Acute coronary syndrome consists of acute myocardial infarction associated with electrocardiographic ST segment elevation (STEMI) and unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI). Theses three conditions are differentiated primarily by clinical, electrocardiographic, and laboratory presentations correlating with the duration and extent of thrombotic occlusion as a consequence of plaque rupture. Acute coronary syndrome is now the most prevalent presentation of ischemic heart disease in Korea as well as developed countries. Q-wave acute myocardial infarction is the most easily identified syndrome ; persistent angina and ST-segment elevation are characteristic of sudden total or near-total thrombotic arterial occlusion. Urgent reperfusion is the mainstay of therapy, whereas UA/NSTEMI is usually associated with severe coronary obstruction but not total occlusion of the culprit coronary artery. The distinction between unstable angina and non-Q wave, non-ST segment elevation myocardial infarction is often not clear at the initial presentation of patients. Unstable angina is defined as angina pectoris with at least one of the following three features : ① It occurs at rest usually lasting more than 20 minutes. ② It is severe and described as frank pain and of new onset within 1 month. ③ It occurs with a crescendo pattern (more severe, prolonged, or frequent than previously). Some patients with this pattern of ischemic discomfort, especially those with prolonged rest pain, develop evidence of myocardial necrosis on the basis of the release of cardiac markers and thus have a diagnosis of NSTEMI. This diagnosis has been based on the elevation of serum creatine kinase (CK)-MB, level but recently troponin T and I assays are used to define ischemic myocardial damage based on their higher sensitivity for myocardial necrosis and prognostic implication. Troponin has become the standard myocardial marker. A certain number of patients have elevated levels of troponins in the absence of significant CK elevation. Several studies have shown that despite nondiagnostic CK levels, an elevated troponin level often indicates a poor prognosis. Successful treatment strategies for acute coronary syndrome that improve survival include anticoagulant, antiplatelet, thrombolytic, and interventional approaches.
Acute Coronary Syndrome* ; Angina Pectoris ; Angina, Unstable ; Coronary Vessels ; Creatine Kinase ; Developed Countries ; Diagnosis ; Electrocardiography ; Humans ; Korea ; Myocardial Infarction ; Myocardial Ischemia ; Necrosis ; Prognosis ; Reperfusion ; Rupture ; Troponin ; Troponin T

OBJECTIVES: Radiofrequency(RF) ablation is an effective and low risk curative treatment for supraventricular arrhythmias. Catheter ablation produced cardiac lesions primarily through formation of coagulation necrosis. We evaluated the degree of myocardial injury after RF catheter ablation by means of serial measurement of myocardial enzyme. METHODS: Fifty-one patients with symptomatic supraventricular tachycardia were included. There were 32 men and 19 women(mean age. 39.5+/-15.4 years)All patients underwent electrophysiologic study to detect accessary pathway and ablation with radiofreguency current. A mean of 18.3+/-14.2 radiofrequency pulses were delivered. The pulses were at a power of 50 to 60 Volts for a duration of 20 to 30 seconds. Unipolar method and a 6F or 7F catheter with a 4 mm tip electrode was used. LDH, CPK and Ck-MB as a kind of cardiac enzyme were measured before and after ablation. RESULTS: 1) The concentration of LDH and CPK were elecated at 8 hours and 16 hours after ablation (p<0.05). 2) The concentration of CK-MB was elevated at 8 hours, 16 hours, 24 hours and 72 hours after ablation(p<0.05). 3) There was no correlation between the number of applications and amounts of radiofrequency current and rise in LDH, CPK, CK-MB concentration. CONCLUSION: The concentration of LDH, CPK and CK-MB were elevated after ablation but they were within normal limits. RF catheter ablation produced myocardial damage inevitably but were within normal limits. RF catheter ablation produced myocardial damage inevitably but minimally, then RF ablation is an effective and safe therapeutic modality for patients with symptomatic tachyarrhythmias.
Arrhythmias, Cardiac ; Catheter Ablation* ; Catheters ; Electrodes ; Humans ; Male ; Necrosis ; Tachycardia ; Tachycardia, Supraventricular*

CT and portographic findings of 63 patients with hepatoma, undergone hepatic angiography and superiormesenteric portography for evaluation of tumor and thrombosis of portal vein and determination of indication oftranscatheter arterial embolization for palliative treatment of hepatoma from April,85 to June, 86 in Hanyanguniversity hospital, were reviewed. The results were as follows: 1. In 36 cases, portal vein thrombosis wasdetected during portography. Nineteen of 37 cases which revealed localized hepatoma in the right lobe of the livershowed portal vein thrombosis; 9 of 11 cases of the left lobe; 8 of 14 cases which were involved in entire liverrevealed thrombosis. One case localized in the caudate lobe showed no evidence of invasion to portal vein. 2.Twenty-four of 34 cases with diffuse infiltrative hepatoma revealed portal vein thrombosis and the incidence ofportal vein thrombosis in this type were higher than in the cases of the nodular type. 3. The portal veinthrombosis appeared as filling defects of low density in the lumen of the portal veins in CT and they did notreveal contrast enhancement. 4. CT revealed well the evidences of obstructions in the cases of portal veinthrombosis and the findings were well-corresponded to the findings of the superior mesenteric portography. 5. Fiveof the cases of the portal vein thrombosis were missed in the CT and the casuses were considered as due to partialvolume effect of enhanced portal vein with partial occlusion or arterioportal shunts. 6. Six of 13 cases withocclusion of main portal vein showed cavernous transformation and they were noted as multiple small enhancedvascularities around the porta hepatis in the CT. According to the results, we conclude that CT is a usefulmodality to detect the changes of the portal veins in the patients of the hepatoma.
Angiography ; Carcinoma, Hepatocellular ; Humans ; Incidence ; Palliative Care ; Portal Vein ; Portography ; Thrombosis ; Veins ; Venous Thrombosis

BACKGROUND: It was recently shown that human atherosclerotic plaque contains large numbers of T lymphocytes : this indicates that immune and inflammatory mechanism may be important factors in the pathogenesis of atherosclerosis. By measuring the soluble interleukin 2 receptor(sIL-2R) level we can evaluate the activation of T lymphocyte. The purpose of this study is to evaluate relationship between T cell activation and ischemic heart disease by measuring the soluble interleukin 2 receptor (sIL-2R) level in patient with ischemic heart disease. METHOD: Seventy-two patients(40 males and 32 female, mean age : 56.5+/-9.9 years) who were taken coronary angiography were included in this study. Among them, 49 patients showed abnormal coronary angiographic findings and 23 patients showed normal coronary angiographic findings. Ten mililiters of arterial blood was drawn at the time of coronary angiography. The blood was allowed to coagulate and then the serum was removed and tested in duplicate for soluble interleukin 2 receptor (sIL-2R) level by ELISA. RESULTS: 1) The soluble interleukin 2 receptor (sIL-2R) level was significantly different between abnormal coronary angiographic findings and normal coronary angiographic findings (P < 0.001). 2) According to clinical severity of ischemic heart disease (i.e. stable angina, unstable angina, acute myocardial infarction.), soluble interleukin 2 receptor (sIL-2R) level was not significantly different between single vessel disease group and multivessels disease groups (p > 0.05), but showed increasing tendency with clinical severity. 3) According to numbers of involved coronary vessels, soluble interleukin 2 receptor (sIL-2R) level was not significantly different between single vessel disease group and multivessels disease groups (p > 0.05). CONCLUSION: T lymphocyte activation, as reflected in elevated soluble interlekin 2 receptor (sIL-2R) level, is frequent in patient with ischemic heart disease. In the further we will investigate relationship between clinical diagnosis of ischemic heart disease of the numbers of involved coronary vessels and T cell activation.
Angina, Stable ; Angina, Unstable ; Atherosclerosis ; Coronary Angiography ; Coronary Vessels ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Interleukin-2 ; Lymphocyte Activation ; Lymphocytes ; Male ; Myocardial Ischemia* ; Plaque, Atherosclerotic ; Receptors, Interleukin-2 ; T-Lymphocytes

No abstract available.
Thymus Hyperplasia*

BACKGROUND: Mitral regurgitation is a valvular heart disease that produce complex hemodynamic alternations and myocardial dysfunction occurs subclinically, so result in a high incidence of left ventricular dysfunction that might affect postoperative result. In order to assess preoperative factors affecting the outcome of mitral valve replacement in patients with chronic mitral regurgitaion, we evaluated prognostic factors from preoperative clinical, laboratory, and echocardiographic findings in 71 patients with chronic mitral regurgitation who received mitral valve replacement. METHODS: From 1985 to 1994, 71 patients with chronic mitral regurgitation, who received mitral valve replacement, were included in this study. The patients were defined as group I who had improved symptom and / or decreased left ventricular end-diastolic dimension after operation, and group II who had persistent symptom and / or over 60mm of left ventricular end-diastolic dimension after operation. RESULTS: 1) In clinical findings, preoperative systolic blood pressure was higher in Group I patients(p<0.05). 2) Hemoglobin, serum creatinine, and blood urea nitrogen level were not significantly different in both groups. 3) In echocardigraphic findings, left atrial dimension, left ventricular end-systolic / end-diastolic dimension, and left ventricular volume index of Group II were much higher than those of Group I patients(p<0.05). 4) In the discriminant analysis, left ventricular end-diastolic dimension, age, NYHA functional class, and left ventricular mass index were defined as important prognostic factors. CONCLUSION: According to the above results, preoperative age, NYHA functional class are significant prognostic factors in clinical and laboratory findings. And left atrial dimension, left ventricular end-systolic and end-diastolic dimensions, left ventricular volume index, and left ventricular mass index are significant prognostic factors in echocardiographic findings.
Blood Pressure ; Blood Urea Nitrogen ; Creatinine ; Echocardiography ; Heart Valve Diseases ; Hemodynamics ; Humans ; Incidence ; Mitral Valve Insufficiency* ; Mitral Valve* ; Ventricular Dysfunction, Left

No abstract available.

BACKGROUND: Measurement of echocardiographic mitral valve area (MVA) is an useful noninvasive method of estimating the stenotic mitral valve area. This study was undertaken to evaluate the accuracy of echocardiographic MVA measurement by comparing MVAs measured by the planimetric and pressure half-time method versus direct MVA measurement by using a cone shaped device specifically made for direct measurement of MVA. METHODS AND RESULTS: The study population consisted of 22 consecutive patients from August 1993 to February 1996. All the patients underwent 2D planimetry and Doppler echocardiographic MVA measurement before and after valve replacement surgery ; direct measurement also was performed after surgery. Five patients (22.7%) had normal sinus rhythm, and the rest of the patients had atrial fibrillation. Two-dimensional echocardiographic examinations were attempted in 22 patients, and adequate measurements were obtained in 21 of the patients studied. Mean mitral valve area were 0.99+/-0.32cm (2) ranged from 0.42 to 1.68cm (2) on 2D planimetry method, 0.93+/-0.32cm (2) ranged from 0.42 to 1.68cm (2) on Doppler pressure half-time method, 1.17+/-0.20cm (2) ranged from 0.93 to1.68cm (2) on direct measurement of mitral valve area after surgery. 2D planimetry method (r=0.621, p=0.003, SE=0.165), pressure half-time method (r=0.454, p=0.003, SE=0.187), and transmitral peak velocity (r=-0.480, p=0.026, SE=0.189) was relatively well correlate with operative mitral valve area. There was relatively good agreement between direct and 2D planimetric measurement and between direct and Dopler pressure-half time method. CONCLUSION: 2D planimetry and Doppler pressure half-time method on echocardiography are useful, noninvasive measurement method in patients with mitral stenosis.
Atrial Fibrillation ; Echocardiography* ; Humans ; Mitral Valve Stenosis* ; Mitral Valve*

BACKGROUND: Left ventricular hypertrophy is common in chronic renal failure patients and may contribute increased risk of cardiovascular morbidity and mortality. We evaluated the left ventricular morphology and function in renal transplant recipients to find the relationship between hemodynamic changes and morphologic and functional improvement after transplantation. METHODS: Serial echocardiographic evaluations were performed in 27 adults(20 men and 7 women) at the time of transplantaion and posttransplantation 1 month and 4 months. The average duration of hemodialysis was 16+/-24 months(mean+/-S.D.). RESULTS: At the time of transplantation, the hematocrit level was 21+/-6% and posttransplantation 1 month and 4 months, that was increased to 39+/-5% and 42+/-7%, respectively(p<0.001). Left ventricular mass index by echocardiography was decreased significantly from 246+/-87g/m2(pre-KT) to 169+/-38g/m2(post-KT 1 month) and 153+/-40g/m2(post-KT 4 months), respectively (p<0.001). Interventricular septal thickness and left ventricular posterior wall thickness were decreased significantly after 4 months of transplantation. Left ventricular systolic and diastolic dimensions were also decreased significantly after 1 month and 4 months of transplantation. Left ventricular volumes and cardiac output were also decreased significantly. But A/E ratio, ejection fraction and fractional shortening did not change significantly. CONCLUSION: These findings showed that pretransplant high output state was resolved radipidly(within 1 month) but the diastolic function did not improved after transplantation 1 month and 4 months.
Cardiac Output ; Echocardiography* ; Hematocrit ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mortality ; Renal Dialysis ; Transplantation*

Coronary arteriovenous fistula is relatively rare disease and originates more commonly in the right than in the left cononary artery. We report one case of cononary arteriovrnous fistula which we have experienced recently in 22 years old female, who has complained of dyspnea on exertion and intermittent anterior chest pain radiating to the left shoulder for several years. It was detected by transthoracic and transesophageal echocardiography and confirmed by cardiac catheterization and coronary angiography. In this case, the fistula was originated from the right coronary artery and drained into the posterior wall of the right ventricle, the coronary artery was dilated(diameter=1.5cm) and tortuous and significant shunt was measured(Qp/Qs=2.31). The opening of the fistula draining into right ventricle was obliterated with sutures.
Arteries ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Dyspnea ; Echocardiography* ; Echocardiography, Transesophageal ; Female ; Fistula ; Heart Ventricles ; Humans ; Rare Diseases ; Shoulder ; Sutures ; Young Adult