ABSTRACT
INTRODUCTION: Careful observations of long- and short-term outcomes associated with carotid intima-media thickness (IMT) are relatively limited. METHODS: A total of 2,972 patients (male:female = 1,960:1,012; mean age = 62 ± 12 years) who underwent carotid IMT measurements from September 2003 to March 2009 were divided into four groups. Group I (n = 271; mean age, 42 ± 7.8 years) included normotensive younger subjects (males, <45 years and females <55 years), group II (n = 992; mean age, 63 ± 9 years) included normotensive elderly subjects, group III (n = 177; mean age, 46 ± 7.8 years) was hypertensive younger subjects, and group IV (n = 1,532; mean age, 63 ± 10.2 years) was hypertensive elderly subjects. We analyzed the clinical and cardiovascular events in the younger hypertensive subjects based on IMT measurements. RESULTS: The baseline characteristics of the subjects showed that carotid IMT increased in the elderly subjects and in patients with hypertension. Poor clinical outcomes, such as all-cause death and major adverse cardiac events, were related with age, not with hypertension. Among the conventional risk factors, age and the highest quartile level of right maximum carotid IMT were related with major adverse events (young: odds ratio [OR], 0.47; 95% confidence interval [CI], 0.25 to 0.9 vs. OR, 1.73; 95% CI, 1.20 to 2.49). The patients in the highest quartile of carotid IMT had worse survival outcomes than those with the lowest IMT (p = 0.03). DISCUSSION: Subjects with hypertension had increased carotid IMT levels. Controlling hypertension and carefully evaluating carotid IMT are important to prevent cardiovascular events even in younger subjects with hypertension.
ABSTRACT
Complex regional pain syndrome (CRPS) is a very rare complication of transradial coronary intervention (TRI). We present the case of a 51-year-old man who suffered severe pain of the right forearm after TRI and progressed to type I CRPS. The patient had effort angina and underwent successful coronary artery stent deployment on the right coronary artery. After removing the hemostatic device, the patient had swelling and severe pain that was not relieved by analgesics. Continued pain progressed to allodynia, hyperalgesia, and hyperesthesia, which met the diagnostic criteria for CRPS. Electromyography showed no abnormalities in nerve conduction and thermography of the forearm showed temperature discrepancy between both forearms, which confirmed the diagnosis of CRPS. We treated the patient with sympathetic nerve block, but he still suffers from minor pain in the right forearm. This case demonstrates that unalleviated pain after TRI can progress to CRPS, and that thermography is a useful method to diagnose CRPS.
Subject(s)
Coronary Stenosis/therapy , Percutaneous Coronary Intervention/adverse effects , Radial Artery , Reflex Sympathetic Dystrophy/diagnosis , Reflex Sympathetic Dystrophy/etiology , Thermography , Autonomic Nerve Block/methods , Body Temperature/physiology , Electromyography , Forearm/blood supply , Forearm/innervation , Forearm/physiology , Humans , Male , Middle Aged , Neural Conduction/physiology , Reflex Sympathetic Dystrophy/therapy , Treatment OutcomeABSTRACT
Cardiac conduction system impairment is a rare clinical manifestation of Behçet's disease. We report a patient who showed 1st degree atrioventricular block at first presentation, and showed aggravated finding of 3rd degree atrioventricular block on five months later. His cardiac manifestation finally developed to acute severe aortic regurgitation on six months later from his first cardiac manifestation. We observed this rapid progression during 6 months and successfully improved symptom and disease severity of the patient with treatment targeting Behçet's disease.
ABSTRACT
Situs ambiguous is rare congenital anomaly in adults. In 2 adult patients who admitted for different cardiac problems, situs ambiguous with polysplenia was detected. A 42-year-old male admitted for radio frequent catheter ablation of atrial fibrillation, and he had left-sided inferior vena cava (IVC), hepatic segment of IVC interruption with hemiazygos continuation, multiple spleens and intestinal malrotation. And in a 52-year-old female case who was hospitalized due to infective endocarditis after implanting pacemaker for sick sinus syndrome, multiple spleens, left-sided stomach, bilateral liver with midline gallbladder, and left-sided IVC were found. Those findings were consistent with situs ambiguous with polysplenia, but their features were distinctive.
