Cardiac relaxation is impaired in many cardiac disorders and is the subject of extensive investigation. Though measurement of isovolumic relaxation time ought to prove a simple means of quantifying such abnormalities in clinical practice, the problem of defining the timing of mitral valve opening at the onset of ventricular filling has been a difficulty. previous studies have used the 'O' point of the apexcardiogram, but more recently it has been shown that this may be open to considerable error. It was the purpose of the present study to determine the duration of true isovolumic relaxation and the factors influencing its duration, and to evaluate its use as a simple noninvasive measurement of cardiac dynamics in terms of the present approach. True isovolumic relaxation time (IRT) was measured noninvasively from the onset of the aortic component of the second heart sound to the onset of rapid opening of the mitral leaflets from simultaneous recording of echocardiogram, phonocardiogram, electrocardiogram and carotid tracing in 60 normal subjects, 30 male and 30 female and in 50 with hypertension, 28 male and 22 female ranging in age from 20 to 45 years. 1. The duration of IRT was 53.6+/-9.9 msec in normal subjects with no relation to sex. 2. IRT was related to heart rate, systemic blood pressure, and systolic and diastolic time intervals. 1) IRT tended to decrease with increasing heart rate and a regression equation for predicting it in relation to heart rate was 'IRT(msec)=88.97-0.466xH.R.(beats/min)' (P<0.01). 2) IRT tended to increase with increasing systemic blood pressure and a regression equation for predicting it in relation to aortic closing pressure was 'IRT(msec)=5.09+0.459xaortic closing pressure(mmHg)' (P<0.01). IRT was prolonged in patient with hypertension. 3) IRT was in close relation to left ventricular contraction indices such as preejection period(PEP), isovolumic contraction time and preejection period/left ventricular ejection time ratio. 4) There was no relation between IRT and left ventricular pump performance indices such as stroke volume, ejection fraction, fractional shortening and left ventricular dimension. 5) There was strong association between IRT and diastolic time intervals. Authors were impressed through this study that IRT is a useful measurement of left ventricular dynamics in early diastole.
Blood Pressure ; Diastole ; Electrocardiography ; Female ; Heart Rate ; Heart Sounds ; Humans ; Hypertension ; Male ; Mitral Valve ; Relaxation* ; Stroke Volume

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

In the real-time two-dimensional Doppler flow mapping(2DD) system, Doppler signals are processed using auto-correlation technique, so that the direction, velocity and turbulence of the intracardiac blood flow are displayed by coloration on the B mode image of the heart in real time. Aortic regurgitant flow is imaged as a mosaic jet spurting out from the aortic valve orifice to cardiac chamber. Dynamic features in the direction and extent of regurgitant flow and the site of regurgitation on the aortic valve orifice are readily obtained. Feasibility of the 2DD system in the assesment of aortic regurgitation was examined in 30 cases documented by angiography. In 30 cases, there were 20 cases with aortic regurgitation(AR) aged 16 to 57 years(mean 34) and 10 cases without AR aged 17 to 39 years(mean 30). The underlying disorders of AR were rheumatic in 15 cases, bicuspid aortic valve in 1, ventricular septal defect in 1, aortitis in 1, Marfan's syndrome in 1 and unknown in 1. The results are as follows : 1) In 19 out of 20 cases with AR the 2DD showed regurgitant jet spurting out from valve orifice(sensitivity=95%). One case missed by the 2DD had 1+AR. None of the 10 cases who had no AR manifested the evidence of AR on the 2DD(specificity=100%). 2) There was an excellent positive correlation between the maximal jet length of regurgitant flow on the 2DD and angiographic severity of regurgitation(r=0.998, p<0.001). The maximal jet length was less than 3cm for cases with 1+, 3-4.9cm for 2+, 5-5.9cm for 3+, and 6cm or more for 4+AR. 3) In 19 out of 20 cases with AR, the 2DD identifed the anatomic valvular site of regurgitation(sensitivity=95%, specificity=100%). 4) The regurgitant aortic valvular area was measured as 0.6cm2 or less in all of 12 cases with 2+ or less AR, while 0.9cm2 or more in 6 out of 7 cases with 3+or more AR. Thus, a less or greater than 0.8cm2 regurgitant aortic valvular area provides to discriminate between mild(< or = 2+) and severe(> or = 3+) AR. 5) In all 8 cases with fluttering of anterior mitral leaflet and 8 out of 9 cases with fluttering of interventricular septum, a regurgitant jet impinged on them. The results of this investigation indicate that the 2DD system is a very useful and unique noninvasive technique in the detection, estimation of severity and spatial orientation of AR.
Angiography ; Aortic Valve ; Aortic Valve Insufficiency* ; Aortitis ; Bicuspid ; Equidae ; Heart ; Heart Septal Defects, Ventricular ; Marfan Syndrome

We evaluate the effects of diltiazem in 19 patients with ischemic heart disease (15 patients) of classical anginal pectoris & 4 patients of variant angina) by means of clinical status & electrocardiographic changes and obtain the results as follows: 1. The pulse rate & blood pressure were decreased by diltiazem slightly but these decreases were not significant in statistical meaning. 2. Diltiazem administration of 4 weeks duration normalized EKG completely in 4 patients & partially in 3 patients among the 13 patients who showed abnormal resting EKG initially. 3. All 19 patients who received diltiazem showed clinical improvement; 9 patients had excellent responses, 7 patients good responses & 3 patients fair responses. 4. Diltiazem had side effects in 3 patients, drowsiness, mild euphoria & possibly tolerance respectively in each patients.
Angina Pectoris* ; Blood Pressure ; Diltiazem ; Electrocardiography ; Euphoria ; Heart Rate ; Humans ; Myocardial Ischemia ; Sleep Stages

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*

Mitral valvular orifice area is important for the evaluation of prognosis and treatment of patients with mitral valvular stenosis. Until recently, Gorlin's formula using cardiac catheterization has been utilized in the measurement of mitral valve area, but it is invasive and impractical to examine repeatedly. Recently 2-Dimensional echocardiography appeared to be a practical and useful substitute in measurement of valve area and also it is economical and has no risk to patients. In 31 patients with mitral valvular stenosis examined at the echocardiography room of Busan national University Hospital from March 1982 to March 1983, we measured the mitral valve area with 2-Dimensional echocardiography and evaluated its relationship with the left ventricular functions measured on M-mode echocardiogram. Among many parameters on M-mode measurements EF slope, excursion amplitude and the ratio of left atrial dimension to aortic root dimension were rather helpful for the assessment of severity of mitral valvular stenosis than other parameters. And each relationship with the valve area showed correlation coefficient of 0.60, 0.05 and -0.58, respectively.
Busan ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic* ; Echocardiography* ; Humans ; Mitral Valve* ; Prognosis ; Ventricular Function, Left

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

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 trial was carried out to investigate the efficacy and tolerance of isosorbide 5-mononitrate(Elantan(R)) in 30 patients diagnosed as angina pectoris at Pusan national university hospital. Drugs were given 20mg two times daily for 2 to 3 weeks and the results were assessed in terms of effects on anginal pain and untoward side effects experienced during administration of medication. Treament resulted in an overall improvement in 25 patients(83.4%), complete abolition of anginal attacks in 17 patients(56.7%) and reduction in frequency of attacks in 8 patients(26.7%). So called "Nitrated headache" was observed in 5 patients(16.6%) but improved with proceeding of administration in 3 patients. This trial indicates that isosorbide 5-mononitrate should be efficacious as well as tolerated in patients with coronary heart disease.
Angina Pectoris* ; Busan ; Coronary Disease ; Humans ; Isosorbide*

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