. Fewer than twenty cases of coronary artery occlusive disease in thrombocythemia have been reported since Cheitlin et al had included thrombocythemia in their review of rare causes of myocardial infarction. We experienced a case of coronary artery disease in a 53-year-old woman with thrombocythemia, who had not coronary artery disese risk factors at all. Presence of multiple thrombus in the coronary artery was suggested in coronary angiography.

A Case of Reflux Esophagitis, Classic Migraine and Raynaud's Disease in Proven Variant Angina

The high prevalence of migraine. Raynaud's phenomenon, visual field defect and Crohn's disease in variant angina raises the possibility that a common underlying defect of mechanism may partially account for all conditions. These are generalized vascular smooth muscle hypercontractility syndromes. Recently high prevalence of esophageal motility disorders has been noted in patients with coronary artery spasm or microvascular angina, leading to the hypothesis of a generalized abnormality in smooth muscle function1,4,5). We expirienced a case of 55-year-old man with angiographically proven variant angina. Who showed reflux esophagitis, classic migraine and Raynaud's disease.

Clinical Efficacy of Pravastatin in Patients with Hypercholesterolemia

BACKGROUND: This study was designed to evaluate the clinical efficacy of pravastatin, HMG-CoA reductase inhibitor, in patients with hypercholesterolemia. Methods and RESULTS: Pravastatin 5 mg was administered twice daily for 12 weeks in twenty five patients(12 male, 13 female) with hypercholesterolemia(>240 mg/dl). Compared with pretreatment levels, pravastatin significantly decreased levels of total cholesterol(281+/-41mg/dl versus 218+/-31mg/dl) by 22% and LDL-cholesterol(199+/-46mg/dl versus 137+/-37mg/dl) by 31% with significantly decreased total-cholesterol/HDL-cholesterol ratio(7.1+/-3.0 versus 5.1+/-1.6) and LDL-cholesterol/HDL-cholesterol ratio(5.1+/-2.5 versus 3.3+/-1.4) (p<0.005, respectively). During pravastatin treatment, the level of Apo B(164+/-38mg/dl versus 123+/-20mg/dl) was decreased significantly by 24% with significantly decreased Apo B/Apo A-1 ratio(1.4+/-0.5 versus 1.0+/-0.3) (p<0.005, respectively). No serious side effects were found. CONCLUSIONS: Results from the present study show that pravastatin is an effective and well-tolerated cholesterol-lowering agent.

Coronary Arteriogram in Valvular Heart Disease

Coronary neovascularity may be formed in patients with the left atrial thrombus, and coronary artery disease may be associated with valvular heart disease. From August 1989 through September 1990, 109 patients over 40 years old with valvular heart disease were performed coronary arteriogram to evaluate the incidence of the associated coronary artery disease. And 9 patients with left atrial thrombi detected noninvasively were also performed coronary arteriogram to evaluate the significance of the neovascularity to predict the left atrial thrombus. The results were as follows : 1) Significant coronary arterial lesion(greater than 50% narrowing of the luminal diameter) was noted in three of 109 patients over 40 years old(2.8%), but there was no typical chest pain in all of the three patients. 2) The coronary neovascularity was found in 19 of 118 patients -18 with mitral valvular disease and one with combined valvular disease. All of the patients with the coronary neovascularity had established atrial fibrillataion and the neovasculaity was originated from the left circumflex artery in all of them. 3) Prosthetic valve replacement was performed in 42 of 118 patients during the study period and left atrial thrombus was found in ten patients with mitral valve disease. Neovascularity on coronary arteriogram was detected in six patients(sensitivity 60%) of the above 10 patiets, and 28 patients without neovascularity had no left atrial thrombus (28/32, specificity 87.5%). Our observation revealed that neovascularity might represent the left atrial thrombus in valvular heart disease, and the incidence of the associated coronary artery disease in valvular heart disease was very low(2.8%) in Korea. Coronary arteriography as a routine preoperative evaluation might be unnecessary in valvular heart disease in Korea.