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

BACKGROUND AND OBJECTIVES: Studies in patients with mitral valve prolapse syndrome (MVPS) have shown the coexistence of various forms of autonomic dysfunction, and so this is an area that requires further investigation. METHODS AND MATERIALS: The study group consisted of 65 patients (36 men and 29 women), aged 16 to 43 years (mean+/-SD, 28+/-8) with symptomatic, echocardiographically proven mitral valve prolapse (MVPS) who were free of other organic heart diseases and arrhythmias. In a prospective study, heart rate variability (HRV) indexes were calculated from 24-hour Holter recordings obtained during normal daily activity and plasma norepinephine was measured, and then these data were compared among the study group according to clinic heart rate (HR). RESULTS: The study group was divided into below 60 bpm (group 1: n=13), 60 - 80 bpm (group 2: n=36) and over 80 bpm (group 3: n=16) on the basis of clinic HR. These patient groups were matched with respect to age and gender. There were significant difference in SDNNIDX, rMSSD and pNN50 between these groups (p=0.005, 0.009 and 0.002 respectively), and these HRV measures correlated inversely with clinic HR (p<0.01). As clinic HR increased, there was a tendency for plasma norepinephrine concentration to also rise (p<0.05), but there was no statistical significant difference between these groups. CONCLUSION: Our data suggests that MVPS may have subgroups of HRV, reflecting cardiac autonomic modulation, according to clinic HR.
Arrhythmias, Cardiac ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Male ; Mitral Valve Prolapse* ; Mitral Valve* ; Norepinephrine ; Plasma ; Prospective Studies

A noninvasive method for assessing cardiac output was evaluated by comparing it with thermodilution determinations in 25 patients who admitted to Pusan national university hospital from March, 1985 to December, 1986. This method used M-mode & two dimensional echocardiography to measure the internal diameter of aortic valve anulus & pulmonary valve anulus and pulsed doppler echocardiography to obtain aortic & pulmonary blood velocity. Good correlations were observed between thermodilution and doppler echocardiographic measurements of cardiac output from aortic flow (r=0.98, p<0.05) & pulmonary flow (r=0.86, p<0.05). Linear regression analysis yielded y=0.91x0.14 for aortic flow and y=0.77x0.84 for pulmonary flow. These results indicate that accurate cardiac output can be measured by noninvasive & simple doppler echocardiography.
Aortic Valve ; Busan ; Cardiac Output* ; Echocardiography* ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed ; Humans ; Linear Models ; Pulmonary Valve ; Thermodilution

BACKGROUND: In essential hypertensive patients, newer classification method according to the left ventricular remodeling is gaining more clinical acceptance, and as such it requires further domestic researches. METHODS: The echocardiographys of 110 normal control population (43 males and 67 females) and 137 essential hypertensive patients (44 males and 93 females) were done, and by applying Penn convention method, the left ventricular mass was calculated and was corrected by body surface area to determine the left ventricular mass index. Afterward, according to the criteria by American Society of Echocardiography, the relative ventricular wall thickness was calculated. With the estimated left ventricular mass index and the relative ventricular thickness of normal control population's upper limit, the patterns of left ventricular remodeling of essential hypertensive patients were classified and analyzed. RESULTS: 1) In normal control group, males exhibited higher left ventricular mass index tendency than females (p=0.053) and showed similar increase with age (p=0.006). Also, the partition value of left ventricular mass index was less than 125 g/m for male and 110 g/m for female. 2) The relative ventricular wall thickness of normal control group showed similar tendency in which males had thicker ventricular wall than females. Also, the thickness increased with age, however it lacked statistical significance. The partition value of relative ventricular wall thickness was less than 0.44. 3) Among hospitalized essential hypertensive patients, the frequency of concentric left ventricular hypertrophy was 57%, eccentric left ventricular hypertrophy was 29%, concentric remodeling was 11%, and normal was 4%. Thus, the findings showed more progressed left ventricular remodeling. CONCLUSION: The normal population of Korea exhibited similar left ventricular mass index and relative ventricular wall thickness as compared to foreigners, and hospitalized essential hypertensive patients had rather progressed left ventricular remodeling.
Body Surface Area ; Classification ; Echocardiography ; Emigrants and Immigrants ; Female ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular ; Korea ; Male ; Ventricular Remodeling*

The routine evaluation of coronary artery disease should include a history that obtains data on the charactor of pain, age, associated symptoms, and past history. The physical examination should include vital signs, a cardiovascular and pulmonary examination. The initial resting ECG plays a central role. Exercise ECG is an appropriate first-line test for patients with an intermediate probability of coronary artery disease. Echocardiogram is as a routine test for diagnosis of the case of acute chest pain especially in patients with a systolic murmur or regional wall motion almormality. Imaging during physical or pharmacological stress is considered to be appropriate in patients for whom exercise ECG is unlikely to be useful because of baseline ECG abnormalities. Pharmacological stress with adenosine or dipyridamole is appropriate for patients who are unable to exercise. Coronary angiography is not considered clearly appropriate as routine test for diagnosis of chronic stable angina in most patients except for those who had survived sudden cardiac death. But it is considered appropriate for diagnosis of angina whose diagonsis is still uncertain after noninsasive testing. Cardiac troponin is as a preferred marker for acute ischemic injury. Biochemical cardiac markers should be performed for all patients with suspected acute myocardial infarction.
Adenosine ; Angina, Stable ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Death, Sudden, Cardiac ; Diagnosis* ; Dipyridamole ; Electrocardiography ; Humans ; Myocardial Infarction ; Physical Examination ; Systolic Murmurs ; Troponin I ; Vital Signs

BACKGROUND AND OBJECTIVES: As mitral stenosis worsens, the cardiac output can be reduced, with a compensatory increase in the sympathetic nervous activity. An accelerated sympathetic nervous activity is responsible for various pathophysiological changes, including atrial thrombus formation, pulmonary congestion and myocardial ischemia. In this study, the sympathetic nervous activity was evaluated in patients with rheumatic mitral valvular stenosis, both before and after a percutaneous mitral balloon valvuloplasty (PMV). SUBJECTS AND METHODS: A PMV was successfully performed in 19 patients with mitral stenosis. The hemodynamic data were obtained by Swan-Ganz catheterization, and the variability in the heart rate evaluated by time domain measure via 24-hour ECG monitoring. An exercise test was performed according to Chung's exercise protocol, with the plasma norepinephrine level obtained before, during and after exercise. RESULTS: After the PMV, the right ventricle systolic, mean pulmonary arterial, pulmonary capillary wedge and left atrial pressures were significantly decreased. However, there were no significant changes in the right atrial, right ventricle end-diastolic and left ventricle end-diastolic pressures. After the PMV, the plasma norepinephrine level, an indicator of the sympathetic activity, was significantly decreased. On the other hand, the variability in heart rate, indicator of parasympathetic activity, was significantly decreased. CONCLUSION: In patients with mitral valvular stenosis, the sympathetic activity is accelerated, while the parasympathetic activity is decreased. This situation can be immediately reversed after a successful PMV.
Atrial Pressure ; Balloon Valvuloplasty* ; Capillaries ; Cardiac Output ; Catheterization, Swan-Ganz ; Constriction, Pathologic ; Electrocardiography ; Estrogens, Conjugated (USP) ; Exercise Test ; Hand ; Heart Rate ; Heart Ventricles ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Myocardial Ischemia ; Norepinephrine ; Plasma ; Sympathetic Nervous System ; Thrombosis

No abstract available.
Child* ; Hip* ; Humans ; Osteoma, Osteoid*

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

No abstract available.
Atrial Fibrillation ; Tachycardia