No abstract available.
Female ; Humans

Patient with Kawasaki disease who presented with acute myocardial infarction in young age Although the clinical course of Kawasaki disease is self limiting, coronary aneurysm or myocardial disorders develop in about 20% of the patients. In recent years there have been reports of ischemic heart disease as sequelae of Kawasaki disease in adults, especially young adults. In Korea, there was only one case report in 1995. We report a young woman who presented as acute myocardial infarction with coronary artery aneurysms which highly suggest the underlying Kawasaki disease. The acute myocardial infarction in this patient seems to be the late cardiologic sequelae of Kawasaki disease, which has been silent clinically until the presentation as an acute myocardial infarction. New noninvasive diagnostic tests are being tried to improve the detection of coronary artery complication. However, coronary angiography is still widely used to determine the presence of coronary artery lesions and access the feasibility of coronary intervention. Another advantage of coronary angiography is that, it is possible to analyze the shape and the size of aneurysm and predict the prognosis. In this case we performed the percutaneous transluminal coronary angioplasty(PTCA) instead of surgery. Further study comparing surgery with percutaneous coronary angioplasty is needed.
Adult ; Aneurysm ; Angioplasty ; Coronary Aneurysm ; Coronary Angiography ; Coronary Vessels ; Diagnostic Tests, Routine ; Female ; Humans ; Korea ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction* ; Myocardial Ischemia ; Prognosis ; Young Adult

The evaluation of the regional wall motion abnormalities were done in 16 patients with myocardial infarction and 9 patients with anginal pectoris by the two dimensional echocardiography. The regional wall motion abnormalities detected by the two dimensional echocardiography were the highly sensitive indexes of the location of infarction(sensitivity: 84.6%) and were well correlated with the sites of infarction of the 12-lead EKG. In the patients with myocardial infarction, the apex and the distal septum of the left ventricle were the most frequently observed regions with wall motion abnormalities, which comprised 60.7% of the regions with the abnormal wall motion. The frequency of the regional wall motion abnormalities were much less frequently seen in the patients with anginal pectoris. The severity and the extent of the regional wall motion abnormalities as well as the global function of the left ventricle were well correlated with the clinical course and the prognosis in the patients with myocardial infarction during the short term observation.
Coronary Artery Disease* ; Coronary Vessels* ; Dyskinesias* ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Myocardial Infarction ; Prognosis

BACKGROUND AND OBJECTIVES: Percutaneous transluminal septal myocardial ablation (PTSMA) and surgical septal myotomy-myectomy are two treatment options for patients with drug-resistant hypertrophic cardiomyopathy & a left ventricular outflow tract (LVOT) obstruction. The clinical courses, after nonsurgical and surgical septal myotomy-myectomy, are described in 3 patients with hypertrophic cardiomyopathy that continued to be symptomatic following medical management. SUBJECTS AND MEHTODS: 3 patients (2 women, 1 man), with symptomatic drug-refractory obstructive hypertrophic cardiomyopathy, were the subjects of this study. One patient underwent a PTSMA by injection of ethanol into the septal perforator branches of the left anterior descending coronary artery, and 2 a surgical myotomy-myectomy. Examinations of the early and late follow-up echocardiographic results were performed. RESULTS: Both treatment modalities significantly reduced the peak gradient across the LVOT (ablation : 85 to 7.7 mmHg, myectomy : 104 to 10 mmHg), and led to similar improvements in the New York Heart Association class (ablation : NYHA IV to II, myectomy : NYHA III or IV to NYHA I or II). One patient, who underwent a successful PTSMA, showed a temporary right bundle branch block on the ECG for several days following the PTSMA. At the 1-year follow-up, 2 patients were observed to have persistent symptomatic improvements, with no cardiac complications. CONCLUSION: Both a percutaneous septal myocardial ablation and a surgical myotomy-myectomy resulted in similar degrees of significant improvements of the left ventricular outflow tract obstructions, with improvements of the symptoms. Prospective studies are necessary to compare the long-term efficacy of these two treatment modalities.
Bundle-Branch Block ; Cardiac Surgical Procedures ; Cardiomyopathy, Hypertrophic* ; Catheter Ablation ; Coronary Vessels ; Echocardiography ; Electrocardiography ; Ethanol ; Female ; Follow-Up Studies ; Heart ; Humans ; Ventricular Outflow Obstruction*

BACKGROUND: The diagnostic methods of atherosclerosis before the development of clinical diseases(such as angina pectoris, myocardial infarction, cerebral infarction or peripheral vascular disease) are rather limited. The Russian doctors made the observations through the autopsy studies that there is a good correlation between the degree of atherosclersis or the cholesterol content of the aorta and the cholesterol content of the skin. We tried to investigate whether there is a significant degree of differences in the cholesterol content of the skin between the patietns with atherosclerotic disease(disease group), the patients who have not developed the clinical atheroscleric disease but have risk factors for atherosclerosis(risk group), and the normal control patients(normal group). METHODS: The skin choleterol was extracted from the palm of the hands by the closed contact with the chemicals. RESULTS: 1) The skin cholesterol was 2.77+/-1.08/microg/cm2in the disease group, 2.47+/-1.13microg/cm2in the risk group, and 1.84+/-0.60microg/cm2in the control group, The difference between the disease group and the normal group was significant(p<0.001), but the difference between the disease group and the risk group was not significant. 2) When the skin cholesterol of 2.1microg/cm2was used as a criterion. its sensitivity and specificity to predict either the disease gorup or the risk group was 66.1% and 70.8%. 3) In addition to the skin cholesterol of 2.1microg/cm2or more, if we add a criteria of cholesterol >220mg/dl, or TC/HDL-C ratio >4:1, or Apo B/A ratio >0.9, these separated the normal group from either the disease group or risk group much beter. 4) There was no significant correlation between the skin cholesterol and blood cholesterol. Also there were not any significant correlations between the skin cholesterol and the LDL cholesterol, TC/HDL-C ratio or Apo B/A ratio. CONCLUSION: On the basis of the above mentioned observations made by the Russian doctors and the present data showing significantly higher skin cholesterol level in the disease and risk group compared with normal control group, and little significant correlation between the skin cholesterol and the blood cholesterol level, it is likely that the skin cholesterol can be considered as an independent risk index for the atherosclerotic disease. Measuring the skin cholesterol by extraction of cholesterol from the palms of the hands may help predicting the presence or the risks of the atherosclerotic diseases.
Angina Pectoris ; Aorta ; Atherosclerosis* ; Autopsy ; Cerebral Infarction ; Cholesterol* ; Cholesterol, LDL ; Hand ; Humans ; Myocardial Infarction ; Risk Factors ; Sensitivity and Specificity ; Skin*

A total of 33 patients with infective endocarditis were observed in the Guro and Hye Hwa Hospitals of Korea University Between September, 1981 and Feb, 1987. Among thses patients four patients presented with heart murmur and heart failure and had vegetation like findings observed on the two dimensional echocardiography. But these patients did not have any fever or leukocytosis in the peripheral blood and the repeated blood cultures were negative. They showed the immunologic phenomena of infective endocarditis such as microscopic hematuria in 4 patients, rheumatoid factor in 3 patients, false positive VDRL in one patient. The serum complement was decreased in 2 patients in whom it was checked. We report these 4 patients because we think these patients might be in the clinical stage in which the infecting organism is spontaneously cleared but the immunologic sequelae are remained.
Complement System Proteins ; Echocardiography ; Endocarditis* ; Fever ; Heart Failure ; Heart Murmurs ; Hematuria ; Humans ; Korea ; Leukocytosis ; Rheumatoid Factor

In an attempt to investigate which of the ST-segment parameters, e.g., ST-segment level, ST-segment slope, ST-segment index and ST-segment intergral obtained by mannual drawing can most sensitively indicate quantitatively the extent of exertional myocardial ischemia in patients with angina pectoris, 26 patients with angina pectoris underwent exrecise stress testing, using a bicycle ergometer and thallium-201 myocardial perfusion scintigraphy(Thallium-201 MPS). The exrecise was terminated either when symptoms or signs indicative of myocardial ischemia developed or when the heart rate reached the predicted maximal heart rate during exrecise. The myocardial ischemia region was quantitated by Thallium-201 MPS. The number of myocardial ischemia segments was similar in patients who had positive exrecise test(4.9+/-1.9) and in those who had negative result(3.7+/-2.2). However, it was greater in patients who showed pseudonormalization of the T wave in exercise ECG(6.3+/-2.6) than in those with negative exercise test(3.7+/-2.2)(P<0.05). The extent of myocardial ischemia region expressed by the number of myocardial ischemia segments correlates best with the ST-segment index(r=-0.83) among ST-segment slop(r=-0.60), ST-segment intergral(r=-0.59) and ST-segment(r=0.50). These data suggest that the ST-segment index is the most reliable indicator to reveal the extent of exertional myocardial ischemia among the ST-segment parameters and that pseudonormalization of T wave in exercise ECG is a finding indicative of exertional myocaridial ischemia in patients with angina pectoris.
Angina Pectoris ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Ischemia ; Myocardial Ischemia* ; Perfusion

In humans, early lesions of atherosclerosis, fatty streaks, already begin to be observed from the twenties. In animals grown in nature, atherosclerosis is not known to exist and serum cholesterol levels in the animals are lower than 100mg/dL. Recent clinical trials suggest that if we lower the LDL cholesterol to below 40mg/dL, we can probably halt the progression of atherosclerosis. Atherosclerosis can either progress or regress according to the control of risk factors. If the risk factors are not well controlled, the pressure in the core can be increased and the cap weakens because of the infiltration of macrophages and foam cells instead of healthy smooth muscle cells and the matrix metalloprotenases secreted from these cells weakens the collagen. Acute coronary syndrome results when rupture or erosion occurs in the cap. Recently, atherosclerosis is understood as an inflammatory process, because the infiltrating cells, inflammatory cytokines and T-cells are very much similar to the other inflammatory lesions such as rheumatoid arthritis. Endothelial dysfunction, lipid oxidation and insulin resistance are also the main abnormal findings observed from the early stages of atherosclerosis. HMG Co-A reductase inhibitors can effectively prevent and regress atherosclerosis and is now very widely prescribed for these purposes.
Acute Coronary Syndrome ; Animals ; Arthritis, Rheumatoid ; Atherosclerosis* ; Cholesterol ; Cholesterol, LDL ; Collagen ; Cytokines ; Foam Cells ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Insulin Resistance ; Macrophages ; Myocytes, Smooth Muscle ; Oxidoreductases ; Risk Factors ; Rupture ; T-Lymphocytes

An exercise stress test using the bicycle ergometer was carried out in Korea University Hospital in 121 untrained apparently healthy male Koreans with the ages ranging from 20 to 69 years. The graded exercise test consisted of 12 minutes' work on the bicycle ergometer, 4 minutes with each work load, such as 50 W, 100W and 150W, and an additional time with the maximal load to the point of voluntary exhaustion or until other symptoms of exercise intolerance appeared. During the graded exercise a bipolar electrocardiogram from the forehead to the V 5 position(lead CH5) was monitored with an oscilloscope with the sweep speed of 50mm per second and recorded for the analysis. The results obtained were summarized as follows. 1. Heart rates were measured before and during the graded exercise at 50W, 100W, 150W and maximal work loads, and those of the 98 cases with no significant ST segment depression in the exercise ECG are presented. Mean heart rates per minute on 150W load by age group were: 171.0 in the 20-29 year-old group, 170.8 in the 30~39 year-old group, 168.0 in the 40-49year-old group, 162.9 in the 50-59 year-old group and 153.6 in the 60-69 year-old group. Mean heart rates per minute on maximal work load by age group were: 186.0 in the 20-29 year-old group, 178.8 in the 30-39 year-old group, 174.7 in the 40-49 year-old group, 166.0 in the 50-59 year-old group and 161.8 in the 60-69 year-old group. 2. The maximal working capacities by age group were: 266.3W in the 29-29 year-old group, 186.1W in the 30-39 year-old group, 182.2W in the 40-49 year-old group, 160.0W in the 50-59 year-old group and 161.8W in the 60-69 year-old group. 3. More than 1mm ST segment depression 0.08 second after the J point was seen in 10.7% and that 0.06 second after the J point in 19.1%. 4. Electrocardiographic QX/QT ratios ranging from 50 to 59% were seen in 21.5% and more than 60% in 0.8% of the cases. 5. Arrhythmias observed during the exercise test included premature ventricular contraction (2.5%), atrial premature contraction(1.7%) and nodal premature contraction(0.8%). 6. Distressing symtoms experienced during the graded exercise test were dizziness(6.6%) and leg pain(5.8%). Excessive sweating(3.3%), hypotension(1.7%) and nausea and vomiting (0.8%) were noticed immediately after the maximal exercise was finished.
Arrhythmias, Cardiac ; Depression ; Electrocardiography ; Exercise Test* ; Forehead ; Heart Rate ; Humans ; Korea ; Leg ; Male* ; Nausea ; Ventricular Premature Complexes ; Vomiting

A 63 Year-old-lady has had substernal chest pain on exertion for 8 years. The chest pain has been increased over the last 3 years. A continuous murmur was heard at the left second to third inercostal spaces along the left sternal border. The electrocardiogram showed the inverted T-waves in the precordial leads. The right heart catheterization revealed 5% oxygen step up between RV and PA. The right sided pressures were normal. The coronary arteriography revealed markedly tortuous vessels starting shortly after the left main stem coronary artery was normally originated. One of the large vessel was shown to be drained into the pulmonary artery. In the operation room, without using heart-lung machine this abnormally drained vessel was simply ligated at it's draining site into pulmonary artery. After the operation the patient is feeling well with little symptoms and the continuous murmur is no longer heard.
Angiography ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Vessels* ; Electrocardiography ; Heart-Lung Machine ; Humans ; Middle Aged* ; Oxygen ; Pulmonary Artery*