A Case Report of Gynecomastia Due to Rosuvastatin

Gynecomastia is a common benign disease characterized by the progressive enlargement of the glandular tissue of the male breast due to an imbalance between the levels of estrogen and androgen in the blood. The etiology may vary and may be physiological, pharmacological, pathological, or even idiopathic. Among men, drug-induced gynecomastia may account for 10% to 20% of cases. The literature contains six case reports of rosuvastatin-induced gynecomastia. Withdrawal of statin or switching to a less potent statin can lead to symptom improvement and avoidance of unnecessary tests and patient anxiety. A 62-year-old male patient developed unilateral gynecomastia after 13 months of rosuvastatin therapy. After switching to a different statin (pravastatin), his symptoms improved within 2 months. Thus, clinicians should be aware of the possibility of occurrence of gynecomastia when statins are prescribed.

A Case of Gynecomastia Induced by Use of Doxazosin / 대한내과학회지

Doxazosin is an adrenergic alpha-1 receptor antagonist used to treat lower urinary tract symptoms that are common in prostatic hyperplasia. To our knowledge, few cases of gynecomastia and mastodynia, as a complication of adrenergic alpha-1 receptor antagonist, have been reported to date; no cases have been reported in Korea. We describe a case involving a 78-year-old man treated for prostatic hyperplasia with 13 months of doxazosin. He complained about unilateral gynecomstia and mastodynia. Five months after the discontinuation of doxazosin, the gynecomastia was significantly improved. This is the first reported case of gynecomastia and mastodynia associated with doxazosin use in Korea.

Inverted-Takotsubo Cardiomyopathy in a Patient with Pulmonary Embolism

As the use of early coronary angiography and echocardiography become widely available in the setting of acute coronary syndrome, the gradual increase for variant forms of transient left ventricular (LV) apical ballooning syndrome have been recognized. This syndrome usually occurs in women and is frequently elicited by an intense emotional, psychological, and physical event. While the patients' characteristics between typical and non-typical LV ballooning syndrome seem to differ, the presentation, clinical features, and reversibility of LV wall motion abnormalities are similar. We present a middle-aged woman who experienced inverted takotsubo cardiomyopathy triggered by pulmonary embolism. To the best of our knowledge, this case is particularly unique and is rarely reported in the disease entity.

A Case of Infective Endocarditis Occurred during Treatment for Infectious Spondylitis Accompanied by Peptostreptococcus Anaerobius Bacteremia / 고신대학교의과대학학술지

It is necessary to distinguish between pyogenic and tuberculous spondylitis of infectious spondylitis, if it is pyogenic spondylitis, antimicrobial therapy should be directed against an identified microorganism and clinical assessment should be done at 4 weeks. But if microorganism is a anaerobic bacteria, especially Peptostreptococcus anaerobius, combination antibiotic therapy should be considered bacause it may be a component of mixed infections as a passenger and have abilities to induce abscesses, other bacterial growth as a synergy effect. In addition, echocardiography may be necessary because pyogenic spondylitis is associated with infective endocarditis about 12%. We report a 64-year-old man who was treated for infectious spondylitis accompanied by Peptostreptococcus anaerobius bacteremia, but had to undergo heart surgery because an attack of infective endocarditis with systemic embolism during hospitalization.

A Case of Angiotensin Converting Enzyme Inhibitor-Induced Systemic Lupus Erythematosus

Drug-induced lupus erythematosus is defined as a lupus-like syndrome related to continuous drug exposure which resolves after discontinuation of the offending drug. Here we report a case of a 70-year-old man who developed drug-induced lupus erythematosus after receiving angiotensin converting enzyme inhibitor medication for unstable angina pectoris, for 5 years. He was hospitalized with arthralgia, edema, and newly developed pleural effusion. The serum analysis revealed an elevated level of antinuclear antibody and antihistone antibody. After discontinuation of angiotensin converting enzyme inhibitor and receiving a course of prednisolone treatment, his symptoms and pleural effusion improved. To the best of our knowledge, this is, the first case report of angiotensin converting enzyme inhibitor-induced systemic lupus erythematosus in Korea.

A Case of Prolonged QT Interval Association with Galantamine / 고신대학교의과대학학술지

Among the Acetylcholinesterase inhibitors as used for Alzheimer's disease treatment, Galantamine has been recently developed and widely used owing to proven its clinical efficacy and safety. However, it has reported that prolonged QT interval, which can lead to ventricular arrythimias such as Torsade de points, has developed in Galantamine-treated patients. A 74-year-old female Alzheimer's patient been treated with galantamine for 8 months visited the hospital complaining about frequent dizziness. ECG monitor was performed promptly, it was informed that the prolonged QTc interval was increased 450 ms to 486 ms. So, we made her stop taking the galantamine, and after that QTc interval has normalized to 406 ms. In this article, we reported the first case on prolonged QT interval associated with galantamine in Korea.

A Case of Pulmonary Embolism with Protein C, S Deficiency in Apical Hypertrophic Cardiomyopathy / 고신대학교의과대학학술지

Pulmonary embolism is caused by various conditions including genetic and acquired factors, and among them, C and S protein deficiency are known as a cause of pulmonary embolism although their incidences are low. Apical hypertrophic cardiomyopathy is known as a subtype of hypertrophic cardiomyopathies which was reported to be a cause of diastolic heart failure or thromboembolism by activating coagulation system, and this may have an effect on developing pulmonary embolism. We report this since we experienced a case of both C and S protein deficiencies in a patient with apical hypertrophic cardiomyopathy who was diagnosed as pulmonary embolism and has been examined to find the cause of the disease.

A Case of Acute Myopericarditis with Localized ST Elevation Mimicking Myocardial Infarction / 대한내과학회지

Although, with regard to diagnosis, history, physical examination, laboratory data, and electrocardiogram (ECG) are helpful, it can be difficult to distinguish between pericarditis, myopericarditis, and myocardial infarction. Typically, the ECG pattern evolves similarly in acute pericarditis and myopericarditis and includes diffuse ST elevation and PR depression, and then diffuse T wave inversion. Nevertheless, atypical ECG features are seen occasionally in both, especially in myopericarditis. They are characterized by localized ST elevation (inferolateral or anterolateral) and T wave inversion before ST segment normalization. This makes it difficult to distinguish acute myopericarditis from acute myocardial infarction. We report the case of a 27-year-old man with acute myopericarditis with localized ST elevation mimicking acute myocardial infarction.

A case of acute myocardial infarction associated with coronary vasospasm in a patient with systemic sclerosis / 대한내과학회지

Systemic sclerosis is a chronic, systemic disease that targets the skin, lungs, heart, gastrointestinal tract, kidneys, and musculoskeletal system. Prominent features are vascular damage, immune activation, and the deposition of extravascular matrix. Scleroderma heart disease manifests as myocardial fibrosis. Intermittent spasm of the blood vessels in patients with systemic sclerosis may result in contraction band necrosis, similar to the changes observed in myocardial infarction in patients with atherosclerotic coronary artery disease. Coronary vasospasm has been demonstrated during attacks of cold-induced Raynaud's disease. However, acute myocardial infarction associated with coronary vasospasm in patients with systemic sclerosis has not been reported. We describe a rare case of acute myocardial infarction due to coronary vasospasm associated with systemic sclerosis in a 43-year-old woman who presented with severe chest pain.

A case of gingival hyperplasia caused by felodipine / 대한내과학회지

Felodipine is a calcium channel blocker that is used in the management of hypertension. Calcium channel blockers, along with phenytoin and cyclosporin, are implicated as a cause of gingival hyperplasia. Calcium channel blockers associated with this undesired side-effect include nifedipine, nicardipine, isradipine, amlodipine, felodipine, verapamil, and diltiazem. Several cases of adverse gingival hyperplasia related to felodipine have been reported since 1991, although no case has been reported in Korea. We report a case of gingival hyperplasia in a 55-year-old man on long-term felodipine.

Impact of Drug-Eluting Stents on Clinical Outcomes in Patients With Diffuse Coronary Lesions

BACKGROUND AND OBJECTIVES: In the era of stents, lesion length remains an important predictor of restenosis. Drug-eluting stents (DESs) have significantly reduced in-stent restenosis (ISR), but results in long lesions are still lacking. Therefore, we investigated the impact of DESs on clinical outcomes in patients with diffuse coronary lesions. SUBJECTS AND METHODS: Between January 2004 and January 2005, 80 patients (94 lesions) with lesions >20 mm in length were treated with one or more DESs and underwent follow-up coronary angiography. The patients were divided into three groups: Group 1 was composed of those with lesions 21 to 35 mm in length, Group 2 was composed of those with lesions 36 to 50 mm in length, and Group 3 was composed of those with lesions > or =51 mm in length. RESULTS: The mean clinical follow-up duration was 9 months. On the 6-month follow-up angiogram, 6.4% of the lesions had binary ISR (5.0% in group 1, 8.7% in group 2, and 9.1% in group 3). The percent diameter stenosis was 6.0+/-18.15% in Group 1, 12.61+/-21.99% in Group 2, and 19.81+/-31.26% in Group 3(p< 0.05). Late lumen loss was 0.17+/-0.50 mm in Group 1, 0.39+/-0.66 mm in Group 2, and 0.59+/-0.93 mm in Group 3 (p<0.05). Lesion length was associated with an increase in percent diameter stenosis and late lumen loss (of 6.9% and 0.21 mm per 15 mm). CONCLUSION: DES implantation is considered safe and effective in the treatment of diffuse lesions. However, lesion length may be associated with an increase in percent diameter stenosis and late lumen loss at 6-month follow-up.

A Case of a Single Coronary Artery Originating From the Right Coronary Sinus

No abstract available.

Very Late Stent Thrombosis in Coronary Bare-Metal Stent Implantation: A Case Report

Stent thrombosis is generally a fatal complication after percutaneous coronary intervention. Despite the incidence of stent thrombosis has reduced with improved techniques and drugs, stent thrombosis persists at a rate of 0.5-2% in elective cases, and up to 6% in patients with acute coronary syndromes. It almost always causes acute myocardial infarction or sudden cardiac death. While very late stent thrombosis, occurring beyond 1 year, is not uncommon with the use of drug-eluting stents, it is distinctly unusual with the use of bare-metal stents. We report a case of very late thrombosis of a bare-metal stent occurring 880 days after coronary stent implantation.

Comparison of Early and Six Month Outcomes of Direct Stenting vs. Conventional Stenting in Patients with Angina Pectoris

BACKGROUND AND OBJECTIVES: Direct stenting (DS) has been shown to be safe and feasible, with demonstrable reductions in cost, procedural time and radiation exposure, and may also result in less vessel injury. The aim of this study was to compare the immediate and six month clinical and angiographic outcomes of direct stent (DS) with stent implantation implantation following balloon predilatation (conventional stenting, CS). SUBJECTS AND METHODS: Between July 2001 and June 2004, 266 patients (293 lesions) with angina pectoris were included in this study. Patients having lesion characteristics with excessive calcification, left main lesion, chronic total occlusion, severe proximal tortuosity and a bifurcated lesion were excluded. Follow up angiography was performed about six months after the initial procedure. RESULTS: Direct (73 lesions) and conventional stenting (220 lesions) were performed respectively. In the DS group, the minimal luminal diameter was larger (0.36+/-0.18 vs. 0.31+/-0.19 mm, p=0.036) and diameter stenosis lower than in the CS group (89.1+/-5.1 vs. 90.6+/-3.9%, p=0.026). However, no difference was found in the reference vessel diameter between the two groups. From the immediate angiographic results, the CS group showed a longer stent length than the DS group (18.84+/-5.61 vs. 16.16+/-3.67 mm, p=0.000), but the DS group had a higher balloon inflation pressure than the CS group (12.25+/-1.71 vs. 11.35+/-1.72 atm, p=0.000). However, no difference was found in the post-stent minimal luminal diameter, acute gain and angiographic success rates. Follow up angiography was performed in 68.6% (201/293) of lesions. The angiographic restenosis rate was similar between the two groups (DS, 19.6 vs. CS, 19.3%, p=0.966), as were the other angiographic findings. The rates of in-hospital and 6 month follow up major adverse cardiovascular events (MACE) were similar between the two groups. CONCLUSION: Direct stenting showed similar rates of angiographic restenosis as well as inhospital and 6 months MACE (death, myocardial infarction, target lesion revascularization, cerebrovascular accident) compared with conventional stenting.

The usefulness of cardiovascular MR in prediction of wall motion recovery after revascularization in acute myocardial infarction / 대한내과학회지

BACKGROUND: Cardiovascular MR has recently been reported that it can determine the viable myocardium. We investigated this study to determine the usefulness of cardiovascular MR in prediction of wall motion recovery after revascularization in acute myocardial infarction METHODS: Both cardiovascular MR with contrast enhancement and coronary angiogram were performed in 19 patients with acute myocardial infarction who treated with precutaneous intervention or thrombolytic therapy. Six months follow-up angiogram and MR study were also preformed. Thirty two matched segments model of the left ventricle were used to analysis the wall motion change and the grade of transmural extent of hyperenhancement (TEI). RESULTS: Among 628 segments, 177 segments showed wall motion abnormality. In group of segments showing hypokinesia (68 segments), the proportion of segments showing wall motion improvement was not different from that of the akinetic segments group (109 segments) (50% vs 41.3%, p=0.26). The proportion of segments showing wall motion improvement were 60.5% in group of TEI grade 0, 58.9% in TEI grade I, 51.2% in TEI grade III, 29.4% in TEI grade IV, 8% in TEI grade V. If the groups were divided into two according to cut-off value of TEI 50%, In the group of TEI less than 50%, 67 out of 118 segments (56.8%) showed wall motion improvement in contrast with 12 out of 59 segments (20.3%) in the group of TEI above 50% (p<0.001). The status of baseline wall motion abnormality (hypokinesia or akinesia) did not effect on wall motion improvement after revascularization. CONCLUSIONS: The baseline wall motion abnormality (hypokinesia or akinesia) did not predict the wall motion improvement. But, TEI grade was significant factor to predict the wall motion improvement.

Prevalence of and Risk Factors for Atrial Fibrillation in Korean Adults Older than 40 Years

Atrial fibrillation (AF) is a common arrhythmia that is a potent independent risk factor for stroke. The incidence of AF increase with age and most affected people have underlying cardiac disease. This study aimed to describe the prevalence of and risk factors for AF in Korean. In this study, 14,540 adults (male 6,573/female 7,967) > or =40 yr old received screening test for general health between April 2000 and December 2000. Participants answered questionnaires and underwent examinations that included blood pressure, electrocardiogram (ECG), total cholesterol, and fasting glucose. Data analysis was done by SPSS 10.0 for Windows. The prevalence of AF was 0.7% in people older than 40 yr and 2.1% in those older than 65 yr. The prevalence in men was 1.2% and women was 0.4% in people older than 40 yr. The prevalence in men was 3.3% and women was 1.1% in people older than 65 yr. Approximately 56.6% of individuals with AF are older than 65 yr. The prevalence of AF was higher at all age group in men than in women. Also, the prevalence of AF was highest in people older than 80 yr. In univariate analysis, male sex, old age (> or =65 yr), hypertension, diabetes mellitus, left ventricular hypertrophy in ECG, stroke, and cardiac disease were associated with an increased risk of AF. In multivariate analysis, however, risk factors of AF were male (odds ratio, OR 4.1; 95% confidence interval [CI] : 2.6 to 6.5; p=0.000), old age (OR 5.3; 95% CI:3.5 to 7.9; p=0.000), and cardiac disease (OR 19.8; 95% CI:12.3 to 31.8; p=0.000). In this study, the most potent risk factors of AF was cardiac disease.

The Safety of Tirofiban Therapy in Patients with Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Recent randomized studies have shown a significant reduction in the rate of recurrent cardiac events with adjunctive pharmacotherapy, using Glycoprotein IIb/IIIa inhibitors (GPI), in patients undergoing percutaneous coronary intervention (PCI) procedures. However, in Korea, there is a paucity of data concerning complications of tirofiban therapy in patients with acute coronary syndrome (ACS). Therefore, this study was performed to evaluate the safety of tirofiban therapy. SUBJECTS AND METHODS: ACS patients who underwent tirofiban administration between May 2002 and October 2003 were reviewed. The rates of bleeding, transfusion, and thrombocytopenia were analyzed, and the rates of complications by ages, gender and PCI compared with medical treatment, renal function and vascular access route. RESULTS: A total of 261 ACS patients (male/female=150/111) underwent tirofiban therapy. The mean ages of the subjects was 64.5 years, the rates of minor bleeding, major bleeding, transfusion and thrombocytopenia were 8.1% (n=21), 2.3% (n=6), 4.6% (n=12) and 1.2% (n=3), respectively. Minor bleeding occurred at similar rates in both sexes (8 vs. 8.1%) and to a greater extent in old age (> or =65) (12.5 vs. 2.6%, p=0.093), but major bleeding occurred to a greater extent in females and old age (5.4 vs. 0% and 4.2 vs. 0%, p=0.25 and 0.093, respectively). The rates of thrombocytopenia and transfusion were greater in old age (2.1 vs. 0% and 8.3 vs. 0%, p=0.052 and 0.087, respectively). In-hospital days were greater in old age (14.7+/-9.5 vs. 11.9+/-4.4 days, p=0.065). The rates of complications were similar in both groups when compared by PCI or medical treatment and vascular access route. The serum creatinine was 3.3 mg/dL in those with major bleeding, which was higher than in the other groups (p=0.000). CONCLUSION: The tirofiban therapy in patients with ACS did not induce an increase in the bleeding rates, in-hospital days and it was safe and well tolerated in old age.

Incidence of and Risk Factors for Bundle Branch Block in Adults older than 40 years

BACKGROUND: In the general population, the incidence of bundle branch block (BBB) is relatively low, and its effects on long-term prognosis have not been established. Previous studies on the incidence and correlation of BBB to clinical factors have produced conflicting results. However, the incidence of BBB was strongly related to age. This study aimed to describe the incidence of and risk factors for BBB in Korea. METHODS: In this study, 14, 540 adults (male 6, 573/female 7, 967) > or=40 years old received screening tests for general health between April and December 2000. Participants answered questionnaires and underwent examinations, which included blood pressure, electrocardiogram (ECG), total cholesterol and fasting glucose. The data analysis was performed using SPSS 10.0 for windows. RESULTS: The incidences of complete right bundle branch block (CRBBB) were 1.5 and 2.9% in people older than 40 and 65 years, respectively. Approximately 38.0% of individuals with CRBBB were older than 65 years. The incidence of CRBBB was higher in men than women at all age groups was highest in those aged 75-79 years. Males, advancing age (> or=65 years), hypertension and diabetes mellitus (DM) were associated with an increased risk of CRBBB. The incidences of complete left bundle branch block (LBBB) and bifascicular bundle branch block (BBBB) were 0.1 and 0.08% and 0.3 and 0.2% in those older than 40 and 65 years, respectively. Approximately 71.4 and 58.3% of individuals with LBBB and BBBB, respectively, were older than 65 years. Advancing age and cardiac disease were associated with an increased risk of LBBB. Advancing age was associated with an increased risk of BBBB. The most potent risk factor for BBB in this study was advancing age. CONCLUSION: The incidences of BBB were 1.7 and 3.4% in those older than 40 and 65 years respectively. Bundle branch block correlates strongly with age, and is common in the older ages groups. These findings support the theory that bundle branch block is a marker of slowly progressing degenerative diseases.

The Meaning of Pathologic Q wave in Myocardial Infarction Assessed by Magnetic Resonance Imaging

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.

Incidence of and risk factors for bundle branch block in screening test for 40 years and older adults / 대한내과학회지

BACKGROUND: In the general population, the incidence of bundle branch block (BBB) is relatively low, and its effects on long-term prognosis have not been established. Previous studies of incidence and correlation to clinical factors have produced conflicting results. But, the incidence of BBB was strongly related to age. This study aimed to describe the incidence of and risk factors for BBB in Korean. METHODS: In this study, 14,540 adults (M/F=6,573/7,967) >or=40 years old were received screening test for general health between April 2000 and December 2000. Participants answered questionnaires and underwent examinations that included blood pressure, electrocardiogram (ECG), total cholesterol, and fasting glucose. Data analysis was done by database statistics (dBSTAT) for windows program. RESULTS: The incidence of complete right bundle branch block (CRBBB) was 1.5% in people older than 40 years and 2.9% in those older than 65 years. Approximately 38.0% of individuals with CRBBB were older than 65 years. The incidence of CRBBB is higher at all age group in men than in women. Also, the incidence of CRBBB is most highest in aged 75~79 years. Male, advancing age ( >or=65 years), hypertension, and diabetes mellitus (DM) were associated with an increased risk of CRBBB. The incidence of complete left bundle branch block (LBBB) and bifascicular bundle branch block (BBBB) were 0.1%, 0.08% in people older than 40 years and 0.3%, 0.2% in those older than 65 years, respectively. Approximately 71.4%, 58.3% of individuals with LBBB and BBBB were older than 65 years, respectively. Advancing age ( >or=65 years) and myocardial infarction (MI) were associated with an increased risk of LBBB and BBBB. The most potent risk factor of BBB was advancing age in this study. CONCLUSION: The incidence of BBB was 1.7% in those older than 40 years and 3.4% in those older than 65 years. Approximately 89.3% of individuals with BBB were CRBBB. The incidence of CRBBB is 1.5-fold in men than in women. The most potent risk factor of BBB was advancing age.