The antihypertensive effects of diltiazem was observed in 30 cases of essential hypertension, and following results were obtained. 1) Mean decrease in systolic and diastolic blood pressure by oral diltiazem was 42.0+/-2.5mmHg and 17.8+/-1.7mmHg. The results of antihypertensive therapy revealed good control in 50% fair control in 30% poor in 17% and failure in 3% of the cases. In 80% of the cases, good or fair control of Hypertension which means drop of diastolic pressure to the level of less than 100mmhg was observed. 2) Mean drop in heart rate was 21+/-2 beats/min. 3) Daily dose was 90-180mg. 4) The side effect of oral Diltiazem was mild headache and dizziness, respectively one case.
Blood Pressure ; Diltiazem* ; Dizziness ; Headache ; Heart Rate ; Hypertension

No abstract available.
Humans ; Hyperbilirubinemia* ; Infant, Newborn*

Clinical EPS was performed in 16 normal adults without evidence of conduction disease on the surface standard 12 lead electrocardiogram in order to provide normal electrophysiological values of the sinus node function and AV conduction. EPS was also performed in 15 patients with sick sinus syndrome and 10 patients with AV conduction disturbance to evaluate the clinical usefulness of EPS in detecting sinus node dysfunction and AV conduction disturbance. The results were as follows. 1) The results of sinus node function test in the normal group were m-SNRT 853+/-198msec(range 800-1,560msec), c-SNRT 230+/-66msec(range 120-370msec), and %m -SNRT/SCL 127+/-11%(range 114-149%). 2) In 15 patients with SSS, the M-SNRT were ranged from 1,270 to 12,330msec and 10 patients(66%) had significantly increased m-SNRT exceeding 1,560msec. The c-SNRT were ranged from 230 to 10,730msec and 13 patients(83%) had significantly increased c-SNRT exceeding 370msec. The % m-SNRT/SCL were ranged from 136 to 770% and 12 patients(80%) had significantly increased % m-SNRT/SCL exceeding 150%. 3) The SACT in normal group were 84+/-14msec(range 70-105msec) measured by continuous atrial pacing method and 80+/-19 msec(range 60-115msec) measured by atrial extrastimulation method. 4) In SSS, the SACT measured by continuous atrial pacing method was ranged from 80 to 1,050msec and 11/12 patients(92%) had significantly increased SACT exceeding 112 msec. The SACT measured by atrial extrastimulation method was ranged from 90 to 310msec and 7/8 patients(88%) had significantly increased SACT exceeding 118 msec. 5) C-SNRT, % m-SNRT/SCL, and SACT were more useful in detecting sinus node dysfunction than m-SNRT. 6) The AV conduction intervals in normal group were PA interval 17+/-6(range 5-25msec), AH interval 96+/-18 msec(range 70-135msec), and HV interval 46+/-7msec(range 35-55msec). 7) Rapid atrial pacing induced Wenckebach type second degree AV block proximal to H at pacing rate of 90 to 190/min in 14/16 normal adults. 2 patients maintained intact AV conduction upto maximum pacing rate of 200/min. 8) His bundle electrogram showed the site of AV block in 9 of 10 patients with AV conduction disturbances. The sites of AV block were AV nodal area 1 case, intraHis bundle 4 cases, and infraHis bundle 4 cases. 9) EPS provided a good supportive information that was useful in selecting pacemaker therapy in a patient with chronic bifascicular block who revealed prolonged HV interval and infraHis bundle block at a pacing rate of 70min. 10) The refractory periods of AV conduction system in normal group were AERP 274+/-54msec (range 170-410msec), AVN-FRp 467+/-74msec(range 285-600msec), AVN-ERP 341+76msec(range 190-460), and V-ERP 280+/-25msec(range 240-320msec).
Adult ; Atrioventricular Block ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Humans ; Sick Sinus Syndrome ; Sinoatrial Node*

The force-interval relationship of cardiac muscle has been known as not only a fundamental manifestation of beat-to-beat kinetics of intracellular activator calcium which control contractile response but also a potential clinical tool for evaluating cardiac contracile function. In this study were evaluated the force-interval relationship of intact canine left ventricle through mechanical restitution curves by plotting contrctile responses to varying steady state, extrasystolic and postextrasystolic intervals, and compared the force-interval relationships of intact canine left and right ventricles quantitatively. Effects of localized myocardial ischemia on the left ventricular force-interval relationship and relaxtion function were also evaluated 30 minutes after ligating proximal left anterior descending coronary artery through observing contractile and relaxtion responses to various intervals. 1) Mechanical restitution curve of left ventricle showed that left ventricular dp/dt max responses rose stiffly until plateau level with increasing postextrasystolic intervals, then declined with further increment of postextrasystolic intervals. 2) Mechanical restitution curve of left ventricle shifted leftward and upward with shortening of steady state and extrasystolic intervals, which suggest intracellular calcium kinetics during electrical diastole may operate as a mechanism of the force-interval relationship. 3) Steady state contractile responses remained unchanged but maximal contractile responses increased significantly or contractile reserve in intact left ventricle. 4) Normalized force-interval relationships of left and right ventricle were similar quantitatively, which suggest the force-interval relationship is independent of structural factors in intact canine heart. 5) Occlusion of coronary artery lowered absolute values of left ventricular dp/dt max responses to varying postextrasystolic intervals, but didn't show significant changes of normalized dp/dt max responses, which suggest force-interval relationship be also present in spite of localized myocardial ischemia. 6) Responses of normalized left ventricular dp/dt min to varying postextrasystolic intervals were similar to those of normalized dp/dt max but reduced after coronary artery occlusion in the range above 100% dp/dt max response, which may be used for the detection and evaluation of deranged myocardial relaxation in the left ventricle with localized myocardial ischemia.
Calcium ; Coronary Vessels ; Diastole ; Heart ; Heart Ventricles ; Kinetics ; Myocardial Ischemia ; Myocardium ; Relaxation ; Ventricular Function, Left*

BACKGROUND: Propafenone is a new class IC antiarrhythmic drug that has been found to be effective in both supraventricular and ventricular tachyarrhythmias. We studied the electrophysiologic and long-term effects of oral propafenone in the patients with paroxysmal supraventricular tachycardia(PSVT). METHODS: The electrophysiologic study was done in 15 patients with PSVT to assess the short-term efficacy of propafenone 450mg daily. For 10 patients with short-term efficacy, follow up study was done to assess the long-term efficacy of propafenone 450mg daily. RESULTS: The electrophysiologic mechanisms of PSVT were AV nodal reentry in 6 patients and AV reentry in 9 patients. During the electrophysiologic study, propafenone prolonged AH, HV and PR intervals significantly(p<0.05), but did not change the corrected SNRT, SACT, and the ERP of atrium, ventricle, AV node and accessory pathway(AP) significantly. The anterograde and retrograde 1:1 conduction capacity of AV node and AP seemed to decrease. Complete block of anterograde conduction over the AP was noted in 2 of 3 patients with manifest WPW syndrome and complete block of retrograde conduction was noted over the AV node in 1 patient with AV nodal reentry and over the AP in 1 patient with AV reentry. Propafenone was effective in 3 of 6 patients with AVNRT and 7 of 9 patients with AVRT. During long term administration for 3 to 11 months in 10 patients with short-term efficacy of propafenone, 7 patients did not report any episode of symptomatic tachycardia and 3 patients reported less frequent palpitation. There were no side effects during short-and long-term follow up except 2 patients with mild indigestion. CONCLUSIONS: Propafenone seems to be a safe, well tolerated and effective drug for short and long-term therapy of patients with PSVT, especially of orthodromic AV reentry.
Atrioventricular Node ; Dyspepsia ; Follow-Up Studies ; Humans ; Propafenone* ; Tachycardia ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome

Myxoma is the commonest intracardiac tumor and it is well known to present in bizarre ways. Calcification of the tumor is uncommon, though probably more frequent in right than in left heart tumors. Diagnosis can be followed by surgery with satisfactory results. A 36 years old man with partially calcified right ventricular myxoma and a 51 years old man with calcified left atrial myxoma, which were revealed different echogenic densities on 2-dimensional echocardiogram and gross calcification on fluoroscopy, were treated with surgical removal. We report above two cases of calcified myxoma with literature review.
Adult ; Diagnosis ; Fluoroscopy ; Heart Neoplasms ; Humans ; Middle Aged ; Myxoma*

Preoperative and postoperative echocardiography were performed in 33 patients with isolated ostium secondum atial septal defect(ASD), confirmed by right heart catheterization and operation at Seoul National University Hospital from November 1980 to June 1982. The ratio of right ventricular enddiastolic dimension to leftventricular enddiastolic dimension(RVED/LVED) was compared to the pattern of interventricular septum, before and after operation. In patients with persistent paradoxical septal motion during 2wks after operation, repeated echocardiograms were performed upto 9 months, postoperatively. The results obtained are as follows: 1) The ratio of RVED/LVED in patients with ASD, was 0.95+/-0.35(mean+/-standard deviation), which was significantly larger than that of 14 normal subjects(p<0.005). 2) There was statistically correlation between the ratio of pulmonary blood flow to systemic blood flow(QP/QS) and the ratio of RVED/LVED(r=0.44, p<0.025). 3) Thirty three patients were divided into 3 groups according to the pattern of intervent ricular septal motion.(Group "M": Patients with normal septal motion, Group "B": Patients with paradoxical type B septal motion, Group "A": Patients with paradoxical type A septal motion) Preoperatively, the ratio of RVED/LVED was 0.68+/-0.28 in Group "N" (N=9), and 0.88+/-0.23 in Group B (N=9) and 1.14+/-0.34 io Group "A" (N=15). In Group "A, the ratio of RVED/LVED was significantly larger than of Group "N" (p<0.005). Postoperatively, the ratio of RVED/LVED was 0.51+/-0.13 in Group "N" (n=23), and 0.68+/-0.15 in Group "B" (n=7), and 0.79+/-0.14 in Grop "A" (n=3). In Group "A" and Group "B, the ratio of RVED/LVED was significantly larger than that of Group "N" (p<0.005, p<0.01). 4) Postoperative RVED index(18.9+/-4.9) was significantly decreased, compared with preoperative RVED index(27.6+/-8.9) (p<0.005). But there was no significant change in LVED index, before and after operation. 5) Among 10 patients with persistent paradoxical septal motion, repeated echocardiograms were performed in 5 patients. Interventricular septal motion was normalized in 4 out of 5 patients. Thus the ratio of RVED/LVED has significant correlation with QP/QS and the pattern of interventricular septal motion. These results suggest the evidence that interventricular septal motion is determined by septal position at enddiastiole.
Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Heart Septal Defects, Atrial* ; Humans ; Seoul

The antiplatelet aggregation effect of ticlopidine was studied in 22 cases of coronary artery disease(CAD) and 17 cases of control by obseving changes of plarma beta-thromboglobulin(beta-TG) and platelet factor 4(PF-4) before and after administration of ticlopidine 500mmg daily for 2 weeks. 1) Compared with the controls, CAD patients had significantly greater plasm levels of beta-TG(52.6+/-32.7ng/ml. mean +/-SD vs. 91.0+/-52.0, P<0.05) and PF-4(17.5+/-12.8 ng/ml vs. 32.9+/-24.5, P<0.05). 2) In controls, plasma levels of beta-TG and PF-4 didn't change significantly after taking ticlopidine. 3) In CAD patients, plasma levels of beta-TG (91.0+/-52.0ng/ml vs. 53.9+/-20.0, P<0.05) and PF-4(32.9+/-24.5ng/ml vs. 18.8 +/-11.9(P<0.05) decreased significantly after ticlopidine. 4) The side effects were observed in 2 cases such as mild indigestion and urticaria.
Blood Platelets ; Coronary Vessels ; Dyspepsia ; Humans ; Plasma ; Ticlopidine* ; Urticaria

To assess the diagnostic value of low level predischarge exercise test in the prediction of multivessel disease and left ventricular abnormality rate limited treadmill test, coronary arteriography and left ventriculography were admitted to the coronary care unit at Seoul National University Hospital from February 1985 to April 1986. The following results were obtained; 1) During and immediately after the treadmill test, ischemic ST segment depression were observed in 7 patients (20.6%). On subsequent coronary arteriography, 6 of them were found to have multivessel coronary artery disease. The sensitivity of ST segment depression in prediction of multivessel disease was 31.6%, the specificity was 93.3% and prediction value was 85.7%. 2) In 11 patients (32.3%), the exercise test were discontinued because of anginal pain, fatigue, or dyspnea. The sensitivity of above symptoms in prediction of multivessel disease was 47.4%, the specificity was 86.7% and prediction value was 81.8%. 3) The sensitivity of ST segment depression and/or symptom in prediction of multivessel disease was 68.4%, the specificity was 80%, and the prediction value was 81.25%. 4) The ST segment elevation were observed in 10 patients (29.4%). The sensitivity of ST segment elevation in prediction of complicated left ventricular aneurysm was 58.3%, the specificity was 87.5%, and the prediction value was 70%. 5) No serious complication developed by the treadmill test. It is concluded from above results that low level predischarge treadmill exercise test is useful and safe test in the prediction of multivessel disease and left ventricular aneurysm in patients with recent acute myocardial infarction.
Aneurysm ; Angiography ; Coronary Artery Disease ; Coronary Care Units ; Depression ; Dyspnea ; Exercise Test* ; Fatigue ; Humans ; Myocardial Infarction* ; Sensitivity and Specificity ; Seoul

The coronary arteriography and left ventriculography were performed on 63 patients with acute myocardial infarction who were admitted to coronary care unit of Seoul National University Hospital from September 1984 to October 1986 within 30 days after onset of acute myocardial infarction (median: 16 days) to delineate the extent of coronary artery disease and the left ventricular function. The results were as follows; 1) The ratio of male to female was 59:4 (14.75:1) and 34.9% of all patients were at their 6th decade. 2) The infarction were transmural in 58 patients (92.1%) and nontransmural in 5 patients (7.9%). Among 58 patients with transmural infarction, 33 (56.9%) had anterior wall infarction, 15 (25.9%) had inferior wall infarction and 10 (17.2%) had anteroinferior wall infarction. 3) Among 63 patients, 4 (6.3%) showed completely normal coronary artery on coronary arteriography and 3 (4.8%) had insignificant stenosis (lesser than 50%) reduction in luminal diameter). The 39.7% of all patients had one-vessel disease, 27% two-vessel disease and 22.2% three-vessel disease. 4) Among 58 patients with transmural infarction, 31 (53.4%) showed complete occlusion of infarct related artery. And 73.4% of the patients with inferior wall infarction showed complete occlusion of infarct related artery. None of the patients with non-transmural infarction had complete occlusion. 5) In 21 patients who had the coronary arteriography within 14 days after the onset, 12 (57.2%) showed complete occlusion of infarct related artery and among 42 patients who were studied 15-30 days after the onset, 19(45.2%) showed complete occlusion. 6) Nineteen patients (30.2%) were found to have left ventricular aneurysm. 7) The left ventricular ejection fraction were significantly higher in the patients with non-transmural infarction than in patients with transmural infarction. The difference in left ventricular ejection fraction between the patients with anterior infarction and with inferior infarction, between single vessel disease and multiple vessel disease were not significant. 8) The older age group showed a tendency to have higher prevalence of multivessel disease. 9) As complication of coronary arteriography and left ventriculography, one episode of ventricular fibrillation was observed without mortality. From the above results of this study, it is concluded that coronary arteriography and left ventriculography can be safely performed within 30 days after the onset of acute myocardial infarction: A significant number of patients had normal or minimally diseased coronary artery: more than half of the patients with transmural infarction had complete occlusion of infarct related artery: the patients with nontransmural infarction had better left ventricular function than with transmural infarction.
Aneurysm ; Angiography ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Care Units ; Coronary Vessels ; Female ; Humans ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Phenobarbital ; Prevalence ; Seoul ; Stroke Volume ; Ventricular Fibrillation ; Ventricular Function, Left