A recently reported cardiac syndrome of transient left ventricular dysfunction, clinically resembles acute myocardial infarction and presents with chest pain, ECG changes and minimal elevation of cardiac enzymes in absence of myocardial ischemia or injury. The clinical presentation includes a wide range of symptoms and left ventricular function is normalized completely within days to weeks. This syndrome is likely a non-ischemic, metabolic-dependent syndrome caused by stress-induced activation of the cardiac adrenoreceptors. We report three cases of stress-induced transient LV dysfuction.
Cardiomyopathies* ; Chest Pain ; Electrocardiography ; Myocardial Infarction ; Myocardial Ischemia ; Ventricular Dysfunction, Left ; Ventricular Function, Left

Atrial aneurysms involving the free wall or atrial appendage are very rare intracardiac anomalies, less than 100 case reported worldwide. It is usually detected by chance and also could be associated with atrial arrhythmias or systemic embolism. Transthoracic echocardiography and cardiac MRI is the standard diagnostic modality. Aneurysmectomy is usually recommended especially in symptomatic cases. We review the literature and report a case of atrial appendiceal aneurysm, a 23 year-old young man whose diagnosis was established with transthoracic echocardiography and cardiac CT angiography.
Aneurysm* ; Angiography ; Arrhythmias, Cardiac ; Atrial Appendage* ; Diagnosis ; Echocardiography ; Embolism ; Heart Aneurysm ; Humans ; Magnetic Resonance Imaging ; Young Adult

BACKGROUND AND OBJECTIVES: Stress induced cardiomyopathy has been reported as reversible left ventricular dysfunction with electrocardiographic changes. Although the exact mechanism of this dysfunction has not been clarified, catecholamine "surge" is suspected as a potential cause of this disease. It has not been undergone the studies about the effect of chronic or recurrent psychological stress on the myocardium. We suspect that reversible ischemic change of myocardium could be induced by chronic or recurrent emotional stress. MATERIALS AND METHOD: The clinical, echocardiographic and angiographic data of 189 patients (72 women) who presented with ischemic symptoms and eletrocardiographic changes were participated. BAI (Beck anxiety inventory) and BDI (Beck Depression inventory) were obtained and analyzed for evaluation of degree of psychological stress. RESULTS: 54 patients who had left ventricular apical wall motion abnormalities without significant angiographical stenosis in the coronary artery were younger than the others with left ventricular wall motion abnormalities and angiographic stenosis. And they increased the BAI and BDI as tools of evaluation of psychological stress (p<0.05). CONCLUSION: Data of this study suggested that psychological stress can be associated with myocardial dysfunction. It can be postulated that psychological stress should be considered as one of the cause of non-coronary myocardial injury.
Anxiety ; Cardiomyopathies ; Constriction, Pathologic ; Coronary Vessels ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles* ; Humans ; Myocardium ; Stress, Psychological ; Ventricular Dysfunction, Left

OBJECTS: Atherosclerosis is closely related with the coronary artery disease, cerebrovascular disease, and peripheral arterial disease. Recently, It was revealed that a common cause of death in Korea is cardiovascular disease, like a western country. So the early detection of atherosclerosis and prevention of atherosclerosis is very important aspect. There are several methods to evaluate the early atherosclerosis. Among them, flow mediated vasodilation of brachial artery and intima-media thickness of carotid artery are commonly used surrogate marker of early atherosclesrosis. The aim of this article is to review published papers how we can apply these methods to assess the early atherosclerosis. METHOD AND RESULT: In medline search, seventy four articles were selected to review the method and clinical application of these two methods. Most of these papers were from peer reviewed journals. CONCLUSION: Flow-mediated vasodilation and the measurement of intima-media thickness of carotid artery were very useful and important methods to detect early atherosclerosis. and also to evaluate the clinical efficacy of various kinds of intervention to assess the vascular function and structure.
Atherosclerosis* ; Biomarkers ; Brachial Artery ; Cardiovascular Diseases ; Carotid Arteries ; Cause of Death ; Coronary Artery Disease ; Korea ; Peer Review ; Peripheral Arterial Disease ; Ultrasonography* ; Vasodilation

The cardiomyopathies constitute a group of diseases in which the dominant feature is direct involvement of the heart muscle itself. They are distinctive because they are not the result of pericardial, hypertensive, congenital, valvular, or ischemic diseases. Although the diagnosis of cardiomyopathy requires the exclusion of these etiological factors, the features of cardiomyopathy are often sufficiently distinctive-both clinically and hemodynamically-to allow a definitive diagnosis to be made. With increasing awareness of this condition, along with improvements in diagnostic techniques, cardiomyopathy is being recognized as a significant cause of morbidity and mortality. Whether the result of improved recognition or of other factors, the incidence and prevalence of cardiomyopathy appear to be increasing. A variety of schemes have been proposed for classifying the cardiomyopathies. The most widely recognized classification is that promulgated jointly by the World Health Organization (WHO) and the International Society and Federation of Cardiology (ISFC). In the WHO/ISFC classification, the cardiomyopathies are classified based on their predominant pathophysiological features; other diseases that affect the myocardium that are associated with a specific cardiac disorder or are part of a generalized systemic disorder are termed specific cardiomyopathies. Three basic types of functional impairment have been described: 1) dilated (DCM, formerly called congestive), the most common form, accounting for 60 percent of all cardiomyopathies and characterized by ventricular dilatation, contractile dysfunction, and often symptoms of congestive heart failure; 2) hypertrophic (HCM), recognized by inappropriate left ventricular hypertrophy, often with asymmetrical involvement of the interventricular septum, with preserved or enhanced contractile function until late in the course; and 3) restrictive (RCM), the least common form in western countries, marked by impaired diastolic filling and in some cases with endocardial scarring of the ventricle. Two other forms of cardiomyopathy are recognized: arrhythmogenic right ventricular cardiomyopathy and unclassified; the latter includes fibroelastosis, systolic dysfunction with minimal dilatation, and mitochondrial involvement. The distinction between the three major functional categories is not absolute, and often there is overlap; in particular, patients with HCM also have increased wall stiffness as a consequence of the myocardial hypertrophy and thus present some of the features of an RCM. Late in their course, ventricular dilation and systolic heart failure, bearing some resemblance to DCM, may occur. The aim of this review is to introduce the unusual forms of cardiomyopathy with the current literatures in this field.
Arrhythmogenic Right Ventricular Dysplasia ; Cardiology ; Cardiomyopathies* ; Cicatrix ; Classification ; Diagnosis ; Dilatation ; Heart Failure ; Heart Failure, Systolic ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Incidence ; Mortality ; Myocardium ; Prevalence ; World Health Organization

Left ventricular thrombus (LVT) is a frequent complication in patients with acute large anterior myocardial infarction or dilated cardiomyopathy. The clinical importance of LVT lies in its potential for systemic embolization. We experienced a case of surgically treated LVT in a patient with acute myocarditis with embolic splenorenal infarction.
Cardiomyopathy, Dilated ; Heart Ventricles ; Humans ; Infarction ; Myocardial Infarction ; Myocarditis* ; Thrombosis*

Lipomatous hypertrophy of interartiral septum (LHIS) is a rare entity that is characterized by the excessive deposition of fat in the interatrial septum. The appearance of LHIS on echocardiogram is a bilobed or dumbbell-shaped in interatrial septum. We report a case of 56-years man with frequent premature ventricular contraction on holter monitoring which may related to his sudden cardiac death diagnosed lipomatous hypertrophy of interatrial septum by echocardiography.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac ; Echocardiography ; Electrocardiography, Ambulatory ; Heart Septum ; Hypertrophy* ; Ventricular Premature Complexes

2D echocardiography (2DE) is a well established tool for the diagnosis of the mechanical complications after acute myocardial infarction (AMI) such as free wall and ventricular septal rupture. However, the extension of the rupture and the relationship with contiguous anatomic structures may not be clearly defined by 2DE. Real-time 3D echocardiography (RT3DE) is known to provide surgical enface view allowing complete visualization of the cardiac structures and comprehension of their spatial orientations to other anatomic structures. Obtaining such information with RT3DE before operation in AMI patient with mechanical complication may be essential for the optimal surgical treatment. We report a case of extensive ventricular wall rupture from the posterior wall to the ventricular septum after AMI demonstrated by RT3DE.
Comprehension ; Diagnosis ; Echocardiography ; Echocardiography, Three-Dimensional* ; Humans ; Myocardial Infarction* ; Rupture* ; Ventricular Septal Rupture ; Ventricular Septum*

Midventricular obstructive hypertrophic cardiomyopathy (MOHCM) is a rare variant of hypertrophic cardiomyopathy. Apical dilatation and myocardial infarction can be complicated without significant coronary artery disease. We report a case of apical dilatation in a patient with MOHCM without atherosclerotic coronary artery disease. A 76-year-old woman was admitted for recent cerebral infarction and consulted to cardiologist for abnormal electrocardiographic findings. She had been suffering from exertional dyspnea (NYHA II) for about four years. Two dimentional-echocardiography revealed midventricular obstructive hypertrophy with an apical dilatation and paradoxical jet flow from the apical aneurysm to the left ventricular outflow tract during early diastole. Cardiac catheterization demonstrated dyskinesia in the apical wall with midventricular obstruction and a peak-to-peak intraventricular pressure gradient of 110 mmHg during pull-back from the apical high-pressure chamber to the subaortic low-pressure chamber in the left ventricle. Coronary angiograms showed no significant stenotic lesion of the coronary arteries. She was prescribed oral beta-adrenergic antagonist to decrease the intraventricular pressure gradient.
Aged ; Aneurysm* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Cerebral Infarction ; Coronary Artery Disease ; Coronary Vessels ; Diastole ; Dilatation* ; Dyskinesias ; Dyspnea ; Electrocardiography ; Female ; Heart Ventricles ; Humans ; Hypertrophy ; Myocardial Infarction ; Ventricular Pressure

BACKGROUND: Severe tricuspid regurgitation (TR) may develop later after mitral valve replacement (MVR) in the absence of prosthetic mitral valve (MV) dysfunction and other causes of left heart failure. The aim of this study was to investigate the incidence and predictors of severe TR late after MVR for rheumatic MV disease. METHODS: From 309 patients who underwent MVR between 1995 and 1997 at Yonsei Cardiovascular Hospital, we selected 193 patients (M:F=52:141; mean age 48.5+/-11.3) who underwent MVR for rheumatic valvular disease [concomitant TAP (Tricuspid annuloplasty) group: 56, No TAP group: 137]. The mean follow up duration was 83.2+/-26.4 months. Primary end point was time to clinical events, such as death, reoperation for tricuspid valve, admission due to right heart failure and the development of severe TR without left side heart failure. Patients were classified into 3 groups based on the degree of TR at the time of MVR: Group I; patients with coexisting mild TR (Grade 0, trivial), Group II; mild to moderate TR (Grade I-II), Group III; severe TR (Grade III-IV). RESULTS: Twenty-one patients (10.9%) developed clinical events [Group I: 2/78 (2.6%), Group II: 8/76 (10.5%), Group III: 11/39 (28.2%)]. Event free survival rate was different during the follow-up period between groups. By Cox regression analysis, initial severe TR (Hazard Ratio: 5.2, 95%CI 2.2-12.3), old age (Hazard Ratio: 4.3, 95%CI 1.4-12.8), and TAP (Hazard Ratio: 4.3, 95%CI 1.8-10.5) were the risk factors for the development of late severe TR. CONCLUSION: The incidence of severe TR or right heart failure in the absence of prosthetic MV dysfunction was 10.9% in MVR patients. Despite of successful TAP, the severity of TR at the time of MVR was the most important factor for prediction of late severe TR. It can be suggested that initial TR grade and RV function rather than TAP, is the important factor for the recurrence of severe TR after MV surgery.
Disease-Free Survival ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Incidence* ; Mitral Valve* ; Recurrence ; Reoperation ; Risk Factors ; Tricuspid Valve ; Tricuspid Valve Insufficiency*