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Objective@#Serum hemoglobin (Hb) level affects the viscosity of blood. Several studies have reported that Hb level is associated with adverse cardiovascular outcome. However, there is a paucity of evidence on the association between serum Hb level and the risk of subclinical atherosclerosis. Thus, the objective of this study was to investigate the relationship between Hb level and risk of carotid plaque in a health checkup cohort. @*Methods@#This retrospective study analyzed a total of 3,805 individuals without history of cardiovascular disease (CVD) who underwent carotid ultrasonography (USG) between January 2016 and June 2018. Participants were divided into 4 groups based on Hb quartiles in each of male and female. Carotid plaque score was calculated based on USG reports.Multivariable logistic regression analysis was performed for each index of quartile groups regarding the risk of carotid plaque. @*Results@#Of 3,805 individuals (mean age, 52.62±10.25 years; 2,674 [70.28%] males), mean Hb level was 15.11±0.75 g/dL in male and 13.35±0.74 g/dL in female. When the Q1 group was compared to the Q4, increasing quartile of Hb was associated with the presence of significant carotid plaque (plaque score ≥3) in male (adjusted odds ratio [OR], 1.538; 95% confidence interval [CI], 1.182–2.001; p=0.001) and female (adjusted OR, 1.749; 95% CI, 1.058–2.676; p=0.01). @*Conclusion@#A high Hb level is associated with an increased risk of carotid plaques in individuals without history of CVD. This finding may support the need for early screening of CVD in individuals with high Hb levels.
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Morel-Lavallée lesions (MLL) create pre-fascial space by shearing the subcutaneous tissues away from the underlying fascia, in a patient with trauma. Necrosis of the overlying skin can develop over a wide area of the lesion. The lesion might be contaminated by the surgical site due to careless intrusion when treating the combined arteriopathy. A 70-year-old woman presented with avulsion of the skin over the right foot and bilateral leg pain following a car accident. Computed tomography showed bilateral popliteal artery occlusion with large hematoma on both legs. Percutaneous angioplasty was performed with successful restoration of the flow. However, the skin color changes over time. Necrosis of the skin occurred over a wide area of the right leg. Extensive debridement was performed, and the defect was covered with a skin graft. MLLs can occur in patients with multiple traumas, multiple vascular injuries, and complex skeletal injury. Vascular surgeons treating multiple traumas should be aware of the diagnostic and management options for MLL. It should be diagnosed early because it can be difficult to manage once the overlying skin develops necrosis.
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Background@#Cardiac arrest during or after office-based cosmetic surgery is rare, and little is known about its prognosis. We assessed the clinical outcomes of patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics. @*Methods@#Between May 2009 and May 2016, 32 patients who developed cardiac arrest during or after treatment at cosmetic surgery clinics were consecutively enrolled. We compared clinical outcomes, including complications, between survivors (n=19) and non-survivors (n=13) and attempted to determine the prognostic factors of mortality. @*Results@#All 32 of the patients were female, with a mean age of 30.40±11.87 years. Of the 32 patients, 13 (41%) died. Extracorporeal life support (ECLS) was applied in a greater percentage of non-survivors than survivors (92.3% vs. 47.4%, respectively; p=0.009). The mean duration of in-hospital cardiopulmonary resuscitation (CPR) was longer for the non-survivors than the survivors (31.55±33 minutes vs. 7.59±9.07 minutes, respectively; p=0.01).The mean Acute Physiology and Chronic Health Evaluation score was also higher among non-survivors than survivors (23.85±6.68 vs. 16.79±7.44, respectively; p=0.01). No predictor of death was identified in the patients for whom ECLS was applied. Of the 19 survivors, 10 (52.6%) had hypoxic brain damage, and 1 (5.3%) had permanent lower leg ischemia.Logistic regression analyses revealed that the estimated glomerular filtration rate was a predictor of mortality. @*Conclusion@#Patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics experienced poor prognoses, even though ECLS was applied in most cases. The survivors suffered serious complications. Careful monitoring of subjects and active CPR (when necessary) in cosmetic surgery clinics may be essential.
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OBJECTIVE: Contrast-induced nephropathy (CIN) frequently occurs after percutaneous intervention. Objective of this study was to investigate the usefulness of serum cystatin C, neutrophil gelatinase-associated lipocalcin (NGAL), urinary kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) as early predictors for CIN after percutaneous coronary intervention (PCI). METHODS: In 53 patients who underwent PCI were enrolled. Serum creatinine and cystatin C level were measured immediately before, and 24 hours and 48 hours after catheterization. Serum NGAL, urinary KIM-1, and IL-18 were measured immediately before, and 4 hours, 24 hours, and 48 hours after catheterization. CIN was defined as a rise in creatinine 0.5 mg/dL or 25% above baseline. RESULTS: CIN occurred in four patients (7.5%). Serum cystatin C levels were higher at 24 hours and 48 hours in CIN patients than in those without CIN (P<0.05). Serum NGAL levels were higher at 48 hours in CIN patients than in those without CIN. Urinary KIM-1 levels were higher at 48 hours in CIN patients than in those without CIN. There were no significant markers of CIN on multi-variate analysis. CONCLUSION: In this study, the occurrence of CIN after PCI was 7.5%. Although there were some time-course changes in serum cystatin C and urinary KIM-1 after PCI, there was no significant predictor for CIN after PCI.
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Humanos , Cateterismo , Catéteres , Meios de Contraste , Creatinina , Cistatina C , Interleucina-18 , Rim , Neutrófilos , Intervenção Coronária PercutâneaRESUMO
BACKGROUND AND OBJECTIVES: It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD). METHODS: Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants. RESULTS: The mean follow-up time was 259.9±148.8 days with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF ( < 55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36–0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39–0.97, p=0.037) for all-cause mortality. CONCLUSIONS: LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.
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Humanos , Fibrilação Atrial , Doença das Coronárias , Ecocardiografia , Seguimentos , Incidência , Ataque Isquêmico Transitório , Mortalidade , Infarto do Miocárdio , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral , Volume Sistólico , Função Ventricular EsquerdaRESUMO
BACKGROUND AND OBJECTIVES@#It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD).@*METHODS@#Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants.@*RESULTS@#The mean follow-up time was 259.9±148.8 days with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF ( < 55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36–0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39–0.97, p=0.037) for all-cause mortality.@*CONCLUSIONS@#LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.
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Radial artery perforation is one of the major complications of transradial percutaneous coronary intervention (PCI). Previous reports have suggested that sealing the perforation with a smaller guiding catheter may be possible. In one such study, the perforated segment was sealed with a 0.014- or 0.021-inch guidewire, and PCI was successfully completed. In this study, we describe a radial artery perforation that occurred after diagnostic coronary angiography and during insertion of a 6 French (FR) guiding catheter. PCI and the perforation were successfully managed through the use of a 5 Fr guiding catheter and a 0.035-inch guidewire.
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Catéteres , Angiografia Coronária , Intervenção Coronária Percutânea , Artéria RadialRESUMO
We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding.
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Humanos , Pessoa de Meia-Idade , Angiografia , Encéfalo , Artéria Carótida Primitiva , Tontura , Emergências , Hemorragia , Infarto , Reflexo de Babinski , Convulsões , Acidente Vascular Cerebral , Tórax , Ativador de Plasminogênio TecidualRESUMO
No abstract available.
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Adolescente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Cardiomiopatia Hipertrófica Familiar/complicações , Cardioversão Elétrica , Eletrocardiografia , Predisposição Genética para Doença , Insuficiência Cardíaca/etiologia , Septos Cardíacos/efeitos dos fármacos , Imageamento por Ressonância Magnética , Linhagem , Fenótipo , Taquicardia Ventricular/etiologia , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologiaRESUMO
Polycystic kidney disease (PCKD) is rarely associated with aortic dissection (AD), which is a life-threatening disease. Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported. This case shows a 37-year-old male who had sudden onset of sharply stabbing epigastric pain with severe hypertension, who was diagnosed with TBAD and PCKD by a computed tomography and initially underwent medical treatment. Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion. Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms. We report the case of complicated TBAD in a patient with PCKD treated with endovascular stent-graft repair.
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Adulto , Humanos , Masculino , Doenças da Aorta , Procedimentos Endovasculares , Hipertensão , Perna (Membro) , Parestesia , Doenças Renais PolicísticasRESUMO
The incidence of infective endocarditis (IE) in hemodialysis patients is higher than the general population. Hemodialysis patients with IE have a poorer prognosis than other patients with IE. The most common sites of IE in hemodialysis patients are the mitral valve and aortic valve. A 47-year-old woman had suffered from recurrent catheter-related blood stream infection and she was strongly suspected of IE. Despite repeated transthoracic echocardiography and transesophageal echocardiography (TEE), IE was revealed several months later by TEE due to the unusual location of the vegetation. The vegetation was detected on the left ventricle outflow tract. She recovered well without any complication after mitral valve replacement surgery.
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Feminino , Humanos , Pessoa de Meia-Idade , Valva Aórtica , Infecções Relacionadas a Cateter , Ecocardiografia , Ecocardiografia Transesofagiana , Endocardite , Ventrículos do Coração , Incidência , Valva Mitral , Prognóstico , Diálise Renal , RiosRESUMO
OBJECTIVE: Longstanding hypertension lead to left ventricular diastolic dysfunction with a development of a left atrial enlargement (LAE) which may result in vulnerability to atrial fibrillation (AF). Paroxysmal AF is usually unrevealed in the acute period of ischemic stroke, but is crucial for anticoagulation to prevent recurrent stroke. This study was aimed to investigate the frequency of LAE and the predictors of paroxysmal AF during the hospitalization of acute ischemic stroke. METHODS: A total 1,643 consecutive patients with acute ischemic stroke were registered in between January 2005 and December 2014. The subjects who had AF before index stroke or at admission were excluded. The clinical and echocardiographic findings of all patients were reviewed. Paroxysmal AF were detected on electrocardiography of Holter monitoring during hospitalization. LAE were defined as LA diameter larger than 44 mm in echocardiography. We compared the frequency of LAE between the patients with or without AF. Logistic regression analysis were performed to determine the echocardiographic parameters for prediction of paroxysmal AF. RESULTS: The mean age was 67.3 and the male was 55.6%. AF were detected in 123 (11.4%) of LAE(-) group but were detected in 102 (49.0%) in LAE(+) group. In logistic regression analysis, LAE significantly predicted for newly detected AF during hospitalization after adjusting covariates (odds ratio, 5.698; 95% confidence interval, 3.799-8.546; P<0.001). CONCLUSION: LAE was an independent predictor for AF during hospitalization in patients with acute ischemic stroke. Prolonged electrocardiography monitoring should be meticulously indicated for acute ischemic stroke with LAE to detect paroxysmal AF.
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Humanos , Masculino , Fibrilação Atrial , Função do Átrio Esquerdo , Ecocardiografia , Eletrocardiografia , Eletrocardiografia Ambulatorial , Hospitalização , Hipertensão , Modelos Logísticos , Acidente Vascular CerebralRESUMO
A 46-year-old male arrived at the emergency department with acute dyspnea. On the way to the hospital, heart massage was performed in the ambulance due to asystole on electrocardiography. After 2 hr of resuscitation, sinus rhythm was restored. Extracorporeal life support and an intra-aortic balloon pump were applied due to cardiogenic shock, but the patient showed sustained hypotension. Echocardiography showed moderate pericardial effusion with physiological evidence of cardiac tamponade; emergency pericardiocentesis was performed, which produced bloody pericardial fluid. An explorative sternotomy revealed a massive hematoma in the mediastinum and right ventricular (RV) free wall rupture. After primary repair, echocardiography showed improved left ventricular systolic function and the patient was stable clinically. This case presents RV free wall rupture as an unusual complication of prolonged heart massage. Heart rupture should be considered in hemodynamically unstable patients after prolonged heart massage.
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Humanos , Masculino , Pessoa de Meia-Idade , Ambulâncias , Tamponamento Cardíaco , Reanimação Cardiopulmonar , Morte Súbita Cardíaca , Dispneia , Ecocardiografia , Eletrocardiografia , Emergências , Serviço Hospitalar de Emergência , Parada Cardíaca , Massagem Cardíaca , Ruptura Cardíaca , Hematoma , Hipotensão , Mediastino , Derrame Pericárdico , Pericardiocentese , Ressuscitação , Ruptura , Choque Cardiogênico , EsternotomiaRESUMO
Stress cardiomyopathy or Takotsubo cardiomyopathy can mimic acute myocardial infarction and recognition of this disease by emergency physician is important. Cardiomyopathy can be represented as variant type - classic, inverted or reverse, mid ventricular, localized. The left ventricular dysfunction that occurs with stress cardiomyopathy is believed to be secondary to a catecholamine surge brought on by intense psychological or physical stress. Regional differences in adrenergic sensitivity or innervation could explain the different variations in wall motion abnormalities. We report here on a case of inverted type stress cardiomyopathy due to iatrogenic epinephrine injection. We hope to raise awareness of the possible harmful effects of epinephrine on the myocardium even in younger patients. Thus, clinicians should be prepared to suspect, recognize, and manage this disease in patients with acute coronary syndrome like symptoms and be aware of possible iatrogenic triggers.
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Humanos , Síndrome Coronariana Aguda , Cardiomiopatias , Emergências , Epinefrina , Esperança , Infarto do Miocárdio , Miocárdio , Cardiomiopatia de Takotsubo , Disfunção Ventricular EsquerdaRESUMO
We report a case of a 41-year-old man undergoing hemodialysis who presented with a sudden fever and dyspnea. He developed a severe pericardial effusion due to methicillin-resistant Staphylococcus aureus, which was identified in both blood and pericardial fluid cultures. He was successfully treated with intravenous vancomycin for 6 weeks. Although such cases are very rare in Korea, the current case describes a primary purulent pericarditis without any other potential infectious foci.
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Adulto , Humanos , Dispneia , Febre , Coreia (Geográfico) , Staphylococcus aureus Resistente à Meticilina , Derrame Pericárdico , Pericardite , Diálise Renal , VancomicinaRESUMO
ST-elevation myocardial infarction (STEMI) involving multivessel coronary arteries is extremely rare. Consecutive STEMI in a nonculprit vessel during primary percutaneous coronary intervention (PCI) of the culprit vessel has not been reported. A 53-year-old male presented to the emergency department with anterior wall STEMI. Just after successful primary PCI of the left anterior descending artery, inferior wall STEMI developed. PCI of the right coronary arteries was performed successfully. Five days later, the patient was discharged without symptoms of heart failure. This case underlines the high thrombogenicity along the coronary arteries in patients with STEMI.
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Humanos , Masculino , Pessoa de Meia-Idade , Artérias , Vasos Coronários , Serviço Hospitalar de Emergência , Insuficiência Cardíaca , Infarto do Miocárdio , Intervenção Coronária PercutâneaRESUMO
No abstract available.
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Feminino , Humanos , Pessoa de Meia-Idade , Administração Cutânea , Monitorização Ambulatorial da Pressão Arterial/efeitos adversos , Dermatite de Contato/diagnóstico , Antagonistas dos Receptores Histamínicos/administração & dosagem , Hipertensão/diagnóstico , Esteroides/administração & dosagem , Resultado do TratamentoRESUMO
A 52-year-old woman presented with atypical chest pain. Coronary angiography demonstrated multiple microfistulae between left coronary artery and left ventricle (LV) cavity, extensive enough to produce an LV angiogram. This LV angiogram revealed apical hypertrophic cardiomyopathy (HCM) which was confirmed by echocardiography. Coronary steal phenomenon by coronary artery microfistulae and HCM might have a role for developing of angina in patient with apical HCM.
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Feminino , Humanos , Pessoa de Meia-Idade , Cardiomiopatia Hipertrófica , Dor no Peito , Angiografia Coronária , Vasos Coronários , Ecocardiografia , Fístula , Ventrículos do Coração , VeiasRESUMO
ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.
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Humanos , Aorta , Aterosclerose , Dor no Peito , Oclusão Coronária , Vasos Coronários , Diagnóstico , Emergências , Cirurgia Geral , Máscaras , Infarto do Miocárdio , Revascularização MiocárdicaRESUMO
ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.