Long-Term Clinical Effects of Carotid Intraplaque Neovascularization in Patients with Coronary Artery Disease

Objective@#To investigate the predictive value of intraplaque neovascularization (IPN) for cardiovascular outcomes. @*Materials and Methods@#We evaluated 217 patients with coronary artery disease (CAD) (158 men; mean age, 68 ± 10 years) with a maximal carotid plaque thickness ≥ 1.5 mm for the presence of IPN using contrast-enhanced ultrasonography. We compared patients with (n = 116) and without (n = 101) IPN during the follow-up period and investigated the predictors of major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, coronary artery revascularization, and transient ischemic accident/stroke. @*Results@#During the mean follow-up period of 995 ± 610 days, the MACE rate was 6% (13/217). Patients with IPN had a higher maximal thickness than those without IPN (2.86 ± 1.01 vs. 2.61 ± 0.84 mm, p = 0.046). Common carotid artery-peak systolic velocity, left ventricular mass index (LVMI), and ventricular-vascular coupling index were significantly correlated with MACE. However, on multivariate Cox regression analysis, increased LVMI was independently related to MACE (p < 0.05). The presence of IPN could not predict MACE. @*Conclusion@#The presence of IPN was related to a higher plaque thickness but could not predict cardiovascular outcomes better than conventional clinical factors in patients with CAD.

Acute Pericarditis with Pericardial Effusion That Developed after Swine Influenza A (H1N1) Infection in a Healthy Adult / 대한내과학회지

A 21-year-old male with no any other diseases presented with fever, chills, and chest discomfort. A chest radiography scan and a transthoracic echocardiogram revealed a large amount of pericardial effusion. An H1N1 viral real-time PCR test confirmed the presence of H1N1 viral infection. Pericardiocentesis was performed to reduce symptoms, and oseltamivir (Tamiflu(TM)) was administered. His symptoms improved during the first 4 days, and there was no relapse of the pericardial effusion. The most common manifestation of influenza A infection is respiratory tract infection. Although a cardiovascular manifestation is possible, it is extremely rare. We have reported here a case of acute pericarditis with a large amount of pericardial effusion in a healthy adult infected with influenza A virus (H1N1, swine-origin).

Acute regional myocarditis with normal ventricular wall motion diagnosed by two-dimensional speckle tracking imaging

No abstract available.

Preliminary Clinical Experience with Waon Therapy in Korea: Safety and Effect

BACKGROUND: Waon therapy has beneficial effects on chronic heart failure (CHF), peripheral arterial disease, and other various diseases. This was to assess the safety and effect of Waon therapy by echocardiography for the first time in Korea. METHODS: Ten patients with CHF were enrolled. The patients with a light gown were placed in a sitting-position in an evenly maintained 60degrees C dry sauna system for 15 minutes, and then after leaving the sauna, they underwent bed rest with a blanket to keep them warm for an additional 30 minutes. Waon therapy was performed once a day, 5 days a week. RESULTS: Four of the 5 patients who had been treated for more than 2 weeks as protocol noted improvement of heart failure (HF) symptoms and decrease in left ventricular (LV) volume. There were trends in improvement of LV ejection fraction and parameters of diastolic function after the therapy although statistical significance was lack. No one complained of worsening of HF symptoms. In each session, body weight (61.8+/-10.2 kg vs. 61.6+/-10.3 kg, p=0.008) and blood pressure (systolic, 119+/-28 vs. 111+/-27 mmHg, p=0.005; diastolic, 69+/-12 mmHg vs. 63+/-10 mmHg, p=0.005) were significantly decreased, oral temperature (35.9+/-0.4degrees C vs. 37.0+/-0.9degrees C, p=0.017) was increased by 1.0degrees C at the end of sauna bathing, but the heart rate (71+/-10/min vs. 72+/-8/min, p=0.8) was not changed. CONCLUSION: We have experienced Waon therapy which was safe and well tolerated and some beneficial effects for patients with CHF. Large scale randomized study is needed to apply Waon therapy as a promising therapy in Korean HF patients.

Effect of Lacidipine on Blood Pressure and Endothelial Function in Mild-to-Moderate Essential Hypertension Patients With Diabetes in Korea

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy of lacidipine in reducing blood pressure (BP) and to determine its effect on endothelial function in mild-to-moderate hypertensive patients with type 2 diabetes mellitus (DM). SUBJECTS AND METHODS: This was a prospective, multicenter, open-label, single-arm study, enrolling 290 patients with mild-to-moderate hypertension and type 2 DM. Patients were initially treated with 2 mg lacidipine orally once daily for 4 weeks, which was then increased as necessary every 4 weeks to a maximal dose of 6 mg daily. The primary endpoint was the mean change in systolic blood pressure (SBP) from baseline after 12 weeks of treatment. Secondary endpoints included mean changes in diastolic blood pressure (DBP), flow-mediated vasodilatation (FMD), and serum concentrations of biochemical markers such as high-sensitivity C-reactive protein (hs-CRP), monocyte chemo-attractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), and plasminogen activator inhibitor-1 (PAI-1). RESULTS: Lacidipine treatment significantly reduced SBP by -13.4+/-13.0 mmHg (p<0.001) and DBP by -6.2+/-9.3 mmHg (p<0.001). Lacidipine treatment did not improve endothelial-dependent vasodilatation, despite significantly improved nitroglycerin-induced, endothelial-independent vasodilatation. MCP-1 levels significantly decreased from 283.66+/-110.08 pg/mL to 257.83+/-100.23 pg/mL (p<0.001); whereas there were no significant changes in the levels of hs-CRP, MMP-9, or PAI-1. CONCLUSION: Twelve weeks of treatment with lacidipine was effective and well tolerated in mild-to-moderate hypertensive patients with type 2 DM. In spite of inducing a significant reduction in MCP-1 levels, lacidipine did not improve endothelial function.

Impact of Glutathione S-Transferase M1 and T1 Gene Polymorphisms on the Smoking-Related Coronary Artery Disease

Glutathione S-transferase (GST) plays a key role in the detoxification of xenobiotic atherogen generated by smoking. To analyze the effect of GSTM1/T1 gene polymorphisms on the development of smoking-related coronary artery disease (CAD), 775 Korean patients who underwent coronary angiography were enrolled. The subjects were classified by luminal diameter stenosis into group A (>50%), B (20-50%), or C (<20%). GSTM1 and GSTT1 gene polymorphisms were analyzed using multiplex polymerase chain reaction (PCR) for GSTM1/T1 genes and CYP1A1 gene for internal control. Of 775 subjects, 403 patients belonged to group A. They had higher risk factors for CAD than group B (N=260) and group C (N=112). The genotype frequencies of null GSTM1 and GSTT1 showed no significant differences among 3 groups. Considering the effect of GSTM1 gene polymorphisms on the smoking-related CAD, smokers with GSTM1 null genotype had more increased risk for CAD than non-smoker with GSTM1 positive genotype (odds ratios [OR], 2.07, confidence interval [CI], 1.06-4.07). Also the effect of GSTT1 gene polymorphism on smoking-related CAD showed the same tendency as GSTM1 gene (OR, 2.00, CI, 1.05-3.84). This effect of GSTM1/T1 null genotype on smoking-related CAD was augmented when both gene polymorphisms were considered simultaneously (OR, 2.76, CI, 1.17-6.52). We concluded that GSTM1/T1 null genotype contributed to the pathogenesis of smoking-related CAD to some degree.

The Difference of Left Ventricular Hypertrophy and the Diastolic Function between Prehypertensives and Normotensives

BACKGROUND AND OBJECTIVES: We investigated whether prehypertensives (PHs) exhibit more prevalent electrocardiographic and echocardiographic left ventricular hypertrophy (ECG LVH) and if they are are more associated with impaired left ventricular (LV) diastolic function than are normotensives (NTs). SUBJECTS AND METHODS: A total of 608 subjects> or = 40 years of age with normal BP (SBP<120 mmHg and DBP<80 mmHg, n=335) and PH (n=273) and who were without a history of hypertension, diabetes and any other known cardiovascular diseases underwent blood sampling for obtaining the lipid profile, and they also underwent 12-lead electrocardiography and echocardiography. RESULTS: Compared with the NTs, the PHs had significantly higher Sokolow-Lyon and Cornell voltage for ECG LVH, and they ahd a higher prevalence of ECG LVH (men: 16.9% vs 5.9%, women: 2.0% vs 1.0%, respectively). The PHs had a more increased left ventricular mass index (LVMI, Men: 118.1+/-24.4 g/m2 vs 102.0+/-19.1 g/m2, p=0.02; Women: 117.5+/-26.4 g/m2 vs 101.9+/-30.7 g/m2, p=0.02) and a more decreased LV diastolic function (E/A, Men: 1.14+/-0.6 vs 1.30+/-0.4, p=0.03; Wemen: 1.11+/-0.6 vs 1.25+/-0.5, p=0.03) on echocardiography than the NTs. CONCLUSION: The PHs were associated with a higher prevalence of ECG LVH and a more increased LVMI on echocardiography than that of the NTs. Therefore, we should pay earlier attention to diagnose and screen the pre-hypertensive group.

Tissue Doppler Image-Derived Myocardial Performance(Tei Index) as a Simple Assessment of Global Cardiac Function in Adults

BACKGROUND AND OBJECTIVES: A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. SUBJECTS AND METHODS: We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E' ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction<50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a') minus the duration of the systolic wave (b') divided by b', which is (a'-b')/b', is defined as the TDI-tei index. RESULTS: The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. CONCLUSION: We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults.

The Relation of Circadian Blood Pressure Variation to Left Ventricular Mass, Diastolic Function, and Dynamic QT Dispersion

BACKGROUND AND OBJECTIVES: A non-dipping pattern in hypertensive patients has been shown to be associated with a greater left ventricular (LV) hypertrophy, LV diastolic impairments and prolonged ventricular repolarization. The dynamic parameters of the QT dispersion (QTd) have been highlighted as markers of ventricular repolarization heterogeneity. The aim of this study was to demonstrate if the extent of nocturnal blood pressure (BP) fall was related to the LV mass, LV diastolic function and dynamic parameters of the QTd. SUBJECTS AND METHODS: 122 subjects, receiving electrocardiography, 24-hour ambulatory BP monitoring, 12 lead-24hr Holter monitoring and 2-dimensional Doppler echocardiography examinations, were enrolled. The subjects were classified as normotensive, dipper and non-dipper. The LV mass (LVM) and LV diastolic indices were measured. Using the QT Guard software, with 12 lead-24hr Holter monitoring, the QTd, mean QTd, QTd variation (the difference between the maximum minus the minimum QTd value observed over the recording time), QTd maximum (the maximum difference of QTd between consecutive beats) and QTd variability (QTd standard deviation) were analyzed. RESULTS: Of the 122 patients, 39 and 40 were placed in the dipper and non-dipper groups, respectively. The non-dipper group had a greater LVM index (LVMI) than the dipper group (p<0.01). The non-dipper group had greater increases in their A velocity (p<0.01), and more prolonged deceleration (p<0.01) and isovolumic relaxation (p<0.01) times than the dipper group. There were no significant differences in the QT and QTc interval between the 3 groups, but the QTd was much more increased in the non-dipper than the dipper and normotensive groups (p<0.01). For the dynamic parameters of the QTd, the QTd variation, QTd maximum and QTd variability were significantly increased in the non-dipper compared to the dipper and normotensive groups (p<0.05). Comparing the dipper and normotensive groups, there were no significant differences in the LVMI, LV diastolic indices, QTd and dynamic parameters of the QTd. CONCLUSION: The non-dipper group of hypertensive patients had a greater LVMI, more impaired LV diastolic function and greater increases in their QTd and dynamic parameters of the QTd compared to the dipper and normotensive groups, suggesting the possibility of a much greater chance of cardiovascular events, and their complications, in the non-dipper compared to the dipper group.

Clinical Usefulness of the Second Derivative of a Photoplethysmogram Waveform(SDPTG)

BACKGROUND AND OBJECTIVES: The second derivative of a photoplethysmogram (SDPTG) is a simple, convenient and non-invasive technique for pulse wave analysis. The SDPTG index correlates with age and other risk factors of atherosclerosis in the Japanese population, but has not yet been described in the Korean population. The purposes of this study were to analyze the age-related changes in the SDPTG of healthy subjects (study 1), and investigate the differences in the SDPTG of patients with hypertension, compared with those of normotensive subjects (study 2). We also compared the differences in the SDPTG between coronary artery disease (CAD) patients and normal subjects (study 3), to test the clinical usefulness of SDPTG in the evaluation of atherosclerosis. SUBJECTS AND METHODS: We consecutively studied 235 healthy adults, 40 with essential hypertension and 42 with CAD. Their SDPTG were recorded in the sitting position using a Fukuda FCP-3166. RESULTS: In study 1, the b/a ratio increased with age, whereas the c/a, d/a and e/a ratios decreased. The SDPTG aging index (AGI)(y) increased with age (x)(r=0.71, p=0.000;y=22.731x+54.571). In study 2, the patients with hypertension showed a lower average d/a ratio (-0.47+/-0.15 vs. -0.38+/-0.15, p=0.02) and higher average SDPTG AGI (-0.09+/-0.34 vs. -0.26+/-0.37, p=0.011) than the normotensive subjects. In study 3, the patients with CAD had higher average b/a ratio (-0.47+/-0.19 vs. -0.59+/-0.17, p=0.001) and SDPTG AGI (-0.01+/-0.41 vs. -0.23+/-0.40, p=0.004) than the normal subjects. In a logistic regression analysis, the SDPTG AGI was a significant determinant of CAD (p=0.046). CONCLUSION: The SDPTG aging index may be useful in the evaluation of vascular aging and damage due to hypertension and atherosclerosis.

A Case of Thrombotic Thrombocytopenic Purpura Associated with Acute Myocardial Infarction

Thrombotic thrombocytopenic purpura (TTP) is an unusual syndrome characterized by a clinical picture of micro-angiopathic hemolytic anemia, thrombocytopenic purpura, neurologic symptoms, renal disease and fever. Although widespread vascular thrombosis is common in TTP, the evidence of cardiac involvement is less clear. We report the first Korean case of a 22-year-old woman with TTP associated with acute myocardial infarction. With continued plasmapheresis, the clinical status of TTP improved markedly and was stabilized. Serial echocardiograms showed improvement of the cardiac wall motion.

Clinical Characteristics of Ventricular Premature Beats Originating from Right Ventricular Outflow Tract

BACKGROUND AND OBJECTIVES: Ventricular premature beat (VPB) with a left bundle branch block morphology and an inferior axis usually originates from the right ventricular outflow tract (RVOT) and is a frequent clinical problem. Although some investigators have suggested that RVOT VPBs are associated with RVOT ventricular tachycardia, few data are available on patients with RVOT VPBs. The purpose of this study was to determine the clinical characteristics and prognosis of RVOT VPB. SUBJECTS AND METHODS: The study subjects were 161 consecutive patients with frequent RVOT VPBs on standard electrocardiography. All patients underwent clinical examinations, echocardiography and 24-hour ambulatory electrocardiography. Among these patients, 50 were followed up for a period averaging 28.5+/-18.1 months. RESULTS: No structural cardiac abnormalities were found in 149 (92.5%) of the 161 patients with frequent RVOT VPBs. The prevalence of complex VPBs was relatively high (101 of 161 patients: 62.7%) on initial 24-hour electrocardiography. In the case of the 50 follow-up patients, there was no significant difference in mean frequency of RVOT VPBs between baseline and follow-up study (636+/-482/hour vs. 569+/-502/hour, p=NS). Furthermore, VPBs tended to persist over the follow-up period in the majority (92%) of patients with frequent RVOT VPBs. Five patients (10%) developed nonsustained ventricular tachycardia, 2 (4%) sustained ventricular tachycardia and 1 (2%) died suddenly. Antiarrhythmic drugs are effective in decreasing the frequency of VPBs, and beta-blockers especially seem to be effective in decreasing the severity of VPBs. CONCLUSION: In the patients with frequent RVOT VPBs, sustained ventricular tachycardia or sudden death could develop. Therefore, careful observation is required in patients with frequent RVOT VPBs.

Evaluation of Cardiac Function by TEI Index: Before and After Hemodialysis

BACKGROUND AND OBJECTIVES: Large volume reduction after hemodialysis in patients with chronic renal failure alters the preload. We investigated the cardiac function by total ejection isovolume (TEI) index- a new simple, readily reproducible Doppler echocardiographic index combining systolic and diastolic function- before and after dialysis. MATERIALS AND METHOD: Thirty-one patients on maintenance hemodialysis including 6 diabetes and 13 hypertensives without known organic heart disease and with normal systolic function were enrolled. They were divided into two groups according to ultrafiltration volume at the study dialysis session, group 1 (2.5kg or less) and group 2 (more than 2.5 kg). They are 46+/-12 years old on average. We examined two-dimensional, M-mode, pulsed wave and tissue Doppler before and after dialysis immediately. TEI index was calculated by dividing the sum of the isovolumic relaxation time (IVRT) and isovolumic contraction time (ICT) by the ejection time. RESULTS: After dialysis, significant decrease of body weight was noted, but baseline heart rate, blood pressure, Left ventricular (LV) ejection fraction and LV mass index were not changed significantly. LV end-diastolic volume was decreased significantly after dialysis in all group, and end-systolic volume was decreased significantly in total and group 2. Peak early E velocity and ratio of E to the peak late (A) velocity (E/A) from mitral inflow signal were decreased significantly after dialysis in all group and deceleration time of early filling phase was prolonged in total and group 1, but A and IVRT did not change significantly. Of the septal mitral annulus motion, Ean velocity and Ean/Aan ratio was decreased, but no significant change was noted in the lateral annulus. The TEI index did not chage significantly after dialysis in all group. CONCLUSION: A new simple echocardiographic TEI index can be used to measure the global myocardial function in patients with chronic renal failure before and after dialysis, relatively independent of preload change.

A Case of Acute Aortic Regurgitation due to Non-traumatic Rupture of the Aortic Valve Commissure

Trauma and non-traumatic aortic pathologies such as infective endocarditis, syphilis, fenestrated aortic valves, valves with myxomatous transformation, cystic medionecrosis of the aorta, and inherited disorders of connective tissue may occasionally lead to a rupture of the aortic valve. Among the causes of the rupture of the aortic valve, the non-traumatic aortic valve commissural rupture is extremely rare. The aortic valve rupture typically results in a rapidly progressive heart failure and frequently, death. Therefore, early diagnosis is followed by an immediate operation is necessary. The purpose of this article is to report the first successful operation in Korea of a 44-year-old male patient with acute aortic regurgitation due to non-traumatic rupture of the aortic valve commissure.

Efficacy of Sotalol and Amiodarone for Atrial Fibrillation

BACKGROUND AND OBJECTIVES: Atrial fibrillation(AF) is the most frequently encountered arrhythmia in clinical practice. Pharmacologic therapy has been advocated for both immediate restoration of sinus rhythm and prevention of recurrent AF. Because conventional antiarrhythmic therapy is often ineffective in maintaining sinus rhythm or is associated with adverse side effects in patients with AF, recent interest has focused on the use of class III antiarrhythmic agents. This study investigated the efficacy and safety of sotalol and amiodarone for conversion of chronic AF and prevention of recurrent AF. MATERIALS AND METHOD: Thirty six patients with AF were firstly received sotalol by prospective study protocol. The patients were classified as having paroxysmal AF(PAF, N=2) or chronic AF(CAF, N=4) based on AF pattern. If the patients with CAF did not convert to sinus rhythm or the patients with PAF recurred in AF, the patients were received second agents(amiodarone). Patients were followed up for one year. RESULTS: Among the 12 patients with PAF receiving sotalol, 10(83.3%) patients remained in normal sinus rhythm for average 9.4+/-3.6 months. Sotalol was replaced by amiodarone in the remaing 2 patients with arrhythmia recurrence and 1 of the 2 patients remained in sinus rhythm during the follow-up period. In the case of 24 patients with CAF, conversion to sinus rhythm was achieved in 5(20.8%) patients with sotalol. Among the patients with CAF who were not respond to sotalol, 17 patients received amiodarone subsquently and 3 patients successfully converted to sinus rhythm. There were no proarrhythmic effects related to both agents during the study period. CONCLUSION: Both sotalol and amiodarone appear to be less effective in the termination of CAF, but sequential use of these two agents seem to be very effective for the prevention of recurrence of PAF.

Two cases of honey poisoning with syncope / 대한내과학회지

Intoxifications caused by toxic honey were occurred recently in Korea. Honey poisoning is known to be induced by grayanotoxins, that appear in flowers of different species of Rhododendron. These toxic compounds cause depolarization of membranes that contain fast Na channel by increasing in Na permeability. After ingestion of toxic honey patients may present with neurological, cardiovascular, gastrointestinal sign and symptoms. Two cases of honey poisoning are described here. Both patients experienced syncope and severe arterial hypotension after ingestion of honey which was brought from Nepal and Brazil. Conservative treatement was fully successful in both patients within 24 hours. We report the first case of honey poisoning in Korea.

A Case of Aortic Valve Endocarditis Complicated with an Aneurysm and Perforation of Anterior Mitral Leaflet

Aortic valve is usually involved in infective endocarditis. Aortic valve endocarditis produces destruction and perforation of leaflets and results in ring abscess, frequently. Less commonly, direct extension or infected aortic regurgitant jet can produce secondary involvement of anterior mitral leaflet (AML) and result in the formation of an aneurysm or perforation of AML. A 60-year-old woman was admitted to Kyung Hee University hospital because of a febrile illness and dyspnea. Transthoracic echocardiography (TTE) showed an aortic valve vegetation, an aneurysm of AML, and an eccentric jet of mitral regurgitation through AML. Transe-sophageal echocardiography (TEE) showed a perforation of AML. -streptococcus was isolated from blood culture. The patient was treated with Vancomycin and Sisomicin sulfate. On hospital day 21, heart failure was aggravated and emergent double valve replacement was done. The patient was recovered and discharged.

Plasma Concentration of Atrial and Brain Natriuretic Peptides in the Patients with Essential Hypertension

BACKGROUND: Left ventricular hypertrophy(LVH) is one of the complications of hypertension and has been known as an independent risk factor of cardiovascular complications. Recently, it has been reported that hypertensive patients with LVH had the most advanced extracardiac target-organ damage compared with other groups. Previous reports have shown that mean plasma atrial natriuretic peptide(ANP) and brain natriuretic peptide(BNP) levels in hypertensive patients are higher than in normotensive subjects. Therefore, in this study, we investigated the relationships between the plasma ANP and BNP levels and the degree of LVH in hypertensive patients and in normotensive subjects and also investigated the clinical significance of measurement of plasma ANP and BNP levels. METHODS: In all study subjects, left ventricle mass index(LVMI) and left ventricle geometry were measured by M-mode echocardiography. Measurements were made by the recommendations of the American Society of Echocardiography. Plasma ANP and BNP levels were measured by radioimmunoassay method. RESULTS: 1) 57% of the hypertensive patients had eccentric hypertrophy and 6% had concentric hypertrophy. 2) LV mass and LVMI of normotensive subjects and hypertensive patients were 169+/-53 g, 229+/-64 g and 99+/-27.3 g/m2, 142+/-37.7 g/m2, respectively(P<0.05). 3) There were statistically significant correlations between blood pressure and LVMI in all subjects(r=.43, P<0.05). 4) Plasma ANP levels were significantly increased in hypertensive patients than normotensive subjects (28.2+/-14.3 pg/mL and 42.8+/-26 pg/mL, respectively; P<0.05). 5) Plasma BNP levels were significantly increased in hypertensive patients than normotensive subjects (18.4+/-5.4 pg/mL and 36.5+/-26 pg/mL; respectively, P<0.05). 6) Plasma BNP levels were significantly increased in 63% of the hypertensive patients with LVH(P<0.05). 7) There were statistically significant correlations between blood pressure and plasma ANP and BNP levels(ANP:r=.39, p<0.05, BNP:r=.31, P<0.05). CONCLUSIONS: Plasma ANP and BNP levels were increased in the hypertensive patients but only plasma BNP levels were significantly increased in the hypertensive patients with LVH. Measurement of plasma BNP levels may be useful for early detection of LVH, an independent risk factor of cardiovascular complications. Therefore intensive blood pressure control in these patients may reduce cardiovascular morbidity and mortality.

Cardiovascular aspects of aconitine poisoning

BACKGROUND AND OBJECTIVES: The Oriental herbal materials known as aconitine have long been used in oriental traditional medicine for their analgesic and antiinflammatory effects. Aconitine and its related alkaloids are known cardiotoxins with no therapeutic role in modern western medicine. We have studied the cardiovascular side effects of intoxication that took place in otherwise healthy individuals after ingestion of herbal decoctions containing aconite alkaloids. MATERIALS AND METHOD: During a six-year interval from 1990 to 1996, 9 cases of accidental herb-induced aconitine intoxication were managed in Kyung Hee university medical center. Hospital records were reviewed in detail. RESULTS: All patients developed symptoms of aconitine toxicity within 4 hours of herb ingestion. The frequency of the order in cardinal symptoms of acute aconitine poisoning was nausea or vomiting, irritability, chest discomfort, dizziness, etc. Nine patients developed arrhythmias, including multifocal APC with aberrancy, multifocal VPC, ventricular tachycardia, etc. Administration of isotonic saline, dopamine, atropine and lidocaine with supportive cares brought clinical recovery and disappearance of arrhythmias in most cases within several hours. However, one case of acute aconitine poisoning had been dead of cardiac arrest due to ventricular fibrillation. CONCLUSION: Aconitine and its related alkaloids can cause toxic effects and even fatal poisoning. These cases point to the need for strict surveillance of herbal substances with low safety margins.

Three cases of pacemaker-mediated tachycardia

Pacemaker-mediated tachycardia (PMT) is a well-known complication of dual-chamber pacemaker with atrioventricular sensing and pacing (DDD) or atrial synchronous, ventricular demand pacemaker (VDD). PMT usually starts with sensing a retrograde P waves linked to ventricular extrasystole with retrograde ventriculoatrial conduction and forms reentrant or circus movement tachycardia with the pacemaker itself as an antegrade limb and the conducting tissue of the heart as a retrograde limb. Recently, a number of pacemaker manufactures have incorporated in their devices a variety of relatively complex algorithms to prevent PMT. Despite these measures, PMT may still occur because of inappropriate programming or unpredictable variations of ventri-culoatrial conduction. We report two cases of PMT in 78 year-old man and 60 year-old man who received DDD type pacemakers due to sick sinus syndrome, and a case of PMT in 69 year-old man who had suffered complete heart block and received a VDD type pacemaker. In these cases, we investigate symptoms, mechanism of PMT, programed parameters of pacemaker and treatments of PMT.