BACKGROUND: In an effort to improve the diagnostic accuracy of the exercise electrocardiography (ECG) to detect coronary artery disease, exercise-induced changes in Q, R and S wave amplitudes has been evaluated in conjunction with or without ST segment changes. We measured the exercise-induced changes in Q, R and S wave amplitudes, and calculated the Athens QRS score to assess its diagnostic value. MATERIALS AND METHOD: Fifty patients who underwent the exercise test and MIBI myocardial scan and were proved to have coronary artery diameter stenosis > or =50% in coronary angiography were included in the patient group. Data of forty-nine persons showing negative findings in the exercise test and MIBI scan were used as control. The exercise test was performed according to the modified Bruce protocol using Marquette case 16. Exercise ECG was positive in 58% (29/50) of the patient group. The Q, R and S wave amplitudes at peak exercise were subtracted from the values of standing position at rest to obtain Athens QRS score. RESULTS: The mean age of patients and control were 54.5+/-9.4 years and 49.8+/-11.4 years respectively (p=NS), and their exercise capacity was 8.5+/-3.1 mets and 9.8+/-1.9 mets respectively (p=NS). The values of delta(R-Q-S)V5 + delta(R-Q-S)aVF and delta(R-Q-S)aVF were significantly lower in patients than the control (0.85+/-6.60 mm vs 3.72+/-5.09 mm, p=0.017, -0.60+/-4.76 mm vs 1.00+/-2.72 mm, p=0.030), and the values of deltaQV5 and deltaSaVF were significantly higher in patients than the control (-0.045+/-0.65 mm vs -0.41+/-0.78 mm, p=0.012, -0.84+/-1.90 mm vs -1.62+/-1.60 mm, p=0.009). However, the values were too widely overlaped between the patients and the control to give diagnostic cutoff points. CONCLUSION: It seems that exercise QRS scores do not have additive diagnostic value for coronary artery disease.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Exercise Test ; Humans

No abstract available.
Dipyridamole* ; Heart Ventricles*

Recent studies suggest that apolipoproteins may be better predictor of ischemic heart disease than are plasma lipids, such as total cholesterol and high density lipoprotein cholesterol(HDL-C). To examine this hypothesis, plasma levels of major lipids and major apolipo-proteins were measured and their derivatives were calculated in 30 male patients with ischemic heart disease(16 angina pectoris and 14 old myocardial infarction) and 30 age-matched male healthy controls. Plasma levels of lipids were obtained by conventional methods and apolipoproteins by Rocket immunoelectrophoresis. Levels of HDL-C, HDL2-cholesterol(HDL2-C), and apolipoprotein-AII, and ratios of HDL-C/total cholesterol, HDL2-C/total cholesterol, and apolipoprotein-AI/apolipoprotein-B were lower in the group of patients than in controls. Levels of low density lipoprotein cholesterol(LDL-C) and apolipoprotein-B, and ratios of lDL-C/HDL-C and apolipoprotein-AI/apolipoprotein-AII were higher in the group of patients. There were no statistically significant differences in the levels of total cholesterol and apolipoprotein-AI between the two groups. Stepwise discriminators analysis showed that apolipoprotein-B and apolipoprotein-AII were better discriminators than plasma lipids for identifying those with ischemic heart disease. One could correctly classify 78% of the cases by using the levels of the two apolipoproteins. By using the level of apolipoprotein-B, one could correctly classify 73% of the cases. There were no correlations between the levels of total cholesterol and HDL-C in the controls whereas there were positive correlations between the levels in the group of patients. In conclusion, this study showed that apolipoprotein-B was the best single discriminator for identifying the patients with ischemic heart disease, followed by apolipoprotein-AII.
Angina Pectoris ; Apolipoproteins A* ; Apolipoproteins* ; Cholesterol ; Heart ; Humans ; Immunoelectrophoresis ; Lipoproteins ; Male ; Myocardial Ischemia* ; Plasma* ; Risk Factors*

No abstract available.
Adenosine* ; Dipyridamole* ; Dobutamine* ; Exercise Test*

To observe the antihypertensive effects of the angiotensin-converting enzyme inhibitor, enalapril, a daily average dosage of 20mg was administred to 38 patients with essential hypertension for 4 weeks. Changes in blood pressure and heart rate, and the frequencies of adverse reactions during the drug administration were constantly observed. At the end of the 4th week of administration the mean diastolic blood pressure decreased from 104+/-11.3 to 91+/-7.9mmHg(<0.001), and the mean systolic blood pressure from 165+/-16.8 to 142+/-10.6mmHg(P<0.001), An effective antihypertensive action of enalapril was observed in 31 out of 38 cases(82%), and normalization of diastolic blood pressure below 85mmHg was shown in 27 cases(71%). The most remarkable antihypertensive effects were shown at the end of first week, and the effect increased progressively until the end of 4th week of therapy. There were no significant changes in heart rate during the observation period. Adverse reactions occured in only 7 cases(18%). These reactions included headache, dizziness, fatigue, skin rash and facial flushing in the order of frequency. Almost all of these reaction were mild and transient, disappearing spontanously without discontinuation of the medication. In conclusion, enalapril seems to be a safe and effective primary antihypertensive drug for the treatment of essential hypertension.
Blood Pressure ; Dizziness ; Enalapril* ; Exanthema ; Fatigue ; Flushing ; Headache ; Heart Rate ; Humans ; Hypertension

No abstract available.
Coronary Artery Disease* ; Coronary Vessels*

No abstract available.
Adenosine* ; Diagnosis* ; Radionuclide Imaging*

Milwaukee shoulder syndrome is a rare clinical entity that is a rapid destructive shoulder arthropathy associated with deposition of calcium hydroxyapatite crystals. It mainly affects elderly women. It is characterized by the presence of large amount of noninflammatory synovial fluid containing calcium hydroxyapatite crystals, a complete tear of the rotator cuff and progressive degenerative changes at the humeral head, leading to almost complete functional impairment. We present a case of a 65-year-old woman suffered by Milwaukee shoulder syndrome with literature view.
Aged ; Durapatite ; Female* ; Humans ; Humeral Head ; Rotator Cuff ; Shoulder* ; Synovial Fluid

BACKGROUND AND OBJECTIVES: Reverse redistribution pattern (RRP), that is defined as the worsening of the perfusion defect at rest image, can be observed in 99mTC-sestamibi (methoxy isobutyl isonitrile) myocardial scan with standard stress-rest protocol. This study was prepared to evaluate the prevalence and clinical characteristics of RRP in stress 99mTc-sestamibi myocardial scan. MATERIALS AND METHODS: We retrospectively reviewed 1304 images of 99mTC-sestamibi myocardial perfusion scan performed between January 1995 and June 1997, and scintigraphic findings were compared with clinical and angiographic data. RESULTS: The prevalence of RRP was 5.2%(68 of 1,304). RRP was noted in 6.0% (41 of 679) of the adenosine study and 4.3% (27 of 625) of the exercise study. The mean coronary artery stenosis at RRP territory was 51.5+/-38.9%. However, normal coronary artery at RRP territory was noted in 45.8% (11 of 24). There was no significant differences in luminal narrowing of coronary arteries, TIMI flow grade and LV wall motion between the patient with RRP positive and RRP negative at the infarct related artery territory. CONCLUSION: Reverse redistribution pattern on 99mTC-sestamibi myocardial SPECT does not seem to indicate the presence of significant coronary artery disease or patency of the infarct related arteries in the patients with acute MI.
Adenosine ; Arteries ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Perfusion* ; Phenobarbital ; Prevalence ; Retrospective Studies ; Technetium Tc 99m Sestamibi* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Exact and early diagnosis of acute myocardial infarction (AMI) is essential for the subsequent routine management of this frequent cardiovascular disease. Currently, AMI has been diagnosed using the combination of the history, electrocardiogram(ECG), and biochemical markers of myocardial necrosis. At present, many biochemical markers are used to diagnose AMI. In this study, the predictive values of serum myoglobin and creatine kinase-MB (CK-MB) were compared in the emergency department. METHODS: Fifty-four consecutive patients who presented within 12 hours from onset of chest pain of presumed cardiac origin were enrolled into the study. Patients with trauma or renal failure were excluded. The serial serum myoglobin and CK-MB levels were obtained prospectively at admission and 2, 4, 6, 12, 24 and 48 hours after admission. We compare the levels of serum myoglobin and CK-MB within 2, 4, 6, 8, 10, 12, 24, and 48 hours after symptom onset respectively. And we compare the sensitivity, specificity, positive predictive value, and negative predictive value of myoglobin and CK-MB. RESULTS: Using World Health Organization criteria, 28 AMI patients were identified. Mean time from symptom onset to presentation was 4.1+/-1.3 hours. the predictive values of serum myoglobin were better than those of CK-MB within 6 hours after symptom onset. But, 6 hours after symptom onset, the predictive values of CK-MB were better than those of serum myoglobin. The false positive cases of serum myoglobin were 3-one was lung cancer with pleural effusion and the others were unstable angina. The false positive cases of CK-MB were 6-one case was viral myocarditis and the ohters were unstable angina. CONCLUSION: To compare the serum myoglobin and CK-MB in the diagnosis of AMI, serum myoglobin had better predictive values than CK-MB within 6 hours after symptom onset and useful in the early diagnosis of AMI. But, 6 hours after symptom onset, CK-MB had better predictive values than serum myoglobin and useful in following up.
Angina, Unstable ; Biomarkers ; Cardiovascular Diseases ; Chest Pain ; Creatine ; Diagnosis ; Early Diagnosis* ; Emergency Service, Hospital ; Humans ; Lung Neoplasms ; Myocardial Infarction* ; Myocarditis ; Myoglobin* ; Necrosis ; Pleural Effusion ; Prospective Studies ; Renal Insufficiency ; Sensitivity and Specificity ; World Health Organization