To study factors related to release of atrial natriuretic polypeptide(ANP) in human subjects, instracardiac pressure and plasma ANP concentration in peripheral and central circulation were measured in patients with various heart disease (18 valvular heart disease, 4 congenital heart disease, 2 cardiomyopathy). 1) The concentration in peripheral venous plasma were increased in 14 patients with New York Heart Associaion (NYHA) functional class III-IV (87+/-38 pg/ml) as compared with that in 10 patients with NYHA functional class I-II (39+/-21 pg/ml, P<0.005)and 15 normal subjects (51+/-21 pg/ml, P<0.01). 2)The concentration of plasma ANP in inferior vena cava, right ventricle, pulonary artery, left ventricle and aorta were markedly increased in patient with NYHA functional class III-IV, elevated mean right atrial pressure (MRAP> or =8 mmHg) elevated mean pulmonary capllary wedge pressure (MPCWP> or =15 mmHg) and/or elevated pulminary artery systolic pressure (PASP> or =35 mmHg), as compared with those in patients with NYHA functional class I-II and/or lower intracardiac pressure (MRAP<8 mmHg, MPCWP<15 mmHg, and/or PASP<35 mmHg). 3) A step up in ANP concentration between inferior vena cava and right atrium was seen in patients with elevated MRAP (81+/-28pg/ml, 137+/-60pg/ml, P<0.05), MPCWP (74+/-37pg/ml,112+/-62pg/ml, P<0.05) and/or PASP (75+/-29 pg/ml,119+/-64 pg/ml, P<0.05). But there were no differences among intracardiac ANP concentrations from right atrium though aorta. 4) Plasma concentrations in right atrium, pulmonary artery, left ventricle and aorta correlated with MRAP (r=0.82, 0.63, 0.56, p<0.005 and r=0.52, P<0.01, respectively), MPCWP (r=0.86, 0.75, 0.73 and 0.72 respectively, P<0.005 in all) and PASP (r=0.73, 0.57, 0.68 and 0.59 respectively P<0.005 in all). 5) Left atrial diameter correlated with plasma ANP concentration in peripheral plasma (r=0.55, P<0.01), inferior vena cava (r=0.51, P<0.025), right atrium (r=0.45, P<0.05), right ventricle (r=0.55, P<0.01), pulmonary artery (r=0.52, P<0.01), left ventricle (r=0.55, P<0.01) and aorta (r=0.56, P<0.005). These results suggest that the heart secrets atrial natriuretic polypeptide into right atrium in response to increased mean right atrial pressure, mean pulmonary capillary wedge pressure, pulmonary artery systolic pressure and/or left atrial distention.
Aorta ; Arteries ; Atrial Natriuretic Factor ; Atrial Pressure ; Blood Pressure ; Heart ; Heart Atria ; Heart Defects, Congenital ; Heart Diseases* ; Heart Valve Diseases ; Heart Ventricles ; Humans ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Vena Cava, Inferior

Imipramine(Tofranil(R)) is one of the tricyclic antidepressants commonly used in depressive symptoms or enuresis. An accidental or nonaccidental poisoning of imipramine is common today. A 16 years old girl was admitted to Seoul National university Hospital because of unocnsciousness and frequent attacks of seizure after the impulsive ingestion of 1.4gm of imipramine. She showed variable arrhythmias such as complete RBBB, secod degree AV block and ventricular tachycardia and recovered from poisoning without residual myocardial damage. We present a case of imipramine poisoning with cardiac arrhythmias with review of literatures.
Adolescent ; Antidepressive Agents, Tricyclic ; Arrhythmias, Cardiac* ; Atrioventricular Block ; Depression ; Eating ; Enuresis ; Female ; Humans ; Imipramine ; Poisoning* ; Seizures ; Seoul ; Tachycardia, Ventricular

Regional left ventricular dysfunction is common in patients with coronary artery disease and accurate analysis of regional dysfunction is of particular interest. For the quantitative assessment of regional dysfunction, we measured regional ejection fraction by radial sector division method in 19 patients with acute myocardial infarction and 13 normal controls who had multigated blood pool scan. And two independent observer analyzed regional wall motion using 5 point grading system in 18 patients undergoing radionuclide ventricular cineangiography. The results obtained were as follows : 1) Regional wall motion scores for the gated blood pool study agreed completely in 72 of 108 segments (66.7%) and agreed within 1 grade in 88 of 108 segments(81.5%) and agreement rate is lowest in the septal area. 2) Global left ventricular ejection fraction was 63.2+/-4.2% in normal controls, 36.6+/-6.8% in extensive anterior wall infarction group and 52.6+/-9.7% in inferior wall infarction group. The value of extensive anterior wall infarction group was significantly lower than that of inferior wall infarction group(p<0.005). 3) Regional left ventricular ejection fraction by radial sector division method in normal control group were as follows : area 1 ; 56.5+/-6.7%, area 2 : 77.9+/-4.8%, area 3 ;84.3+/-5.5%, area 4 : 76.8+/-6.6%, area 5 ; 84.7+/-7.6%, area 6 ; 85.9+/-11.2%, area 7 ; 75.5+/-12.3%, area 8 ; 74.9+/-14.0%, area 9 ; 75.5+/-8.8%, area 10 ; 54.2+/-11.0%, 11 ; 34.5+/-16.3, area 12 ; 37.1+/-18.0%. 4) Mean regional ejection fraction in 7 patients with anterior wall infarction showed significantly lower values in area 4 to area 8, and in area 2 to area 5 in case of inferior wall infarction group. 5) We thought that regional ejection fraction obtained by radial sector division method is valuable index for the management and evaluation of patients with coronary artery disease.
Cineangiography ; Coronary Artery Disease ; Humans ; Infarction ; Myocardial Infarction* ; Septum of Brain ; Stroke Volume ; Ventricular Dysfunction, Left

The force-interval relationship of cardiac muscle has been known as not only a fundamental manifestation of beat-to-beat kinetics of intracellular activator calcium which control contractile response but also a potential clinical tool for evaluating cardiac contracile function. In this study were evaluated the force-interval relationship of intact canine left ventricle through mechanical restitution curves by plotting contrctile responses to varying steady state, extrasystolic and postextrasystolic intervals, and compared the force-interval relationships of intact canine left and right ventricles quantitatively. Effects of localized myocardial ischemia on the left ventricular force-interval relationship and relaxtion function were also evaluated 30 minutes after ligating proximal left anterior descending coronary artery through observing contractile and relaxtion responses to various intervals. 1) Mechanical restitution curve of left ventricle showed that left ventricular dp/dt max responses rose stiffly until plateau level with increasing postextrasystolic intervals, then declined with further increment of postextrasystolic intervals. 2) Mechanical restitution curve of left ventricle shifted leftward and upward with shortening of steady state and extrasystolic intervals, which suggest intracellular calcium kinetics during electrical diastole may operate as a mechanism of the force-interval relationship. 3) Steady state contractile responses remained unchanged but maximal contractile responses increased significantly or contractile reserve in intact left ventricle. 4) Normalized force-interval relationships of left and right ventricle were similar quantitatively, which suggest the force-interval relationship is independent of structural factors in intact canine heart. 5) Occlusion of coronary artery lowered absolute values of left ventricular dp/dt max responses to varying postextrasystolic intervals, but didn't show significant changes of normalized dp/dt max responses, which suggest force-interval relationship be also present in spite of localized myocardial ischemia. 6) Responses of normalized left ventricular dp/dt min to varying postextrasystolic intervals were similar to those of normalized dp/dt max but reduced after coronary artery occlusion in the range above 100% dp/dt max response, which may be used for the detection and evaluation of deranged myocardial relaxation in the left ventricle with localized myocardial ischemia.
Calcium ; Coronary Vessels ; Diastole ; Heart ; Heart Ventricles ; Kinetics ; Myocardial Ischemia ; Myocardium ; Relaxation ; Ventricular Function, Left*

Background: The transmission mode of severe acute respiratory syndrome coronavirus 2 is primarily known as droplet transmission. However, a recent argument has emerged about the possibility of airborne transmission. On June 17, there was a coronavirus disease 2019 (COVID-19) outbreak in Korea associated with long distance droplet transmission. Methods: The epidemiological investigation was implemented based on personal interviews and data collection on closed-circuit television images, and cell phone location data.The epidemic investigation support system developed by the Korea Disease Control and Prevention Agency was used for contact tracing. At the restaurant considered the site of exposure, air flow direction and velocity, distances between cases, and movement of visitors were investigated. Results: A total of 3 cases were identified in this outbreak, and maximum air flow velocity of 1.2 m/s was measured between the infector and infectee in a restaurant equipped with ceiling-type air conditioners. The index case was infected at a 6.5 m away from the infector and 5 minutes exposure without any direct or indirect contact. Conclusion Droplet transmission can occur at a distance greater than 2 m if there is direct air flow from an infected person. Therefore, updated guidelines involving prevention, contact tracing, and quarantine for COVID-19 are required for control of this highly contagious disease.

BACKGROUND: To evaluate the efficacy, complication and restenosis rate of percutaneous transluminal coronary angioplasty(PTCA), we analized the results of PTCA for 277 cases(308 lesions) in 240 patients admitted to Seoul National University Hospital under the diagnosis of stable angina, unstable angina, acute myocardial infarction(AMI)or postinfarction angina between April 1986 and October 1991. METHODS: We performed PTCA with over-the-guidewire technique and followed up for 2-42 months(mean 16.2 months). To evaluate the clinical efficacy, patients without AMI and unstable angina underwent pre- and post-PTCA exercise test. RESULTS: Successful PTCA's were performed in 273 out of 308 lesions(88.6%). The success rate of PTCA for left anterior descending artery(LAD), left circumflex artery(LCX) and right coronary artery(RCA) was 88.5%(177/200), 88.9%(40/44) and 87.5%(56/64), respectively. Simultaneous PTCA for multiple coronary arteries were successfnlly perfomed in 26 out of 27 cases(96.3%). Success rate for individual coronary artery subtypes according to ACC/AHA PTCA subcommitte was 99.1% for type A lesions and 78.2% for type B lesions. Total exercise duration by treadmill test increased from 6.74+/-3.24min to 9.70+/-2.85min after PTCA(p<30.01). There were non-fatal acute coronary occlusions in 8 patients(3.3%), but there was no death related to PTCA nor emergency coronary artery bypass graft(CABG). During the follow-up period of 2 to 42months(mean : 16.2months), restenosis was suspected clinically in 90 patients, and was confirmed in 43 patients with coronary angiography. Among them, we performed second PTCA in 31 patients, and third PTCA in 2 patients. Seventy nine percent of restenosis developed within 6 months after PTCA. CONCLUSION: We conclude that PTCA was an effective and safe treatment modality for patients with coronary artery disease, especially when performed in patients with type A or B lesions and some of selected type C lesions.
Angina, Stable ; Angina, Unstable ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Occlusion ; Coronary Vessels* ; Diagnosis ; Emergencies ; Exercise Test ; Follow-Up Studies ; Humans ; Seoul

No abstract available.
Korea* ; Typhus, Epidemic Louse-Borne*

To evaluate the clinical significance of atrioventricular blocks in acute inferior myocardial infarction, we reviewed the clinical recordes of 75 patients who were diagnosed as acute inferior myocardial infarction with or without associated atrioventricular conduction blocks and compared the difference in clinical observation and laboratory data including coronary angiography between these two groups of patients. We also followed the clinical courses of atrioventrticualr block during admission among the patients with blocks. 1) 40% of 75 patients had atrioventricualr block associated with acute inferior myocardial infarction and there were 7 first-degree, 8 second-degree and 15 third-degree atrioventricular blocks. 2) There was no statistically significant differences between two groups in mean age ; Killip classification : incidence of previous prodromal angina ; incidende of associated initial symptoms such as dyspnea, nausea, and syncope ; risk factors such as smoking, hypertension and previous muocardial infarction and incidence of complication such as ventricular arrhythmias and heart faliure. 3) The peak serum CK(1,442.9+/-1,703.6 vs. 1,942.8+/-2,022.9IU/L, P<0.01)and LDH(1,014.7+/-429.7 vs. 1,579.2+/-1,544.9 IU/L, P<0.01) levels were significantly higher in the patients group with atrioventricualr blocks than in the patient grouop without blocks. 4) Left ventricualr resting ejection fraction obtained by radinuclide geted blood pool heart scan was significantly less in the patient group with atrioventricular blocks than in the patient group without blocks. 5) The prevalence of multivessel disease and that of associated left anterior descending artery lesion showe no differences between two patient groups. 6) Hospatal mortality of two patient groups were 9.8% and 16.6% respectively and had no statistical significance. 7) Among the patients who had associated atrioventricualr blocks, 70% of patients showed temporary course of block for mean 4.8days, and 6.7% developed permanent first degree block.
Arrhythmias, Cardiac ; Arteries ; Atrioventricular Block ; Classification ; Coronary Angiography ; Dyspnea ; Heart ; Humans ; Hypertension ; Incidence ; Infarction ; Inferior Wall Myocardial Infarction* ; Mortality ; Nausea ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Syncope

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography* ; ROC Curve*