BACKGROUND: Carotid atherosclerosis and aortic at herosclerosis are both a predictor of atherosclertic cardiovascular diseases. However, the relationship between carotid and aortic atherosclerosis is not well known. METHODS: We performed B-mode ultrasound examinations of the carotid arteries in 38 consecutive elderly cases(13 men, mean age 69+/-3 years and 25 women, mean age 69+/-5 years) who underwent transesophageal echocardiography, to assess whether atherosclerosis in the carotid artery correlates with thoracic aortic atherosclerosis or may be a marker for it. RESULTS: The incidence of carotid and thoracic aortic atherosclerotic plaques were 44.7% and 50%, respectively. There was a significant relationship between carotid atherosclerosis and thoracic aortic atherosclerosis(r=0.532, p<0.01), and a increase in the extent of aortic atherosclerosis with increasing grades of carotid atherosclerosis. In the entire study cases, the presence of carotid atherosclerosis had a sensitivity 63.2%, specificity 73.7%, positive value 72.6% and negative predictive value 66.7% in detec-ting thoracic aortic atherosclerosis. CONCLUSION: In the Korean elderly, B-mode ultra sound examination of the carotid arteries is a easy and useful technique for the prediction of the presence and severity of thoracic atherosclerosis.
Aged* ; Aorta ; Aorta, Thoracic* ; Atherosclerosis* ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Artery Diseases* ; Echocardiography, Transesophageal ; Female ; Humans ; Incidence ; Male ; Plaque, Atherosclerotic ; Sensitivity and Specificity ; Ultrasonics ; Ultrasonography

Aneurysms of the pulmonary artery are uncommon in general but have a potentially fatal prognosis. This is derived from the potential for rupture of the aneurysm from the fact that there is commonly underlying severe pulmonary hypertension. Most cases are documented in the large postmortem series. Aneurysms of the pulmonary artery can be classified as congenital or acquired. Possible symptoms include dyspnea on exertion, cough, hemoptysis, and thoracic pain. When a large aneurysm formation of the pulmonary artery is diagnosed, surgical intervention is indicated because conservative treatment of the aneurysm will undoubtedly result in rupture with fatal outcome. We report a case of 46-year old patient with a giant left pulmonary artery aneurysm associated with severe pulmonary hypertension. A Doppler echocardiogram and a computed tomographic scan showed a giant saccular aneurysm of the left pulmonary artery (12 cm in diameter) and estimated systolic right ventricular pressure of 80 mmHg.
Aneurysm* ; Cough ; Dyspnea ; Fatal Outcome ; Hemoptysis ; Humans ; Hypertension, Pulmonary* ; Middle Aged ; Prognosis ; Pulmonary Artery* ; Rupture ; Ventricular Pressure

Ischemic heart disease is a common complication of thyrotoxicosis, although the exact mechanism has not been defined. In patient with dextrocardia as a part of situs inversus, coronary heart disease may occur with similar frequency and manifestation as in the general population. A case is reported of angina and thyrotoxicosis in patient with situs inversus totalis in which the angina was manifested by ST-segment elevation during graded exercise, relieved by antithyroid treatment. This unusual case establishes an association between hyperthy-roidism and ischemic heart disease.
Coronary Disease ; Dextrocardia ; Humans ; Hyperthyroidism* ; Myocardial Ischemia ; Situs Inversus* ; Thyrotoxicosis

Patent foramen ovales (PFOs) are common congenital cardiac defects that have been associated with the occurrence of stroke, especially with cryptogenic stroke, or those of undefined cause, accounting for up to 40% of all ischemic strokes. A number of studies have demonstrated the association of larger PFOs with increased shunting in patients with cryptogenic strokes. Medical treatment is often considered inadequate, and percutaneous closure offers an attractive, albeit controversial, alternative in stroke patients with PFOs. Although it is plausible that percutaneous PFO closure will reduce the rate of recurrent stroke in these patients, no prospective, randomized trials examining the efficacy of closure devices in this setting have been completed. This paper reviews the known relationship between PFOs and cryptogenic strokes and discusses current therapeutic options, including percutaneous closure.
Accounting ; Foramen Ovale, Patent ; Humans ; Stroke

No abstract available.
Aneurysm, Infected* ; Endocarditis* ; Mesenteric Artery, Superior*

BACKGROUND AND OBJECTIVES: The transradial approach has been suggested as an alternative entry site for coronary angiography. The complication and success rates of the vascular procedure have been associated with age. The aim of this study was to determine the safety, feasibility, and efficacy of transradial coronary angiography for patients greater than age 70 compared with younger patients. SUBJCETS AND METHODS: Clinical and angiographic data were reviewed retrospectively in 894 consecutive patients who underwent transradial coronary angiography from January 2001 through May 2003. Procedure-related results were used to compare 2 groups, patients aged < 70 years and those >70 years. RESULTS: In a consecutive series of 894 patients, 638 were < 70 years of age and 256 were >70 years of age. There was no significant difference in the rate of success in patients >70 years compared with patients < 70 (91.1% vs 93.6%). No severe complications, such as death, vascular dissection, rupture, and major cerebrovascular accidents were present in either group. Procedure-related variables, including procedure time, radiographic contrast use, and the number of catheters used per case, were similar between the two groups. CONCLUSION: Transradial access is a safe and feasible approach for coronary angiography in elderly patients, yielding results similar to those achieved with younger patients.
Aged* ; Catheters ; Coronary Angiography* ; Humans ; Retrospective Studies ; Rupture ; Stroke

BACKGROUND AND OBJECTIVES: The transradial approach has been suggested as an alternative entry site for coronary angiography. The complication and success rates of the vascular procedure have been associated with age. The aim of this study was to determine the safety, feasibility, and efficacy of transradial coronary angiography for patients greater than age 70 compared with younger patients. SUBJCETS AND METHODS: Clinical and angiographic data were reviewed retrospectively in 894 consecutive patients who underwent transradial coronary angiography from January 2001 through May 2003. Procedure-related results were used to compare 2 groups, patients aged < 70 years and those >70 years. RESULTS: In a consecutive series of 894 patients, 638 were < 70 years of age and 256 were >70 years of age. There was no significant difference in the rate of success in patients >70 years compared with patients < 70 (91.1% vs 93.6%). No severe complications, such as death, vascular dissection, rupture, and major cerebrovascular accidents were present in either group. Procedure-related variables, including procedure time, radiographic contrast use, and the number of catheters used per case, were similar between the two groups. CONCLUSION: Transradial access is a safe and feasible approach for coronary angiography in elderly patients, yielding results similar to those achieved with younger patients.
Aged* ; Catheters ; Coronary Angiography* ; Humans ; Retrospective Studies ; Rupture ; Stroke

BACKGROUND: Primary pulmonary hypertension(PPH) that affects predominantly young and productive people, is a progressive fatal disease of unknown cause. The objectives of this study were to characterize mortality in patients with PPH and to investigate the factors associated with their mortality. METHODS: Thirteen patients with PPH were enrolled between 1988 and 1996 and followed up through July 1999. Measurements at diagnosis included hemodynamic and pulmonary function variables in addition to information on demographic data and medical history. RESULTS: 1) The mean age of the patients with PPH enrolled into the study was 36.1+/-9.3 years with female predominance. 2) The estimated median survival was 3.4+/-0.6 years. 3) Decreased cardiac index was the only significant predictor of mortality(Cox proportional hazards model). CONCLUSION: Patients with PPH have a high mortality. In this limited study with a small number of patients, mortality is largely associated with decreased cardiac index.
Diagnosis ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Mortality ; Prognosis

BACKGROUND: There has been reports which suggest that non-specific symptom of patients with mitral valve prolapse is associated with autonomic dysfunction. METHODS: To assess autonomic dysfunction of patients, we examined five cardiovascular reflex tests in 25 asymptomatic MVP patients(identified as MVP group), 25 symptomatic MVP patients(identified as MVP syndrome group) and 25 control group. RESULTS: In the five cardiovascular autonomic function tests, abnormalities of Valsalva ratio were detected in 1(4%) control group, 7(28%) MVP group, 9(36%) MVP syndrome group, heart rate response to deep breathing in 0(0%), 2(8%), 4(16%) respectively, immediate heart rate response to standing in 0(0%), 2(7.4%), 2(8%) respectively and in postural hypotension, there were no abnormal group. Abnormalities of blood pressure response to sustained handgrip were only detected in 2(8%) MVP syndrom group. According to the five categories of cardiovascular autonomic functon tests, normal in 24(96%) and early damage in 1(4%) were detected in control group. In the MVP group, normal 17(68%), early damage 6(24%) and definite damage 2(8%) were noted. In the MVP syndrome group, normal 9(36%), early damage 13(52%), definite damage 1(4%) and combined damage 2(8%) were detected. In case of heart rate response to deep breathing, we found significant differences between control and MVP syndrome group(p=0.043), and between MVP and MVP syndrome group(p=0.0043). In case of heart rate response to standing, between control and MVP syndrome group(p=0.0009), between MVP and MVP syndrome group(p=0.001), the differences were noted. In case of blood pressure response to standing, between control group and MVP group(p=0.0019), between MVP and MVP syndrome group(p=0.0075), we found significant differences. Resulting from our study, heart rate response to deep breathing and standing, blood pressure response to standing were of considerable value in assessing the autonomic dysfunction of patients with mitral valve proapse. CONCLUSION: We found autonomic dysfunction in addition to increased autonomic tone and responsiveness which have been already known previously in mitral valve prolapse. And autonomic dysfunction was more severe in symptomatic patients with mitral valve prolapse than asymptomatic ones.
Blood Pressure ; Heart Rate ; Humans ; Hypotension, Orthostatic ; Mitral Valve Prolapse* ; Mitral Valve* ; Reflex ; Respiration

BACKGROUND: There has been reports which suggest that the morphologic feature of ventricular premature complex(VPC) might reflect the cardiac state. METHODS: To test this, we studied retrospectively the association between the morphologic feature of VPC(shape and duration) and cardiac state(structural and functional) by analysing the records of ECG(179 cases) obtained from reviewing echocardiogram performed in our hospital from 1988 to early 1991. Group 1(n=84) had VPC-QRS complexes with either smooth and uniterruped contour or narrow(<0.04 sec) notching and group 2(n=95) demonstrated VPC with broad(> or =0.04 sec) notching or shelves. Without taking into account of either the presence of the type of the underlying cardiac disease and other constitutional disease state, we classified the type of VPC on ECG according to the above criteria and analysed its simple association with cardiac size and functional state on echocardiogram. RESULTS: In group 1, 68 of 84 cases with a VPC had no notching. In group 2, the VPC-QRS duration was greater than group 1(0.154+/-0.022 vs 0.141+/-0.011 sec(mean+/-S.D.), p=0.0001).Left ventricular end-diastolic diameter(LVED) and ejection fraction(EF) showed a significant difference between the two groups(5.12+/-0.64 vs 5.72+/-0.95cm, p=0.0003 and 65.89+/-10.84 vs 60.82+/-15.5%, p=0.012 respectively). In group 2, 50 of 95 cases(53%) showed ejection fraction less than 64%. By defining left ventricular structural dilatation and functional impairment on echocardiogram as LEVD greater than 5.5cm and EF less than 64% respectively, the sensitivity and specificity of VPC morphology was 60% and 74% respectively. CONCLUSIONS: We conclude that a broadly(> or =0.04 sec) notched VPC of long duration(> or =0.15 sec) is a simple and reliable 12-lead ECG marker for an abnormal structural and functional state of the heart(dilatation and hypokinetic left ventricle), irrespective to underlying cardiac disease, while a VPC with smooth contour or narrow(<0.04 sec) notching with short duration(<0.15 sec) reflects a normal sized heart with normal systolic function.
Dilatation ; Electrocardiography ; Heart ; Heart Diseases ; Retrospective Studies ; Sensitivity and Specificity