Cerebral arterial embolism which resulted in total occlusion of right proximal middle cerebral artery was occured in 33 years old female patients with severe mitral stenosis and atrial fibrillation during percutaneous mitral balloon valvuloplasty(PMV). The occluded artery could be detected by transfemoral carotid angiography and recanalized immediately by intra-arterial infusion of urokinase. There were no cerebral hemorrhage by CT scan after intra-arterial urokinase infusion and the patients discharged without any neurologic sequale 7 days after thrombolysis. We report a case of successful recanalization with intraarterial infusion of urokinase in patient with cerebral arterial embolism occurred during PMV.
Adult ; Angiography ; Arteries ; Atrial Fibrillation ; Cerebral Hemorrhage ; Embolism* ; Female ; Humans ; Infusions, Intra-Arterial* ; Intracranial Embolism ; Middle Cerebral Artery ; Mitral Valve Stenosis ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator*

Pacemaker Runaway is a rare, but potentially lethal complication after pacemaker implantation. Pacemaker runaway was one of the common manifestations of malfunctioning pacemaker at the time of fixed rate pacemaker, but has been less common after the demand type pacemaker had replaced the fixed rate model. The early recognition of runaway pacemaker is very important because runaway pacemaker can cause bradyarrhythmia, ventricular tachycardia-fibrillation and asystole resulting in syncope or death. We report a clinical experience of runaway pacemaker in 68 year-old woman, who received permanent pacemaker implantation(fixed rate 72/min, VVI, Micropulse 22U, Edwards system) due to sick sinus syndrome eight years ago. She complained of sudden chest tightness and dyspnea 10 days prior to admission. On physical examination, increased jugular venous pressure, rapid heart beats, basal rales on both lung fields and three finger-breath tender hepatomegaly. Electrocardiogram showed a rapid pacemaker rhythm of 140 beats per minute. So, the malfunctioning pacemaker was removed and replaced with a new programmable demand type pacemaker(VVI, OPTIMA-MP, Telectronics) in the same pocket under the diagnosis of pacemaker runaway. Her subject symptoms were relieved and electrocardiogram showed a regular pacemaker rhythm of 71 BPM. She was discharged ten days after pacemaker replacement.
Aged ; Bradycardia ; Child ; Diagnosis ; Dyspnea ; Electrocardiography ; Female ; Heart ; Heart Arrest ; Hepatomegaly ; Homeless Youth* ; Humans ; Lung ; Physical Examination ; Respiratory Sounds ; Sick Sinus Syndrome ; Syncope ; Thorax ; Venous Pressure

Antihypertensive effect of Bunazosin was evaluated in 23 patients with essential hypertension. Systolic blood pressure decreased from 175.5+/-16.9mmHg to 167.5+/-30.2mmHg after 4 weeks and to 165.4+/-29.7mmHg(p<0.05) after 8 weeks of medication. Diastolic blood pressure decreased from 105.6+/-9.7mmHg to 98.6+/-11.6mmHg(p<0.05) after 4 weeks and to 98.1+/-12.2mmHg(p<0.05) after 8 weeks of medication. Heart rate and serum lipid profiles did not change significantly. Transient side effects such as nausea(two cases), headache (one case), and weakness(one case) were observed, but there were no significant side effects. Therefore Bunazosin seemed to be effective in lowering blood pressure without reflx tachycardia, changes of serum lipie profiles, and significant side effects.
Blood Pressure ; Headache ; Heart Rate ; Humans ; Hypertension* ; Tachycardia

To evaluate the efficacy and safety of lovastatin, new hypolipidemic agent of HMG-CoA reductase inhibitor, we administered lovastatin 40mg to 80mg once daily for 12 weeks in 20 patients(7 males, 13 females) with primary hypercholesterolemia, and observed the sequential chamges of the lipid profile every 4 weeks. The results are as follows ; 1) The seurm total cholesterol was reduced significantly by 31% from 321+/-36mg% to 210+/-26mg%(p<0.05). 2) The serum triglycerides was significantly reduced from 321+/-168mg% to 228+/-74mg% by 29%(p<0.05). 3) The low density lipoprotein cholesterol was reduced significantly from 177+/-36mg% to 120+/-22mg% by 32%(p<0.05). 4) The total lipid, high density lipoprotein cholesterol and very low density lipoprotein cholesterol were also reduced significantly. 5) The ratio between total cholesterol and high density lipoprotein cholesterol, low density lipoprotein cholesterol and high density lipoprotein cholesterol did not change after lovastatin therapy. 6) There was no adverse reaction due to lovastatin therapy during 12 weeks of therapy. These results suggested that lovastatin is a effective and safe now hypolipidemic agent and is a convenient HMG-CoA reductase inhibitor for clinical use.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Cholesterol, VLDL ; Humans ; Hypercholesterolemia* ; Lovastatin* ; Male ; Oxidoreductases ; Triglycerides

The plasma cholesterol, TG,LDG,HDL of 101 Korean hypertensive patients were measured to compare with plasma cholesterol, TG,LDL,HDL level of healthy people(control group). The plasma cholesterol level in hypertensive patients was 189.6+/-39.5mg% and was 188.7+/-33.7mg% in healthy people(P>0.5). The plasma TG level in hypertensive patients was 200.5+/-154.2mg% and was 116.1+/-32.4mg% in healthy people(P<0.05). The plasma HDL level in hypertensive patients was 44.6+/-15.5mg% and was 45.1+/-9.8mg% in healthy people(P>0.05). The plasma LDL level in hypertensive patients was 119.0+/-68.6mg% and was 98.1+/-53.4mg% in healthy people(P>0.05). The serum level of the total cholesterol, HDL and LDL cholesterol in the hypertensive patients group were not significantly different from the control group, but the serum level of the TG was significantly increased in the patients group. We thought that this difference of plasma TG level is due to exogenous TG in hypertensive patient group but further evalution in properties of TG is required.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Humans ; Plasma

The criteria for differentiation of wide QRS tachycardias by electrocardiogram were evaluated in 24 cases of ventricular tachycardia(VT) and 8 cases of supraventricular tachycardia with wide QRS of various causes. There were some differences in Koreans from western countries due to plenity of idiopathic ventricular tachycardias(VTs) and infrequency of VTs by ischemic heart diseases. The characteristics were as follows : 1) Heart rate, QRS duration, QRS axis, distribution of RBBB and LBBB patterns, and QRS configurations of V1 and V6 leads were of limited values for differentiation of wide QRS tachycardias. 2) AV dissociation with or without capture beat and fusion bear was found in 63 % of VTs and very useful for differential diagnosis. Concordance of precordial leads was not frequently noted(2 cases) and and usually favored VT. 3) In LBBB patterns, notching of S wave, interval from Q wave to nadir of S wave greater than or equal to 60 msec, and R wave duration greater than or equal to 30 msec in V1 or V2 lead were present in 60%, 90%, and 29% of VTs respectively. The findings were also noted in accessory pathway conduction of supraventricular tachycardia. 4) Electrical alternans was present in 71% of VTs but also found in accessory pathway conduction of atrial fibrillation.
Atrial Fibrillation ; Axis, Cervical Vertebra ; Diagnosis, Differential* ; Electrocardiography* ; Heart Rate ; Myocardial Ischemia ; Tachycardia* ; Tachycardia, Supraventricular

To analyse the clinical characteristics of children with atrial flutter(AF1), we reviewed(the medical records of the children who had been admitted and diagnosed as AF1 or 12 leads surface ECG during the period between February, 1986 and Octobe, 1990. The onset age of 25 children was evenly distributed between gestational period and upto 14 years of age. The sex ratio between boys and girls was 11:14. The cardiac abnormalities were detected in 21 children(dilated cardiomyopathy in 3, congenital heart defect in 18). In 4 children, AF1 occured in apparently normal heart. In 9 children, AF1 developed without relation to cardiac surgery(4 in normal heart, 3 in dilated cardiomyopathy, 2 in preoperative CHD). AF1 developed in 9 children within 30 days postoperatively(group A) and in 7, after 30 days postoperatively(group B). In group A, various types of operation were done. In 2 of them, AF1 persisted beyond the immediate postoperative period and 1 died of cardiac decompensation 3 months postoperatively. In group B, operative procedures before AF1 were Senning operation in 2, Fontan operation in 2, operation for tetralogy of Fallot, ventricular septal defect with severe tricuspid regurgitation, endocardial cushion defect in 1 each. Five children in group B( except 1 Senning operation and 1 Fontan operation) had significant residual atrioventricular regurgitation. The associated rhythm disturbance besides AF1 could be determined in 23 children. The sinus node dysfunction was associated in 8 ; the supraventricular dysrhythmia in 10; the ventricular dysrhythmia in 6; the atrioventricular conduction disturbance in 3, and no other associated rhythm disturbance in 6. The efficacy of various methods in conversion of AF1 to sinus rhythm were 57.1%(4/7) with DC cardioversion, 38.5%(5/13) with digoxin and other antiarrhythmic drug(amiodarone, beta blocker, quinidine, verapamil, flecainide), 25%(5/20) with pacing in esophagus or endocardium. The follow-up evaluation was possible in 24 children. Eight children were dead : 5 due to chronic decompensation, 2 due to sudden cardiac arrest, and 1 due to sepsis. Of the 16 alive children, 14 had recovered the normal sinus rhythm and the other 2 had persistent AF1. Twelve children without AF1 and 1 with persistent AF1 were on medication, Although there were none cardiac death in children without persistent AF1, 7 out of 9 children with persistent AF1 were dead. Of the 7 children with significant atrioventricular regurgitation, corrective procedures were done in 4. There were no death in these 4 children, despite of 2 cardiac death out of 3 children on whom corrective procedure were not done. In conclusion, the atrioventricular regurgitation was a significant factor in relation to the occurrence and persistence of AF1 and the prognosis was bad in children with persistent AF1. It is recommended to trat the children with AF1 associated with atrioventricular regurgitation promptly and more aggressively.
Age of Onset ; Atrial Flutter* ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Child* ; Death ; Death, Sudden, Cardiac ; Digoxin ; Electric Countershock ; Electrocardiography ; Endocardial Cushion Defects ; Endocardium ; Esophagus ; Female ; Follow-Up Studies ; Fontan Procedure ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Medical Records ; Postoperative Period ; Prognosis ; Quinidine ; Sepsis ; Sex Ratio ; Sick Sinus Syndrome ; Surgical Procedures, Operative ; Tetralogy of Fallot ; Tricuspid Valve Insufficiency ; Verapamil

Normally the AC segment of mitral valve echogram consists of a rapid slope, from A peak to C point(complete closure). The initial portion is usually less steep than its final portion ; the latter represents abrupt mitral valve closure secondary to the rapid rise in left ventricular(LV) pressure at the onset of LV systole. The point on the mitral echogram at which closure aburptly accelerates in the B point. In order to see wither or not the echocardiographically recorded mitral valve could reflect alterations in left ventricular pressure, mitral valve echograms and left ventricular pressure were obtained on 30 patients undergoing diagnostic cardiac catheterization. The results were as follow : 1) Of 23 patients with LV ejection fraction>55%(71.2%+/-7.9%), 2 had B-bump ; of 7 patients with LV ejection fraction<55%(47.0%+/-4.9%), 5 had B-bump. The difference in frequency of B-bump between the normal LV ejection fraction and the low LV ejection fraction groups was statistically significant(p<0.001). 2) Of 6 patients with LVEDP>5mmHg (17.7mmHg+/-3.6mmHg), 5 had B-bump ; of 24 patients with LVEDP<15mmHg (8.5mmHg+/-2.6mmHg), 2 had B-bump. The difference in frequency of B-bump between the normal LVEDP and the elevated LVEDP groups was statistically significant(p<0.001). 3) Of 22 patients with LV ejection fraction>55%(71.2%+/-7.9%), as well as LVDEP<15mmHg(8.5mmHg+/-2.6mmHg), 1 had B-bump ; Of 5 patients with LV ejection fraction<55%(47.0+/-4.9%), as well as LVEDP>15mmHg(17.8mmHg+/-3.6mmHg), 4 had B-bump. The difference in frequency of B-bump between in normal LV ejection fraction, as well as normal LVEDP and the low LV ejection fraction, as well as elevated LVEDP groups was statistically significant(p<0.001). Thus, the mitral B-bump correlated primarily with LV dysfunction. When properly recorded, the presence of a B-bump is a useful sign of significantl LV dysfunction.
Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Humans ; Mitral Valve ; Systole ; Ventricular Dysfunction, Left* ; Ventricular Pressure

Transmitral left ventricular diastolic inflow velocities determined by pulsed Doppler in 47 normotensives, 80 hypertensives and 44 age-matched hypertensives were measured to evaluate the effects of age and left ventricular hypertrophy on left ventricular diastolic fuction in normotensives and hypertensives. The results were as follows: 1) The peak E velocity in normotensives(77.82+/-13.53cm/sec) was significantly different from those of hyeprtensives(58.13+/-11.80cm, p<0.01) and age-matched hypertensives(59.31+/-10.94cm/sec, p<0.01). The peak E/A in normotensives(1.31+/-0.45) was significantly different from those of hypertensives(0.83+/-0.21,p<0.01) and age-matched hypertensives(0.83+/-0.20, p<0.01). 2)In normotensives, simple linear regression analysis revealed strong inverse correlations of peak E with age(r=-0.758, p<0.01), peak E/A with age(r=-0.748, p<0.01), but no significant correlation of peak E and peak E/A with LVMI(p>0.05). Stepwise regression analysis revealed that age was the most important correlate of peak E and peak E/A in normotensives(peak E: R
Heart Diseases ; Hypertrophy, Left Ventricular* ; Linear Models

Atrial fibrillation in mitral stenosis(MS) may be cause of error in calculation of mitral valve area(MVA) by Doppler derived pressure half-time(PHT) method. This is due to changes of peak velocity and diastolic slope in mitral inflow Doppler spectrum in cases of assoociated with atrial fibrillation. However, few data exist regarding the effect of atrial fibrillation on the validity of this method. Two hundreds and three patients with mitral stenosis were studied by Doppler echocardiography and two-dimensional echocardiography(2DE) to assess whether atrial fibrillation affected the calcullation of MVA. Total patients was divided into four groups according to the accompanied mitral or aortic regurgitation. Ninety patients had mitral stenosis only(group 1), 45 patients had mitral stenosis only(group 2), 54 patients were combined with aortic regurgitation(group 3) and 14 patients were combined with both mitral and aortic regurgitation(group 4). And then, each group was divided into sinus rhythm subgroup and atrial fibrillation subgroup respectively. In total patients, Doppler echocardiographic indices(pressure half-time, mean pressure gradient, peak pressure gradient and peak velocity) were correlated significantly with 2DE-MVA in both patients with sinus rhythm and patients, with atrial fibrillation(P<0.005). In group 1 patients, Doppler echocardiographic indices were significantly correlated with 2DE-MVA in both patients with sinus rhythm and patients with atrial fibrillation(P<0.005). In group 2 patients, these Doppler derived indices were significantly correlated with 2DE-MVA in both patients with sinuns rhythm and patients with atrial fibrillation(P<0.005). In group 3 patients, only pressure half-time was significantly correlated with 2DE-MVA in both patients with sinus rhythm and patients with atrial fibrillation(P>0.005). In group 4 patients, pressure half-time was significantly correlated in patients with atrial fibrillation(P<0.005). Therefore, Doppler echocardiography can estimates mitral valve area in patients with mitral stenosis associated with mitral and aortic regurgitation regardless of presence of the atrial fibrillation.
Aortic Valve Insufficiency ; Atrial Fibrillation* ; Echocardiography ; Echocardiography, Doppler* ; Humans ; Mitral Valve ; Mitral Valve Stenosis*