Rupture of the interventricular septum is a serious complication of acute myocardial infarction, accounting for 5% of death due to acute myocardial infarction. The mortality with medical therapy alone exceeds 90%. Accurate diagnosis, urgent management, and early operative correction are necessary for survival. We report cases of 3 patients with ventricular septal rupture after acute myocardial infarction.
Diagnosis ; Humans ; Mortality ; Myocardial Infarction* ; Rupture ; Ventricular Septal Rupture*

myocardial infarction (AMI) and the difference between regions has not been reported in Korea since 2010. Thus, we aimed to inspect recent trends and regional differences in the incidence of AMI and case-fatality between 2007 and 2016.METHODS: Data from the medical utilization cohort from 2002 to 2016 were analyzed. New incidence of AMI was identified by checking the diagnosis code, duration of admission, type of test, treatment, and medication. Age-standardized incidence rate by gender, age group, and resident region was calculated from 2007 to 2016. Cumulative case-fatality rate was calculated until 3 years.RESULTS: Age-standardized incidence of hospitalized AMI decreased from 53.6 cases per 100,000 person-years in 2007 to 38.9 cases in 2011. Thereafter, the incidence gradually increased to 43.2 cases in 2016. The trend by gender and age groups was also similar to the total trend. The regional age-standardized incidence was the highest in Daegu (50.3 cases per 100,000 person-years) and the lowest in Sejong (30.2 cases), which were similar to the ischemic heart disease mortality in these regions. The 7-, 30-, and 90-days and 1- and 3-years average case-fatality over 10 years were 3.2%, 6.9%, 9.9%, 14.7%, and 22.4%, respectively.CONCLUSION: Although case-fatality continuously decreased from 2007 to 2016, hospitalized AMI incidence decreased from 2007 to 2011 and gradually increased from 2011 to 2016, with marked disparity between regions. Effective preventive strategies to decrease AMI incidence are required to decrease cardiovascular disease mortality in Korea.]]>
Cardiovascular Diseases ; Cohort Studies ; Daegu ; Diagnosis ; Humans ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Myocardial Ischemia

Pulmonary embolism is a common condition with considerable morbidity and mortality. The diagnosis of pulmonary embolism remains a vexing problem. Prompt and accurate diagnosis is important because the mortality of untreated pulmonary embolism is high and serious complications can occur. Most physicians are inexperienced in the use of thrombolytic agents fo r pulmonary embolism, even though they utilize these agents routinely for acute myocardial infarction. We compared 2 domestic cases with 2 foreign cases. On comparison, we spent a long time in making a definite diagnosis in the domestic cases. Moreover, in the second domestic case, we did not use thrombolytic agents early, in spite of a suspected massive pulmonary embolism and then eventually he died. We conclude that bolus administration of thrombolytic agents during CPR for clinically suspected massive pulmonary embolism in emergency departments may be an acceptable technique.
Cardiopulmonary Resuscitation ; Diagnosis ; Emergency Service, Hospital ; Fibrinolytic Agents ; Mortality ; Myocardial Infarction ; Pulmonary Embolism*

Aortic dissection is an uncommon, life-threatening medical emergency that is associated with a high mortality rate, and death from aortic dissection is mainly related to secondary complications, namely cardiac tamponade, severe aortic regurgitation, acute myocardial infarction, and abdominal organ vessel obstruction. Hence, prompt and accurate diagnosis followed by proper treatment is important for patient survival. Herein, we present a rare case of sudden death after aortic dissection with concomitant acute myocardial infarction and cardiac tamponade.
Aortic Valve Insufficiency ; Autopsy ; Cardiac Tamponade ; Coronary Vessels ; Death, Sudden ; Diagnosis ; Emergencies ; Humans ; Mortality ; Myocardial Infarction

BACKGROUND/AIMS: Chest pain is an essential symptom in the diagnosis of acute coronary syndrome (ACS). One-third of patients with ACS present atypically, which can influence their receiving timely lifesaving therapy. METHODS: A total of 617 NSTEMI patients from the Korea Acute MI Registry (KAMIR) and the Korea Working Group on MI (KorMI) databases were analyzed. The study population was divided into two groups by symptoms at presentation (typical symptoms group, 128; atypical symptoms groups, 128). RESULTS: In this study population, 23% of patients presented without chest pain. After propensity score matching, the contact-to-device time (2,618 ± 381 minutes vs. 1,739 ± 241 minutes, p = 0.050), the symptoms-to-balloon time (3,426 ± 389 minutes vs. 2,366 ± 255 minutes, p = 0.024), and the door-to-balloon time (2,339 ± 380 minutes vs. 1,544 ± 244 minutes, p = 0.002) were significantly higher in the patients with atypical symptoms than in those with typical symptoms, respectively. Atypical symptoms were an independent predictor for 1-year mortality (hazard ratio, 2.820; 95% confidence interval, 1.058 to 7.515; p = 0.038). The Kaplan-Meier estimates showed higher risk for 12-month mortality in patients with atypical symptoms (p = 0.048) and no significant difference for 12-month major adverse cardiac events (p = 0.487). CONCLUSIONS: Acute myocardial infarction patients with atypical symptoms were not rare in clinical practice and showed a high risk of delayed reperfusion therapy. After imbalance between the groups was minimized by use of propensity score matching, patients who presented atypically had a high mortality rate.
Acute Coronary Syndrome ; Chest Pain ; Diagnosis ; Humans ; Korea ; Mortality ; Myocardial Infarction* ; Propensity Score ; Reperfusion

To assess the early results, risk factors and optimal timing for coronary artery bypass graft surgery(CABG) after an acute myocardial infarction(AMI), we reviewed our 19 patients who underwent CABG within 30 days after AMI, between June 1994 and October 1996. This study excluded 1 patient whose diagnosis was AMI with ventricular septal rupture. 14 of the patients were male and 5 were female. Their ages ranged from 41 to 77 years(mean age, 60.6+/-10.4 years), and the amount of time between AMI and CABG ranged from 8 hours to 24 days(mean time, 10.6+/-6.4 days). There were 11 anteroseptal infarctions and 8 inferior wall infarctions. 11 patients had transmural infarctions and 8 had subendocardial infarctions. Indications of operations were primary revascularization and postinfarction angina. Three patients required preoperative intra-aortic balloon pump(IABP) support, and 4 additional patients required IABP to be separated from cardiopulmonary bypass. An average of 3.6+/-0.6 vessels per patient were bypassed. The early mortality rate for these 19 patients was 5.3% and late mortality rate was 5.5%, 1-year and 2-year actuarial survival rates were 89.5%. Univariate analysis of mortality showed that an ejection fraction less than 30% and intraopretative IABP supports were associated with risk factors(p value=0.018 and 0.015 respectively). Age, sex, time to CABG, emergency operations, types and locations of infarctions were not significant. Although our studies have weak points in that there was only a small number of patients and the lack of long-term results, we could conclude that early myocardial revascularization is relatively safe after AMI for those individuals with an ejection fraction greater than 30%.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Diagnosis ; Emergencies ; Female ; Humans ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Myocardial Revascularization ; Risk Factors ; Survival Rate ; Transplants ; Ventricular Septal Rupture

BACKGROUND: Acute myocardial infarction is one of major cardiovascular disease that increases according to the changes of diet and life style. Early diagnosis and treatment of acute myocardial infarction is critical for better prognosis and for reducing mortality. But early diagnosis of acute myocardial infarction is limited by several factors. Recently it was reported that measurements of several serum cardiac enzymes were useful for early diagnosis of acute mocardial infarction. This study was performed to investigate which method of serum creatine kinase measurement is the faster and accurate and whether serum creatine kinase is an early noninvasive predictor of coronary artery patency following thrombolysis in patients with acute myocardial infarction by means of analysis of serial changes in serum creatine kinase. METHODS: This study included 32 patients who had acute myocardial infarction. Serum CK-MB was measured by electrophoretic method and enzymatic immuoasssay method. and compared with EKG and total CK activity which measured by photoabsorbance method. Also we studied whether CK time-activity could be predictor for reperfusion. RESULTS: Immunoassay method accurately measures the serum CK-MB and correlates well with that of electrophoretic method in patients with acute mocardial infarction. Immunoassay method is more sensitive than EKG and has the similar sensitivity to electrophoretic method in diagnosis of acute myoardial infarction. Reperfusion of an occluded coronary artery results in early elevation of serum creatine kinase and CK-MB reflected by earlier appearance time, peak, and onset of clearance. CONCLUSION: Because immunoassay measurement of serum creatine kinase is faster than electrophoresis and requires less technical expertise, it is possible to make diagnosis in patients with acute myocardial infarction in a more timely and cost effective manner and creatine kinase is good predictor of recanalization of an occluded coronary artery after intravenous thrombolytic therapy.
Cardiovascular Diseases ; Coronary Vessels ; Creatine Kinase* ; Creatine* ; Diagnosis ; Diet ; Early Diagnosis* ; Electrocardiography ; Electrophoresis ; Humans ; Immunoassay ; Infarction ; Life Style ; Mortality ; Myocardial Infarction* ; Professional Competence ; Prognosis ; Reperfusion* ; Thrombolytic Therapy

BACKGROUND AND OBJECTIVES: During coronary angioplasty, a distal embolization of the intracoronary thrombus is associated with an increased risk of myocardial infarction and mortality. Recently, distal protection devices have been tested for distal embolization with varying success. Here we report the experiences with one of the distal protection devices, Percusurge(r). SUBJECTS AND METHODS: From January 2001 to August 2001, 5 cases of a Percusurge(r) being used in patients with intracoronary thrombus were experienced during the angioplasty (male:4, female:1). Both the pre- and post-procedural clinical findings of the patients, the angiographic findings, the number of acute complications, the presence of biochemical marker such as CK-MB, and any in-hospital cardiac events were reviewed. RESULTS: Percusurge(r) was used in the right coronary artery (RCA) in 4 cases and in the saphenous vein graft in 1. The clinical diagnosis included stable angina (2 patients), non-Q wave myocardial infarction (1 patient), and Q-wave myocardial infarction (2 patients). The patients showed a TIMI 0 or 1 flow in 4 patients with a RCA lesion and TIMI 3 flow in 1 patient with a saphenous vein graft lesion. However, the TIMI 3 flow was recovered in all cases after the intervention. The CK-MB level did not show any significant changes between the pre- and post-procedure in 4 cases (11.2 +/- 3.2 U/L vs 10.2 +/- 2.1 U/L). However, one of the distal branchs was totally occluded by the distal embolization of the thrombus, and the CK-MB level increased from 2.1 U/L to 22.7 U/L. Otherwise, no procedure-related complications or major in-hospital cardiac events were observed. CONCLUSION: The use of the distal protection device, Percusurge(r), may reduce both the procedural and clinical complications during a coronary intervention in the thrombus-containing lesion. However, a large prospective study is needed to define the role of the distal protection device.
Angina, Stable ; Angioplasty ; Biomarkers ; Coronary Thrombosis ; Coronary Vessels ; Diagnosis ; Humans ; Mortality ; Myocardial Infarction ; Saphenous Vein ; Thrombosis* ; Transplants

Pulmonary thrombo-embolism in operating room is one of the important cause of morbidity and mortality in patients undergoing femur neck fracture surgery. However, the diagnosis of pulmonary thromboembolism may not be easy because sudden shock can have many different causes (e.g. myocardial infarction, hypovolemia, pneumothorax, non-cardiogenic pulmonary edema, pulmonary thrombo- embolism) and specialized diagnostic tools are not readily available in the operating room. Rapid and accurate diagnosis of pulmonary thromboembolism is very important in outcome of patients. We report a case in which pulmonary thromboembolism under spinal anesthesia occured just before the beginning of operation.
Anesthesia, Spinal* ; Diagnosis ; Femoral Neck Fractures ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction ; Operating Rooms ; Pneumothorax ; Pulmonary Edema ; Pulmonary Embolism* ; Shock

BACKGROUND AND OBJECTIVES: Without typical electrocardiographic (ECG) changes, and the elevation of cardiac enzymes, the early identification of high risk chest pain patients remains a major challenge. We hypothesized that myocardial contrast echocardiography (MCE) was more sensitive than conventional echocardiography (Echo) for the identification of high risk patients. SUBJECTS AND METHODS: We prospectively enrolled 75 consecutive patients (age ; 62+/-11 yrs, 34 men), presenting to the emergency room, with suspected cardiac chest pain at rest. The exclusion criteria for enrolment were : age <40 yrs, the presence of a Q wave or ST segment elevation, an initial troponin I level >1.5 ng/mL and a poor Echo window. Echo and MCE were performed to evaluate regional wall motion abnormalities (RWMA), and assess myocardial perfusion defects (PD), using a continuous infusion of PESDA during intermittent power Doppler harmonic imaging. The Echo and MCE studies were interpreted by different reviewers, blinded to the clinical data. We defined major adverse cardiac events (MACE) as mortality, myocardial infarction (MI) and severe ischemia requiring revascularization. RESULTS: There were 35 MACE, including 12 MI, during hospitalization. No significant differences were found in the clinical characteristics between patients with, or without, MACE. A RWMA or a PD were seen in 18 (24%) and 27 (36%) of patients, respectively, and the sensitivity, specificity of RWMA were 46 and 95% for a MACE, and 59 and 86% for a MI. The sensitivity and specificity of a PD were 69 and 93% for MACE, and 88 and 79% for MI, respectively. CONCLUSION: The assessment of a PD by MCE is clinically feasible, and a MCE can improve the sensitivity of Echo in identifying high risk chest pain patients.
Acute Coronary Syndrome* ; Chest Pain ; Early Diagnosis* ; Echocardiography* ; Electrocardiography ; Emergency Service, Hospital ; Hospitalization ; Humans ; Ischemia ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Prospective Studies ; Sensitivity and Specificity ; Troponin I