A Rapid Improvement of Heart Failure after Treatment of Hyperthyroidism

BACKGROUND: Heart failure is a rare condition of thyrotoxicosis. We report a case of thyrotoxicosis-inducing heart failure. CASE REPORT: A 29-year old female had been suffered from thyrotoxicosis for 3 years without proper medication. She complained progressive dyspnea and palpitation with atrial fibrillation with rapid ventricular response. Marked cardiomegaly, and severe right ventricular dysfunction with biatrial enlargements were found on Two-dimensional (2D) echocardiography. We treated her with medications for heart failure and thyrotoxicosis, and the patient's symptoms and objective cardiac functions are improved after two weeks. CONCLUSION: Severe heart failure caused by thyrotoxicosis could be reversible with proper management. Patients who have thyrotoxicosis should be assessed closely, and suitable treatment can markedly improve the patient's prognosis.

A Case of Successful Treatment of Femoral Artery Pseudoaneurysm Using Thrombin Injection

No abstract available.

A successful stenting of the coarctation of aorta in a patient with acute pulmonary edema / 대한내과학회지

Coarctation of aorta is a rare vascular disorder which is one of causes of secondary hypertension. Since the early 1990s stenting in the coarctation of aorta has been introduced as an alternative treatment method, there were a few cases which were treated by stent implantation for the coarctation of the aorta in Korea. But the case which was treated using stent in congestive heart failure with pulmonary edema has never been reported. We report on successful management of a 64-year-old female patient, who presented with acute heart failure and pulmonary edema due to severe aortic coarctation. After endotracheal intubation, aortogram was performed, which revealed a severe narrowing in the distal thoracic aorta with a peak systolic pressure gradient of 100 mmHg across the lesion. Stent implantation was performed with 24x100 mm self-expandable Nitinol-S stent after predilation with 10x40 mm balloon. After stenting, patient's symptom and sign of congestive heart failure were remarkably improved and endotracheal intubation tube was able to be removed. And no significant adverse cardiac events observed during a nine-month clinical follow-up.

A Randomized Trial for the Secondary Prevention by Azithromycin in Korean Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: There is serological and epidemiological evidence of an association between Chlamydia pneumoniae infection and coronary artery disease. We conducted a randomized study using azithromycin treatment in Korean patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) to determine whether azithromycin treatment reduced the inflammatory markers and major adverse cardiac events (MACE). SUBJECTS AND METHODS: One hundred twenty nine patients were randomly selected to receive 500 mg azithromycin daily for 3 days before and after PCI, followed by 500 mg/week for 2 weeks (Group l: 64 patients, 43 male, 60.0+/-10.0 years), or they received a placebo (Group ll: 65 patients, 45 male, 59.6+/-10.1 years). Patients were followed up for 12 months. The primary endpoints were cardiac death, recurrent myocardial infarction (MI), target lesion revascularization (TLR) and Non-TLR during the 12-month follow-up. RESULTS: There were no differences between the two groups in baseline characteristics, coronary angiography finding, lesion characteristics, baseline inflammatory markers and baseline antibody titers of Chlamydia pneumoniae, Helicobacter pyroli and Mycoplasma. After the antibiotic treatment, ESR and CRP decreased from 19.6+/-20.7 mg/dL and 0.75+/-0.99 mg/dL to 9.36+/-10.5 mg/dL and 0.22+/-0.20 mg/dL in group l (p=0.002, 0.001 respectively), and from 19.6+/-21.5 mg/dL, 1.44+/-2.69 mg/dL to 10.4+/-10.8 mg/dL, 0.55+/-1.48 mg/dL in group ll (p=0.052, <0.0001 respectively). However, there were no significant changes in the serologic markers. MACE developed in 17 (26.6%) out of 64 patients in group l with 2 death, 2 MI and 13 TLR. In group ll, 14 (21.5%) out of 65 patients had MACE with 2 death, 1 MI and 10 TLR during the 12-month clinical follow-up (p=NS). CONCLUSION: Short-term treatment with azithromycin does not reduce the major adverse cardiac events in Korean patients with ACS after PCI.

The Clinical Outcome of Acute Myocardial Infarction with Normal Coronary Angiogram

BACKGROUND AND OBJECTIVES: Little data exist concerning the clinical outcome of patients with acute myocardial infarction (AMI) and angiographically normal coronary arteries (NCA). The purpose of this study was to evaluate the clinical outcome, the etiological factors and prognosis of these patients. SUBJECTS AND METHODS: The subjects were divided into two groups according to findings from coronary angiograms performed between January 1999 and December 2001, Group 1 : comprised of 46 patients, 34 males and 12 females, with a mean age of 50.4+/-11.9 years, had AMI with NCA ; Group II : 181 patients, 143 males and 38 females, with a mean age of 59.0+/-10.3 years, with AMI and total occlusion of the coronary arteries. RESULTS: The percentages of smoking and hypertension were similar between the two groups ; a higher prevalence rates of hyperlipidemia and diabetes were observed in group II compared to group I (p=0.03, 0.01). In group I, coronary spasm, combined inflammatory diseases and embolization were demonstrated in 32.6, 6.5 and 4.3% of subjects, respectively. The left ventricular ejection fraction was higher in group I than group II (51.5+/-11.3% vs. 46.2+/-10.5%, p=0.006). In-hospital outcomes, with the combined end-point defined as death, re-infarction and stroke was 0% in group I vs. 7.7% in group II (p=0.07). The mean long-term survival rate during the 26.5-month clinical follow-up were 100 and 92.2% in groups I and II (p=0.04), respectively. CONCLUSION: A coronary spasm is the most common cause of AMI with NCA, but these patients had the higher long-term clinical event-free survival.

The Changes of Fractional Flow Reserve after Intracoronary Nitrate and Nicorandil Injection in Coronary Artery Ectasia

BACKGROUND AND OBJECTIVES: Little data exist relating to the mechanism of myocardial ischemia in patients with coronary artery ectasia (CAE). The purpose of this study was to evaluate the fractional flow reserve (FFR), as an index of myocardial ischemia, in patients with CAE. SUBJECTS AND METHODS: Ten patients (7 males, 54.0+/-12.6 years) who diagnosed as CAE, by coronary angiographies, between March 2002 and July 2002, were analyzed. The clinical diagnosis of all the patients was unstable angina. FFR were performed using a pressure wire on the patients diagnosed with slow flow CAE from their coronary angiograms. After measurement of the baseline FFR using adenosine 20 microgram for the right coronary artery, and 24 microgram for the left anterior descending artery, the changes in the FFR with 500 microgram of intracoronary nitrate and 2 mg of Nicorandil were observed. RESULTS: Smoking was the most frequently associated risk factor. Type I CAE, according to Markis' classification, was the most prevalent at 60.0%. The values of the baseline FFR in the left anterior descending artery and right coronary artery, following the intracoronary injection of adenosine were both normal, and there were no significant changes in the FFR following the intracoronary injections of nitrate and Nicoronadil. CONCLUSION: The value of the FFR with CAE was normal, and an intracoronary injection of vasodilators did not change the FFR in patients with CAE. Therefore, vasodilator therapy might be beneficial for patients with symptomatic CAE.

A case of spiral dissection during diagnostic coronary angiography / 대한내과학회지

Severe, occlusive spiral dissection during diagnostic coronary angiogram is very rare. A 41-year old female patient was admitted because of chest pain at night. Her left coronary angiogram revealed no significant stenosis with diffuse luminal narrowing. Immediately after right coronary artery (RCA) injection, sudden occlusion of middle RCA was noted, which was not improved despite multiple injections of intracoronary nitrate. The patient complained of severe chest pain and ST segment elevation was observed on electrocardiogram monitoring. After wiring into true lumen of RCA, distal flow was improved and intravascular ultrasound revealed spiral dissection flap extending from proximal to middle RCA. Final coronary angioram showed patent RCA with spiral dissection and good distal flow into the distal RCA. The patient had no clinical events during 2-month clinical follow-up.

A Case of Acute Myocardial Infarction after Blunt Chest Trauma in a Young Man

Coronary artery injury rarely occurs after blunt chest trauma, but it can lead to extensive myocardial infarction and be frequently overlooked. A 16-yr-old man was presented with comatose mental state and rapid respiration rate. He ran into guard rail while riding a motorcycle. In routine examination, his electrocardiogram showed Q wave and 2 mm ST segment elevation in all precordial leads, I and aVL. The cardiac enzymes were also elevated: creatine kinase (CK)-MB was 300 U/L, and cardiac specific troponin I was 5.7 ng/mL. Two-dimensional echocardiography showed anteroseptal akinesia with severely depressed left ventricular function, ejection fraction of 28%. He could not receive any anticoagulation or thrombolytic therapy because of his brain lesion. Three weeks later, his mental state improved. A diagnostic coronary angiogram revealed total occlusion in the proximal left anterior descending artery (LAD) with collaterals from the right coronary artery and left circumflex artery. We successfully performed a percutaneous coronary intervention for the LAD lesion, and the final angiogram showed a good coronary flow without residual stenosis.

The Prognostic Significance of Statin Therapy According to the Level of C-Reactive Protein in Acute Myocardial Infarction Patients who Underwent Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: As well as lowering lipids, statins are known to possess antiinflammatory and antithrombotic properties. Recent studies have suggested an association between statins and the early reduction in deaths, or myocardial infarction following percutaneous coronary intervention (PCI). The aim of this study was to examine the interrelationship between inflammation, statin use and PCI outcomes in patients with an acute myocardial infarction (AMI). SUBJECTS AND METHODS: A total of 340 patients with AMI, who underwent PCI between June 2000 and Dec 2001 at Chonnam National University Hospital, were divided into two groups: Group I (n= 158, 58.9+/-10.7 years, male 82.9%) those with normal C-reactive protein (CRP) ( or =0.5 mg/dL, mean value=3.71+/-1.73 mg/dL) on admission. RESULTS: The levels of the erythrocyte sedimentation rate, white blood cell, monocyte, creatine kinase (CK), CK-MB and troponin I and T were higher in Group II than in Group I. Severe coronary lesions (type B2/C lesion), according to American College of Cardiology/American Heart Association, were more frequently observed in Group II than in Group I. During the one year clinical follow up, major adverse cardiac events (MACE) occurred significantly more frequently in those patients with elevated CRP levels without statin therapy. Using a multiple logistic regression analysis, the independent predictors for the one year MACE were: a CRP above 0.5 mg/dl, a left ventricular ejection fraction less than 40%, an age above 75 years, statin use and a type B2/C lesion on the coronary angiogram (p<0.001, =0.001, 0.002, 0.031 and 0.035, respectively). CONCLUSION: Statin therapy significantly attenuates the increased risk for MACE in AMI patients, with elevated CRP levels, undergoing PCI.

Acute and Long-term Clinical Outcomes after Coronary Stenting of CrossFlex, GFX and NIR Stents

BACKGROUND AND OBJECTIVES: New coronary stents are displacing for the broader array of lesions, but disagreement remains which device is more advantageous and whether design determines outcomes. The present study investigates the impact of stent design on early and one year outcomes. MATERIALS AND METHODS: A retrospective analysis of 350 patients with 378 lesions (60+/-10 years, 265 male), that underwent 181 CrossFlex, 95 GFX, 102 NIR coronary stentings at Chonnam National University Hospital from January 1996 to December 1999, was performed. Early procedural success rates, major adverse cardiac event (MACE) within one year and follow-up angiographic findings in 227 patients (240 lesions, follow-up duration=8.1+/-5.9 months) were compared among three groups. METHODS: 1) There were no significant differences in the baseline clinical and angiographic characteristics except the lesion length (CrossFlex: GFX: NIR=11.5+/-5.2: 14.5+/-6.7: 13.9+/-5.7 mm, p<0.05). 2) There were no significant differences in early angiographic success rates among three groups (CrossFlex: 98.9%, GFX: 100.0%, NIR: 99.0%). 3) There were no significant differences in late luminal loss (CrossFlex: GFX: NIR=1.03+/-0.69: 1.11+/-0.75: 1.09+/-0.70 mm, p=NS), restenosis rates (CrossFlex: 30.6%, GFX: 30.8%, NIR: 28.4%, p=NS) and MACE (CrossFlex: GFX: NIR=27.6%: 29.5%: 27.5%, p=NS) among three groups. CONCLUSION: Despite different lesions length, the early and late angiographic outcomes, and MACE within one year were not different among three different types of coronary stents.

Long-term Clinical and Angiographic Results of Coronary Stenting in Diabetic Patients

BACKGROUND: Diabetes is a major risk factor for restenosis and high mortality after percutaneous coronary intervention. The impact of coronary stenting on the clinical outcome of diabetic patients remains controversial. METHOD: The in-hospital and long-term clinical outcomes of 104 consecutive diabetic (60+/-8 year-old, 74 male) and age-matched 193 control (57+/-10 year-old, 162 male) patents underwent coronary stenting between January 1998 and March 1999 at Chonnam National University Hospital were compared. RESULTS: 1) Coronary stenting was successful in 98% of diabetic patients and 97% of non-diabetic patients. Post-procedural minimal luminal diameter (MLD) was not different between two groups(2.89+/-0.42 vs. 2.95+/-0.62 mm), but follow-up MLD was lower in diabetics than that in non-diabetics (1.70+/-0.96 vs. 2.05+/-0.72 mm, P < 0.05). 2) Restenosis rate on follow-up coronary angiograpy was not different between two groups (40.7% in diabetics and 32.0% in non-diabetics. 3) In-hospital outcome was not different between two groups. Long-term clinical follow-up (16+/-11 months) revealed higher overall major adverse cardiac events in diabetics than in non-diabetics (38.7 vs. 30.7 %, P < 0.05). CONCLUSION: Coronary stenting in diabetics can be performed with acceptable short-term results. However, long-term clinical outcome in diabetic patients was worse than in non-diabetics.

Long-term Clinical and Angiographic Outcomes of Side Branch Occlusion after Coronary Stenting

BACKGROUND: Coronary stent is one of effective and well-accepted treatments for coronary artery diseases. Stenting of coronary lesions, however, sometimes involves the coverage of relatively large side branches located in the vicinity of the target lesion. Serial angiographic changes in side branches of stented coronary segments were analyzed to determine the incidence and clinical outcomes of side branch occlusion. METHODS: Serial angiographic findings of 51 patients who had total 60 side branches originating from the stented segments including large branches more than one millimeter in diameter were analyzed. Side branches were divided into two types:type A (> or =1 mm in diameter, with ostial narrowing>50%), type B (> or =1 mm in diameter, with ostial narrowing>50%). Side branch occlusion was defined as development of total occlusion or morphologic changes from type B to A or reduction of TIMI flow more than I after stenting. RESULTS: After stent deployment, 4 out of 60 side branches occluded totally and 2 out of 4 side branches regained luminal patency with the improvement of TIMI flow (type A, TIMI II) on follow-up coronary angiography. Another one branch which showed type B, TIMI flow II changed into type A, TIMI flow I. There were no clinical cardiovascular events associated with acute side branch occlusion. On follow-up coronary angiogram, side branch occlusion developed in 20 (33.3%) side branches. The incidences were significantly related with in-stent restenosis (11/17, 64.7% in group with retenosis vs. 9/34, 26.4% in group without restenosis, p=0.003). CONCLUSIONS: Acute side branch occlusion can develop in a few stented patients without any clinical deteriorations and delayed side branch occlusion may be associated with in-stent restenosis.

Potentiating Effects of Bay K 8644 on the Relaxation Induced by Ultraviolet or Visible Light in Porcine Coronary Artery

BACKGROUND: This study was aimed at defining the varying responses of porcine coronary artery(PCA) to various wavelengths of ultraviolet irradiation, and at relating them to the changes in cyclic GMP contents. METHODS: The ring preparations of PCA with intact or removed endothelium were irradiated with the ultraviolet or visible light of wavelengths(240-520mm) from xenon lamp of a spectrofluorometer, and the changes in vascular tension were recorder on polygraph. For cyclic GMP assay, rat thoracic aorta was frozen after irradiation and homogenated. The supernatant was extracted with water-saturated ether and the cyclic GMP contents were measured with radioimmunoassay. RESULTS: Ultraviolet irradiation relaxed the preparations(UVR-relaxation) in resting state and those precontracted by prostaglandin F2alpha, the maximal relaxation occurring at 410nm, and the magnitude depending on the duration of irradiation. The UVR-relaxation was not affected by removing the endothelium, while it was markedly potentiated by pretreatment with Bay K 8644. The Bay K 8644-induced potentiation of UVR-relaxation was abolished by hemoglobin and slightly reduced by wrapping the rings with aluminum foil. Cyclic GMP contents in the increase was markedly potentiated by pretreatment with Bay K 8644. CONCLUSION: The observations suggest that UVR-relaxation in procine coronary artery is caused by activating the nitric oxide-cyclic GMP system, which is most sensitively activated by UVR of 410nm and that its potentiation induced by Bay K 8644 may be related nitrous substance released from the agent upon UVR.

Risk Factors For Subtypes of Cerebrovascular Disease in Korea

With a purpose to difine risk factors of respective subtypes of cerebrovascular disease, a case-control study was performed in 1,251 cases with cerebrovascular disease who were admitted to twelve large institutions over the country during the year of 1988. All cases were subtype-proven by computerized tomography. Three hundred and eighty three patients were selected as control among the patients who were admitted to the same hospitals during the same period. The variables were collected prospectively and the data were processed by univariate and multiple logistic regression analyses and the significance was tested by chi-square methods. In the univariate analysis, female sex, being a physical worker, history of hypertension either treated or not and previous stroke history were significantly related with cerebral hemorrhage. Male sex, being aged 60 or more, living in city area, being a mental worker, history of hypertension either treated or not, history of stroke, being a diabetic and positive family history of stroke were significantly related with cerebral infarction. In multiple logistic regression analysis hypertension and alcohol drinking were strong independent risk factors for cerebral hemorrhage. Hypertension, being aged 60 or more, and living in urban area were also independent risk facrots for cerbral infarction. Of the other variables analyzed, socioeconomic class, smoking history or body mass index did not constitute significnat risks for either cerebral hemorrhage or cerebral infarction.

The frequency distribution of cardiovascular diseases in 13 hospital admitted patients in Korea: Korean Society of Circulation

The frequency distribution of cardiovascular disease are changing recently due to the development of living environment. Unfortunately there are few epidemiological studies of cardiovascular diseases in general population, we tried to estimate the recent trend of cardiovascular diseases studying hospitalized patients in nationwide 13 large hospitals during a year of 1985. The hypertensive disease (24.1%) was the most common cardiovascular disease and the next were cerebrovascular disease (15.8%), arrhythmias (12.2%), ischemic heart disease (9.7%), congenital heart disease (9.1%), and rheumatic heart disease (5.4%) in order. This results showed that hypertensive disease and cerebrovascular disease are still the major cardiovascular disease and ischemic heart disease and arrhythmias are increased. But chronic rheumatic heart disease is declined compared with previous studies in hospitalized patients.