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 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 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 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

BACKGROUND: Total obstruction of the left main coronary artery is a common cause of sudden death but is rarely seen in patients who survive to undergo diagnostic evaluation or treatment. METHODS: During twenty six-year period, we encountered 5 patients with chronic total obstruction of the left main coronary artery out of about 4,000 patients who underwent coronary angiography. RESULTS: All patients have undergone coronary bypass surgery. These patients present with increasingly severe angina. A right dominat coronary anatomy is always found, usually with well-developed right-to-left collaterals. Left ventricular function was severely impaired in two patients out of five patients. CONCLUSIONS: The results of surgical revascularization in our patients and others described in the literature can support the safety and efficacy of this approach.
Coronary Angiography ; Coronary Vessels* ; Death, Sudden ; Humans ; Ventricular Function, Left

BACKGROUND: Improvements in catheter equipments and increasing experience of the operators have brought about a broadening of the indications and applications of percutaneous transluminal coronary angioplasty(PTCA). In particular, coronary angioplasty has been employed in total occlusions.We evaluated the initial success rate and safety of PTCA total occulsive coronary artery disease. METHODS: To assess the success rate and safety of PTCA total coronary artery occlusion, the data of 24 patients(male 19, female 5, mean age 55+/-9 years), in whom PTCA for total occlusion were performed, were examined. RESULTS: Primary success rate of procedure was 66.7%(16 out of 24 lesions).The success rate according to the duration of total occlusions was 8 out of 11(72.7%) with occlusions<4 weeks duration and 3 out of 7(42.9%) with occlusions>4 weeks duration(p=0.07). There was no difference in success rate according to vassel dilate(left anterior descending 75.0%, right coronary 44.4%) and length of occluded lesion(0.93%+/-0.47%cm, p=0.35). Eight procedural failures included inability to cross the lesion with a guide wire in 6 and inability to dilate the lesion in 2, but there was no emergency coronary bypass surgery or cardiac death. CONCLUSION: Even though the recanalization of occluded coronary arteries has a lower initial success rate than angioplasty for stenotic arteries, PTCA in total occlusion can be performed as a safe and effective therapeutic modality in selective patients.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Catheters ; Coronary Artery Disease ; Coronary Vessels* ; Death ; Emergencies ; Female ; Humans

BACKGROUND: Indications and applications of percutaneous transluminal coronary angioplasty(PTCA) have been broaden recent years. We evaluated the initial success rate and safety of PTCA in mulitiple lesions and vessels. METHODS: To assess the success rate and safety of PTCA In mulitiple lesions and vessels, the data of 60 lesions from 28 patients(male 23, female 5, mean age 56+/-12 years), in whom PTCA for multiple lesions and vessels were performed, were examined. Initial results and complications were compared in 37 lesions undergoing multivessel and 23 lesions undergoing multilesion PTCA. RESULTS: Overall primary success rate of procedure was 82%(49 out of 60 lesions). Angioplasty was attempted in mean 2.1 stenotic lesions per patient. Primary success rate per lesion was 84%(31 of 37) among those who underwent multivessel and 78%(18 of 23) among those who underwent multilesion PTCA(p>0.05). Success rate according to the combination of dilated vessels was 85.7%(12 of 14) in left anterior descending(LAD) and left circumflex(LCX), 83.3%(10 of 12) in LAD and right coronary artery(RCA), 100.0%(4 of 4) in LAD and diagonal branch, RCA and LCX in 75.0%(3 of 4), and 66.7%(2 of 3) in LAD, LCX and diagonal branch. Eleven failures(18.3%) included inability to pass the guide wire cross the lesion or inability to locate the balloon catheter in 5(8,3%), abrupt closure in 2(3,3%), coronary spasm in 1(1.7%) and major branch occlusion in 3(5.0%), but there was no emergency coronary bypass surgery or cardiac death. CONCLUSION: Coronary angioplasty in selected patients with multivessel and multilesion coronary artery disease might be useful and have relatively good initial results, but the long-term efficacies with other forms of treatment must be evaluated prospectively.
Angioplasty* ; Catheters ; Coronary Artery Disease ; Death ; Emergencies ; Female ; Humans ; Spasm