We report a case of a 69-year-old man presenting with acute right chest pain radiating to the right shoulder. Physical examination revealed a right sided apex beat with a palpable liver on the left side. Reversed normalizing electrocardiogram are presented, allowing for correct diagnosis of an acute anterior myocardial infarction. Dextrocardia with situs inversus is an uncommon congenital condition, the patient also diagnosed hypertrophic cardiomyopathy by two dimensional echocardiography. Successful percutaneous coronary intervention was performed and the patient was discharged after uneventful recovery.
Cardiomyopathy, Hypertrophic ; Chest Pain ; Dextrocardia ; Echocardiography ; Electrocardiography ; Humans ; Liver ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Physical Examination ; Shoulder ; Situs Inversus

OBJECTIVE: C-reactive protein (CRP), lipoprotein (a)[Lp(a)], and fibrinogen are associated with systemic inflammatory reactions. Statins have anti-inflammatory effects. However, the effect of statins on these parameters is inconsistent. We evaluated the effect of statins on inflammatory markers and variables related to changes in these markers. METHODS: A total of 390 hypercholesterolemic patients were enrolled. Atorvastatin (n=112), lovastatin (n=25), pitavastatin (n=49), rosuvastatin (n=20), and simvastatin (n=184) were administered. Lipids, CRP, Lp(a), and fibrinogen levels were measured before and after 2 months of the therapy. RESULTS: Statins reduced cholesterol, low density lipoprotein (LDL) cholesterol, and triglyceride levels by -28.9+/-9.1% (P=0.000), -41.4+/-12.4% (P=0.000), and -11.6+/-39.4% (P=0.000), respectively and increased high density lipoprotein (HDL) cholesterol level by 2.56+/-13.2% (P=0.014). CRP levels decreased from 1.23+/-1.30 to 1.14+/-1.29 mg/L (P=0.000). Lp(a) levels were not changed (P=0.91) and fibrinogen levels increased from 277.8+/-54.4 to 282.6+/-56.9 mg/dL (P=0.042). Changes in CRP levels were associated with baseline CRP levels (r=-0.56, P=0.000) and changes in HDL cholesterol levels (r=-0.14, P=0.005). Changes in Lp(a) levels were associated with changes in triglyceride (r=-0.24, P=0.000) and baseline aspartate aminotransferase level (r=0.12, P=0.015). Changes in fibrinogen levels were associated with baseline fibrinogen levels (r=-0.40, P=0.000), sex (r=0.18, P=0.001), and changes in HDL cholesterol levels (r=-0.15, P=0.003). CONCLUSION: Inflammatory markers showed different responses to statins and changes in these markers were associated with different parameters. This finding suggests that anti-inflammatory effect of statin is confined to a specific pathway of inflammation.
Aspartate Aminotransferases ; C-Reactive Protein ; Cholesterol ; Cholesterol, HDL ; Fibrinogen ; Fluorobenzenes ; Heptanoic Acids ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Lipoprotein(a) ; Lipoproteins ; Lovastatin ; Pyrimidines ; Pyrroles ; Quinolines ; Simvastatin ; Sulfonamides ; Atorvastatin Calcium ; Rosuvastatin Calcium

OBJECTIVE: Peroxisome proliferator-activated receptor delta (PPAR-delta) is an ubiquitously expressed nuclear receptor that has been implicated in adipose tissue formation, brain development, and atherosclerosis. Despite mouse studies demonstrating that PPAR-delta activation has favorable anti-atherogenic properties by improving systemic lipid profiles, the relationship between PPAR-delta agonist and angiogenesis is unknown. We hypothesized that PPAR-delta ligands modulate the angiogenesis. METHODS: To test this hypothesis we treated primary cultures of bovine aortic endothelial cells with PPAR-delta specific ligand, GW501516 (50-800 nM) for 6 h. RESULTS: GW501516 dose-dependently decreased nitric oxide production without alteration in endothelial nitric oxide synthase (eNOS) expression. Analysis with phospho-specific antibodies against eNOS demonstrated that GW501516 significantly decreased the phosphorylation of eNOS at Serine1179 (eNOS-Ser1179). Concurrently, GW501516 also decreased the Akt phosphorylation. GW501516 did not affect endothelial cell proliferation or induce apoptosis. However, GW501516 inhibited endothelial cell migration, and tube formation in a high nanomolar concentration. The inhibition of endothelial cell tube formation by GW501516 was prevented by addition of the nitric oxide donor, DETA NONOate (5 microM). GW501516 was also found to inhibit angiogenesis in vivo in the chicken chorioallantoic membrane assay. CONCLUSION: These results provide that high nanomolar range of GW501516 inhibits angiogenesis by a mechanism involving dephosphorylation of eNOS-Ser1179.
Adipose Tissue ; Animals ; Antibodies, Phospho-Specific ; Apoptosis ; Atherosclerosis ; Brain ; Chickens ; Chorioallantoic Membrane ; DEET ; Endothelial Cells ; Humans ; Ligands ; Mice ; Nitric Oxide ; Nitric Oxide Synthase Type III ; Nitroso Compounds ; Peroxisomes ; Phosphorylation ; PPAR delta ; Thiazoles ; Tissue Donors

Cardiovascular disease (CVD) is the leading cause of death worldwide and small dense low-density lipoprotein (sdLDL) has been suggested to be a potential risk factor for cardiovascular disease (CVD). We reviewed published studies on formation and measurement of sdLDL, as well as relationship between LDL subfractions and CVD. sdLDL particle formation is highly dependent on triglycerides (TG) levels, and the physicochemical properties of sdLDL particles provide a potential for increased atherogenicity. Various conditions (e.g. hypertriglyceridemia, diabetes mellitus, metabolic syndrome, chronic renal failure and HIV infections) with increased cardiometabolic risk are associated with increased sdLDLs. Most studies suggest that sdLDL particles are associated with increased prevalence of clinical and subclinical CVDs, as well as non-coronary forms of atherosclerosis. Moreover, LDL size seems to be an important determinant of the progression of CVD. Therapeutic modulation (mostly fibrates, but also some statins, as well as niacin and thiazolidinediones) of small LDL size, number and distribution may decrease CVD risk. However, no definitive causal relationship is yet established, probably due to the close association between sdLDL and triglycerides and other risk factors.
Atherosclerosis ; Cardiovascular Diseases ; Cause of Death ; Diabetes Mellitus ; Fibric Acids ; HIV ; Hypertriglyceridemia ; Kidney Failure, Chronic ; Lipoproteins ; Niacin ; Prevalence ; Risk Factors ; Triglycerides

Left Ventricular Thrombus (LVT) formation after acute myocardial infarction is a serious complication. And the most feared complication of LVT is the systemic thromboembolic events, especially to the brain. Nowadays patients with acute myocardial infarction are treated with primary PCI and more aggressive anticoagulation therapies, resulting in the lower incidence of LVT. Early detection of LVT is very important, and echocardiography is the definitive test for detecting intracardiac thrombus. However, the need for serial echocardiography remains controversial. In this case report, we describe a 55-year-old man with major trauma induced LVT after acute myocardial infarction who underwent successful therapy.
Brain ; Echocardiography ; Humans ; Incidence ; Middle Aged ; Myocardial Infarction* ; Thrombosis*

OBJECTIVE: The aim of this study was to evaluate the characteristics of the young Korean obese but metabolically healthy subjects and to identify the factors associated with metabolic health status among them. METHODS: We reviewed the medical record of South-Korea Navy soldiers at 1st marine division with routine medical examination. Within this population, we selected obese subjects whose body mass index (BMI) were more than 25 kg/m². The clinical characteristics between obese subjects with metabolically healthy and unhealthy factors were retrospectively compared. RESULTS: Of the 1,522 subjects with medical record, 319 (20.9%) subjects were identified as obese. Among them, 60 subjects (18.8%) were classified as metabolically unhealthy, whereas 259 (81.2%) subjects were metabolically healthy. Multivariate analysis revealed that higher BMI (odds ratio, OR 1.26, 95% confidence interval, CI, 1.07-1.49), higher alanine transaminase (ALT) (OR 1.03, 95% CI 1.01-1.06), and drinking alcohol (OR 3.65, 95% CI 1.02-13.02) were associated with metabolically unhealthy status in obese subjects. Meanwhile, regular physical activity was associated with metabolically healthy status in obese subjects. (OR 0.33, 95% CI 0.17-0.62) CONCLUSION: This study found that higher BMI, higher ALT, and drinking alcohol were related to metabolically unhealthy status in young Korean obese subjects; meanwhile, regular physical activity was related to metabolically healthy status.
Alanine Transaminase ; Body Mass Index ; Drinking ; Healthy Volunteers ; Humans ; Medical Records ; Metabolic Diseases ; Military Personnel ; Motor Activity ; Multivariate Analysis ; Obesity ; Republic of Korea* ; Retrospective Studies*

OBJECTIVE: Atrial fibrillation (AF) is a common arrhythmia which is generally more prevalent in the elderly population. However, the new onset of AF is frequently found in young populations. In order to identify putative prognostic biomarkers for detection of young-onset AF, we purified and characterized lipoproteins in terms of oxidative and inflammatory properties. METHODS: Male patients with AF (46±7 years of age, n=19) were recruited. Their serum and individual lipoproteins were analyzed and compared with healthy controls (48±9 years of age, n=17). RESULTS: The patients with AF revealed hypertriglyceridemia, hyperuricemia with mild obesity, elevated levels of CRP, and a normal level of cholesterol. All lipoproteins from patients with AF demonstrated higher levels of TG and advanced glycated end products, and decreased particle size than controls. AF-LDL showed an increased extent of oxidation with increased atherogenic macrophage phagocytosis. AF-HDL showed impaired antioxidant ability and a lower level of apoA-I expression. CONCLUSION: These data suggest that lipoprotein properties are severely modified in young AF patients, which were correlated with increased oxidation and inflammation.
Aged ; Apolipoprotein A-I ; Apolipoproteins ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Biomarkers ; Cholesterol ; Humans ; Hypertriglyceridemia ; Hyperuricemia ; Inflammation ; Lipoproteins ; Macrophages ; Male* ; Obesity ; Particle Size ; Phagocytosis ; Triglycerides

OBJECTIVE: We investigated serum lipid levels in asymptomatic HBsAg carriers and the general population using the Korean National Health and Nutrition Examination Survey (KNHANES). METHODS: We analyzed the data of patients aged ≥30 years from the KNHANES 2007-2014 datasets. Subjects with diabetes mellitus, triglyceride levels >1000 mg/dL, a history of heavy alcohol consumption, or lipid-lowering medication were excluded. HBsAg carriers were divided into “unknown HBsAg carrier” and “known HBsAg carrier” according to previous self-recognition of HBsAg status using a questionnaire. RESULTS: Compared with control subjects (n=24,880; male 33.9%; mean age 52±14 years), HBsAg carriers (n=1,061; male 40.6%; mean age 50±13 years) showed significantly higher AST and ALT levels, lower platelet counts and higher body mass index (BMI) (all p<0.001). HBsAg carriers revealed lower total cholesterol, LDL cholesterol and triglyceride levels (all p<0.001) compared with control subjects, irrespective of previous awareness of HBsAg positivity. Hypertriglyceridemia and low HDL cholesterolemia were less prevalent even in the “unknown HBsAg carrier” group compared with control subjects [age, sex and BMI-adjusted odds ratio, 0.566 (95% confidence interval, 0.468-0.684) and 0.822 (0.708-0.956), respectively]. CONCLUSION: In conclusion, HBsAg carriers exhibited low total cholesterol, LDL cholesterol, and triglyceride levels compared with control subjects. Hypertriglyceridemia and low HDL cholesterolemia were also less frequently detected in HBsAg carriers even after adjustments for age, sex, and BMI.
Alcohol Drinking ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Dataset* ; Diabetes Mellitus ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Hepatitis* ; Humans ; Hypertriglyceridemia ; Male ; Nutrition Surveys ; Odds Ratio ; Platelet Count ; Triglycerides

We report a case of a superficial femoral artery pseudoaneurysm in 52-year old patient with a history of having renal allograft. The pseudoaneurysm spontaneously developed while standing up from squatting position after defecation, and it was successfully managed by an endovascular repair with an endograft. This case suggests that an atherosclerotic superficial femoral artery is vulnerable to torsion and tension movement during changing position from squatting to standing, which is repeatedly practiced by the people using the Korean traditional toilet. The endovascular therapy is also recommended for elderly patients with poor clinical conditions such as having a renal allograft and diffuse atherosclerosis of peripheral arteries.
Aged ; Allografts* ; Aneurysm, False* ; Arteries ; Atherosclerosis ; Defecation ; Femoral Artery* ; Humans

Acute stent thrombosis after percutaneous coronary intervention (PCI) is still problematic because of the subsequent development of myocardial infarction and poor prognosis. The incidence of acute stent thrombosis, occurring within 0-24hours after PCI, is relatively low, but underlying causes and treatment strategy are not well defined. Multi-vessel disease, ST-elevated myocardial infarction (STEMI), and large thrombotic burden are known risk factors of acute stent thrombosis. Thrombus aspiration, balloon angioplasty and glycoprotein IIb/IIIa receptor blocker could be therapeutic options. Recently we experienced two cases of acute stent thrombosis which developed during PCI with the aggravation of chest pain, and acute stent thrombosis were diagnosed immediately and successfully treated. Here we report two cases of acute stent thrombosis during PCI for one patient with STEMI and the other with acute coronary syndrome, which were successfully treated with thrombus aspiration and intravenous infusion of glycoprotein IIb/IIIa receptor blocker.
Acute Coronary Syndrome* ; Angioplasty, Balloon ; Chest Pain ; Coronary Thrombosis ; Glycoproteins ; Humans ; Incidence ; Infusions, Intravenous ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Risk Factors ; Stents* ; Thrombosis*