Clinical Outcomes of Elderly Patients with Non ST-Segment Elevation Myocardial Infarction Undergoing Coronary Artery Bypass Surgery / 전남의대학술지

The aim of this study is to investigate the clinical outcomes of the elderly patients with Non ST-segment elevation myocardial infarction (NSTEMI) undergoing coronary artery bypass surgery (CABG) compared to non-elderly patients. Patients with NSTEMI and undergoing CABG (n=451) who were registered in the Korea Acute Myocardial Infarction Registry between December 2003 and August 2012 were divided into two groups.; the non-elderly group ( < 75 years, n=327) and the elderly group (≥75 years, n=124). In-hospital mortality was higher in the elderly group (4.9% vs. 11.3%, p=0.015), but cardiac death, myocardial infarction, and major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, percutaneous revascularization, and redo-CABG after a one-year follow up were not different between the two groups. Predictors of in-hospital mortality in patients with NSTEMI undergoing CABG were left ventricular (LV) dysfunction (ejection fraction ≤40%) [hazard ratio (HR): 2.76, 95% confidence interval (CI): 1.16–6.57, p=0.022] and age (HR: 1.05, 95% CI: 1.01–1.10, p=0.047). So elderly NSTEMI patients should be considered for CABG if appropriate, but careful consideration for surgery is required, especially if the patients have severe LV systolic dysfunction.

Multivessel spontaneous coronary artery dissection presenting as acute myocardial infarction

No abstract available.

Sinus Conversion of Atrial Fibrillation by Restoration of Atrial Perfusion in a Patient with Chronic Total Occlusion

Atrial fibrillation (AF) is a common arrhythmia, and restoration of sinus rhythm is very important in treating this condition. Recently, we experienced a rare case of immediate cardioversion from AF after successful revascularization in a patient with chronic total proximal part of the right coronary artery (RCA) occlusion. A 72-year-old woman with hypertension and diabetes mellitus experienced chest discomfort. An electrocardiogram (ECG) revealed AF. Despite 3 months of appropriate pharmacologic therapy for AF, she continued to complain of effort angina, which was relieved by sublingual nitroglycerin. She subsequently underwent cardiac catheterization, which revealed chronic total occlusion of the proximal RCA with grade III collateral vessels from the left anterior descending (LAD) artery. Balloon angioplasty and stenting restored the blood flow of the RCA, and the AF promptly reverted to sinus rhythm. There was no recurrence of AF over 12 months of follow-up at the outpatient clinic.

Effects of Age on Arterial Stiffness and Blood Pressure Variables in Patients with Newly Diagnosed Untreated Hypertension

BACKGROUND AND OBJECTIVES: To investigate the impact of age on arterial stiffness and blood pressure (BP) variables in newly diagnosed untreated hypertension (HT). SUBJECTS AND METHODS: A total of 144 patients with newly diagnosed untreated HT were divided into two groups: young group (age 50 years, n=73). BP variables were measured on office or 24 hours ambulatory BP monitoring (ABPM). Parameters of arterial stiffness were measured on pulse wave velocity (PWV). Pulse wave analysis (PWA) was compared. RESULTS: Although office BP and pulse pressure (PP) were significantly (p<0.05) higher in the young group than in the old group, BP and PP on ABPM were not significantly different. Central systolic BP and PP, augmentation pressure, augmentation index on PWA, and PWV were significantly higher or faster in the old group compared to that in the young group. Age showed significant positive correlation with both PWV and PWA variables in the young group with HT. However, age only showed significant positive correlation with PWV in the old group with HT. In the young group with HT, PWA variable showed better correlation with age than PWV. CONCLUSION: Considering BP levels on ABPM, office BP is prone to be overestimated in young patients with HT. Parameters of arterial stiffness measured by PWV and PWA were more affected by age rather than by BP level in patients with HT. Therefore, PWA variable might be a more sensitive marker of arterial stiffness in young patients with HT. However, PWV might be a better marker for old patients with HT.

A Case of Left Coronary Artery Milking Treated by Direct Stenting During Percutaneous Coronary Intervention in A Patient with Unstable Angina / 대한내과학회지

Coronary artery milking is defined as a systolic compression of the coronary artery, usually resulting from myocardial bridging. Rarely, congenital heart disease, pulmonary hypertension and ventricular aneurysm can lead to coronary artery milking, and there has been a reported case of left anterior descending coronary artery milking after coronary stenting. Percutaneous coronary intervention (PCI) is an emerging strategy for treatment of stenosis in the left main stem. We report a case of symtomatic systolic milking at the left main stem treated by direct stenting during PCI in a patient with unstable angina pectoris.

The effects of statins on electrical stability in patients with essential hypertension / 대한내과학회지

BACKGROUND/AIMS: Essential hypertension is the most common cardiovascular disease and is involved in the development of the various cardiac arrhythmias, including atrial fibrillation. Recently, several studies have shown that statins have anti-arrhythmic effects, including the prevention of atrial fibrillation. This study investigated the effects of statins on cardiac electrophysiologic remodeling in patients with essential hypertension using the signal-averaged electrocardiogram (ECG) and standard 12-lead ECG. METHODS: This prospective multicenter study enrolled 115 patients with hypertension. Various antihypertensive drugs were administered alone or in combination according to their blood pressure. Statins were administrated in 56 patients. Laboratory tests, a standard 12-lead ECG, and signal-averaged ECG were performed at 1, 3, 6, and 12 months. Statistical analysis was performed using paired and independent t-tests and repeated measures analysis of variance (ANOVA). RESULTS: There was no significant difference in the clinical characteristics of the patients with and without statins. After antihypertensive therapy for 1 year, the P wave dispersion, high-frequency low-amplitude (HFLA) signals in the QRS complex of less than 40 micronV, and T peak-to-end dispersion were increased significantly (p<0.001, p<0.05, and p<0.01, respectively) in the patients who were not taking statins, while these changes were not seen in the statin group. CONCLUSIONS: These results demonstrate that electrophysiologic remodeling was progressive in patients with essential hypertension, despite antihypertensive therapy. However, combination therapy with a statin may inhibit the deterioration of inhomogeneity in atrial refractoriness and conduction disturbance.

The Effect of Hypothermia on Lung Inducible Nitric Oxide Synthase Gene Expression in Intestinal Ischemia-Reperfusion Injury

PURPOSE: Although hypothermia has been used in many clinical situations, such as post cardiopulmonary resuscitation, stroke, traumatic brain injury, septic shock, and hemorrhagic shock, the mechanism by which it works has not been clearly elucidated. We aimed to evaluate the effect of hypothermia on the plasma nitric oxide (NO) concentration, lung iNOS expression, and histologic changes in intestinal ischemia-reperfusion (IR). METHOD: Male Sprague-Dawley rats were randomly divided into the hypothermia group (HT, n=8, 27~30 degrees C) and the normothermia group (NT, n=8, 36~37 degrees C). They underwent 30 min of intestinal ischemia by clamping the superior mesenteric artery, which was followed by 1.5 h of reperfusion. They were then sacrificed. The acute lung injury (ALI) score, the plasma NO concentration, and lung iNOS gene expression were measured. RESULTS: Compared with the HT group, the NT group showed severe infiltrations of inflammatrory cells, alveolar hemorrhages, and interstitial hypertrophies in lung tissues. There were significant differences in the ALI scores between the NT and the HT groups (8.7 +/- 1.5/HPF in NT vs 5.8 +/- 1.2/HPF in HT, p=0.008). Although the plasma NO concentration was slightly lower in the HT group, there was no significant difference between the two groups (0.80 +/- 0.24 micromol/L in NT vs 0.75 +/- 0.30 micromol/L in HT, p=0.917). Lung iNOS gene expression was stronger in the NT group than in the HT group. The band density of the expression of iNOS in lung tissues was significantly increased in the NT group compared to the HT group (5.54 +/- 2.75 in NT vs 0.08 +/- 0.52 in HT, p=0.002). CONCLUSIONS: This study showed that hypothermia in intestinal IR reduces inflammatory responses, ALI scores, and iNOS gene expression in lung tissues. There was no significant effect of hypothermia on the plasma NO concentration.

Norovirus Outbreak after a School Trip among Girls' High School Students

Norovirus is one of the common causative agents of viral gastroenteritis in developed countries. A large outbreak of gastroenteritis occurred among girls' high school students in Cheongju city, Chungbuk province, who had attended a school trip to Cheju island from 19 to 21 May 2003. One hundred and ninety six students were consistent with case definition and attack rate was 54.9%. The epidemic curve was characteristic of a point-source outbreak. The frequency of diarrhea was 1 to 6 times (76.8%) and the duration of diarrhea was within two days (85.1%) in most cases. The most common symptom with diarrhea was abdominal pain followed by headache, tenesmus, febrile sense, chill and vomiting. The following bacterial organisms, Salmonella spp, Shigella spp, Vibrio spp, Staphylococcus aureus, and E coli O157 were examined in 196 stool specimens, but no suspicious organism was detected. In virological examinations, Norovirus was dectected in 3 out of 25 stool specimens from the sick students. Among the 22 stool specimens of the food handlers during the school trip, both bacterial and virological examinations were all negative. Among the 13 environmental specimens, the groundwater of the hotel, where the students had stayed during their school trip, was contaminated with general bacteria and E. Coli. However, we could not detect Norovirus in the groundwater of the hotel. We concluded that Norovirus might be a possible cause of this outbreak, and the water supply of the hotel might be a probable source of this outbreak.

Hypernasality correlates with acoustics and aerodynamics

Predictive Factors for the Restenosis after Long Coronary Stent Implantation

BACKGROUND AND OBJECTIVES: In-stent coronary restenosis remains one of major clinical problems in percutaneous coronary intervention. Long stent has been known to be associated with high restenosis rate. Predictive clinical and angiographic factors were analyzed after long coronary stenting. METHODS: One hundred four patients (57.2+/-9.6 year-old, 105 male) who underwent long coronary stent implantation and follow-up coronary angiogram, out of 237 patients implanted long coronary stents between June 1996 and January 1999 at Chonnam National University Hospital. RESULTS: Primary success rate was 100%. Lesion length was 18.5 +/- 9.2 mm and the length of stent was 27.3 +/- 6.1 mm. Mean duration of clinical follow-up and follow-up coronary angiogram was 20.1+/-6.8 months and 6.3+/-2.7 months respectively. Restenosis rate according to follow-up coronary angiogram was 42.5% (57/134). Clinical variables of age, sex, clinical diagnosis, risk factors, and angiographic variables of target artery and lesion types, indications for stenting, stent types, reference diameter, lesion length, minimal luminal diameter, and acute gain were not related with late stent restenosis. Diameter stenosis before stenting was higher in the group with restenosis (81.9+/-16.9 %) than in group without restenosis (71.1+/-18.5%; p<0.05), and lower lower in the group with restenosis (-7.6+/-15.7%) and in the group without restenosis (5.6+/-22.4%; p<0.05) after stenting. CONCLUSIONS: Primary success rate was comparable. Severe luminal stenosis before stenting and overdilation after stenting are associated with restenosis after long coronary stenting.

The percutaneous coronary intervention in elderly women over 70 years of age / 대한내과학회지

BACKGROUND: Previous reports have mentioned the increased mortality of percutaneous coronary intervention (PCI) in elderly female patients compared with elderly male. The purpose of this study was to evaluate the clinical characteristics, coronary lesion, characteristics and differences of success rate of PCI between male and female elderly patients. METHODS: Three hundred sixty six elderly patients (454 lesions), including 210 male (255 cases, 73.4+/-2.45 year-old) and 156 female (199 cases, 73.5+/-2.55 year-old) who underwent PCI at Chonnam National University Hospital between Jan '96 and Dec '98 (out of 3,030 patients during same period). We compared clinical characteristic, coronary artery lesion morphology, success and complication rates of PCI in elderly male and female patients. RESULTS: Clinical diagnosis and risk factors for atherosclerosis were not different between two groups. Right coronary lesions were more common in female and left circumflex artery lesion less common in female patients. The success rate of balloon angioplasty was 93.2% (110/118) in male and 93.3% in (98/105) in female patients, and the success rates of stenting were 99.2% (136/137) in male and 100% (94/94) in female. Success rates of PCI were not different between two groups. Procedure-related mortality was one cardiac death (1/255, 0.39%) in male group only. Complications of elderly male were two occlusive dissection (OD: 2/255, 0.8%), three thrombotic occlusion (TO: 3/255, 1.2%) and two ventricular arrhythmia (VA) with shock (2/255, 0.8%). In 199 female patients, three OD (3/199, 1.5%), three TO (3/199, 1.5%) and two VA (2/199, 1.0%) developed. The complications rates were not different two groups. CONCLUSION: PCI in female patients older than 70 years can be performed with comparable success and complication rates to those of elderly male patients.

The percutaneous coronary intervention in elderly women over 70 years of age / 대한내과학회지

BACKGROUND: Previous reports have mentioned the increased mortality of percutaneous coronary intervention (PCI) in elderly female patients compared with elderly male. The purpose of this study was to evaluate the clinical characteristics, coronary lesion, characteristics and differences of success rate of PCI between male and female elderly patients. METHODS: Three hundred sixty six elderly patients (454 lesions), including 210 male (255 cases, 73.4+/-2.45 year-old) and 156 female (199 cases, 73.5+/-2.55 year-old) who underwent PCI at Chonnam National University Hospital between Jan '96 and Dec '98 (out of 3,030 patients during same period). We compared clinical characteristic, coronary artery lesion morphology, success and complication rates of PCI in elderly male and female patients. RESULTS: Clinical diagnosis and risk factors for atherosclerosis were not different between two groups. Right coronary lesions were more common in female and left circumflex artery lesion less common in female patients. The success rate of balloon angioplasty was 93.2% (110/118) in male and 93.3% in (98/105) in female patients, and the success rates of stenting were 99.2% (136/137) in male and 100% (94/94) in female. Success rates of PCI were not different between two groups. Procedure-related mortality was one cardiac death (1/255, 0.39%) in male group only. Complications of elderly male were two occlusive dissection (OD: 2/255, 0.8%), three thrombotic occlusion (TO: 3/255, 1.2%) and two ventricular arrhythmia (VA) with shock (2/255, 0.8%). In 199 female patients, three OD (3/199, 1.5%), three TO (3/199, 1.5%) and two VA (2/199, 1.0%) developed. The complications rates were not different two groups. CONCLUSION: PCI in female patients older than 70 years can be performed with comparable success and complication rates to those of elderly male patients.

A Case of Artifact Mistaken for Cardiac Tumor on Computed Tomography

Laminar flow within large vessels or organs can cause artifact that may simulate thrombus during computed tomographic study. The degree of venous enhancement depends on the size of blood pool and cardiac output in relation to the time of scanning. When venous structures are scanned too fast after injection of contrast material, poor mixing of enhanced and unenhanced blood creates flow artifact that gives an appearance of deep venous thrombosis. As compared with dynamic computed tomography (CT), because of a shorter acquisition time of spiral CT, vascular and organ enhancement on spiral CT scan are more dependent on factor that affect delivery of contrast material into the blood stream. Differentiation from true thrombus can be made by use of delayed scan as well as increased density and finding of relatively poor margination of artifact. In addition, both angiography and echocardiography could complement CT to assure that false-positive results are minimized. We experienced a case of artifact mistaken for intracardiac mass on spiral CT, but it was not noted on echocardiography.

A Case of a Budd-Chiari Syndrome Associated with a Large Atrial Thrombus in Antithrombin Deficiency and Antiphospholipid Syndrome / 대한혈액학회지

Antiphospholipid antibody is associated with a clinical syndrome of vascular thrombosis, thrombocytopenia, recurrent fetal loss and cerebrovascular accident whether or not the clinical diagnosis of SLE coexists. Antithrombin deficiency leads to thromboembolism in the venous system. It develops an asymptomatic venous occlusion in many cases, but when it develops cerebral venous thrombosis, mesenteric venous thrombosis or Budd-Chiari syndrome, it leads to special clinical problems. We report the finding of a low anti-thrombin level and IgM anticardiolipin antibody in a patient who has had episodes of a large thrombus in the right atrium and Budd-Chiari syndrome due to the thrombus.

Differential Diagnosis Using 12-lead Electrocardiogram and Significance of ST-T in Paroxysmal Supraventricular Tachycardia / 대한내과학회지

OBJECTIVES: Accurate differential diagnosis of paroxysmal supraventricular tachycardia (PSVT) has become more important after introduction of curative catheter ablation technique into clinical practice. It has been reported that ST-T changes during supraventricular tachycardia are frequent, but its association is different according to the type of PSVT and the location of the AV bypass tracts. Therefore, this study was performed to evaluate the significance of ST-T changes in addition to classic ECG parameters in differentiating AV nodal reentrant tachycardia (AVNRT) and AV reentrant tachycardia (AVRT), and predicting the location of the AV bypass tracts. METHODS: One hundred thirty patients presenting with narrow-QRS complex ( or =1 mm was observed in 27.8% of AVNRT and 79.9% of AVRT (p or =2 mm was observed in 76.9% of the left posterior pathways, 28.1% of the left anterolateral pathways, 66.7% of the right posterior pathways, and 1.1% of the right anterior pathways. Sensitivity, specificity, and positive predictive value in differentiating AVRT from AVNRT with visible p wave were 72%, 91%, and 92%, respectively : 78%, 72%, and 80%, respectively with ST segment depression > or =1 mm, and 30%, 93%, and 85%, respectively with T wave inversion. In differentiating AVNRT from AVRT, Sensitivity, Specificity, and positive predictive value of pseudo r' wave and pseudo s wave were 59%, 92%, 84%, respectively and 33%, 99%, 94%, respectively. Sensitivity, specificity, and positive predictive value in distinguishing posterior location from anterior location of the pathways were 74%, 76%, and 72%, respectively with ST segment depression (> or =2 mm) and 46%, 83%, and 70%, respectively with T wave inversion. CONCULSIONS: ST Segment depression during PSVT can be used complementally to the classic ECG parameters in the differential diagnosis of PSVT and predicting the location of the AV bypass tracts.

Cases of the surgical correction of facial asymmetry

No abstract available.