Anticoagulation therapy is widely used to prevent thromboembolism in patients with atrial fibrillation, venous thromboembolism, and mechanical heart valves. The temporary interruption of anticoagulants is common to reduce the bleeding risk during peri-procedures. Traditionally, warfarin was held for several days before procedures with heparin bridging therapy. However, recent data showed that stopping warfarin was not necessary before procedures with a low bleeding risk, such as a gastrointestinal endoscopy, cataract eye surgery, and dental procedures when the thromboembolic risk of the patient is moderate-to-high. This review article outlines the estimation of the thromboembolic and bleeding risk before procedures, and determines the timing of anticoagulant interruption.
Anticoagulants ; Atrial Fibrillation ; Cataract ; Endoscopy ; Endoscopy, Gastrointestinal ; Heart Valves ; Hemorrhage ; Heparin ; Humans ; Thromboembolism ; Tooth Extraction ; Venous Thromboembolism ; Warfarin

Arterial hypertension leads to both structural and functional changes of the heart. Hypertensive heart disease (HHD) is characterized by complex changes in myocardial structure (e.g., enhanced cardiomyocyte growth, excessive cardiomyocyte apoptosis, accumulation of interstitial and perivascular collagen fibers, disruption of endomysial and perimysial collagen network) that cause the remodeling of the myocardium. In the 1970s, hypertrophic growth of cardiomyocytes is compensatory to reduce wall stress on the ventricular wall imposed by pressure overload. Recent data from animal studies suggest that inhibition of ventricular hypertrophy was not associated with ventricular dilatation or reduced wall motion despite elevated wall stress. The genetic complexity (gene-gene and/or gene-environment interactions) may modulate left ventricular mass and transcriptional regulators are participated in pathologic myocardial growth. Many hormones and cytokines lead to a profibrotic and inflammatory environment. Excess of ventricular collagen in hypertensive patients is the result of both increased collagen synthesis by fibroblasts and stimulated myofibroblasts, and unchanged or decreased collagen degradation by matrix metalloproteinase. Several biochemical markers of myocardial remodeling will prove to be useful. The development of noninvasive methods like echoreflectivity, cardiac magnetic resonance imaging, speckle tracking echocardiography, and cardiac molecular imaging would enable broader application. Meta-analysis showed that there was a significant difference among medication classes in decreasing left ventricular mass.
Animals ; Apoptosis ; Biomarkers ; Collagen ; Cytokines ; Dilatation ; Echocardiography ; Fibroblasts ; Heart ; Heart Diseases ; Humans ; Hypertension ; Hypertrophy ; Magnetic Resonance Imaging ; Molecular Imaging ; Myocardium ; Myocytes, Cardiac ; Myofibroblasts ; Track and Field ; Ventricular Remodeling

No abstract available.
Evoked Potentials, Auditory, Brain Stem*

The authors are reporting a rare case of supratentorial rhabdomysarcoma which arose in the left middle fossa and unusually revealed symptoms of increased intracranial pressure only without focal signs. We also reviewed literatures.
Intracranial Pressure ; Rhabdomyosarcoma*

PURPOSE: Cardiac dysfunction and hyperdynamic systemic circulation may be present in patients with cirrhosis. The purpose of this study was to identify relations between plasma levels of N-terminal-proBNP (NT-proBNP), reflecting early ventricular dysfunction, and the severity of liver disease and cardiac dysfunction in cirrhotic patients. MATERIALS and METHODS: Sixty-three cirrhotic patients and 15 controls (group 1) were enrolled in this study. Plasma levels of NT-proBNP were determined in echocardiographically examined patients, which were allocated to 1 of 3 groups according to Child-Pugh classification or into 2 groups, i.e., a compensated group without ascites (group 2) and decompensated group with ascites (group 3). RESULTS: Plasma NT-proBNP levels were significantly higher in cirrhotic patients (groups 2 and 3) than in age-matched controls (155.9 and 198.3 vs. 40.3pg/mL, respectively, p < 0.05). NT-proBNP levels were significantly increased in Child class C patients than in classes B and A (250.0 vs. 168.6 and 119.6pg/mL, respectively, p < 0.05). Left atrial dimension, wall thickness of left ventricle, and EF or E/E' were significantly increased, and EDT was prolonged in cirrhotic patients than in controls. Increased LVMI and decreased E/A ratio were noted in the group of patients with ascites as compared with the other groups. CONCLUSION: Plasma NT-proBNP levels were high in cirrhotic patients and are likely to be related to the severity of disease. Advanced cirrhosis is associated with advanced cardiac dysfunction, and NT-proBNP levels has predictive value for concomitant cardiac dysfunction and cirrhosis progression.
Adult ; Aged ; Electrocardiography ; Female ; Heart Diseases/*blood/complications/*pathology ; Humans ; Liver Cirrhosis/*blood/complications/*pathology ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood

BACKGROUND AND OBJECTIVES: Stress induced cardiomyopathy has been reported as reversible left ventricular dysfunction with electrocardiographic changes. Although the exact mechanism of this dysfunction has not been clarified, catecholamine "surge" is suspected as a potential cause of this disease. It has not been undergone the studies about the effect of chronic or recurrent psychological stress on the myocardium. We suspect that reversible ischemic change of myocardium could be induced by chronic or recurrent emotional stress. MATERIALS AND METHOD: The clinical, echocardiographic and angiographic data of 189 patients (72 women) who presented with ischemic symptoms and eletrocardiographic changes were participated. BAI (Beck anxiety inventory) and BDI (Beck Depression inventory) were obtained and analyzed for evaluation of degree of psychological stress. RESULTS: 54 patients who had left ventricular apical wall motion abnormalities without significant angiographical stenosis in the coronary artery were younger than the others with left ventricular wall motion abnormalities and angiographic stenosis. And they increased the BAI and BDI as tools of evaluation of psychological stress (p<0.05). CONCLUSION: Data of this study suggested that psychological stress can be associated with myocardial dysfunction. It can be postulated that psychological stress should be considered as one of the cause of non-coronary myocardial injury.
Anxiety ; Cardiomyopathies ; Constriction, Pathologic ; Coronary Vessels ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles* ; Humans ; Myocardium ; Stress, Psychological ; Ventricular Dysfunction, Left

Coronary artery injury after thoracic injury is very rare, but can result in serious acute myocardial infarction (MI). It can be easily mistaken for chest wall pain or cardiac contusion if relying solely on a history and physical examination. We herein report a rare case of a 60-year-old female patient who presented with inferior wall ST-segment elevation MI due to right coronary artery dissection following blunt chest trauma after a traffic accident. Successful primary percutaneous coronary intervention was performed without complications.
Accidents, Traffic ; Contusions ; Coronary Vessels ; Female ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Physical Examination ; Thoracic Injuries ; Thoracic Wall ; Thorax

An adrenal carcinosarcoma is extremely rare with reported three cases. This neoplasm is extremely aggressive with distant metastasis arising from the sarcomatous component. A 48-year-old female was present with abdominal distention for 1 month. All laboratory studies were within normal reference range including urinary and serum corticosteroids. The tumor consist typical areas of adrenal carcinoma and sarcoma. Sarcomatous elements were identified and confirmed both immunohistochemically and ultrastructurally. After radical resection, the patient developed rapid local and distant metastatic recurrence and died three months after surgery. This is the first reported case of adrenal carcinosarcoma in korea.
Adrenal Cortex Hormones ; Carcinosarcoma* ; Female ; Humans ; Immunohistochemistry ; Korea ; Middle Aged ; Neoplasm Metastasis ; Recurrence ; Reference Values ; Sarcoma

Massive thoracoabdominal aortic thrombosis is a rare finding in patients with iatrogenic Cushing syndrome in the absence of any coagulation abnormality. It frequently represents an urgent surgical situation. We report the case of an 82-year-old woman with massive aortic thrombosis secondary to iatrogenic Cushing syndrome. A follow-up computed tomography scan showed a decreased amount of thrombus in the aorta after anticoagulation therapy alone.
Aged, 80 and over ; Anticoagulants/therapeutic use ; Aorta, Abdominal/ultrasonography ; Cushing Syndrome/*complications/*diagnosis ; Electrocardiography ; Female ; Humans ; Iatrogenic Disease ; Thrombosis/*diagnosis/drug therapy/*etiology ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND/AIMS: The aim of the present study was to evaluate the relationship between thyroid hormone levels and infarct severity in patients with ST-elevation myocardial infarction (STEMI). METHODS: We retrospectively reviewed thyroid hormone levels, infarct severity, and the extent of transmurality in 40 STEMI patients evaluated via contrast-enhanced cardiac magnetic resonance imaging. RESULTS: The high triiodothyronine (T3) group (> or = 68.3 ng/dL) exhibited a significantly higher extent of transmural involvement (late transmural enhancement > 75% after administration of gadolinium contrast agent) than did the low T3 group (60% vs. 15%; p = 0.003). However, no significant difference was evident between the high- and low-thyroid-stimulating hormone/free thyroxine (FT4) groups. When the T3 cutoff level was set to 68.3 ng/dL using a receiver operating characteristic curve, the sensitivity was 80% and the specificity 68% in terms of differentiating between those with and without transmural involvement. Upon logistic regression analysis, high T3 level was an independent predictor of transmural involvement after adjustment for the presence of diabetes mellitus (DM) and the use of glycoprotein IIb/IIIa inhibitors (odds ratio, 40.62; 95% confidence interval, 3.29 to 502; p = 0.004). CONCLUSIONS: The T3 level predicted transmural involvement that was independent of glycoprotein IIb/IIIa inhibitor use and DM positivity.
Aged ; Area Under Curve ; Biological Markers/blood ; Chi-Square Distribution ; Contrast Media/diagnostic use ; Coronary Angiography ; Female ; Humans ; Logistic Models ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/blood/*diagnosis/pathology/radiography ; Myocardium/*pathology ; Odds Ratio ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; Thyroxine/blood ; Triiodothyronine/*blood