Medically refractory ventricular tachycardia (VT) storm can be controlled with radiofrequency catheter ablation (RFCA), however, it may be difficult to control in some patients with hemodynamic overload. We experienced a patient with intractable VT storm controlled by hemodynamic unloading. The patient had mid-septal hypertrophic cardiomyopathy with an implantable cardioverter defibrillator (ICD) back-up. Because of the severe mid-septal hypertrophy, his left ventricle (LV) had an hourglass-like morphology and showed apical ballooning; the focus of VT was at the border of apical ballooning. Although we performed VT ablation because of electrical storm with multiple ICD shocks, VT recurred 1 hour after procedure. As the post-RFCA monomorphic VT was refractory to anti-tachycardia pacing or ICD shock, we reduced the hemodynamic overload of LV with beta-blockade, hydration, and sedation. VT spontaneously stopped 1.5 hours later and the patient has remained free of VT for 24 months with beta-blockade alone. In patients with VT storm refractory to antiarrhythmic drugs or RFCA, the mechanism of mechano-electrical feedback should be considered and hemodynamic unloading may be an essential component of treatment.
Cardiomyopathy, Hypertrophic/complications/diagnosis/*physiopathology/therapy ; Catheter Ablation ; Electrocardiography ; Gated Blood-Pool Imaging ; Heart Catheterization ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular/diagnosis/etiology/*physiopathology/therapy ; Takotsubo Cardiomyopathy/complications/diagnosis/*physiopathology/therapy

BACKGROUND: Aging is associated with increased cardiovascular risk and firmly established as a risk factor for the development of atherosclerosis. However the exact mechanism of age-related damage to the arterial wall and its relation to the atherosclerotic process are not well known.The endothelium plays an important role for the regulation of vascular tone and the endothelial function is impaired in the presence of risk factors early in the process of atherosclerosis. Assessment of endothelial function appears to be a valuable tool for the diagnosing and therapeutic monitoring of coronary artery disease. Anti-oxidants are known to improve endothelial dysfunction in atherosclerosis patients. The aim of this study was, (1) to evaluate the endothelial function in elderly, (2) to investigate whether vitamin C administration has benefit on the endothelial function in elderly. METHODS: The endothelial function was estimated using venous occlusion plethysmography(VOP) in 7 elderly and 7 young healthy volunteers. The strain guage was connected to plethysmograph to record the forearm volume change. A rapid cuff inflator was used to inflate the arm cuff to 40 mmHg instantaneuosly thus occluding venous return from the forearm. The measurement of forearm volume change was repeated for 7 times each stage. The change of the forearm blood flow(FBF) was measured with the acetylcholine infusion through brachial artery and also with intra-arterial vitamin C. RESULTS: Endothelium-dependent vasodilatation was significantly impaired in the elderly group compared to the young group(321 +/-17% in elderly group vs 509 +/-81%, mean+/-SEM) Forearm blood flow response to acetylcholine was significantly enhanced with inraarterial infusion of vitamin C in elderly group(321+/-17% in elderly group vs 78% in vitamin C) Coinfusion of L-NMMA, an inhibitor of nitric oxide synthase, blunted forearm blood flow response to acetylcholine. CONCLUSIONS: Even though the mechanisms leading to drpressed endothelial function in elderly remains to be elucidated, our study shows that vitamin C result in demonstrable improvement by a mechanism that is probably related to antioxidant activity.
Acetylcholine ; Aged* ; Aging ; Arm ; Ascorbic Acid* ; Atherosclerosis ; Brachial Artery ; Coronary Artery Disease ; Endothelium ; Forearm ; Healthy Volunteers ; Humans ; Nitric Oxide Synthase ; omega-N-Methylarginine ; Risk Factors ; Vasodilation* ; Vitamins*

PURPOSE: The optimal pacing mode with either single chamber atrial pacemaker (AAI or AAIR) or dual chamber pacemaker (DDD or DDDR) is still not clear in sinus-node dysfunction (SND) and intact atrioventricular (AV) conduction. MATERIALS AND METHODS: Patients who were implanted with permanent pacemaker using AAI(R) (n = 73) or DDD(R) (n = 113) were compared. RESULTS: The baseline characteristics were comparable between the two groups, with a mean follow-up duration of 69 months. The incidence of death did not show statistical difference. However, the incidence of hospitalization for congestive heart failure (CHF) was significantly lower in the AAI(R) group (0%) than the DDD(R) group (8.8%, p = 0.03). Also, atrial fibrillation (AF) was found in 2.8% in the AAI(R) group, which was statistically different from 15.2% of patients in the DDD(R) group (p = 0.01). Four patients (5.5%) with AAI(R) developed AV block, and subsequently switched to DDD(R) pacing. The risk of AF was lower in the patients implanted with AAI(R) than those with DDD(R) [hazard ratio (HR), 0.84; 95% confidence interval, 0.72 to 0.97, p = 0.02]. CONCLUSION: In patients with SND and intact AV conduction, AAI(R) pacing can achieve a better clinical outcome in terms of occurrence of CHF and AF than DDD(R) pacing. These findings support AAI(R) pacing as the preferred pacing mode in patients with SND and intact AV conduction.
Aged ; Atrial Fibrillation/complications/physiopathology ; Atrioventricular Node/*physiopathology ; Cardiac Pacing, Artificial ; Cohort Studies ; Female ; Follow-Up Studies ; Heart Failure/complications ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Sick Sinus Syndrome/*physiopathology ; Treatment Outcome

A young male patient diagnosed with Klinefelter syndrome was admitted to our hospital via the emergency room with chief complaints of acute chest pain and dyspnea. Pulmonary thromboembolism was diagnosed from his chest CT images. His symptoms improved after he underwent thrombolysis and anticoagulation treatment. Klinefelter syndrome has a tendency towards hypercoagulability due to hormonal imbalance and one or more inherited thromophilic factors. Thus, Klinefelter syndrome patients with a past medical history of venous thromboembolism require continuous oral anticoagulation therapy for a period of at least six months.
Chest Pain ; Dyspnea ; Emergencies ; Humans ; Klinefelter Syndrome ; Male ; Pulmonary Embolism ; Thorax ; Thrombophilia ; Venous Thromboembolism ; Venous Thrombosis

PURPOSE: To evaluate predictors of severe or moderate coronary artery disease (CAD) in individuals with zero or very low (<10) coronary artery calcium (CAC) scores. MATERIALS AND METHODS: The 1175 asymptomatic persons with zero or very low (<10) CAC scores were analyzed for CAD stenosis using coronary computed tomography angiography. Moderate and severe CADs were defined as having more than 50% and more than 70% stenosis in any of the major coronary arteries, respectively. Age, gender, body mass index, hypertension, type II diabetes, dyslipidemia, lipid profile, creatinine, and smoking status were evaluated as predictors for moderate and severe CAD. RESULTS: In the study population, moderate and severe CADs were found in 7.5% and 3.3%, respectively. Among evaluated risk factors, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02−1.07, p<0.001], current smoking status (OR 3.12, 95% CI 1.82−5.34, p<0.001), and CAC 1−9 (OR 1.80, 95% CI 1.08−3.00, p=0.024) were significantly associated with moderate CAD. Meanwhile, age (OR 1.05, 95% CI 1.02−1.08, p=0.003), low high density lipoprotein (HDL) (OR 0.96, 95% CI 0.93−0.99, p=0.003), and current smoking status (OR 2.34, 95% CI 1.14−5.30, p=0.022) were found to be significantly associated with severe CAD. Improvement of discrimination power for predicting severe CAD was observed when smoking and HDL cholesterol were serially added into the age model. CONCLUSION: Smoking showed significant correlations with moderate or severe CAD, and low HDL cholesterol also proved to be a predictor of severe CAD in asymptomatic individuals with extremely low CAC scores.
Angiography ; Asymptomatic Diseases ; Body Mass Index ; Calcium ; Cholesterol, HDL ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Creatinine ; Discrimination (Psychology) ; Dyslipidemias ; Humans ; Hypertension ; Lipoproteins ; Risk Factors ; Smoke ; Smoking

BACKGROUND: The prevalence and clinical significance of white-coat hypertension (WCHT) and masked hypertension (MHT) are unknown in Koreans. Here we measure the frequency of WCHT and MHT in hypertensive subjects and identify the epidemiologic and/or clinical factors that predict it in Korean subjects. METHDOS: This study is a retrospective analysis of a random sample from February 2004 to October 2005. All patients had measurements of blood pressure (BP) in the clinic and 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were classified into four groups on the basis of daytime ambulatory BP and clinic BP level: 1) Normotension (NT), 2) MHT, 3) WCHT, and 4) sustained hypertension (SHT). RESULTS: For all 967 patients, the mean clinic BP was 157.7+/-22.0/ 95.3+/-13.1 mmHg, and the mean daytime ambulatory BP was 136.4+/-15.0/ 86.2+/-10.7 mmHg. The NT, MHT, WCHT, and SHT groups consisted of 51 (5.3%), 55 (5.7%), 273 (28.2%), and 588 (60.8%) subjects, respectively. The left ventricular mass index was significantly higher in SHT than in the other groups, and was positively correlated with BP, especially ABPM. Compared with NT, the factors associated with MHT were younger age, male gender, higher BMI, clinic BP > or =130 mmHg, and alcohol consumption. Compared with SHT, the factors associated with WCHT were female gender, lower BMI, and clinic BP < 150 mmHg. CONCLUSIONS: WCHT and MHT were prevalent in the hypertensive population. ABPM was more predictive of target organ damage than clinic BP, and could be useful in identifying subjects at risk for WCHT and MHT.
Blood Pressure Monitoring, Ambulatory ; Female ; Health Status Indicators ; Heart Ventricles/*physiopathology/ultrasonography ; Humans ; Hypertension/*epidemiology/ultrasonography ; Hypertrophy, Left Ventricular/*physiopathology/ultrasonography ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors

BACKGROUND AND OBJECTIVES: In aortic dissection (AD), CT angiography (CTA) is useful both in initial diagnosis and long term follow-up. In this study, we used CTA to evaluate the morphologic changes of aorta after AD. SUBJECTS AND METHODS: We reviewed the initial and follow-up CTA images of 43 patients with AD. The diagnoses were double-lumen dissection (n=13), intramural hematoma (n=11), and residual dissection after surgery (n=19). The duration of CTA follow-up was 3.3+/-1.9 years (range 7 - 89 months). After reviewing the CTA images of the thoracic aorta level, and of the upper and lower abdominal aorta levels, we compared the areas of total lumen, true lumen and false lumen and the area ratio of true/total lumen. RESULTS: Changes in luminal areas were greatest in the thoracic aorta, where both the true lumen area and the ratio of true/total lumen area increased. Subgroup analysis revealed that although the total lumen area increased significantly in the classic AD group, no changes were noted in the ratio of true/total lumen area. Only the increase in false lumen area (from 5.8 cm 2 to 9.0 cm 2) was significant (p=0.036). In patients with intramural hematoma, a decrease in total lumen area and an increase in the ratio of true/total lumen area were noted. CONCLUSION: In classic AD, false lumen dilatation occurs with false lumen enlargement, whereas in intramural hematoma total aorta size decreases with any increase in the ratio of true/total lumen area.
Angiography* ; Aorta ; Aorta, Abdominal ; Aorta, Thoracic ; Diagnosis ; Dilatation ; Follow-Up Studies ; Hematoma ; Humans ; Phenobarbital ; Tomography, X-Ray Computed