The idiopathic mitral valve prolapse(IMVP) syndrome presents with nonspecific cardiovascular symptoms which need to evaluate those clinical meaning. These symptoms should not necessarily be interpreted as suggesting arrhythmias, conduction abnormalities or myocardial ischemia unless the symptoms and the the electrocardiographic changes documented to occur simultaneously. And it will be that ambulatory electrocardiographic monitoring is a a very sensitive method to detect the transient arrhythmias, conduction abnormalities of ischemic changes in patients with IMVP. Author undertook a study to systemically evaluate the electrocardiographic findings in symptomatic patients with IMVP by means of 24 hour ambulatory Holter electrocardiographic monitoring for the evaluation of the clincal meaning of those symptoms. The following results were obtained; 1) Twenty five subjects, 15 male and 10 female, with IMVP were studied. The subjects ranged in age from 10 to 50 decades. 2) The presenting complaints were palpitation in 20, atypical chest pain in 17, dizziness and syncope in 9, and lyspnea and fatigue in 7 of 25 studied subjects. 3) There were no correlations the presence of complaints with the routine 12 lead electrocardiographic findings, echocardiographic findings, and phonocardiographic findings. 4) The relationship of symptoms recorded in patient diary to Holter monioring electrocardiographic findings is summarized. (1) 20 patients recorded episodes of palpitation. Seven of these patients was associated with sinus tachycardia, 2 with paroxysmal atrial tachycardia, 3 with atrial fibrillation, 2 with atrial premature contractions, 5 with ventricular premature contractions, and 1 with no changes, (2) 17 patients recorded episodes of atypical chest pain. Three of these patients was associated with sinus bradycardia, 2 with sinus tachycardia, 1 with paroxysmal atrial tachycardia, 2 with atrial finbrillation, 2 with ventricular premature contractions, 3 with nonspecific ST segment change, 1 with first degree AV block, and 3 with no changes. (3) 8 patients recorded episodes of dizziness. Three of these patients was associated sinus bradycardia, 2 with paroxysmal atrial tachycardia, 1 with paroxysmal ventricular tachycardia, 1 with ventricular premature contractions, and 1 with no changes. (4) 1 patient recorded episodes of syncope associated with second degree AV block and sinus bradycardia. (5) 3 Patients recorded episodes of dyspnea. One of these patients was associated with sinus bradycardia, 1 with ventricular premature contractions and one with no changes. 5) The prolonged QTc interval revealed in 7 of 25 studied subjects. One of these had frequent ventricular contractions followed by paroxysmal ventricular tachycardia. 6) Ectopic beats associated with bradyarrhythmias tend to decrease in frequency and associated with tachyarrhythmias to increase in frequency in patients with atrial premature contractions during exercise, and with ventricular premature contractions during sleeping, respectively. 7) Bradyarrhythmia accounted for the majority of arrhythmias recorded in 15 of 25 symptomatic IMVP patients. It is concluded that Holter monitoring is of considerable value in assessing the clinical meaning of the nonspecific complaints in patinets with IMVP.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrioventricular Block ; Bradycardia ; Chest Pain ; Dizziness ; Dyspnea ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory* ; Fatigue ; Female ; Humans ; Male ; Mitral Valve Prolapse* ; Mitral Valve* ; Myocardial Ischemia ; Syncope ; Tachycardia ; Tachycardia, Sinus ; Tachycardia, Ventricular

Serial changes of serum IgE, IgG, eosinophils were observed in 25 patients with acute myocaridial infarction and 20 ischemic heart disease without evidence of acute myocardial infarction and evaluated in terms of several parameters and its clinical significance. The results observed were as follows : 1) Serum IgE levels were propgressively elevated from the first hospital day(259+/-3IU/ml) up to peak level of the fifth hospital day(415+/-2IU/ml) and progressively lowered and returned to almost same level as the first hospital day on the twenty first hospital day. On the other hand control group showed significantly lower IgE levels throughout all hospital day and also did not showed serial change. 2) In the patient group with the initial serum IgE level above 200IU/m; showed significantly lower level of serum SGOT, CPK level than the group of below 200IU/ml group. This suggests the initial serum IgE level might have some correlation of the extent of myocardial necrosis. 3) In patients of acute myocardial infarction, ejection fraction was checked at discharge. Initial serum IgE level above 200IU/ml group showed significantly higher ejection fraction than below 200IU/ml group(59.4+/-13.5% vs 38.4+/-13.7%). 4) Serum IgE was checked concomittantly with serum IgE. It showed slightly decreasing tendency at third hospital day but not statistically significant. Eosinophil changed similar pattern as serum IgE but it was also not statistically significant. In conclusion, serial checking of serum IgE level in patient of acute myocardial infarction may give some help in prediction the clinical course and prognosis.
Aspartate Aminotransferases ; Eosinophils ; Hand ; Humans ; Immunoglobulin E* ; Immunoglobulin G ; Immunoglobulins* ; Infarction ; Myocardial Infarction* ; Myocardial Ischemia ; Necrosis ; Prognosis

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

To recognize the hemodynamic change in the constrictive pericarditis, we have reviewed the Doppler echocardiography, cardiac catheterization, and pathology of 6 patients who were admitted to Pusan National University Hospital due to right-side heart failure, diagnosed as constrictive pericarditis and were undertaken pericardiectomy. Doppler echocardiographic findings showed that acceleration and deceleration of early diastolic rapid filling were increased, followed by shortening of duration but there was a tendency to decrease in velocity-time integral of early diastolic rapid filling compared to that of atrial contraction filling in the left ventricle. On the contrary, there was decrease in acceleration of rapid filling in right ventricle, but other indices were comparable to that of left ventricle. The integral of D wave increased relatively compared to that of S wave in superior vena canal flow. Also, there was decrease in peak flow velocity, acceleration and velocity-time integral of aortic and pulmonary arterial flow velocity. One patient who had increased fraction of integral of early diastolic rapid filling compared to that of atrial contraction filling in right ventricle showed that he had higher central venous pressure and D wave was dominant in superior vena caval flow. In conclusion, Doppler flow patterns showed characteristic diastolic filling inpairment and systolic dysfunction in constrictive pericarditis, so that Doppler echocardiography is believed to be a useful method of noninvasive diagnosis and follow-up of hemodynamic change in constrictive pericarditis.
Acceleration ; Busan ; Cardiac Catheterization ; Cardiac Catheters ; Central Venous Pressure ; Deceleration ; Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Pathology ; Pericardiectomy ; Pericarditis, Constrictive*

The index on myocardial contractility of pure mitral regurgitation(MR) after mitral valve replacement is believed to be useful in determining proper operation time before irreversible myocardial damage by volume overload. Thus the authors examined pre and post-operative echocardiographic results of 20 cases of pure MR patients who had been admitted to Pusan National University hospital and compared the usefulness of each index. Pre and post-operative echocardiographic results were as follows respectively ; 1) Left ventricular internal dimension in diastole(LVIDd) were 6.49+/-0.19cm and 5.51+/-0.17cm. 2) Left ventricular internal dimension in systole(LVIDs) were 4.26+/-0.12 and 3.79+/-0.18cm. 3) Ejection fraction were 71.28+/-1.57% and 59.24+/-3.05%. 4) Fractional shortening(FS) were 34.09+/-1.18% and 27.21+/-1.84%. 5) Mean Vcf were 1.53+/-0.08cm/sec and 1.18+/-0.09cm/sec. 6) Left ventricular end-diastolic volume index(EDVI) were 196.35+/-18.33cc/m2 and 98.46+/-9.96cc/m2. 7) Left ventricular end-systolic volume index(ESVI) were 55.28+/-5.12cc/m2 and 41.88+/-6.07cc/m2. 8) Left ventricular end-systolic wall stress/ESVI(ESS/ESVI) were 2.3+/-0.21 and 3.91+/-0.83. ESS/ESVI showed significantly(p<0.05) elevated postoperative change, LVIDd, LVIDs, EF, FS, EDVI, ESVI revealed significantly(p<0.05) reduced postoperative change whereas Mean Vcf had no postoperative change. After examining correlation between preoperative and postoperative results of each index, it is believed that LVIDd, LVIDs, and ESS/ESVI were useful prognostic indices but were unrelated to postoperative ejection phase indices such as EF, FS, and MEan Vcf. Especially in case of LVIDd>6cm, LVIDs>4cm, and ESS/ESVI<2, the prognosis was poor due to myocardial damage by mitral regurgitation.
Busan ; Echocardiography ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Prognosis ; Stroke Volume

An open clinical trial was performed to test the efficacy and side effects of Pravastatin(Mevlotin(R)), HMG-CoA reductase inhibitor, administering 5mg twice daily for 12weeks in 30 patients of hypercholesterolemia in out patient clinics, Pusan National University Hospital. The total cholesterol, triglyceride and HDL-cholesterol were measured with enzyme methods and LDL-cholesterol was calculated indirectly by Friedewald formula. The result obtained were as follows: 1) The degree of change at the end points compared with baseline pretreatment levels were 26.1% fall in serum total cholesterol.36.6% fall in LDL-cholesterol, 20.8% fall in triglyceride and 14, 6% rise in HDL-cholesterol. And the rate of improvement more than moderate degree were 90.0% in total cholesterol(the fall of 10% or more), 53.3% in triglyceride (the fall 20% or more) and 33.3% in HDL-cholesterol(the rise of 7mg% or more). 2) The total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL cholesterol ratios were decreased significantly from 6, 4+/-0.7 to 4.2+/-0.5(34.4%) and from 4.5+/-0.7 to 2.5 +/-0.4(44.4%) respectively. 3) The greatest fall in serum total cholesterol and LDL-cholesterol were observed in 2 weeks after administrating drug and thereafter fell gradually and maintained until 12 weeks of endpoint, but HDL-cholesterol showed significant rise from the 4 weeks of administration. On the other hand triglyceride showed remarkable fall in the measured values from the 4 weeks but statistical significance was observed only in 10 and 12 weeks after administration owing to wide individual variation of values. 4) There observed the tendency that the higher the initial pretreatment levels the greater the degree of fall in total cholesterol and triglyceride. 5) Neither side effects nor abnormal laboratory findings were shown during the period of observation. The results suggest that Pravastatin will be a useful and safe drug in the treatment of hyperlipidemia.
Busan ; Cholesterol ; Hand ; Humans ; Hypercholesterolemia* ; Hyperlipidemias ; Oxidoreductases ; Pravastatin ; Triglycerides

BACKGROUND: There has been reports which suggest that the morphologic feature of ventricular premature complex(VPC) might reflect the cardiac state. METHODS: To test this, we studied retrospectively the association between the morphologic feature of VPC(shape and duration) and cardiac state(structural and functional) by analysing the records of ECG(179 cases) obtained from reviewing echocardiogram performed in our hospital from 1988 to early 1991. Group 1(n=84) had VPC-QRS complexes with either smooth and uniterruped contour or narrow(<0.04 sec) notching and group 2(n=95) demonstrated VPC with broad(> or =0.04 sec) notching or shelves. Without taking into account of either the presence of the type of the underlying cardiac disease and other constitutional disease state, we classified the type of VPC on ECG according to the above criteria and analysed its simple association with cardiac size and functional state on echocardiogram. RESULTS: In group 1, 68 of 84 cases with a VPC had no notching. In group 2, the VPC-QRS duration was greater than group 1(0.154+/-0.022 vs 0.141+/-0.011 sec(mean+/-S.D.), p=0.0001).Left ventricular end-diastolic diameter(LVED) and ejection fraction(EF) showed a significant difference between the two groups(5.12+/-0.64 vs 5.72+/-0.95cm, p=0.0003 and 65.89+/-10.84 vs 60.82+/-15.5%, p=0.012 respectively). In group 2, 50 of 95 cases(53%) showed ejection fraction less than 64%. By defining left ventricular structural dilatation and functional impairment on echocardiogram as LEVD greater than 5.5cm and EF less than 64% respectively, the sensitivity and specificity of VPC morphology was 60% and 74% respectively. CONCLUSIONS: We conclude that a broadly(> or =0.04 sec) notched VPC of long duration(> or =0.15 sec) is a simple and reliable 12-lead ECG marker for an abnormal structural and functional state of the heart(dilatation and hypokinetic left ventricle), irrespective to underlying cardiac disease, while a VPC with smooth contour or narrow(<0.04 sec) notching with short duration(<0.15 sec) reflects a normal sized heart with normal systolic function.
Dilatation ; Electrocardiography ; Heart ; Heart Diseases ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: Antihypertensive effect and safety of the newer, long acting, nonsulfhydryl angiotensin converting enzyme inhibitor, lisinopril, were studied. METHODS: Twenty eight patients of mild to moderate essential hypertension were administered 10-20mg of lisinopril once daily for ten weeks. Patients were evaluated every two weeks concerning the changes of blood pressure and pulse rate in the sitting position and also any untoward sumptoms and signs attributable to the side effect. Chest X-rey, ECG and laboratory examination were performed in principle two times before and after the completion of medication. RESULTS: The blood pressure declined from 165.4/107.6mmHg to 141.3/92.4mmHg at the end of ten weeks of medication, thus the reduction of 24.1mmHg of systolic pressure and 15.2mmHg of diastolic pressure were observed and the overall effective rate was 85.7%. The pulse rate and laboratory findings were not sigificantly changed before and after the administration of lisinopril. The side effects were observed in 2 cases(7.1%) of mild dry cough and in 2 cases(7.1%) of transitory mild headache and in 1 case(3.6%) of dizziness but no one discontinued medication due to adverse effects. CONCLUSION: Lisinopril proved effective and safe in the treatment of mild to moderate essential hypertension.
Blood Pressure ; Cough ; Dizziness ; Electrocardiography ; Headache ; Heart Rate ; Humans ; Hypertension* ; Lisinopril* ; Peptidyl-Dipeptidase A ; Thorax

The antiarrhythmic efficacy if low dose amiodarone treatment was studied in 30 cases of ventricular premature beats(VPBs). Amiodarone was administered 600mg daily in three divided doses for for initial 7-10 days as loadihg dosage,then 100-200mg once daily as maintenance. The results obtained were as follow : 1) The complete control of VPBs was achieved by amiodarone treatment in 90%, 27cases of 30 cases(all 11 cases with simple VPBs and 16 cases of the remainders with complex VPBs). 2) The QT interval and QTc were significantly prolonged, whereas heart rate was reduced significantly after amiodarone treatment. 3) In 27 cases of responder, the frequency of VPBs began to decrease overtly 2-3 days after amiodarone administration, then relatively stablized in 6 days, and complete cnotrol of VPBs was achieved in all cases about 10 days after treatment. 4) No significant side-reaction was observed except the decrease of serm T3 level after treatment.
Amiodarone* ; Arrhythmias, Cardiac* ; Heart Rate ; Selective Estrogen Receptor Modulators

We evaluated the clinical effects of Nicorandil in 27 patients (17 male and 10 female) with ischemic heart disease (17 patients of stable effort angina, 3 patients of unstable effort angina, 6 patients of spontaneous angina, 1 patient of variant angina) in terms of the effect on the anginal pain, electrocardiographic changes and side effects. The results obtained were as follows; 1. The pulse rate was not changed by the drug administration and blood pressure were decreased slightly by Nicorandil in a daily dose of 15 mg divided into 3 dose, but these decrease were not significant in statistical meaning. 2. Improvement in EKG changes was observed in 9 patients (69%) among the 13 patients who showed abnormal EKG initially. 3. Anti-anginal effect of nicorandil were excellent in 14 patients, good in 8 patients, fair in 3 patients and so the rate of global improvement was 82%. 4. Nicorandil had side effects in 7 patients, headache (4 patients), palpitation, ocular pain, edema, but these were transitory and tolerable except of one case who could not be continued because of severe headache.
Angina Pectoris* ; Blood Pressure ; Edema ; Electrocardiography ; Headache ; Heart Rate ; Humans ; Male ; Myocardial Ischemia ; Nicorandil*