A Case of Successful Treatment of Femoral Artery Pseudoaneurysm Using Thrombin Injection

No abstract available.

The peroxisome proliferator-activated receptor-gamma agonist, Rosiglitazone, improves aortic wall stiffness in type 2 diabetic patients / 대한내과학회지

BACKGROUND: Diabetes is a major risk factor for the development of coronary artery disease. Atherosclerosis is thought to arise as a result of a chronic inflammatory process within the arterial wall. Insulin resistance is central to the pathogenesis of type 2 diabetes and may contribute to atherosclerosis, either directly or through associated risk factors. Rosiglitazone, a peroxisome proliferator-activated receptor gamma agonist, is used in the treatment of type 2 diabetes mellitus, and previous findings suggest that it may have anti-inflammatory effects on atherosclerosis. This study was performed to evaluate whether rosiglitazone can improve arterial stiffness in type 2 diabetic patients. METHODS: This study consisted of 40 patients with type 2 diabetes. These subjects were classified into two groups either medicated with glimepiride (GLIME group, 61.5+/-8.2 years, M:F = 9:11) or with glimepiride and rosiglitazone (ROSI group, 65.6+/-9.5 years, M:F = 4:16). For each group, plasma a hsCRP, lipid profile, HOMAIR and HbA1c were measured before and after 12 months of medical treatment. At the same time, pulse wave velocity (PWV) using an automatic device (PP 1000, Hanbyul, Jeonju, Korea) was measured. RESULTS: The plasma hsCRP level was significantly decreased in the ROSI group as compared with the GLIME group (4.22+/-4.65 vs. 1.07+/-0.80 mg/L, p=0.025). The carotid-femoral PWV of the ROSI group improved significantly as compared with the GLIME group (8.29+/-1.25 vs. 7.26+/-1.49 m/sec, p=0.024). The changes of PWV were correlated with the changes of hsCRP (r=0.412, p=0.033). CONCLUSIONS: These findings suggest that rosiglitazone can improve the arterial stiffness in type 2 diabetic patients.

Alterations of Autonomic Nervous Activity Associated with Spontaneous Coronary Spasm in Patients with Variant Angina

BACKGROUND AND OBJECTIVES: It is now well known that coronary artery spasm plays an important role in the pathogenesis of variant angina. Previous studies have shown that stimulation of the sympathetic or parasympathetic nervous system can provoke coronary artery spasms, although the precise causes of such spasms remain unclear. Power spectral analysis of heart rate variability has been proposed as a noninvasive parameter of autonomic nervous activity. To determine the possible role of the autonomic nervous system in the development of variant angina, we used spectral analysis of heart rate variability obtained from ambulatory Holter monitoring in patients with ST-elevation and chest pain to clarify the alterations of autonomic activity before angina. SUBJCETS AND METHODS: Cardiac autonomic nervous activities were evaluated from the power of the low-frequency and the high-frequency spectral components of heart rate variability obtained from Holter monitoring in a total of 18 episodes of 12 patients with variant angina. Samples during each 10-minute period from 60 minutes before to immediately before an anginal attack were analyzed by fast Fourier transformation. RESULTS: Significant organic coronary stenosis and multiple coronary spasms were detected by coronary angiography in two (20%) and four (40%) of the patients, respectively. The values of the power of the low-frequency component and the low-to-high frequency ratio were significantly greater during the 10-to 0-minute period than during the other 10-minute periods. CONCLUSION: Sympathovagal imbalance - or sympathetic activation without parasympathetic augmentation - enhanced in the 10-minute period before an anginal attack may play an important role in the genesis of coronary artery spasms in patients with variant angina.

Alterations of Autonomic Nervous Activity Associated with Spontaneous Coronary Spasm in Patients with Variant Angina

BACKGROUND AND OBJECTIVES: It is now well known that coronary artery spasm plays an important role in the pathogenesis of variant angina. Previous studies have shown that stimulation of the sympathetic or parasympathetic nervous system can provoke coronary artery spasms, although the precise causes of such spasms remain unclear. Power spectral analysis of heart rate variability has been proposed as a noninvasive parameter of autonomic nervous activity. To determine the possible role of the autonomic nervous system in the development of variant angina, we used spectral analysis of heart rate variability obtained from ambulatory Holter monitoring in patients with ST-elevation and chest pain to clarify the alterations of autonomic activity before angina. SUBJCETS AND METHODS: Cardiac autonomic nervous activities were evaluated from the power of the low-frequency and the high-frequency spectral components of heart rate variability obtained from Holter monitoring in a total of 18 episodes of 12 patients with variant angina. Samples during each 10-minute period from 60 minutes before to immediately before an anginal attack were analyzed by fast Fourier transformation. RESULTS: Significant organic coronary stenosis and multiple coronary spasms were detected by coronary angiography in two (20%) and four (40%) of the patients, respectively. The values of the power of the low-frequency component and the low-to-high frequency ratio were significantly greater during the 10-to 0-minute period than during the other 10-minute periods. CONCLUSION: Sympathovagal imbalance - or sympathetic activation without parasympathetic augmentation - enhanced in the 10-minute period before an anginal attack may play an important role in the genesis of coronary artery spasms in patients with variant angina.

Short-Term Effect of High Dose of Vitamin C on Coronary Flow Velocity and Coronary Flow Reserve in Healthy Young Non-Smoker Men

BACKGROUND AND OBJECTIVES: Vitamin C, water-soluble antioxidant, has been reported to restore coronary microcirculatory responsiveness and impaired coronary flow reserve in smokers. However, the effect of high dose of vitamin C on coronary circulation is unclear in nonsmokers. METHODS: We used transthoracic echocardiography to measure the coronary flow reserve, an integrated measure of coronary flow in 20 male healthy nonsmokers (26+/-3 years) before and after administration of the high dose of vitamin C. RESULTS: The coronary peak diastolic velocity was increased by 14.8% after administration of antioxidant vitamin C, whereas the coronary flow reserve did not changed. CONCLUSION: High dose of vitamin C acutely increases the coronary flow velocity without restoration of coronary flow reserve in male healthy nonsmokers.

A Case of Complete Heart Block Complicating Bacterial Endocarditis

Active infective endocarditis, involving native, is often complicated by conduction abnormalities. These conduction disturbances are considered to represent an extension of the infection from the valve to the annulus, and to the surrounding myocardium. We describe a case of a 59-year-old woman who presented with dyspnea due to staphylococcal endocarditis, which was complicated by a complete heart block.

A Case of Primary Cardiac Amyloidosis

Amyloidosis is not a single disease entity but a term applied to a complex of disorders associated with deposition of insoluble fibrillar proteins in virtually pure form in various tissues of the body. This disease is encountered sometimes in America or Europe, but rarely in Korea. We had experienced one case of primary cardiac amyloidosis who was admitted to Won Kwang University Hospital due to dyspnea on exertion. This cardiac amyloidosis was confirmed by echocardiogram and endomyocardial biopsy with congo-red stain. We will report a case and review the pertinent medical literature.

The Effect of Protein Kinase C Pretreatment on Gliotoxin Induced Apoptosis in H9c2 Cells / 체질인류학회지

Aspergillus funigatus and other pathogenic fungi synthesize a toxic epidithi- odiopiperzine (ETP) metabolite called gliotoxin. Gliotoxin is an epidithiodiopiperzine compound which can both react with sulfhydryl groups and form hydrogen peroxide. The fungal toxin gliotoxin induces apoptotic cell death in a variety of cells. Apoptosis induced by gliotoxin need calcium but effect of calcium preconditioning is unknown by gliotoxin. We studied the effect of protein kinase C and calcium preconditioning on gliotoxin-induced apoptosis in H9c2 cell. PKC and calcium preconditiong inhibited DNA fragmentation by gliotoxin. From this above results suggest that gliotoxin induce apoptosis via caspase-3 activation, because caspase-3 inhibitor (DEVD-CHO) didn't induce apoptosis in gliotoxin treated H9c2 clls. Calcium and PKC preconditioning inhibit caspase-3 activation by gliotoxin. These data means that PKC preconditioning is related with caspase-3 regulate in gliotoxin-induced apoptosis.

The Role of Doppler Time Index for Evaluation of Left Ventricular Diastolic Function by Patterns of Left Ventricular Hypertrophy in Hypertensive Patients

OBJECTIVE: Recent studies have shown that easily recordable, non-invasive Doppler time index correlates with left ventricular systolic and diastolic function. The aim of present study was to evaluate the significance of Doppler time index by patterns of left ventricular hypertrophy in hypertensives patients. SUBJECTS AND METHOD: This echocardiographic and Doppler study investigated the relationship between left ventricular geometric shape (normal, concentric remodelling, concentric hypertrophy and eccentric hypertrophy) and diastolic function in a 87 patients with essential hypertension and 55 normal subjects. Doppler time index was defined as the summation of isovolumetric contraction (ICT) and relaxation time (IRT) divided by ejection time (ET). RESULTS: Among left ventricular geometric patterns in hypertensive patients, high prevalence of eccentric hypertrophy (32%). Except IVRT in concentric hypertrophic group, no difference were found in Doppler determination of diastolic function between the geometric groups. The Doppler time index significantly correlated with IVRT and deceleration time (DT) of E wave. However, Doppler time index had 71% sensitivity and 89% specificity in assessment of diastolic dysfunction. CONCLUSION: The Doppler time index was significantly correlate with Doppler index of mitral flow. But, this index can be a lesser sensitive indicator of pure diastolic dysfunction.

The Role of Echocardiography for Evaluation of the Acute Chest Pain Patients with Nonspecific ECG Findings

OBJECTIVE: To evaluate diagnostic role of echocardiography in the patients of acute chest pain with nonspecific ECG findings we have performed prospective study. SUBJECT AND METHOD: 79 out of 101 consecutive patients presenting to the emergency room with symtoms suggestive of acute coronary syndrome (ACS) without diagnostic ECG change were studied. Presence and score of regional wall motion abnormality (RWMA) were assessed according to the American Society of Echocardiography guideline (16 segment model) by two-dimensional echocardiography within 4 hours after arrival. The diagnosis of acute myocardial infarction (AMI) was confirmed by serial myocardial enzyme assay retrospectively. RESULTS: Of the 28 patients with RWMA, 13 (46%) had non-Q AMI, 8 (28%) had unstable angina, 3 (11%) had posterior AMI. Of the 51 patients with normal wall motion, 10 had gastroesophageal disease, 9 had variant angina, 3 had psychologic disease, 1 had aortic dissection and 1 had hypertrophic cardiomyopathy. Thus, Presence of RWMA by echocardiography had a sensitivity of 49% and a specificity of 88% for diagnosis of ACS. In 21 ACS patients with RWMA, regional wall motion score was significantly higher in AMI than in unstable angina (3.1+/-1.8 vs 1.0+/-2.2, p<0.05). As for the significant coronary artery stenosis, there was a higher incidence of multivessel disease in the patients with RWMA (64%). CONCLUSION: RWMA by two-dimensional echocardiography in the emergency room is not a sensitive but a specific technique to diagnose ACS patient with nonspecific ECG change, especially in posterior AMI and non-Q AMI.

Alterations of Heart Rate Variability by Vestibular Stimulation in Rabbits

BACKGROUND: There is a substantial evidence that anatomical connections and functional interactions exist between vestibular and autonomic systems. The nature of these interactions, however, is complex and has not been fully defined. Heart rate variability (HRV) was used to investigate the physiological role of the vestibular system on control of heart rate. METHODS: HRV including mean, standard deviation, coefficient of variation (CV), power spectrum was analyzed from R-R intervals of ECG during vestibular stimulation in rabbits. RESULTS: Urethane anesthesia increased heart rate and maintained regular R-R intervals, however, low frequency region/high frequency region (LF/HF) was not changed. In anesthetized rabbits, electrical stimulation of the vagus nerve decreased heart rate and decreased LF/HF by increasing HF. On the contrary, electrical stimulation of the cervical sympathetic nerve increased heart rate and increased LF/HF by increasing LF. Atropine, cholinergic blocker, increased heart rate and increased LF/HF by reducing HF, and propranolol, beta-adrenergic blocker, decreased heart rate and decreased LF/HF by reducing LF. In unanesthetized rabbits, stimulation of the vestibular system induced by rotation or caloric increased heart rate and increased LF/HF by increasing LF. Also electrical stimulation of the vestibular nerve produced the same effects as rotation or caloric in anesthetized rabbits. CONCLUSION: These results suggest that stimulation of the vestibular system increased heart rate not by inhibiting the parasympathetic nerve but by activating the sympathetic nerve.

The Role of Sek1 in Protecting NO-induced Apoptosis in H9c2 cells by Inhibiting Caspase 3 Activation / 대한해부학회지

The stress activated protein kinase, or Jun N-terminal kinase (SAPKs/JNKs), is activated in response to a variety of cellular stresses such as changes in osmolarity and metabolism, DNA damage, heat shock, ischemia, and inflammatory cytokines. Sek1 (JNKK/MKK4) is a direct activator of SAPKs/JNKs in response to environmental stresses or mitogenic factors. Thus, this study was conducted to investigate the role of Sek1 on nitric oxide (NO) induced apoptotic signaling pathway in H9c2 cell. The viability of SNP (Sodium Nitroprusside) treated inactive Sek1 kinase transfectants [Sek1/KI H9c2] is significantly decreased and SNP induce DNA fragmentation in Sek1/KI H9c2. Interestingly, concomitantly with SNP induced injuries, caspase 3-like activity is increased but caspase 1 like activity is not changed in Sek1/KI H9c2. Whereas wild type Sek1 kinase transfectants [Sek1/WT H9c2] is less susceptible to SNP induced apoptosis. In Sek1/KI H9c2, the injuries and DNA fragmentation by SNP is protected by adding Ac-DEVD-AMC, caspase 3 inhibitor. In conclusion, these results suggest that Sek1 plays a role in protecting NO-induced apoptosis and DNA fragmentaion in H9c2 cells by inhibiting caspase 3-like activation.

Predictors for In-stent Restenosis after Coronary Microstent II Implantation

BACKGROUND: Coronary stent is known as an effective treatment in the intimal dissection after angioplasty and the prevention of restenosis. However, in-stent restenosis still remains a major concern in clinical stenting. METHOD: The Microstents were placed in 151 patients from May '96 to Aug '97 and performed follow-up coronary angiograms in 49 (32.5%) patients. To identify the clinical, angiographic and procedure-related variables that predict late restenosis within the stented artery, 49 patients (58+/-8 year:38 M, 11 F) were studied. Indications for stenting were 25 de novo (52.8%), 9 restenotic (18.7%), 8 suboptimal PTCA (16.7%) and 6 bail-out lesions (12.6%). All patients were treated with aspirin and ticlopidine for one month after stenting. The follow-up angiograms were obtained at 5+/-3 months and variables of 13 patients with restenosis were compared with those of 36 patients without restenosis. RESULTS: The in-stent restenosis rate was 26.5%. Univariate logistic regression analysis was used to determine how in-stent restenosis was influenced. Clinical diagnosis, presence of risk factors, lipid profiles, numbers of involved vessels, target arteries, lesion length, lesion types, stent length, maximal inflation pressure, predilation balloon size, reference vascular diameter, minimal luminal diameter, and stent to artery diameter ratio were analyzed. Among these variables, only lesion length before stent implantation was a predictor for in-stent restenosis (19.9+/-11.1 mm vs. 10.9+/-7.3 mm, p=.017). CONCLUSION: Lesion length before Microstent II implantation is the single predictor of late in-stent restenosis.

Role of Vestibulosympathetic Reflex on Orthostatic Hypotension in Rats

BACKGROUND: The orthostatic hypotension in response to the assumption of an upright posture is regulated by activation of sympathetic nerves. Role of the vestibular system and neural pathway on orthostatic hypotension were investigated. METHODS: Changes of arterial blood pressure produced by head-up tilting, rotatory stimulation of the vestibular system, or electrical stimulation to the vestibular nerve, vestibular nuclei, and rostral ventrolateral medulla (RVLM) were measured in Sprague-Dawley rats. Also, field potentials were recorded in the vestibular nuclei and RVLM and c-Fos expression was evaluated in the brain stem in order to investigate the vestibulosympathetic pathways. RESULTS: The three phasic blood pressure responses were elicited by head-up tilting: initial fall, early recovery, and late sustained pressure at near control levels, the magnitude of the pressure fall was parallel with the degree of head-up tilting in normal rats. Return position from head-up tilting recovered control level of blood pressure after a brief rapid elevation. However, bilateral labyrinthectomy resulted in exaggerated initial falling and devoid of early recovery phase during postural change. Sinusoidal rotation about off-vertical axis of the vestibular system elicited more elevation of blood pressure than rotation about earth vertical axis. Electrical stimulation of the vestibular nerve, vestibular nucleus, and RVLM produced elevation of blood pressure, which was the most prominent by stimulation of RVLM. Field potentials composed of P, N1, N2 waves in the vestibular nuclei were recorded by stimulation of the vestibular nerve, while weak potentials in RVLM were recorded by stimulation of the vestibular nuclei. An electrical stimulation of the vestibular nuclei expressed c-Fos immunoreactive cells in RVLM. CONCLUSION: These results suggest that the otolith organ of the vestibular system plays a major role in control of orthostatic hypotension, and the pathway of vestibulosympathetic reflex in control of blood pressure involves the vestibular nuclei, RVLM, intermed-iolateral nuclei of the thoracic spinal cord.

Comparison of Porcine Corinary Stent Restenosis between MAC (Maximum Arterial Re-Creation)and Palmaz-Schatz Stent

BACKGROUND: Coronary stents are effective in the treatment of acute complications after angioplasty and the prevention of restenosis. However, complications may arise posttreatment, the major cinical problems are stent thrombosis and restenosis. All coronary stents are imported from western countries and are not covered by medical insurance in Korea. Korean stents should be developed to reduce patient's economic burden. METHODS: We placed five Maximum Arterial Re-Creation (MAC) and five Palmaz-Schatz (PS) stents in ten porcine coronary arteries. Stent and artery diameter ratio was 1.3 : 1.0. Follow-up coronary angiogram and histopathologic examinations were performed four weeks after stent overdilation injury. RESULTS: All of the stented arteries were patent on follow-up coronary angiograms. Angiographic diameter stenosis was 23.1+/-9.2% in MAC stents and 18.5+/-12.3% in PS stents and pathologic area stenosis was 35.6+/-11.4% in MAC stent and 39.8+/-9.9% in PS stent at 4 weeks after stenting, which were not different between two stents. Maximal intimal thickness (0.28+/-0.12 vs. 0.36+/-0.17mm) and neointimal area (1.83+/-1.01mm2 vs. 1.50+/-0.65mm2) were not different between MAC and PS stent. CONCLUSIONS: MAC stents are as effective as PS stents in the prevention of stent restenosis in a porcine stent restenosis model.

Clinical Characteristics of Korea Women with Ischemic Heart Disease

BACKGROUND: The prevalence of ischemic heart diseases (IHD) has increased remarkably during the past 10 years in Korea. Because only few reports on risk factors of IHD in Korean women exist, the aim of this study was to determine the clinical characteristics (including risk factors) of IHD in Korean women. METHODS: Fifty-six female patients and 122 (out of 655) of male patients with significant coronary artery stenosis were included in this study. There were 12 cases of angina pectoris and 35 cases of myocardial infarction in the 56 female patients. There were 54 cases of angina pectoris and 68 cases of myocardial infarction in the 122 male patients. Age and sexdistributions, risk factors of atherosclerosis, and coronary angiographic findings were compared between the female and male patients. RESULTS: The female patients were older than the male patients (63+/-8 years vs. 58+/-4 years, p or = 2) was greater in men than in women (43% vs. 25%, p<0.05). Hypertension was more prevalent (66% vs. 11%, p<0.001) and smoking was less (65% vs. 11%, p<0.001) in women than men. After age adjustment, hypertension was more frequent in women, and smoking was more in men (p=0.001). On coronary angiograms there were no difference in the morphology of coronary artery stenosis, the distribution of culprit vessels, and the number of vessels involved between women and men, In terms of therapeutic modalities, there were no differences between women and men in our study. CONCLUSIONS: In Koean women with IHD, hypertension is more common and smoking is less common. However, coronary artery lesion morphology and distribution are comparable between women and men.

Effect of NMDA Receptor Antagonist (APV)on the Toxicity Induced by Oxygen Radicals in Cultured Myocardial Cells / 체질인류학회지

Toxic effect of oxygen radicals and cardioprotective effect of N -methyl -D -aspartate (NMDA) receptor antagonists against xanthine oxidase (XO) and hypoxanthine (HX)-induced cardiotoxicity were measured in order to elucidate the mechanism of cardiotoxicity on cultured mouse myocardial cells. MTT assay was performed after myocardial cells were cultured for 12 hours at various concentrations of XO/HX alone or with D -2 -amino -5 -phosphonovaleric acid (APV) or 6 - cyano -7 -nitroquinoxaline -2,3 -dione (CNQX). In this study, XO/HX was toxic in a time -and dose -dependent manners on cultured myocardial cells, and midcytotoxicity value 50 (MTT50) was at 30 mU/ml XO and 0.1 mM HX after myocardial cells were grown for 12 hours in media containing 1 ~50 mU/ml XO and 0.1 mM HX. When cultures were treated with 30 mU/ml XO and 0.1 mM HX flus 20 80 microM APV for 12 hours, cell viability was increased remarkably, while treatment with 30 mU/ml XO and 0.1 mM HX flus 10 ~50 microM CNQX did not show any protective effect against XO/HX -induced neurotoxicity. From the above results, it is suggested that oxygen radicals are toxic on cultured mouse myocardial cells by the decrease of cell viability, and NMDA receptor antagonists such as APV are very effective in the prevention of myocardial toxicity induced by oxygen radicals.

A Case of Descending Thoracic Aortic Pseudoaneurysm Associated with Thoracolumbar Pedicle Screw Removal

Vascular injuries after spine surgery may result in acute life-threatening hemorrhage, chronic arteriovenous fistula, or pseudoaneurysm formation. The interval between injury and rupture may range from seconds to years, and accordingly, a high index of suspicion is needed to make the diagnosis. Although acute and delayed vascular injury caused by placement of posterior pedicle screw fixation has been reported, the potential for large vessel disruption during posterior pedicle screw removal has been rarely reported. This case report concerns a 50-year-old man who developed an descending thoracic aortic pseudoaneurysm after posterior pedicle screw removal, diagnosed by chest computed tomography(CT) scan and transesophageal echocardiography(TEE).

Arotic Atherosclerotic Plaques as a Potential Embolic Sources in Patients with Cryptogenic Stoke

BACKGROUND: The atherosclerotic plaque in the thoracic aorta has been considered as a potential source of cerebral or peripheral embolization. Especially, complex type of atherosclerotic plaques in the thoracic aorta have strongly been associated with cerebral embolism in ischemic stroke and transesophageal echocardiography(TEE) is a useful diagnostic tool for evaluation of thoracic aorta atherosclerosis. The aim of this study was to evaluate the prevalence and significance of complex type of thoracic atherosclerotic plaques in the patients with cryptogenic stroke who have neither cardiac source nor significant carotid atherosclerosis. METHOD: From 1993 to 1998, TEE and carotid Doppler sonography were performed in 58 consecutive patients with ischemic stroke and in 30 control patients without ischemic stroke. We divided the former into two groups. One is known-cause stroke(n=37) group and the other is Cryptogenic stroke group(n=21). We evaluated cardiogenic source of embolism, thoracic aorta atherosclerotic plaques as well as carotid atherosclerosis by carotid Doppler sonography and TEE. Aortic atherosclerosis was classified as grade 1: normal-appearing aortic intima, grade 2: extensive intimal thickening, grade 3: sessile atheroma protruding 5mm, and grade 5: mobile atheroma. Carotid atherosclerosis was categorized as significant if luminal stenosis of either common carotid artery or internal carotid artery is greater than 50%. RESULTS: 1) There was no statistically significant difference among the three groups in age, gender, diabetes mellitus, hyperlipidemia and smoking. 2) Hypertension was more common in the cryptogenic stroke group(p<0.05). Atrial fibrillation was more common in the known-cause and control group than in the cryptogenic group(p<0.005). 3) The carotid atherosclerosis was found in 7(12%) out of 58 consecutive patients with ischemic stroke. 4) The thoracic aortic atherosclerotic plaque was located primarily on descending aorta. The complex type of plaque was found in 8(38%) out of 21 patients with cryptogenic stroke. The complex type of plaque was found in 10(27%) out of 37 patients with known-cause stroke. The complex type of plaque was found in 3(10%) out of 30 patients with known-cause stroke. CONCLUSION: These results suggest that complex type of thoracic atherosclerotic plaques in cryptogenic stoke can be considered as potential source of ischemic stroke and we suggest that a patient with cerebral embolism without a source identified by the routine transthoracic echocardiograpy or carotid sonography shoud undergo transesophageal echocardiography to evaluate the thoracic aorta atheroma.

A Case of Torsade de Pointes after Treatment with Terfenadine and Ketoconazole

Torsade de pointes (TdP) is a form of polymorphic ventricular tachycardia that is associated with prolongation of the QT interval. Although it occurs in many clinical settings, torsade de pointes is most commonly caused by drugs. The second generation antihistamines, including terfenadine and astemizole, have little sedation or other adverse effects on the CNS. They have been used widely to treat various allergic diseases, but it has been reported that overdoses or combinations with antifungal agents or macrolide antibiotics may lead to TdP. We report a case of TdP that occured during com-bination therapy of terfenadine and ketoconazole.