BACKGROUND: The coronary collateral circulation has been frequently observed in significant coronary artery disease and its protective role in ischemic myocardium is still remained unclear. But the study on the anti-ischemic effect in human model of ischemic myocardium is rare. METHODS: To observe the anti-ischemic role of coronary collateral circulation in ischemic myocardium, perfusion defect areas were measured during PTCA(percutaneous transluminal coronary angioplasty) in angina patients with single vessel disease and analyzed according to the grade of collateral circulation. The 99mTc-MIBI myocardial scanning images were obtained at 24 hours before PTCA with dipyridamole stress, at ballooning during PTCA and at 24 hours after the opening of the artery and perfusion defect volume ratios(DVR) were measured in each of the images of the patient with angina and single vessel disease. RESULTS: 1) Studied subjects were 14 patients(10 male, 4 female, mean age : 56.6+/-103) and subdivided into two groups. All patients had angina with single vessel disease, 7 proximal left anterior descending artery(LAD) stenosis, 4 middle LAD stenosis, 1 middle right coronary artery(RCA) stenosis and 2 proximal left circumflex artery(LCX) stenosis. Group A was composed of 7 patients with angina and coronary collateral circulation more than grade 1. Group B was 7 patients with angina and grade 0 collateral. 2) Mean age of group A was 62.4+/-8.2 years, 5 male and 2 female patients, That of group B was 56.6+/-8.9 years and all male patients. Group A was composed of 7 patients ; 5 unstable and 2 stable angina ; 2 proximal LAD stenosis, 3 midddle LAD stenosis, 1 middle RCA stenosis and 1 proximal LCX stenosis. One patients had grade 1, two patients grade 2 and four patients grade 3 coronary collateral circulation. All of the patients were unstable angina in group B showing 5 proximal LAD stenosis, 1 middle RCA stenosis and 1 proximal LCX stenosis. No collateral circulation was demonstrated in group B. 3) In group A, DVR was 17.5+/-13.9% on stress image before PTCA and 7.1+/-1.4% on the ballooning image during PTCA. DVR was smaller in ballooning image than in stress image(p<0.01). 4) In group B, DVR was 12.4+/-16.0% on stress image before PTCA and 26.6+/-10.0% on ballooning image during PTCA. DVR was larger in ballooning image than in stress image(p<0.001). 5) DVR on stress image and open image were not different in both groups, but DVR on ballooning image were 7.1+/-4.7% in group A and 26.6+/-10.0% in group B, which was larger than in group A(p<0.01). CONCLUSION: These results suggest that myocardial perfusion defect area may be smaller in angina patients with good collateral circulation than patients with no collateral, and coronary collateral circulation have a protective role on the jeopardized myocardium during coronary artery occlusion.
Angina Pectoris* ; Angina, Stable ; Angina, Unstable ; Arteries ; Collateral Circulation* ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Dipyridamole ; Female ; Humans ; Male ; Myocardium ; Perfusion*

Pacemaker twiddler's syndrome is reported as a very rare complication of permanent pacemaker implantation. There was a recent report suggesting that the incidence of pacemaker twiddler's syndrome increase recently presumably as a result of the implantation of thinner and smaller pacemaker system than before. We experienced a case of pacemaker twiddler's syndrome complicated 3 times with the conventional method of implantation or replacement during 14 months after the first implantation(Optims MP 158C and Pacing lead 400, Telectronic)on June 13th 1987. This case was an 18 year-old high school girl who had suffered frequent syncope for 2 years and extertionl dyspnea for 5 years due to congenital complete heart block, of which block site was proved to be AV nodal by His bundle electrogram. Pacemaker twiddler's syndrome developed 3 times;firstly 6 weeks after the first implantation in the right subclavicular fossa, secondly 10 weeks after the replacement of the twisted pacing lead, thirdly 10 months after the change of implantation site to the left subcalvicular fossa with the replacement of the twisted and fractured lead. Finally, the pacemaker generator was anchored to the clavicular periostium and pectoralis fascia at several points by using Dacron pouch.
Adolescent ; Dyspnea ; Electrophysiologic Techniques, Cardiac ; Fascia ; Female ; Heart Block ; Humans ; Incidence ; Polyethylene Terephthalates ; Syncope

The only clinically avilable levo-isomer type of beta-recepter blocker is penbutolol sulfate, and it is already accepted as one of beta-receptor blockers for initial antihypertensive drug therapy according to the report of 1988 Joint National Committee on Detection, Evaluation, and Tratment of High Blood Pressure. To evaluate the antihypertensive efficacy, effect on the quqlity of life, and side effects of penbutolol recently introduced into Korea, penbutolol was administered to 29 essential hypertensive(mild 9, moderate10, and severe 10) patients for 12 weeks or longer. The result of the clinical analysis are as follows; 1) The mean age was 50.0+/-10.9(M+/-SD), and the sex distribution between male and female was16:13. 2) The blood pressure lowering effects of penbutolol as a monotherapy were marked in 16, moderate in 6, and insignificant in 2 cases. The systolic blood pressure was significantly decreased from 179.1+/-20.2 to 135.4+/-16.5mmHg(P<0.005), and the diastolic blood pressure from 112.6+/-13.5 to 84.0+/-11.9mmHg(P<0.005)after 12 weeks' penbutolol therapy. 3) The heart rate was significantly decreased from70.3+/-13.3 to 65.5+/-9.1 per minute(P<0.05). 4) The quality of life was improved markely in 5(17.2%) and slightly in 8 cases(29.6%). 5) There were no significant laboratory changes after 12 weeks' penbutolol therapy. 6) Two out of three cases with non-specific ST segment and T wave changes in EKG and two out of 9 cases with EKG were normalized, 2 cases of LAH with strain were improved. 7) The side effects of penbutolol were dizziness in 4, sexual dysfunction in 2, and skin rash in 1 case. 8) Final multifarious assessment of penbutolol therapy showed that it was very useful in 11(37.9%), useful in 4(13.8%) and slightly useful in 7 cases(24.1%). These reult suggest that penbutolol is a first-line antihypertensive agent with an effective antihypertensive action, improving quality of life, with no significant laboratory changes and few side effects.
Blood Pressure ; Dizziness ; Drug Therapy ; Electrocardiography ; Exanthema ; Female ; Heart Rate ; Humans ; Hypertension ; Joints ; Korea ; Male ; Penbutolol ; Pheniramine ; Quality of Life ; Sex Distribution

OBJECTIVE: Brief epidodes of ischemia have been shown to make the heart more resistant to subsequent ischemia in animal studies(known as ischemic preconditioning, IP). This phenomenon was tested in patients undergoing percutaneous transluminal coronary angioplasty(PTCA). METHODS: Thirteen patients who had significant epicardial coronary stenosis without myocardial infarction, ventricular hypertrophy or conduction defect, received two to four 2-min balloon inflations separated by 5 min of reperfusion. Surface electrocardiogram(S-ECG) and intracoronary electrocardiogram (IC-ECG) from an angioplasty guide wire were recorded before and after balloon inflation. RESULTS: The changes of ST segment were observed in 13 out of 15 lesions on IC-ECG and 7 on S-ECG. The maximal ST changes on IC-ECG and S-ECG were 20.2+/-13.7mm and 1.21.5mm respectively(p<0.01). The time to beginning of ST segment change after balloon inflation were 10.1+/-12.6 seconds and 63.3+/-14.2 seconds on IC-ECG and S-ECG, respectively(p<0.01). The maximal changes of ST segment on IC-ECG during the second inflation were significantly lower than that during the first(20.2+/-13.7 vs 16.312.3mm, p<0.05). However, changes of R wave, T wave and QT interval were not significantly different between two inflations. The recovery time to baseling ECG after initiation of reperfusion were 50.2+/-41.7 seconds and 38.5+/-29.6 seconds for the first inflation and the second, respectively(P<0.05). CONCLUSION: These results suggest that IC-ECG is more sensitive and reliable than S-ECG in detection of myocardial ischemia and that IP may occur during PTCA since ST segment shift is decreased and is normalized earlier at the second balloon inflation compared with the first.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Animals ; Coronary Stenosis ; Electrocardiography* ; Heart ; Humans ; Hypertrophy ; Inflation, Economic ; Ischemia ; Ischemic Preconditioning ; Myocardial Infarction ; Myocardial Ischemia ; Reperfusion

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.
Angioplasty, Balloon, Coronary* ; Cineangiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Jeollanam-do ; Male ; Myocardial Ischemia

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.
Angioplasty, Balloon, Coronary* ; Cineangiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Jeollanam-do ; Male ; Myocardial Ischemia

BACKGROUND: Angina with normal coronary angiogram has been called syndrome X or microvascular angina, but pathophysiologic mechanisms for chest patin in this group of patients are not known exactly. To observe the changes of left ventricular function in patients with angina and normal coronary angiogram, the authors analyzed the left ventricular systolic and diastolic function with echocardiogram and cardiac catheterization. METHODS: The authors performed resting and treadmill exercise electrocardiogram, 201TI dipyridamole scan, M-mode and Doppler echocardiogram, cardiac catheterization and coronary angiogram in patients with angina and normal coronary angiogram. The systolic and diastolic left ventricular function indices from M-mode and Doppler echocardiogram, left ventricular catheterization and coronary angiogram were analyzed in 12 patients excluding diabetes, hypertension, cardiomyopathy and esophageal motility disorders among 1626 patients who underwent coronary angiogram between Jan. 1991 and Aug. 1992 in Chonnam University Hospital. RESULTS: 1) Studied subjects were 12 patients, 5 male and 7 female, mean age was 51+/-9.4 year-old. Resting electrocardiograms were normal in 8 cases and ST-T changes in 4 cases. Ischemic ST-T changes were observed in all cases during treadmill exericise test and perfusion defects in 3 cases out of 8 cases during 201TI dipyridamole scan. 2) On echocardiogram, ejection fraction(EF) was 68.9+/-4.5%, fractional shortening(FS) 37.4+/-4.4%, ratio of left atrial to aortic root dimension(LAD/AOD) 1.2+/-0.1, OR slope 3.8+/-0.8c,/sec, mitral valve Doppler E/A velocity ratio[E/A(V)] 0.9+/-0.2, mitral valve Doppler E/A area ratio[E/A(a)]1.3+/-0.3, early diastolic deceleration rate(EDDR) 4.3+/-1.3m/sec2, isovolumic relaxation time(IVRT) 96.2+/-15.7msec, isovolumic contraction time(IVCT) 38.1+/-9.1 msec and aortic valve Doppler peak flow velocity[Ao(V)] 0.8+/-0.2m/sec. EF, FS, IVCT and A(V) were normal. LAD/AOD and IVRT were increased, but E/A(V), E/A(a), OR slope and EDDR were decreased compared to normal subjects. 3) On cardiac catheterization and angiogram, mean left ventricular end-diastolic pressure was 15.3+/-5.1mmHg and ejection fraction by left ventriculogram 78.2+/-7.4%. There was no regional wall motion abnormality. CONCLUSION: Above results suggest that angina with normal coronary angiogram may be associated with impaired left ventricular diastolic function.
Aortic Valve ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathies ; Catheterization ; Catheters ; Deceleration ; Dipyridamole ; Electrocardiography ; Esophageal Motility Disorders ; Female ; Humans ; Hypertension ; Jeollanam-do ; Male ; Microvascular Angina ; Mitral Valve ; Perfusion ; Relaxation ; Thorax ; Ventricular Function, Left*

OBJECTIVES: Refractory period and conduction time of the slow and fast pathways in the atrioven-tricular node are known to be the most important determinant of the inducibility of atrioventricular nodal reentrant tachycardia (AUNRT) but their relationship has not been determined in Korean. METHODS: Two hundred and ten patients under-gone electrophysioiogic study. One hundred twenty two patients with dual AV nodal pathways were divided into two groups (group I, 77 patients with no inducible AVNRT; group II, 45 patients with inducible AVNRT). RESULTS: Antegrade dual AV nodal pathways were documented in 77 patients (47%) out of 165 patients on whom AVNRT was not induced, Antegrade ERP of slow pathway in paced rhythm (600 msec) was shorter in group II than in group I (331 +/- 14 msec vs 269 +/- 47 msec, p<0.05). Ventriculoatrial block cycle length (VABCL) and retrograde ERP of the AV conduction system were significantly shorter in group 2 than in group 1 (p<0.001). Maximum slow pathway conduction times in sinus rhythm and paced rhythm (600msec) in group 2 were significantly longer than in group 1 (sinus rhythm: 332 +/- 68msec vs. 379 +/- 88msec, p<0.005; paced rhythm: 332 +/- 69msec vs. 392 +/- 85msec, p<0.005). The ERP gaps of two AV nodal pathways of group 2 in sinus rhythm and in paced rhythm were also significantly longer than those of group 1 (sinus rhythm 41 +/- 3msec vs. 78 +/- 50msec, p<0.001; paced rhythm 36 +/- 32 msec vs. 72 +/- 19msec, p<0.005). The incidence of intact ventriculoatrial conduction was significantly higher in group 2 than in group 1 (p<0.05). Antegrade slow pathway conduction time (A2H2 interval) at the time of AVNRT induction with single atrial premature depolarization (APD) with a coupling interval over 10 msec less than that of an APD producing AH jump were not correlated with VABCL (r=0.193, p<0.05). CONCLUSION: Dual AV nodal pathways were observed in 47% of patients with no-inducible AVNRT group. The inducibility of AVNRT appears to be closely ralated to the some conduction characteristics of the dual pathways and the refractoriness, i.e. maximum slow pathway conduction time, the ERP gap of two pathways, retrograde fast pathway ERP, VABCL.
Humans ; Incidence* ; Tachycardia, Atrioventricular Nodal Reentry*

BACKGROUND: Coronary artery stent has been introduced recently to overcome major problems of percutaneous trausluminal coronary angioplasty(PTCA). To evaluate the success rate, complications and predictive factors associated with restenosis in coronary artery stenting, clinical analysis after coronary srtery stent was performed. METHODS: Sixteen patients who underwent coronary artery stent in Chonnam University Hospital beteen Apr. 1992 and Dec. 1993 were observed. The authors analyzed the stent dilivery success, rate complications and restenosis after follow-up coronary angiogram. RESULTS: 1) The palmaz-Schatz stents were implanted in 16 patients(12 male, 4 female, mean age : 53.3 years) and clinical diagnosis of patients were 7 myocardial infarction, 8 unstable angina and one stable angina. Stents were implanted in 10 cases of left anterior descending arteries and 6 cases of right coronary arteries. Three stents were implanted in a patient with long spiral dissection after middle right coronary artery PTCA, single stent was implanted in the other patients. 2) Stent delivery was successful in all cases, but acute stent thrombosis developed just after bail-out procedure for PTCA-induced intimal dissection in myocardial infarction patient who had multivessel lesion and intracoronary thrombus. Subacute stent thrombosis and major bleeding requiring transfusion were not documented. 3) On follow-up coronary angiogram in 10 patients, no restenosis observed in 5 right coronary arterial stents, but restenosis developed in 3 of 5 left anterior descending artery stents. Restenosis was observed in none of 4.0mm stents, two of six 3.5mm stents and one of two 3.0mm stents. 4) Stent restenosis was observed in 3 cases of positive201TI dipyridamole scan which was performed one month after coronary artery stenting. CONCLUSION: Coronary artery stent is a safe and effective in elective procedure. The restenosis rate after intracoronary stent is lower in right coronary artery than left anterior descending artery and larger stent.
Angina, Stable ; Angina, Unstable ; Arteries ; Coronary Vessels* ; Diagnosis ; Dipyridamole ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Jeollanam-do ; Male ; Myocardial Infarction ; Stents* ; Thrombosis

BACKGROUND: Inotropic agents have been shown to improve cardiac function in patients with congestive heart failure. The purpose of the present study is to evaluate the short-term efficacy and safety of denopamine(Cardopamin(R)), and orally available beta-stimulant, in patients with chronic congestive heart failure. SUBJECTS AND METHODS: Twenty-four patients(54.1+/-10.9 years, male:female=1.4:1) with chronic congestive heart failure whose functional classes were equal or greater than New York Heart Association(NYHA) Class II were enrolled in this study after informed consents were obtained. Upon completion of baseline evaluation, denopamine(Cardopamin(R)) was administered orally, startion with 15 mg per day and increased to 30 mg per day according to the clinical response of each patient. Blood pressure, heart rate, electrocardiographic(EKG) findings, AST, BUN, and creatinine were also followed up at 4 weeks' interval. The clinical effects and side effects at 4 weeks' interbal and echocardiographic examination at baseline and 8 weeks after trentment were evaluated. RESULTS: Mean dosage of denopamine(Cardopamin(R)) was 22.9+/-5.3mg per day. The clinical symptoms of 18(75%) of 24 patients were improved. The echocardiographic follow-up revealed a significant decrease in left vetricular(LV) end-Systolic dimemsion(fron 4.8+/-0.2mm to 4.5+/-0.1mm. p<0.005) and LV end-systolic volume(from 92.0+/-8.5ml to 80.3+/-4.5ml, p<0.005). However, there was no significant interval change in LV end-diastolic dimension, LV end-diastolic volume, ejection fraction, and fractional shortening. Blood pressure, heart rate, EKG findings, AST, BUN, and creatinine were not changed significantly during treatment. CONCLUSION: Above results suggest that short-term therapy of denopamine(Cardopamin(R)) may improve clinical symptom with no side effect in patients with chronic congestive heart failure, but the long-term efficacy remains to be determined with a randomized long-term follow up study.
Blood Pressure ; Creatinine ; Echocardiography* ; Electrocardiography ; Estrogens, Conjugated (USP)* ; Follow-Up Studies ; Heart ; Heart Failure* ; Heart Rate ; Humans