, Tae Hoon Yim, Byung Chul Kim, Hyun Sik Ju, Ja Joong Gu, Tae Jin Kim Simultaneous multi-vessel acute myocardial infarction is rare and has poor prognosis. We report a 70-year-old Korean man with an anteroseptal wall ST-elevation myocardial infarction presenting as ventricular tachycardia, sudden cardiac arrest and cardiogenic shock. After successful cardiopulmonary resuscitation, a coronary angiogram revealed three-vessel coronary disease; simultaneous total occlusions of the proximal left anterior descending artery (LAD) and the proximal left circumflex artery (LCX), and chronic total occlusion of the proximal right coronary artery. Primary percutaneous coronary intervention (PCI) of the LAD and LCX was successful and an intra-aortic balloon pump was inserted. Despite the timely and successful PCI result, he died on the 58th day in the hospital due to pneumonia with multiple organ failure.
, Hong Kun Cho, Gil Ja Shin Ticlopidine, a platelet aggregation inhibitor, is widely used in the secondary prevention of stroke and previous manifestation of peripheral arterial occlusive disease, Ticlopidine is also used to prevent myocardial infarction and post-stenting occlusion after intracoronary stent implantation. The exact mechanism of action of ticlopidine is unclear, but likely involves the inhibition of platelet activity by the suppression of adenosine diphosphate-induced patelet aggregation. The most common adverse effects are gastrointestinal problems, skin reactions, and hematologist changes. The adverse hepatic effects are not frequent(4% in different series).
We experienced a case of ticlopidine-induced cholastatic jaundice, and report with review of literatures.
, In Sook Kang, Kihwan Kwon, Wook Bum Pyun, Gil Ja Shin This study designed to find the differences of left ventricular (LV) geometry in acute myocardial infarction (AMI) between ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) and the occurrences of adverse outcome according to the LV geometry.
Comprehensive echocardiographic analyses were performed in 256 patients with AMI. The left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. LV geometry were classified into 4 groups based on RWT and LVMI: normal geometry (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (increased LVMI and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LV geometry and clinical outcomes.
Patients with NSTEMI were more likely to have diabetes mellitus, hypertension, heart failure, stroke and previous myocardial infarction. By the geometric type, patients with NSTEMI were more likely to have eccentric hypertrophy (n=51, 34.7% vs. n=24, 22.0%, P=0.028). There was no significantly different adverse outcome between STEMI and NSTEMI patients. Fifteen patients (5.9%, 7 female [46.7%]) died and the median duration of survival was 10 days (range, 1 to 386 days). Concentric hypertrophy carried the greatest risk of all cause mortality (hazard ratios, 5.83; 95% confidence interval, 1.04 to 32.7).
NSTEMI patients had more likely to have eccentric hypertrophy but adverse outcome after AMI was not different between STEMI and NSTEMI patients. Concentric hypertrophy had the greatest risk of short term mortality.
, Yong-Hyun Kim, Jong Soo Lee, Young Jae Hwang, Jae Min Lee, Keunhee Kang, Woo-Hyuk Song, Jeong-Cheon Ahn A 30-year-old man visited the emergency room for chest pain, dyspnea and fever. Despite increased serum cardiac enzymes, ST segment elevation and inferior wall akinesis in electrocardiography and echocardiography, no atherosclerosis was evident in the coronary angiography. However, radionuclide myocardial perfusion image at day 2 showed a persistent perfusion defect in the left ventricular (LV) inferior wall. At day 3, prominent myocardial edema and severe LV systolic dysfunction developed with signs of heart failure. In this case, fulminant myocarditis seemed to originate from the right coronary artery territory and simulated a ST segment elevation myocardial infarction without coronary artery obstruction. The pathogenesis of the localized perfusion defect was unlcear.
, Gilja Shin, Hong-Keun Cho, Si Hoon Park Hyperlipidemia is an important risk factor of coronary atherosclerosis. Serum lipids, especially cholesterol level is closely related to coronary artery and early identification and treatment of hypercholesterolemia reduced the risk of ischemic heart disease. In secondary prevention studies, lipid regulation has been demonstrated to result in a reduced incidence of myocardial infarction and mortality. But during the acute phase of a myocardial infarction, the serum lipid pattern is known to be rapidly changed and consequently dose not reflect the baseline level of the patient. Total serum cholesterol concentrations measured within 24 hours after acute myocardial infarction are likely to reflect basal levels, thus they must be used as the reference for the diagnosis and treatment of hyperlipidemia. If serum lipid levels were not measured within 24 hours of acute chest pain, it is essential to correct the lipid level to the baseline level. So we investigated the following. First, serum lipid alteration during the acute phase of acute myocardial infarction, second, the factors that are related to lipid change, third, the time to check the baseline value of lipid level during the acute phase of myocardial infarction.
We have measured the total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride at admission time and the next day in a group of 51 acute myocardial infarction patients who had acute chest pain.
First, total cholesterol, LDL cholesterol at the next day were significantly reduced. Second, positive correlation was noted between lipid alteration and the lipid level that was checked at admission time. Last, male groups had more significant reduction of LDL cholesterol than female groups.
Cholesterol levels thats were checked the next day were significantly reduced in comparison with the cholesterol value registered at hopital admission. Consequently, it is essential to check the lipid level at the time of hospital admission. But if it was not done, corrected values are a useful guide to patients basal lipid state and treatment references.
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