We experienced a case of mitral incompetence due to rupture of anterolateral papillary muscle in a 56-year-old male who complained of abdominal pain and mild dyspnea after being struck by car. Clinical manifestation immediately following injury was minimal, but heart failure progressed rapidly 3 days after injury. Echocardiopraphic evaluation revealed ruptured anterolateral papillary muscle and severe mitral regurgitation on color flow imaging. There was no evidence of coronary artery disease on coronary angiography. Operation revealed that the haed of anterolateral papillary muscle was torn out of its insertion. Mitral valve replacement with mechanical prosthesis was performed on the 50th day after injury.
Abdominal Pain ; Coronary Angiography ; Coronary Artery Disease ; Dyspnea ; Heart Failure ; Humans ; Male ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Papillary Muscles* ; Prostheses and Implants ; Rupture* ; Thorax*

Cor triatriatum is a rare cardiac malformation in which the left atrium is subdivided into two chambers by a fibromuscular septum, one locates posterosuperiorly, which is connects with the pulmonary veins, and the other locates anteroinferiorly connecting with the mitral valves and left ventricie. It is often lethal in children with cor triatriatum due to congestive heart faliure which develops abruptly and rapidly. So, the most important thing is early detection of the disease. We experienced a case of cor triatriatum in 20 month-old female. She had severe symptoms related to congestive heart faliure, and the conditions showed dangerous. Echocardiography was used for correct diagnosis. The patients was improved dramatically after proper surgery. So, We reported this case and review literatures briefly.
Child ; Cor Triatriatum* ; Diagnosis ; Echocardiography ; Estrogens, Conjugated (USP) ; Female ; Heart ; Heart Atria ; Heart Septal Defects, Atrial* ; Humans ; Infant ; Mitral Valve ; Pulmonary Veins

Blunt thorax trauma may produce a variety of cardiac lesions, which may occur alone or in combination. Nonpenetrating perforation of interventricular septum with chordae rupture of tricuspid valve is a infrequent pathologic event. A 40-years-old worker was transfered to hospital with increasing symptoms of right heart failure following a blunt compressing chest trauma with a huge overolling cement pipe(Wt.680kg) 6 weeks ago. The immediately diagnosed serial rib fracture of the left thorax cage and dislocation of the left acromoclavicular joint were treat conservatively. A conventional transthoracic color Doppler and two dimensional echocardiogram detected traumatic ventricular septal defect with bilatral shunt and tricuspid regurgitation. An additional transesophageal color echocardiopraphic demonstrated the ruptured chordae tendineae of the tricuspid septal leafet, which prolapsed deeply into the right atrium. The conventional color Doppler echocardiopraphy enhances the ability to detect the presence of a ventricular septal perforation and valve dysfunction in a patient with cardiac contusion. The transesophageal echocardiopraphy is a useful semiinvasive tool for the detailed morphological evaluation of atrioventricular valves and their substructure.
Chordae Tendineae ; Contusions ; Dislocations ; Echocardiography* ; Heart Atria ; Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Joints ; Rib Fractures ; Rupture* ; Thorax* ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Ventricular Septal Rupture*

BACKGROUND: To evaluate depressure effect and safety of delapril, a new ACE inhibitor, in Korea. METHOD: Thirty three patients, aged 37-69, with mild to moderate essential hypertension were first observed for 2 weeks with placebo followed by administration of 15mg of delapril twice daily for 2 weeks, then doubled dosage to 30mg b.i.d. and combined with 25mg of dihydrochlorothiazide if optimal BP were not obtained at the end of 4th week, continued the same dose until the end of 10 week's trial period. RESULT: BP dropped 15/9mmHg inaverage at the end of 10th week rewarding 70% of cumulative effectiveness. Most frequent side reaction was dry cough, occurred in 9% of patients followed by chest tightness, headache, constipation and transient elevation of GPT. CONCLUSION: Delapril 15-30mg twice daily as monotheraphy or combined with diuretics is well tolerated and effective in the treatment of mild to moderate essential hypertension.
Constipation ; Cough ; Diuretics ; Headache ; Humans ; Hydrochlorothiazide ; Hypertension* ; Korea ; Reward ; Thorax

BACKGROUND: As an antihypertensive drug, Nifedipine, a calcium channel blocker was introduced recently, which also has antianginal effect. But due to the relatively short duration of action, another antihypertensive agents having longer duration of action and stronger hypertensive effect were under investigation. Nilvadipine, a new calcium channel blocker, was introduced to have more prologned duration of action and to act more specifically on vascular smooth muscle. So the efficacy and safety of oral Nilvadipine on essestial hypertension was investigated and represented by our institute. METHODS: In order to investigate the efficacy and safety of oral Nilvadipine, daily doses of 4mg twice a day were administered in 30 hypertensive patients whose states were compatible to the criteria : 1) severity of hypertension rated in Stage I and Stage II according to the classification by WHO, 2) ages ranging from 30 to 74 years regardless of sex, 3) blood pressure with 95mmHg or higher but less than 115mmHg in diastolic pressure which was the mean in a sitting position at the last two out of not less three consultations in the 2 week observation period, 4) outpatients with informed consent for 6 weeks. Blood pressure and heart rate were measured every 2 weeks. The complete with blood count with platelet, uronalysis and the electrocardiography were performed at the beginning period and the 6th weeks of therapy. And kinds of side effects were questioned by examining physicians. RESULTS: The following results were obtained : 1) Blood pressure fell significantly in 6 weeks of treatment with Nilvadipine(Mean pressure+/-S.D., 6.00mmHg vs 108.90+/-9.68mmHg p<0.05), 2) There was no significant change in EKG in 6 weeks of treatment with Nilvadipine, 3) Pulse rate was decreased in 6 weeks of treatment with Nilvadipine(80.14+/-11.90/min vs 75.39+/-6.47/min, p<0.05). 4) No significant chsange in body weight was observed(64.50+/-8.7kg vs 63.50+/-10.25kg, p<0.05). 5) There were no significant changes in blood chemistry including blood sugar, cholesterol, electrolytes, serum creatinine and alkaline phosphatase values, 6) Hematologic findings and urinalysis findings reamained unchanged, 7) Total 10 patients(33.30%) had various side effects;facial flushing 30.00%, palpitation 23.33%, headache 20.00%, nausea 10.00%, drowsiness 3.33%, heaviness 3.33% and indigestion 3.33%. But there was no serious side effect that requires to discontinue the medication of the test drug. And there was no need to reduce the dosage due to the side effect, 8) The antihypertensive effect was judged to decrease markedly in 76.70%, decrease 20.00%, unchange 3.30% and increase 0.00%, 9) The utility which was assessed with the data from the overall safety and antihypertensive effect, the drug was judged to be very useful in 60.00%, useful 33.30%, useless 6.67% and inhibited 0.00%. CONCLUSION: From the above results, Nilvadipine in doses of 4mg twice a day was effective and useful in most cases without severe side effects in essential hypertensive patients with diastolic blood pressure of 95 to 115mmHg.
Alkaline Phosphatase ; Antihypertensive Agents ; Blood Glucose ; Blood Platelets ; Blood Pressure ; Body Weight ; Calcium Channels ; Chemistry ; Cholesterol ; Classification ; Creatinine ; Dyspepsia ; Electrocardiography ; Electrolytes ; Flushing ; Headache ; Heart Rate ; Humans ; Hypertension* ; Informed Consent ; Muscle, Smooth, Vascular ; Nausea ; Nifedipine ; Outpatients ; Referral and Consultation ; Sleep Stages ; Urinalysis

BACKGROUND: The stability of A-V junctional rhythm is the most important clinical interest in the patients with the complete heart block with narrow QRS complex. The QRS morphology, the basal heart rate & the reponse of subsidiary pacemaker to drugs may be helpful to assess the stability. But it can not be assessed exactly. The recording of the His-bundle was thought to be a means of predicting the clinical course of the patients and the necessity of the artificial pacemaker insertion;also it can assess the A-V block site. But it is invasive study cannot assessed exactly the stability of subsidiary pacemaker. To investigate the characteristics of subsidiary pacemaker, we studied the responses of the artificial pacemaker to ventricular overdrive suppression and the drugs by used the artificial pacemaker in the patient with the complete heart block with the narrow QRS complex, which can be accepted as "stabli" in general. METHOD: There was total of 11 patients diagnosed with the complete AV block with the narrow QRS complex(the escape junctional rhythm was less than 0.10sec) at the Yeungnam University Hospital from May 1988 to June 1989. To investigate the ventricular overdrive suppression of subsidiary pacemaker, the response of the subsidiary pacemaker after IV administatin of drugs (atropine, isoproterenol, lidocaine) and the junctional recovery time were measured. RESULTS: Thtee patterns were obtained in the overdrive suppression test (fig.1). The recovery time of the subsidiary pacemaker was 364.5+/-212.15% of the basal R-R interval. Among seven of the eight patients who showed syncoped, the JRTmax were 3 times higher than the basal R-R interval. In one of eight, CJRT which represent the absolute time, was prolonged to 560 msec. In one case, we examined overdrive suppression test serially was which shows gradual decrement of junctional recovery time, and normal sinus rhythm was recovered at the 14th after the development of complete heart block. After VOS, the junctional recovery time of the subsidiary pacemaker was 364.5+/-212.1% of basal R-R interval in complete heart block group. After injection of atropine, the decrement of R-R interval was 5.51+/-3.88% of basal R-R interval. After injection of isoproterenol, the decrement of R-R interval was 32.76+/-8.09% of basal R-R interval. Marked increase of the basal heart rate was observed. After injection of lidocaine, the increment of R-R interval was 1.72+/-1.82% of basal R-R inteval. CONCLUSION: The results suggest that measurement of the junctional recovery time following overdrive suppression is useful for evaluation of stability of subsidiary pacemaker. And also the subsidiary pacemaker shows the better response to sympathomimetic agent than to parasympathetic blocker.
Atrioventricular Block ; Atropine ; Heart Block ; Heart Rate ; Humans ; Isoproterenol ; Lidocaine ; Pacemaker, Artificial ; United Nations

BACKGROUND: To evaluvate the hypothesis that reperfusion injury and reperfusion arrhythmia could be caused by oxyzen free redicals and that prolonged myocardial dysfunction could be induced by oxyzen free redical. METHODS: Experimnetal model of anesthetized open chest dogs was used. Coronary artery was occluded for 60 minutes and reperfusion was performed 4 hours. In 5 dogs, superoxide dismutase and catalase were infused concomitantly 15 minutes after coronary occlusion to 15 minutes after reperfusion. In 9 dogs, 0.9% saline was infused instead of free redical scavengers. Hemodynamic parameters such as heart rate, left ventricular peak systolic pressure, end-diastolic pressure, peak positive dP/dt, and peak negative dP/dt were analysed. Infarct size was estimated by the unstained area in nitroblue tetrazolium staining and risk area was calculated from the unstained area after methylen blue infusion. Regional systolic function was observed in systolic thickening of ischemic area by echocardiogram. RESULTS: 1) Reperfusion arrhythmia occurred in 67% of control group and in 50% of drug treated group. 2) Systolic hemodynamic parameters such as peak systolic pressure, peak positive dP/dt showed no difference between control and drug-treated group. 3) Diastolic parameters such as end-diastolic pressure and peak negative dP/dt were not different in two groups. 4) Regional systolic parameter measured by systolic thickening in ischemic area improved after reperfusion and continued to be better in drug treated group than in control group. 5) Infarct size, risk area, ratio of infarct size to risk aera were not different in two groups. CONCLUSION: Superoxide dismutase and catalase showed no effect in reducing the infarct size in anesthetized open chest canine model with 60 minutes of coronary occlusion 4 hours of reperfusion. However, postischemic prolonged myocardial dysfunction tended of improve-after reperfusion in drug treated group.
Animals ; Arrhythmias, Cardiac ; Blood Pressure ; Catalase* ; Coronary Occlusion ; Coronary Vessels ; Dogs ; Heart Rate ; Hemodynamics ; Myocardial Infarction* ; Necrosis* ; Nitroblue Tetrazolium ; Reperfusion ; Reperfusion Injury ; Superoxide Dismutase* ; Superoxides* ; Thorax

BACKGROUND: This study was performed in order to investigate the changes of Na+ transport system in the red blood cells of patients with essential hypertension. METHODS: Na(+)-Li(+) countertransport and Na(+)-K(+) pump activity were measured in 30 cases of essential hypertension and 20 healthy normal controls. And these measurements were analyzed in terms of some important clinical parameters in the patients, i.e., body mass index(BMI), status of hypertension and plasma lipids. RESULTS: Na(+) and K(+) contents of red cells in hypertensive patients were 16.9+/-1.4 and 77.8+/-2.1mmol/L cells, respectively, and no significant difference was found compared with respective value of normal control(14.2+/-0.9 and 82.2+/-2.8mmol/L cells). Na(+)-Li(+) countertransport in the patients group was significantly ancreased compared with control group(62.5+/-4.5 and 46.8+/-3.0umol/L cells.hr), and Na(+)-K(+) pump activity was also showed a significant depression(8.72+/-0.80 and 12.79+/-0.52umol Pi/mg.hr). In the analysis regarding the relationship between Na(+) transport system and some important clinical parameters of the patients with essential hypertension, Na(+)-Li(+) countertransport was related to BMI, and the level of triglyceride. On the other hand, Na(+)-K(+) pump activity was related to the WHO stage and the levels of total cholesterol and triglyceride. But level of blood pressure did not show a significant correlation with either are of the two Na(+) transport system. CONCLUSION: These resluts suggest that Na(+)-Li(+) countertransport and Na(+)-K(+) pump activity in patients with essential hypertension were significantly altered compared with heathy normal controls, and these Na(+) transport system were also influenced by BMI, WHO stage, and the levels of cholesterol and triglyceride. And the individual variation in Na(+) transport system were also suggested by the findings being overlapped between hypertensive patients and controls.
Blood Pressure ; Cholesterol ; Erythrocytes* ; Hand ; Humans ; Hypertension* ; Plasma ; Triglycerides

BACKGROUND: To investigate the possibie difference, if any, between office blood pressure(BP) and home BP may be important in the diagnosis and treatment of hypersensive patients. This report deails the difference between the two BP's and the usefulness of digital electronic sphygmomanometer(DES) for self-monitoring of home BP. METHODS: The BP's of 14 patients with essential hypertension were measured with mercury sphygmomanometers at outpatient department by physician and with DES at home(twice a day) by the patients. Patients were followed up every 2 weeks for 4 weeks and previous 2 weeks' average home BP's were compared with the office BP's of each 2 weeks' end. RESULTS: There was a significant difference between office and home BP(both systolic and diastolic) ; office average BP(151/95mmHg) was higher than home average BP(136/86mmHg). CONCLUSION: Caution may be needed in the interpretation of office BP unless it is measured several times after adequate rest.
Blood Pressure* ; Diagnosis ; Humans ; Hypertension ; Outpatients ; Sphygmomanometers*

BACKGROUND: The reinjection of a small dose of thallium-201 after stress and delayed imaging often shows new redistribution in the region with persistent defect. The purpose of this study was to determine the incidence of incomplete redistribution on conventional delayed image and to compare the left venticular wall motion abnormality with myocardial viability in patients with coronary artery disease. METHODS: We studied 12 patients with chronic coronary artery disease, using exercise thallium-201 Single Photon Emission Tomopraphy(TI-201 SPECT) and coronary angiopraphy with contrast ventriculography. Patients received 2mCi of thallium intravenously during exercise, redistribution images were performd 4 hour late and a second dose of 1mCi of thallium was injected at rest immediately there after. The three sets of image(stress, redistribution and reinjection) were analyzed. The left ventricular myocardium was divided into 7 segments and regional wall motion was scored on scale from 2(normal) to -1(dyskinesis). RESULTS: 1) The redistribution was obtained in 42.9% of the segments with persistent TI-202 defect on 4 hour delayed image. 2) Myocardial viability was observed in 38.9% of regions with all motion abnormality on contrast ventriculography. 3) The wall motion score was lower in the segments with persistent TI-201 defect on reinjection image than those with transient defect(p<0.05). 4) In 42.9% of the regions with wall motion abnormality on contrast ventrculography before coronary artery bypass graft, normal TI-201 image was observed after coronary artery bypass graft. CONCLUSION: Thallium-201 reinjection image can be used to identify viable myocardium in segments that demonstrate a persistent thallium defect on conventional delayed images patients with chronic coronary artery disease and left venticular dysfuction.
Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Incidence ; Myocardium ; Thallium ; Transplants ; Ventricular Dysfunction, Left*