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

The analysis of regional myocardial function is important for the evaluation of myocardial performance. We evaluated whether the motion images of the coronary bifurcation points can be used for computation of the regional deformation and the regional wall stress. In 5 mongrel dogs, 4 to 7 lead markers were implanted adjacent to the bifurcarion points of coronary artery. Left ventricular pressure curve was obtained, and left ventriculography was performed to measure the major and minor axes of the left ventricle. Afterthen, biplane coronary arteriography was performed. The motion images of the lead markers and the corresponding coronary bifurcation points were used as landmarkers for the kinetic analysis of the regional wall deformation and wall stress. The results of the analysis using two kinds of landmarkers were well correlated(P<0.001). Analysis of the diagnosis biplane coronary cineangiograms of each patient group demonstrated that quite difference wave forms between the normally perfused segment and the underperfused segments. In group I there was no coronary arterial narrowings and no regional wall motion abnormalities. Their mean and peak wall thicking were 10.10+/-9.28% and 47.99+/-20.70%. And their peak and mean values of circumferential and longitudinal wall stresses are as follows; 2.70+/-0.74x10(5)dyn/cm2, 2.34+/-0.71x10(5)dyn/cm2, 0.84+/-0.21x10(5)dyn/cm2, 2.34+/-0.71x10(5)dyn/cm2, 0.84+/-0.21x10(5)dyn/cm2 and 0.64+/-0.13x10(5)dyn/cm2. Of 5 male patients having coronary arterial disease with regional wall motion abnotmalities(Group III), 2patients have single vessel disease, 2 paitents have 2 vessel disease. In subgroup b of group III, there was a significant decrease of regional wall thickening(mean and peak value; 0.54+/-9.91%.14.87+/-12.055; P<0.001 vs. group I), and increasing tendency of regional wall stresses. Using biplane coronary cineangiogram, which is routine diagnostic procedure in coronary artery disease, this method can valuate regional myocardial function. And this method can evaluate regional myocardial function. And this method will be especially useful, when serial coronary cineangiograms are needed for serial evaluation of patients, such as before and after percutaneous transluminal coronary angioplasty, coronary arterial bypass graft surgery, etc.
Angiography ; Angioplasty, Balloon, Coronary ; Animals ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Dogs ; Heart Ventricles ; Humans ; Male ; Transplants ; Ventricular Pressure

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

BACKGROUND: Second degree AV block is occasionally induced during AV nodal reentrant tachycardia by programmed electrical stimulation. This study was performed to determine the incidence, the block site, and the mechanism of AV block during AV nodal reentrant tachycardia. METHODS AND RESULTS: The study population was 67 consecutive patients with AV nodal reentrant tachycardia studied by programmed electrical stimulation. Among these patients, common types(slow pathway for anterograde and fast pathway for retrograde conduction) were 64 patients and uncommon types(fast pathway for anterograde and slow pathway for retrograde conduction) were 3 patients. Among 67 patients with AV nodal reentrant tachycardia 10 patients developed 2:1 AV block during tachycardia. The block site of AV block was infrai bundle in 9 patients and supraHis bundle in patient. There were intermittent aberrancies of RBBB and/or LBBB form during tachycardia in 5 patients with infraHis AV block. CONCLUSION: The occurrence of AV block during AV nodal reentrant tachycardia is not rare and might be related to the prematurity of atrial extrastimulation. The block sites of AV block were infraHis bundle in most cases and this finding suggests that distal common pathway of the reentry circuit is present in the AV node.
Atrioventricular Block* ; Atrioventricular Node ; Electric Stimulation ; Humans ; Incidence ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry*