• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.2
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• pp.707-712
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• 2013

In patients with acute myocardial infarction (AMI), the delay from symptom onset to hospital arrival has a critical effect on morbidity and mortality. This study examined to find out the determinants of the prehospital delay in patients with AMI. The study sample consisted of 597 patients hospitalized with AMI between Jan and Dec 2009. Demographic, medical history, and clinical data were abstracted from the hospital medical records of patients with confirmed AMI, the prehospital delay was categorized as less than or greater than 6 hours. Older age, low socioeconomic status(medical aid), and low use of Emergency medical system were associated with delays in seeking emergency care for Acute myocardial infarction. Education programs to improve patient knowledge of acute coronary syndrome symptoms and promote patient responsiveness with regard to seeking medical care should be used to reduce the prehospital delay time, especially in the low socioeconomic group.

• Biomedical Science Letters
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• v.19 no.3
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• pp.254-260
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• 2013

The purpose of this study was to survey the effects of Karvonen exercise prescription in coronary artery disease patients reaching age-predicted maximal heart rates with the exercise stress test on hemodynamic responses and cardiorespiratory fitness. The subject group was comprised of acute coronary syndrome (ACS) patients, who were divided into the maximal heart rate (MHR) group that included those who completed the test with their heart rates reaching the number of 220-age and the maximal dyspnea (MD) group that included those who could not continue the test due to respiratory difficulty and were asked to stop the test. Both groups had the exercise stress test before and after the experiment. In the exercise stress test before the experiment, the exercise prescription intensity of Karvonen was set at the target heart rates of 50~85% with a six-week exercise monitoring arrangement. As a result, there were no interactive effects in rest heart rate (RHR) according to time and group, but interactive effects were observed in maximal heart rate (MHR) (P=0.000). Both rest systolic blood pressure (RSBP) and rest diastolic blood pressure (RDBP) had no interactive effects according to time and group. Maximal systolic blood pressure (MSBP) showed significant interactive effects according to time and group (P=0.017). Maximal diastolic blood pressure (MDBP) showed no interactive effects according to time and group, while maximal rate pressure product (MRPP) showed significant interactive effects according to time and group (P=0.003). Maximal time (MT) had no interactive effects according to time and group. $VO_{2max}$ and maximal metabolic equivalent (MMET) showed significant interactive effects according to time and group (P=0.000, P=0.002, respectively), whereas maximal respiratory exchange ratio (MRER) and maximal rating of perceived exertion (MRPE) showed no interactive effects according to time and group. The exercise test that was discontinued as the subjects reached the predicted maximal heart rates considering age did not reach the maximal exercise intensity and accordingly showed low exercise effects when applied to Karvonen exercise prescription intensity. That is, the test should keep going by monitoring cardiac events, MRER and MRPE until the heart rates exceed the predicted MHR by up to 10~12 even after the subject reaches the predicted MHR considering age in the exercise stress test.

• Journal of Chest Surgery
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• v.12 no.3
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• pp.207-214
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• 1979

This 3-year-old girl was observed frequent exertional dyspnea and cyanosis at crying since birth. She was not premature baby and delivered at full term normally. On physical examination, she was underdeveloped-body weight 13.5 kg, height 99 cm.- and cyanotic. There was severe clubbing on fingers. There was grade II/VI ejection systolic murmur on left lateral border of the sternum. The preoperative examinations [EKG, echocardiogram, cardiac catheterization and biventriculogram] showed that complicated T.G.A. combined vena cava[S.D.D.]. Preoperatively, we decided the corrective surgery of Rastelli operation using a. pulmonary valved conduit. The operation was performed under total circulatory arrest using deep profound hypothermia combining with extracorporeal circulation. On operation, the anatomy of the heart showed that, 1. The subaortic conus was seen and subaortic muscles were hypertrophied. 2. The VSD[type II], behind the subaortic conus-about 1 cm. in diameter, was visible only through LV cavity and, 3. The pulmonary valve ring was hypoplastic and pulmonary valvular stenosis was seen also. The subpulmonic area [LV outflow tract] was obstructed with hypertrophied muscle and mitral valve. 4. Left superior vena cava was drained to RA via coronary sinus. 5. LAD coronary artery was originated from right coronary artery and ran anterior to the pulmonary artery. According to above anatomy, we performed the VSD closure with Teflon patch, and Mustard operation combined with LV-to-pulmonary artery bypass graft using the valve contained [Hancock 16 mm] conduit. Postoperatively, adequate blood pressure could be maintained under the state of using inotropic agent [epinephrine]. On the second postoperative day, the patient died of cardiac arrest due to low cardiac output syndrome, acute renal failure and pulmonary edema.

• Clinical and Experimental Pediatrics
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• v.55 no.12
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• pp.470-473
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• 2012

Purpose: The purpose of this prospective case-control study was to survey the detection rate of respiratory viruses in children with Kawasaki disease (KD) by using multiplex reverse transcriptase-polymerase chain reaction (RT-PCR), and to investigate the clinical implications of the prevalence of respiratory viruses during the acute phase of KD. Methods: RT-PCR assays were carried out to screen for the presence of respiratory syncytial virus A and B, adenovirus, rhinovirus, parainfluenza viruses 1 to 4, influenza virus A and B, metapneumovirus, bocavirus, coronavirus OC43/229E and NL63, and enterovirus in nasopharyngeal secretions of 55 KD patients and 78 control subjects. Results: Virus detection rates in KD patients and control subjects were 32.7% and 30.8%, respectively (P=0.811). However, there was no significant association between the presence of any of the 15 viruses and the incidence of KD. Comparisons between the 18 patients with positive RT-PCR results and the other 37 KD patients revealed no significant differences in terms of clinical findings (including the prevalence of incomplete presentation of the disease) and coronary artery diameter. Conclusion: A positive RT-PCR for currently epidemic respiratory viruses should not be used as an evidence against the diagnosis of KD. These viruses were not associated with the incomplete presentation of KD and coronary artery dilatation.

• Journal of Medicine and Life Science
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• v.21 no.2
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• pp.31-39
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• 2024

This study was conducted to determine whether level-1 emergency medical technicians (EMTs) can adequately recognize ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) and whether their ability to do so differs from that of emergency medicine physicians (EMP). From December 2022 to November 2023, patients aged 20 years or older visiting the ED with chief complaints suggesting acute coronary syndrome (ACS) were enrolled. As soon as the patient arrived at the ED, a level-1 EMT conducted a 12-lead electrocardiogram (ECG) to assess STEMI; an EMP subsequently assessed whether to activate the percutaneous coronary intervention team. Demographic characteristics, test results, and final diagnoses were collected from the medical records. Among the 723 patients with case report forms, 720 were included in the analysis. These were categorized as follows: 117 (16.3%) with STEMI, 159 (22.1%) with non-ST-segment elevation ACS, and 444 (61.7%) with other conditions. STEMI was correctly recognized in 100 patients (91.7%) by level-1 EMTs and in 104 patients (95.4%) by EMPs (kappa=0.646). EMTs with less than 1 year of ED work experience correctly recognized 60 out of 67 STEMI patients (89.6%), which was comparable with the EMPs who recognized 65 out of 67 STEMI patients (97.0%, kappa=0.614). EMTs with more than 1 year of ED work correctly recognized 40 out of 42 STEMI patients (95.2%), and therefore performed better than EMPs, who recognized 39 out of 42 STEMI patients (92.9%, kappa=0.727). The level-1 EMTs adequately recognized STEMI using a 12-lead ECG and were in substantial agreement with the evaluations of the EMPs.

• Pediatric Infection and Vaccine
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• v.28 no.2
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• pp.66-81
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• 2021

The coronavirus disease 2019 pandemic has been continuously spreading throughout the world. As of July 15, 2021, there have been more than 188 million confirmed cases and more than 4.06 million deaths. Although the incidence of severe infections is relatively low in children and adolescents compared to adults, a complication called multisystem inflammatory syndrome in children (MIS-C) may occur in some cases at approximately 2-6 weeks after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. MIS-C can be seen in patients of various ages, from young infants to adolescents, and may present with diverse clinical manifestations. While fever present in a great majority of patients, symptoms suggesting the involvement of the digestive or nervous system and the skin and mucous membranes (Kawasaki disease-like symptoms) also appear in many cases. Cardiac involvement may also be observed, including left ventricular dysfunction, myocarditis, coronary artery dilatation, and coronary aneurysm. In some cases, hypotension or shock can occur, and mechanical ventilation or treatment in the intensive care unit may be necessary. Fortunately, recovery is generally reported after appropriate treatment. MIS-C is a rare but important complication of SARS-CoV-2 infection in children and adolescents. As such, it is important to recognize the clinical symptoms and provide appropriate treatment at an early stage. In this review, the epidemiology, clinical symptoms, suggested pathophysiology, diagnostic approach, and treatment of MIS-C will be discussed.

• The Korean Journal of Physiology and Pharmacology
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• v.27 no.2
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• pp.143-155
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• 2023

Percutaneous coronary intervention and acute coronary syndrome are both closely tied to the frequently occurring complication of coronary microembolization (CME). Resveratrol (RES) has been shown to have a substantial cardioprotective influence in a variety of cardiac diseases, though its function and potential mechanistic involvement in CME are still unclear. The forty Sprague-Dawley rats were divided into four groups randomly: CME, CME + RES (25 mg/kg), CME + RES (50 mg/kg), and sham (10 rats per group). The CME model was developed. Echocardiography, levels of myocardial injury markers in the serum, and histopathology of the myocardium were used to assess the function of the cardiac muscle. For the detection of the signaling of TLR4/MyD88/NF-κB along with the expression of pyroptosis-related molecules, ELISA, qRT-PCR, immunofluorescence, and Western blotting were used, among other techniques. The findings revealed that myocardial injury and pyroptosis occurred in the myocardium following CME, with a decreased function of cardiac, increased levels of serum myocardial injury markers, increased area of microinfarct, as well as a rise in the expression levels of pyroptosis-related molecules. In addition to this, pretreatment with resveratrol reduced the severity of myocardial injury after CME by improving cardiac dysfunction, decreasing serum myocardial injury markers, decreasing microinfarct area, and decreasing cardiomyocyte pyroptosis, primarily by blocking the signaling of TLR4/MyD88/NF-κB and also reducing the NLRP3 inflammasome activation. Resveratrol may be able to alleviate CME-induced myocardial pyroptosis and cardiac dysfunction by impeding the activation of NLRP3 inflammasome and the signaling pathway of TLR4/MyD88/NF-κB.

• Pediatric Infection and Vaccine
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• v.30 no.2
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• pp.97-103
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• 2023

Kawasaki disease (KD) is an acute, systemic inflammatory disorder that often targets coronary arteries. Being the common cause of acquired heart disease in children, timely diagnosis and intravenous immunoglobulin treatment are crucial. However, it is challenging for physicians to diagnose KD if it presents with atypical manifestations. We report the case of a 5-year-old boy who initially presented with appendicitis; after an appendectomy, he had a prolonged fever. He was finally diagnosed with atypical KD and successfully recovered after intravenous immunoglobulin treatment. Through a literature review, we found 21 cases of appendicitis associated with KD. In most cases, the patients were male with a mean age of 5.3 years. Most had higher proportions of incomplete KD and coronary artery complications than expected for typical KD. In conclusion, appendicitis could be a rare complication of KD; therefore, multidisciplinary cooperation and early recognition of atypical KD are essential for timely diagnosis.

• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.234-241
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• 2009

Purpose : We investigated the relationship between thyroid hormone and serum tumor necrosis factor (TNF-${\alpha}$), interleukin (IL-6) and N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in patients with Kawasaki disease (KD). Methods : Serum levels of thyroid hormone, TNF-${\alpha}$, IL-6, and NT-proBNP were measured in 52 KD patients in the acute and subacute phase and 10 patients with acute febrile illness (control group). TNF-${\alpha}$ and IL-6 were determined by sandwich enzyme-linked immunosorbent assay (ELISA). Echocardiography was performed to detect coronary artery lesions (CAL) in KD patients. Results : Low $T_3$ syndrome occurred in 63.5% of KD patients. $T_3$ in the acute phase of KD was lower than that in the control. In KD patients, $T_3$ was lowered in the acute phase and elevated in the subacute phase, whereas TNF-${\alpha}$, IL-6 and NT-proBNP were elevated in the acute phase and decreased in the subacute phase. NT-proBNP, and IL-6 were higher in patients with low $T_3$ than in those with normal $T_3$. In addition, $T_3$ inversely correlated with IL-6 and NT-proBNP. Of the 4 patients with CAL, 3 had very low $T_3$. Compared with intravenous immunoglobulin (IVIG)-responsive patients, IVIG-resistant patients had lower $T_3$ and higher IL-6 and NT-proBNP. Conclusion : $T_3$ decreases in the acute phase of KD and normalizes in the subacute phase without thyroid hormone replacement. Low $T_3$ may be partially induced by IL-6 rather than TNF-${\alpha}$, and is strongly associated with high NT-proBNP. $T_3$ in KD may be used for the differential diagnosis, monitoring the activity of the disease, and predicting the severity of inflammation.

• Journal of Chest Surgery
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• v.38 no.7 s.252
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• pp.476-482
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• 2005

Recently, coronary artery obstructive disease and coronary artery bypass graft surgery have increased, and the operative result has been improved. We reviewed 154 cases of coronary artery bypass graft surgery from Jan. 1985 to Jun. 2004. Material and Method: We reviewed 148 patients, 154 cases of coronary artery bypass surgery from Jan. 1985 to Jun. 2004. This investigation is designed to illustrate the preoperative diagnosis, severity of disease, operative method, the kind of used bypass graft used, number of distal anasomosis, associated surgery, and postoperative morbidity and mortality. Result: There were 84 males, 64 females and the average age was $58.9\pm8.3$ years old. Preoperative clinical diagnosis were unstable angina in 97 cases $(63.0\%)$, stable angina in 31 cases $(20.1\%)$, acute myocardial infarction in 12 cases $(7.8\%)$ and postinfartion angina in 14 cases $(9.1\%)$. Preoperative angiographic diagnosis were three-vessel disease in 68 $(44.2\%)$, two-vessel disease in 39 $(25.3\%)$, one-vessel disease in 35$(22.7\%)$, and left main disease in 12$(7.8\%)$ cases. There were 78 cases of on-pump coronary artery bypass graft surgery and 76 cases of off-pump coronary artery bypass graft surgery. The total distal anastomoses number was 319, mean number of anastomoses was $2.06\pm0.96$. There were 10 concomitant procedures. Postoperative intra-aortic balloon pump was used in 21$(13.6\%)$ cases, but only 4 cases were used at off-pump coronary artery bypass surgery. Total early mortality was $7.8\%$. The mortality was decreased as $4.5\%$ from Jan. 2001 to Jun. 2004. Post operative complication was perioperative yocardial infarction in 9cases$(5.8\%)$, low cardiac output syndrome in 17 cases$(11\%)$, and arrhythmia in 30 cases$(19.5\%)$ cases. Conclusion: Since 1985, The result of coronary artery bypass graft surgery has been improved because of more refined technique, use of off-pump coronary artery bypass surgery, use of internal thoracic artery and radial artery as bypass graft. We should study the long-term follow up more for better operative results.