To evaluate the efficacy and safety of lovastatin, new hypolipidemic agent of HMG-CoA reductase inhibitor, we administered lovastatin 40mg to 80mg once daily for 12 weeks in 20 patients(7 males, 13 females) with primary hypercholesterolemia, and observed the sequential chamges of the lipid profile every 4 weeks. The results are as follows ; 1) The seurm total cholesterol was reduced significantly by 31% from 321+/-36mg% to 210+/-26mg%(p<0.05). 2) The serum triglycerides was significantly reduced from 321+/-168mg% to 228+/-74mg% by 29%(p<0.05). 3) The low density lipoprotein cholesterol was reduced significantly from 177+/-36mg% to 120+/-22mg% by 32%(p<0.05). 4) The total lipid, high density lipoprotein cholesterol and very low density lipoprotein cholesterol were also reduced significantly. 5) The ratio between total cholesterol and high density lipoprotein cholesterol, low density lipoprotein cholesterol and high density lipoprotein cholesterol did not change after lovastatin therapy. 6) There was no adverse reaction due to lovastatin therapy during 12 weeks of therapy. These results suggested that lovastatin is a effective and safe now hypolipidemic agent and is a convenient HMG-CoA reductase inhibitor for clinical use.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Cholesterol, VLDL ; Humans ; Hypercholesterolemia* ; Lovastatin* ; Male ; Oxidoreductases ; Triglycerides

To study left ventricular diastolic filling in patient with hypertension in different form of left ventricular hypertrophy(LVH), 105 patients with hypertension and 30 normal persons underwent M-mode echocardiography and pulsed Doppler measurement of the left ventricular inflow. From the M-mode echocardiographic measurement of left ventricular dimension, hypertensive patients were subdivided into three grouops : group I(n=27) ; no LVH, group II(n=36) ; concentric LVH, grooup III(n=42) asymmetric septal hypertrophy. From the digitized trace of the pulsed Doppler at the mitral valve level, Doppler diastolic time intervals, peak velocities at rapid filling (E velocity) and atrial contraction(A velocity) and the triangle area under the A velocity(A area) and triagle area under the E velocity(E area) were measured. The peak A velocity(normal subjects ; 0.51+/-0.08m/sec, group I ; 0.73+/-0.14m/sec, group II ; 0.78+/-0.15m/sec, group III ; 0.8+/-0.23 m/sec) and the A area(noral subjects ; 4.71+/-1.64, group I; 6.24+/-1.78, group II ; 7.75+/-2.93, group III ; 8.05+/-3.11) and the peak A/E velocity ratio and the A/E area ratio were significantly different from the normal controls(P<0.01). The peak E velocity(normal subjects ; 0.76+/-0.13, group I ; 0.7+/-0.12, group II ; 0.63+/-0.12, group III ; 0.59+/-0.15m/sec) and E area (normal subjects ; 9.61+/-2.8, group I ; 8.11+/-2.13, group II ; 7.82+/-2.73, group III ; 7.34+/-3.07) were significantly different between hypertensive groups with LVH and normal controls. Doppler time intervals, total area were not different between groups. This study shows that abnormal pattern of left ventricular diastolic filling occur in patients with hypertension and the peak A velocity and the peak A/E velocity ratio and the peak A/E area ratio are the earliest findings that can detectable by Doppler echocardiography.
Cardiomyopathy, Hypertrophic ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension* ; Mitral Valve

No abstract available.
Atrial Fibrillation*

Atrial fibrillation (F) the most common cardiac arrhythmia that requires treatment, has been the subject of increased interest and intensive clinical research in recent years. Management strategies are heavily influenced by the temporal pattern of the arrhythmia (paroxysmal or chronic) and by the clinical setting. The clinical presentations and associations of AF are very broad, with symptoms that range from unrecognizable to severely disabling. The hemodynamic consequences of AF are due to 1) the loss of atrial systole and 2) a rapid ventricular rate that decreases the diastolic filling period of the left ventricle and the diastolic flow time of the coronary arteries. There is a tendency toward a more aggressive approach to early reversion, because of 1) the demonstrated effects of 'electrical remodeling' of atrial myocytes during AF, which favor persistence of the arrhythmia and resistance to reversion and 2) the increased thromboembolic risk of patients with AF lasting 48 hours or more. If cardioversion is to be attempted in these patients, 3 weeks of anticoagulation should precede the procedure to reduce embolic risk. An attempt to revert to sinus rhythm either pharmacologically or electrically, the latter usually with a concomitant pharmacological agent, may be an appropriate option. Long-term anticoagulant with warfarin is indicated for patients with AF lasting more than 48 hours. The decision to intervene in longer episodes of AF is based on the balance between hemodynamic tolerance and the likelihood of being able to control future episodes.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Coronary Vessels ; Drug Therapy* ; Electric Countershock ; Heart Ventricles ; Hemodynamics ; Humans ; Muscle Cells ; Systole ; Warfarin

Regional left ventricular wall motion was evaluated by two-dimensional echocardiographic technique with floating-axis (internal frame of reference) system in three groups of subject; normal subject (n=12), patients with acute anterior myocardial infraction(n=16), and patients with acute inferior myocardial infraction(n=10). Significant hypokinetic wall motion were detected in apical portion (Mean Percent Shortening; 0.27-5.84% in anterior infraction group and 9.64-13.17% in controls) and apicoanterior portion (MPS; 2.86% in anterior infraction group and 14.13% in controls) in patients with acute anterior myocardial infraction (P<0.01), and inferior portion (MPS; 3.56-6.93% in inferior infraction group and 18.26-19.8% in controls) and apical portion (MPS; 4.04% in inferior infraction group and 9.64% in controls) in patients with acute inferior myocardial infraction (P<0.01) in apical long-axis views. We conclude that echocardiographic wall motion analysis by floating axis system is an accurate non-invasive method for detecting abnormal wall motion in patients with acute anterior and in ferior myocardial infraction.
Axis, Cervical Vertebra ; Echocardiography* ; Humans ; Myocardial Infarction*

No abstract available.
Coronary Vessels* ; Myocardial Infarction* ; Perfusion*

BACKGROUND: Single pass lead VDD pacing preserves atrioventricular synchrony with a single lead system which incorporates floating atrial electrodes. The objectives of this study were to measure whether different body postures and physical activities cause significant changes of the atrial electrogram amplitudes and to evaluate the effectiveness of its atrial sensing, ventricular sensing and pacing. METHOD: Prospective study was done in 7 patients with high degree AV block and normal sinus node function in whom a single lead VDD pacing system was implanted. The P wave amplitude was been measured in different condition during follow-up period. RESULTS: 1) During follow-up period, the P wave amplitude showed variation with changes in posture and respiration, but there was no consistent increase or decrease in amplitude. The lowest P wave amplitude was above the minimal atrial sensing value of 0.2 mV. 2) The percentage of atrial synchronous ventricular pacing recorded in Holter ECG and during Treadmill exercise test was more than 99%. 3) Atrial oversensing or VA cross sensing were not observed in any of the patients. CONCLUSIONS: Despite floating atrial electrode, the single pass lead VDD pacing maintains reliable atrial sensing and ventricular pacing in different body position and physical activity, so it may offer an excellent alternative in patients with high grade AV block and intact sinus node function.
Atrioventricular Block ; Electrocardiography ; Electrodes ; Electrophysiologic Techniques, Cardiac ; Exercise Test ; Follow-Up Studies ; Humans ; Motor Activity* ; Posture ; Prospective Studies ; Respiration ; Sinoatrial Node

BACKGROUND: Single pass lead VDD pacing preserves atrioventricular synchrony with a single lead system which incorporates floating atrial electrodes. The objectives of this study were to measure whether different body postures and physical activities cause significant changes of the atrial electrogram amplitudes and to evaluate the effectiveness of its atrial sensing, ventricular sensing and pacing. METHOD: Prospective study was done in 7 patients with high degree AV block and normal sinus node function in whom a single lead VDD pacing system was implanted. The P wave amplitude was been measured in different condition during follow-up period. RESULTS: 1) During follow-up period, the P wave amplitude showed variation with changes in posture and respiration, but there was no consistent increase or decrease in amplitude. The lowest P wave amplitude was above the minimal atrial sensing value of 0.2 mV. 2) The percentage of atrial synchronous ventricular pacing recorded in Holter ECG and during Treadmill exercise test was more than 99%. 3) Atrial oversensing or VA cross sensing were not observed in any of the patients. CONCLUSIONS: Despite floating atrial electrode, the single pass lead VDD pacing maintains reliable atrial sensing and ventricular pacing in different body position and physical activity, so it may offer an excellent alternative in patients with high grade AV block and intact sinus node function.
Atrioventricular Block ; Electrocardiography ; Electrodes ; Electrophysiologic Techniques, Cardiac ; Exercise Test ; Follow-Up Studies ; Humans ; Motor Activity* ; Posture ; Prospective Studies ; Respiration ; Sinoatrial Node

BACKGROUND: Exercise echocardiography(ECG) has widely accepted as a simple screening test for coronary artery disease(CAD). But this technique also has well known limitations.Recently numerous studies supports the usefulness of exercise echocardiography(ECHO) for detection of CAD. To determine the value of exercise ECHO for detecting CAD, 54 patients without resting wall motion abnormalities were studied. METHOD: Two-dimensional echocardiogram of parasternal and apical view were recored at rest and immediately after treadmill exercise.The rest and corresponding post-exercise images were analyzed side by side in a continous loop. An abnormal exercise ECHO was defined as wall motion abnormalities after exercise. These wall motion abnormalities were used to predict the extent and distribution of CAD. Significant CAD was difined as a stenosis of luminal diameter more than 50% by coronary arteriography. RESULTS: In 36 patients with significant CAD, exercise ECHO had a higher sensitivity than exercise ECG(86.1% vs 55.6%, P<0.005). The two test had similar specificity (88.9%, respectively). Among 19 patients with single vessle disease, exercise ECHO was significantly than exercise ECG(84.2% vs 42.1%, P<0.05). Among 17 patients with multivessle disease, the two test had similar sensitivity(88.2% vs 70.6%). The sensitivity detection of individual vessle involvement with exercise ECHO was 82.1% for the left anterior descending artery, 76.9% for the right coronary artery and 66.7% for the left circumflex artery. CONCLUSIONS: These results seggest that exercise ECHO is highly specific and more sensitive than exercise ECG for the detection of CAD. The inclusion of exercise ECHO improves the sensitivity of treadmill stress test and aids in localizing the region of ischemia.
Angiography ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Echocardiography* ; Electrocardiography ; Exercise Test ; Humans ; Ischemia ; Mass Screening ; Phenobarbital ; Sensitivity and Specificity

BACKGROUND: The efficacy of oral angiotensin converting enzyme(ACE) inhibitors in the treatment of hypertension has been well documented. Fosinopril is a member of a new class of phosphorous containing ACE inhibitors and is a cleared almost equally by both renal and hepatic routes. METHODS: To evaluate the effects of fosinopril, a new angiotensin converting enzyme inhibitors, in patients with mild to moderate essential hypertension, we administered fosinopril 10~40mg/day once daily to 32 patients(14 males, 18 females; range of age, 40~71 years old) with dose titration every 2 weeks. RESULTS: The baseline blood pressure after 4 weeks wash-out period was 156.3+/-22.3/104.8+/-5.93mmHg. After fosinopril therapy, the blood pressure declined to 150.0+/-27.8/96.4+/-12.2mmHg with 10mmg/day and 144.4+/-20.0/95.21+/-9.95mmHg with 20mg/day, 139.6+/-18.3/85.1+/-9.71mmHg with 30mg/day.During the period of maintenance after dose titration of fosinopril every 2 weeks for 8 weeks, the blood pressure were declined statistically significant (p<0.05). But the heart rate was not changed throughout the period of treatment. The efficacy of fosinopril therapy disclosed 26 patients(81.3%) with normalized diastolic blood pressure and 4 patients(11.8%) with more than 10mmHg decline of diastolic blood pressure. Therefore, the efficacy of fosinopril in these particular patients was 93.1% and two patients(6.9%) showed a failure of fosinopril therapy. The adverse reaction due to fosinopril were reported in 3 patients(9.4%) with dry cough, 1 patients(3.1%) with palpitation and 1 patients(3.1%) with dizziness, but there were patients who discontinued fosinopril due to adverse reaction. CONCLUSION: These results suggested that antihypertensive therapy with fosinopril was effective and well tolerated in patients with mild to moderate essential hypertension.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Blood Pressure ; Cough ; Dizziness ; Female ; Fosinopril* ; Heart Rate ; Humans ; Hypertension* ; Male