No abstract available.
Myocardial Infarction*

Since Romano(1963) described Romano-Ward syndrome which is characterized by Q-T prolongation, abnormal T wave, ventricular tachcardia and syncopal attacks, about twenty cases have been reported in various countries of the world, but this case represents the first report of this syndrome in Korea. Authous experienced a case of Romano-Ward syndrome in a 23-year-old man who had been suffering from intermittent paroxysmal palpitation, chest discomfort and dyspnea for 11 years. On admission, he had tachycardia, gallop and engorgement of jugular veins. EKG showed ventricular tachycardia which promptly recurred after repeated attempts of cardioversion. Then, procainamide and digoxin were given. One day later, sinus bradycardia with Q-T prolongation with Deep T wave inversion occured. Therefore, propranol was prescribed under the impression of Romano-Ward syndrome. About 4 months later, EKG was normal except for mild Q-T prolongation and he was able to maintain normal life activity without difficulty.
Bradycardia ; Digoxin ; Dyspnea ; Electric Countershock ; Electrocardiography ; Humans ; Jugular Veins ; Korea ; Procainamide ; Romano-Ward Syndrome* ; Tachycardia ; Tachycardia, Ventricular ; Thorax ; Young Adult

The effect of oral mexiletin was evaluated by a 10-day double-blind cross-over protocol on 10 subjects with chronic stable high-frequency ventricular premature beats referred to our cardiology clinic from February through July, 1982. Total daily doses were either 450mg or 600mg in three divided portions depending on body weight. The frequency of the premature ventricular beats was measured by 3 separate 24-hour ambulatory EKG recordings by dual-channel Holter monitor on each patient. Mexiletine was judged to be effective in suppressing the ventricular arrhythmias when the 24-hour PVC-counts during the study-drug period showed a decrease by 80% and the hourly average PVC-counts by 70% compared with those of the equivalent intervals of both the baseline and the placebo periods. Mexiletine was effective in 5 of the 10 subjects. Mild tremor and anorexia were noted in 2 patients, but they were able to comply with the study protocol in spite of these minor side effects. Blood level measurements were not done in this study for lack of such facility, the utilization of which would undoubtedly enhance the therapeutic effectiveness of the antiarrhythmic agent in the individualization of treatment.
Anorexia ; Arrhythmias, Cardiac ; Body Weight ; Cardiac Complexes, Premature* ; Cardiology ; Electrocardiography ; Humans ; Mexiletine* ; Tremor ; Ventricular Premature Complexes

The antiarrhythmic effect of oral Mexiletine was evaluated by Holter monitoring on 10 subjects with chronic high-frequency ventricular premature complexes and ventricular tachycardia referred to our cardiology clinic of Severance Hospital from June, 1982 through September, 1983. The frequency of the ventricular premature complexes and the ventricular tachycardia was measured by 24-hour ambulatory electrocardiography on each patient before and during the administration of Mexiletine(450-600 mg/day). The results were as follows : 1) In 10 patients with ventricular tachycardia total suppression of ventricular tachycardial was demonstrated in 8 patients during the administration of oral Mexilletine. 2) The number of the ventricular premature complexes was reduced markedly in 6 out of the 10 patients. 3) Side effects occurred in 5 out of 10 patients. These include tremor, weakness, dry mouth, indigestion, anorexia, chest discomfort, and dizziness but were tolerated except in one.
Anorexia ; Arrhythmias, Cardiac* ; Cardiology ; Dizziness ; Dyspepsia ; Electrocardiography, Ambulatory* ; Humans ; Mexiletine* ; Mouth ; Tachycardia, Ventricular ; Thorax ; Tremor ; Ventricular Premature Complexes

The electrocardiograms of a total of 12,796 patients taken in the past three years at Severance Hospital were reviewed for conduction disturbances which were found in 314 cases(2.46%). Th first degree atrioventricular block occurred in 65 cases, and second degree atrioventricular block with Wenckebach periodicity in 13. There were 9 cases of third degree atrioventricular block with nomal QRS complexes causing Adams-Stokes attacks which represented 2.9% of all conduction disturbances. It occurred equally in both sexes and predominantly after 6th decade of life. There were 99 cases of complete right bundle branch block(RBBB) and 12 cases of complete left bundle branch block(LBBB). The latter were mainly associated with significant heart diseases. As for the intraventricular conduction defects other than the simple bundle branch blocks, the findings were as follows; 1. Simple hemiblocks were found in 92 cases or 0.73% of total series and 29.3% of all conduction disturbances. Left anterior hemiblock(LAH) occurred 3 times more frequently than left posterior hemiblock(LPH). 2. Partial bilateral bundle branch block(BBBB) were found in 25 cases representing 0.2% of the total series and 8.0% of all conduction disturbances. Among the 25 cases of BBB, 11 had RBBB plus LAH, 10 RBBB plus LPH, 1 LBBB plus first degree A-V block, and 3 LBBB of diphtheritic cardic involvement. Trifascicular heart block causing Adams-Stokes attacks occurred in 9 of the 25 cases resulting in death in 7 cases. The underlying diseases were ischemic heart disease, hypertensive heart disease, congenital heart disease and diphtheritic carditis. This report represents the first electrocardiographical documentation of occurrence of trifascicular heart block progressing from BBBB in Korea.
Atrioventricular Block ; Bundle-Branch Block ; Electrocardiography* ; Heart Block ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Korea ; Myocardial Ischemia ; Myocarditis ; Periodicity

Hypertrophic cardiomyopathy has been a well-known genetical transmitted disease entity with the advance of echocardiography. We have recently experienced a family with hypertrophic cardiomyopathy proved by noninvasive methods including chest x-ray,, electrocardiography and echocardiography. The propositus of this family was a 21 year-old solier who was admitted because of exertional dyspnea during military exercise. Both he and his sister had severely affected hearts with typical echocardiographic findings, asymmetrical septal hypertrophy(ASH) and systolic anterior motion of the anterior mitral leaflet(SAM). The clinical study is reported with the concerned literatures.
Cardiomyopathy, Hypertrophic* ; Dyspnea ; Echocardiography ; Electrocardiography ; Heart ; Humans ; Military Personnel ; Siblings ; Thorax ; Young Adult

A 45 year old man with a history of syncopal attacks of 3 days' duration showed complete heart block with occasional retrograde P waves following QRS complexes in the electrocardiogram. The site of A-V block seemed to be below A-V node judging from the QRS complexes when occasional capture occured. This may be a case of complete heart block progressing from right bundle branch block plus left posterior hemiblock. There was a rapid improvement of conduction with sublingual isoproterenol in a few days, EKG's showing normal A-V conduction and QRS complexes on discharge. The mechanism of the retrograde conduction in the presence of complete heart block is discussed with a review of literature.
Atrioventricular Node ; Bundle-Branch Block ; Electrocardiography ; Heart Block* ; Heart* ; Humans ; Isoproterenol ; Middle Aged

Isolated pulmonary stenosis, a relatively common congenital anomaly that accounts for about 10 percent of all congenital heart disease, is characterized by stenosis of pulmonary valve itself, infundibulum or both of them. Since cardiac catherterization was applied to man by Cournand and Ranges, pulmonary stenosis had been easily diagnosed and many clinical studies had been investigated. It has a wide clinical spectrum depending on the degree of stenosis. The electrocardiogram, phonocardiogram and chest X-ray have proved useful in estimating the severity of hemodynamic facotrs in individual cases. This series comprises 47 cases in whom the clinical diagnosis of isolated pulmonary stenosis was confirmed by right heart catheterization with cardiac cineangiography at Severance Hospital, Yonsei University. An attempt was made to correlate the electrocardiographic, phonocardiographic, chest X-ray findings, and types of stenosis with the hemodynamic data in these cases. 1. Of 47 patients, 33 were male and 14 female. Their ages ranged from 2 to 42 years: the mean age was 19.1 years. 2. The incidence was 5.9 percent of all 797 catheterized congenital heart disease cases. The pulmonary valvular stenosis was 30 (68.3%), infundibular 7 (14.6%) and combined 10 (21.6%) cases. 3. The correlation between electrocardiogram and hemodynamic data were as follows. i) The regression equation between right ventricular sysytolic pressure (RVSP) and height of R wave in V1 lead (RV1) was RVSP=3.32 RV1+48.2: its correlation coefficient was 0.818 and it was very significant (p=0.000). ii) The higher the RVSP, the more the frontal axis of QRS complex shifted to the right side (r=0.55. p=0.001). iii) The RVSP of the groups with positive ECG findings such as p-pulmonale, right ventricular hypertrophy or right ventricular strain were much higher than the RVSP of the groups without such findings (p=0.032.0.000, 0.000). iv) The group with RV1 higher than 20 mm showed much more elevated mean of RVSP than the group with lower RV1 (p=0.000). v) The groups with the above mentioned positive ECG findings showed good correlation with the severity of RVSP which was arbitrarily classified as 49 or less, 50~100, and 100 mmHg or more (chi-square=8.96, 26.69, 19.06; p=0.011, 0.000, 0.000). 4. The group with late occurrence of the maximum intensity of the ejection systolic murmur showed higher mean of RVSP than the group with early peak of the murmur (p=0.014). 5. The means of RVSP of the groups with chest X-ray findings such as decreased pulmonary vascularity, were much higher than the means of RVSP of the groups without such findings (p=0.000, 0.005, 0.015). The groups with above mentioned positive chest X-ray findings showed good corelations with the severity of RVSP which was classified as above limits (chi-square=7.55, 10.94, 13.36; p=0.022, 0.004, 0.001). 6. Combined pulmonary valvular and infundibular stenosis showed more severe systolic pressure gradient and higher mean of RVSP than the isolated types (p=0.000).
Axis, Cervical Vertebra ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Cineangiography ; Constriction, Pathologic ; Diagnosis ; Electrocardiography ; Female ; Heart Defects, Congenital ; Hemodynamics* ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Pulmonary Valve ; Pulmonary Valve Stenosis* ; Systolic Murmurs ; Thorax

The ventricular septal defect with aortic insufficiency is a relatively uncommon congenital heart disease. Once the prolapse of aortic cusp complicates the ventricular septal defect, the prolapse of the aortic cusp is a progressive, rather than static lesion. With the curent possibility of surgical correction in cases of ventricular septal defect and other abnormalities, the differential diagnosis assumes marked importance. vTwo cases of ventricular septal defect with aortic insufficiency are presented with a review of pertinent literature. These young female patients had long standing palpitation and dyspnea on exertion since childhood. The physical examination showed with pulse pressure, bounding carotid pulsation and a systolic ejection-type murmur and a decrescendo diastolic murmur at the upper left sternal border, which simulated "machinery" type murmur of patent ductus arteriosus. The ventricular septal defect with aortic insufficiency was demonstrated by cardiac catheterization and cineangiocardiography.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis, Differential ; Ductus Arteriosus, Patent ; Dyspnea ; Female ; Heart Defects, Congenital ; Heart Murmurs ; Heart Septal Defects, Ventricular* ; Humans ; Physical Examination ; Prolapse

Conventional dual chamber pacing (DDD) preserves atrioventricular synchrony but depend on appropriate sinus node function to achieve physiological heart rate with exercise by atrial tracking. Other indirect indicators of metabolic demand have been used to modulate pacing rate increases with exercise including sensing of pH, respiratory rate, ventricular repolarization and oxygen saturation. The activity sensing approach is unique in that noise generated by activity modulates the response and empirical programming of the unit allows for attaining the desired rate for a given level of activity. Physiologic rate increases can be obtained in patients with sinus node dysfunction or even atrial fibrillation. The lead can either be positoned in the atria for patients without atrial fibrillation or AV conduction disturbance or in the ventricle. We present two cases of rate responsive pacing using the Activitrax.
Atrial Fibrillation ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Noise ; Oxygen ; Respiratory Rate ; Sick Sinus Syndrome ; Sinoatrial Node