BACKGROUND AND OBJECTIVES: Unstable angina is an inhomogenous syndrome. A substantial percentage of patients, ranging from 12 to 30% in most series, develops acute myocardial infarction or dies suddenly soon after their hospitalization, while the remainder have a benign prognosis without adverse coronary events. Unstable angina is a complex condition such as angina at rest, crescendo angina, new onset angina and postinfarction angina. These variable clinical presentations suggest that unstable angina have a heterogenous pathogenesis and prognosis. We divided unstable angina into 5 groups and studied the relationship between clinical presentations and coronary angiographic morphology. METHODS: One hundred sixty six patients were selected from the patients who were diagnosed as an unstable angina between January 1989 and March 1991, at Hallym University Hospital. Angiography was performed in patient with typical angina symptoms and transient ECG changes of myocardial ischemia. Coronary angiogram was done as usual method. Calcification of coronary artery as well as the presence of collateral circulation were recorded. Ergonovine test was performed in patients with near normal or normal angiogram. Coronary lesions were morphologically classified as follows; type A is simple lesion such as symmetric, concentric narrowing and smooth border. and type B is complex lesion such as asymmetric, eccentric, ulcerated narrowing and irregular border. RESULTS: These groups were classified as follows; Group I(represented the patients with angina at rest but typical Prinzmetal angina was excluded) 30 patients, Group II(represented the patients with crescendo angina) 24 patients, Group III(represented the patients with new onset angina) 62 patients, Group IVA(represented the patients with early postinfarction angina within 2 weeks after AMI) 34 patients, Group IVB(represented the patients with delayed postinfarction angina) 16 patients, There were no significant differences in age and sex among the 5 groups. Locations of involved vessel were similar among the five groups, and left anterior descending artery was most frequently(mean 60%) involved. Single vessel disease was frequently observed in new onset angina and early postinfarction angina(Group III*, IVa** 48%, 65% VS Group II, IVB 25%, 19% respectively, *p<0.05, **p<0.005) whereas multivessel disease was frequent in crescendo angina and delayed postinfarction angina(Group II, IVB 51%, 76% VS Group II, IVA 16%, 27% respectively, p<0.005). More than two third of patients with unstable angina had complex B lesion of coronary artery (77%), but in new onset angina simple A lesion was frequently observed (Group III 45% VS Group I, IVA, IVB 16%, 10%, 13% respectively, p<0.05). The frequency of calcification increased in early postinfarction angina(Group IVA 18% VS Group III 3%, p<0.05). The frequency of coronary collateral circulation increased in cresendo angina, early postinfarction and delayed postinfarcion angina(Group II*, IVA*, IVB** 38%, 35%, 50% VS Group III 10% respectively, *p<0.005.**p<0.0001). Incidence of coronary vasospasm was higher in resting angina than the others(Group I*, III 30%, 19% VS Group II, IVA 4%, 6% respectively, *p<0.02). The coronary vasospasm was frequently observed in an insignificant lesion(insignificant lesion/total vasopasm: 12/24(50%)). Early postinfarction angina had frequent intracoronary thrombus in infact-related artery(incidence of thrombus : Group IVA*, IVB 21%, 13% VS Group I, II, III 3%, 4%, 5% respectively, *p<0.05). CONCLUSION: This study suggests that patients with unstable angina pectoris may be heterogeneous groups. Coronary angiography must be performed in patients with unstable angina, in order to classify the clinical correlates with each possible angiogrphic finding that could affect treatment modality and outcome of cardiac events.
Angina Pectoris, Variant ; Angina, Unstable* ; Angiography ; Arteries ; Collateral Circulation ; Coronary Angiography ; Coronary Vasospasm ; Coronary Vessels ; Electrocardiography ; Ergonovine ; Hospitalization ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Ischemia ; Prognosis ; Thrombosis ; Ulcer

No abstract available.
Anxiety* ; Depression* ; Humans ; Renal Dialysis*

No abstract available.
Animals ; Embryonic Development* ; Embryonic Structures* ; Female ; Mice* ; Pregnancy

BACKGROUND: A clinical trial was done to evaluate the antihypertensive efficacy and side effects of captopril(Capril(R)), an angiotensin converting enzyme inhibitor, in patients with mild to moderate essential hypertension. METHOD: Captopril was given 25-50mg a day to 46 patients(mean age : 51.3+/-8.9 years, 21 males and 25 females) for 8 weeks. RESULT: The blood pressure dropped significantly in 2 weeks and well maintained throughout 8 weeks of study period(p<0.01). The mean pressure drop was 14.4/8mmHg at 8 weeks without any changes of heart rate. The blood pressure was not dropped in 13 cases(28.3%). There were no significant changes in CBC, urinalysis and blood chemistry(sugar, lipids, electrolytes, creatinine, protein, albumin, AST and ALT) during this trial. The side effects were observed in 20 cases(43.5%). The most frequent was cough(19 cases, 413%) and the others were dysgeusia, dry eyes and edema in each respectively. CONCLUSION: Captopril(Capril(R)) monotherapy with 25-50mg a day regimen was effective in patient with mild to moderate essential hypertension, but somewhat high episodes of cough were observed in this trial.
Blood Pressure ; Captopril ; Cough ; Creatinine ; Dysgeusia ; Edema ; Electrolytes ; Heart Rate ; Humans ; Hypertension ; Male ; Peptidyl-Dipeptidase A ; Urinalysis

BACKGROUND AND OBJECTIVES: Ischemic preconditioning (IP) has been shown to reduce the infarct size and severity of arrhythmia in a post-ischemic reperfused heart. Angina before myocardial infarction reflects brief episodes of myocardial ischemia and may be a marker of ischemic preconditioning. We studied the effect of a history of previous angina on early outcomes (infarct size, left ventricular (LV) function and residual myocardial ischemia) for patients with acute myocardial infarction (AMI) after thrombolytic therapy. MATERIALS AND METHOD: We examined prospectively 58 consecutive patients who had AMI and arrived hospital within 6 hours after chest pain developed. IP was defined as prodromal angina within 24 hours before myocardial infarction. Patients were divided 2 groups:Group I (Gr I, 30 cases) without IP, Group II (Gr II, 28 cases) with IP. Thrombolytic therapy was done 23 cases (77%) and 21 cases (75%) respectively in each groups. Thereafter, electrocardiographic findings, infarct size on the basis of peak creatine kinase, LV function on the 2-D echocardiographic findings, recurrent myocardial ischemia were examined between 2 groups. RESULTS: In predischarge 2-D echocardio-graphic findings, LV dilatation and normal regional wall motion did not differ between two groups. But, there were significantly smaller creatine kinase (CK)-determined infarct size in Gr II than that in Gr I (peak CK level, Gr I:1566.3+/-960.0 IU/L vs Gr II:1066.9+/-773.2; p<0.05). The time interval between the onset of infarction and peak CK level was shorter in Gr II than that in Gr I (Gr I:18.3+/-8.3 vs Gr II:10.7+/-3.4 hours; p<0.001). There were significantly more common incidences of residual myocardial ischemia in Gr II (Gr I:26.7% vs Gr II:60.7%; p<0.01). CONCLUSION: Patients with a history of prodromal angina preceding myocardial infarction had small infarct size and earlier reperfusion of infarct related artery. However, there were significantly more common residual myocardial ischemia in these patients and a trend toward re-infarction on same previous infarction sites.
Angina Pectoris* ; Arrhythmias, Cardiac ; Arteries ; Chest Pain ; Creatine Kinase ; Dilatation ; Echocardiography ; Electrocardiography ; Heart ; Humans ; Incidence ; Infarction ; Ischemic Preconditioning* ; Myocardial Infarction* ; Myocardial Ischemia ; Prospective Studies ; Reperfusion ; Thrombolytic Therapy

The occurrence of fistulous tract between the thoracic subarachnoid space and the pleural cavity due to injury is uncommon. The one was developed after traffic accident and treated by surgical repair of the fistula : The other was post-operative complication of costotransversectomy for T2 sympathectomy. The complication was realized by the surgeon who was aware of the small leakage of cerebrospinal fluid from the dura propria of the T2 nerve root at the time of surgery. Intermittent pleural punctures for drainage and semisitting position were followed by spontaneous closure of the fistula. These cases were reported so that the uncommon condition might be added to the differential diagnosis of pleural effusion.
Accidents, Traffic ; Cerebrospinal Fluid ; Diagnosis, Differential ; Drainage ; Fistula* ; Pleural Cavity ; Pleural Effusion ; Punctures ; Subarachnoid Space ; Sympathectomy

Myocarditis is defined as the myocardial inflammation caused by various infectious agents (such as virus, rickettsia , bacteria, protozoa, fungus and parasites). The clinical manifestations of myocarditis ranges from the asymptomatic state due to focal inflammation to fulminant fatal congestive heart failure secondary to diffuse myocardial involvement. Clinically, in some cases, it may simulate an acute myocardial infarction. We experienced a case of acute fulminant myocarditis that presented as acute myocardial infarction initially, and then progressed into and recovered from congestive heart failure and multiorgan failure.
Asymptomatic Diseases ; Bacteria ; Estrogens, Conjugated (USP)* ; Fungi ; Heart Failure* ; Inflammation ; Myocardial Infarction ; Myocarditis* ; Rickettsia

BACKGROUND: Pravastatin, HMG-CoA reductase inhibitor, has been known to be the most effective drug in patients with hypercholesterolemia. We studied the effectiveness and side effects of this drug. METHODS: We studied twenty four patients(8 males, 16 females), with pravastatin 5mg bid for 8 weeks, whose fasting serum total cholesterol levels were higher than 240mg/dl on the first visit. Lipid profiles were checked at 2 weeks interval for 8 weeks and compared with baseline level individually. RESULTS: Among lipid profiles, pravastatin significantly decreased the total cholesterol from 282.8mg/dL to 224.5mg/dL(reduction rate, 21%), the LDL cholesterol from 197.2mg/dL to 143.8mg/dL(27%), the total cholesterol/HDL cholesterol ratio from 6.2 to 4.6(25%), and the LDL cholesterol/HDL cholesterol ratio from 4.1 to 2.7 (34%). These changes were statistically significant(p<0.05). Triglyceride and HDL cholesterol showed no significant changes compared to baseline levels during treatment. The clinical and laboratory findings after treatment did not show serious abnormalities except two patients who dropped out due to side effect such as constipation and skin eruption. CONCLUSION: Results from the present study show that short-term pravastatin therapy seems to be effective and safe in patients with hypercholesterolemia.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Constipation ; Fasting ; Humans ; Hypercholesterolemia ; Hyperlipidemias* ; Male ; Oxidoreductases ; Pravastatin* ; Skin ; Triglycerides

Spinal cord tumors usually present themselves with severe pain without neurologic deficits during early stages. Cervical or thoracic spinal tumors can evoke anterior neck pain or chest pain without neurologic symptoms. As a result, when chest pain or anterior neck pain occurs initially, many physicians think its origin is a cardiac disorder such as angina. Eventually, during cardiac evaluation and treatment, myelopathy or radiculopathy develops to reveal spinal cord tumor. Even though it is rare, when anterior neck or chest pain is the presenting complaint, the possibility of spinal cord tumors should be considered. We report a case of spinal cord tumor with initial presentations of anginal chest pain and electrocardiographic myocardial ischemic changes (ST segment depression and T-wave inversion) in a 45 year old male patient who had no history of hypertension. It was later discovered that the cause was due to an A-V malformation.
Chest Pain* ; Depression ; Electrocardiography ; Humans ; Hypertension ; Male ; Neck ; Neck Pain ; Neurologic Manifestations ; Radiculopathy ; Spinal Cord Diseases ; Spinal Cord Neoplasms*

No Abstract Available.
Anti-HIV Agents* ; Complement System Proteins* ; HIV-1*