• Journal of The Korean Society of Clinical Toxicology
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• v.2 no.1
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• pp.7-11
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• 2004

Purpose: We would evaluate the cardiovascular manifestations of the patients with acute organophosphate and carbamate poisoning in the emergency department. Methods: This was retrospectively studied with the review of patient's charts, included total 38 patients were admitted during the past two years in the emergency department of Yeungnam university hospital with the diagnosis of organophosphate or carbamate poisoning. Results: Cardiovascular complications were variously developed in many patients. Electrocardiographic findings were as follows; 4 ($10.5\%$) cardiac arrhythmias included 1 cardiac arrest caused by ventricular fibrillation, 14 ($36.8\%$) sinus tachycardias, 3 ($7.9\%$) sinus bradycardias, and 17 ($44.7\%$) normal sinus rhythms. Conduction disturbances were 23 ($60.5\%$) like as prolonged QTc, 4 ($10.5\%$) ST-T changes, 2 (5.3%) first degree AV block, and 3 ($7.9\%$) right bundle branch block were shown. Other cardiovascular complications were 22 ($57.9\%$) hypertensives, 4 ($10.5\%$) hypotensives, 15 ($39.5\%$) tachycardias, 2 ($5.3\%$) bradycardias, 18 ($47.4\%$) hypoxemics, 12 ($31.6\%$) metabolic acidosis, and 9 ($23.7\%$) pulmonary edemas. Sixteen patients ($42.1\%$) needed ventilatory support because of respiratory paralysis. No patients died in hospital and 36 ($94.7\%$) patients were alive-discharged. Conclusion: Cardiovascular complications are variously in patients with acute organophosphate and carbamate poisoning. Especially, some findings included ventricular arrhythmias, QTc prolongation, hypoxemia, acidosis, and blood pressure changes are known as major precipitating factors to increase the mortality. So, intensive support and aggressive treatment are needed in patients shown various cardiovascular manifestations in the emergency department.

• The Korean Journal of Pharmacology
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• v.14 no.1_2
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• pp.41-46
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• 1978

The effects of sodium taurocholate(STC) and sodium deoxycholate(SDC) on cardiac function were examined by using isolated atria of rabbit and guinea pig and heart of anesthetized frog. Also the antiarrythmic action of STC and SDC on atrial arrhythmias induced by epinephrine or ouabain was studied. The results were following. The cholates exhibited a slight decrease in rate and contractile amplitude of the isolated rabbit atria. The cholates abolished partially the spontaneous arrhythmic occurring in isolated rabbit and guinea pig atria but no effect on the atrial arrhythmia induced by ouabain and epinephrine was observed. Concomitant administration of cholates with ouabain produced a marked prolongation of atrial arrhythmia in comparison to that of ouabain alone in both isolated rabbit and guinea pig atria. The cholates exhibited a marked prolongation in ventricular arrhythmia and cardiac arrest time in comparison to that of ouabain treatment. However, the combined treatment with cholates and ouabain produced a slight prolongation in comparison to that of ouabain alone in the heart of anesthetized frog. The above results suggest that cholates have a slight antiarrythmic effect on the heart but this effectiveness is different from those of propranolol that is non-selective antiarrhythmic drug.

• Journal of Korean Critical Care Nursing
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• v.7 no.2
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• pp.14-23
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• 2014

Purpose: The purpose of this study was to provide basic information to develop appropriate nursing guidelines for cardiac telemetry. Methods: This retrospective research was conducted to identify the current usage of cardiac telemetry and considered 1,000 patients hospitalized for telemetry. The collected data were analyzed using IBM (SPSS Statistics for Windows 21.0). Results: Four-hundred and ninety-two patients (49.2%) were diagnosed with arrhythmia and 209 (20.9%) with heart failure. Electrocardiogram (ECG) rhythm changes were detected via telemetry in 464 cases. Major arrhythmias were ventricular tachycardia (183, 39.4%) and bradycardia (99, 21.3%). Interventions after detecting arrhythmia were cardioversion (16, 3.4%), defibrillation (1, 0.2%), and cardiopulmonary cerebral resuscitation (5, 1.1%); other patients were treated conservatively with close observation (381, 82.1%). Conclusion: There was appropriate intervention in 46.4% of the considered cases with the detection of ECG changes before patient notification, which implied that cardiac telemetry could be considered for application to patients with hemodynamic instability. Clear standards and guidelines are required to determine who requires telemetry and when to end the telemetry monitoring.

• Korean Circulation Journal
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• v.53 no.5
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• pp.273-293
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• 2023

Pulsed field ablation (PFA) was recently rediscovered as an emerging treatment modality for the ablation of cardiac arrhythmias. Ultra-short high voltage pulses are leading to irreversible electroporation of cardiac cells subsequently resulting in cell death. Current literature of PFA for pulmonary vein isolation (PVI) consistently reported excellent acute and long-term efficacy along with a very low adverse event rate. The undeniable benefit of the novel ablation technique is that cardiac cells are more susceptible to electrical fields whereas surrounding structures such as the pulmonary veins, the phrenic nerve or the esophagus are not, or if at all, minimally affected, which results in a favorable safety profile that is expected to be superior to the current standard of care without compromising efficacy. Nevertheless, the exact mechanisms of electroporation are not yet entirely understood on a cellular basis and pulsed electrical field protocols of different manufactures are not comparable among one another and require their own validation for each indication. Importantly, randomized controlled trials and comparative data to current standard of care modalities, such as radiofrequency- or cryoballoon ablation, are still missing. This review focuses on the "pearls" and "pitfalls" of PFA, a technology that has the potential to become the future leading energy source for PVI and beyond.

• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.610-617
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• 1995

Sleep apnea occurs in approximately 50% of patients with acromegaly, and sleep apnea is associated with increased cardiovascular diseases and mortality. In view of these findings, sleep apnea may be a factor in the increased incidence of cardiovascular deaths in acromegaly patients. We experienced a case of active acromegaly patient, 54-yr-old man, associated with obstructive sleep apnea syndrome, congestive heart failure with dilated cardiomyopathy and serious cardiac arrhythmias. He was treated for obstructive sleep apnea syndrome, diagnosed by overnight polysomnography, with nasal continuous positive airway pressure(CPAP) for 4 months, which successfully controlled his loud snoring, sleep apnea, nocturnal hypoxemia and apnea-related symptoms. And also he was treated for underlying acromegaly and cardiac complications with bromocriptine and cardiogenic drugs for 4 months, but still had elevated growth hormone(GH) and insulin like growth factor-1(IGF-1) levels and serious cardiac arrhythmias. We describe our experience about the effect of CPAP treatment in an active acromegaly patient associated with obstructive sleep apnea syndrome and cardiac complications with review of literature.

• The Korean Nurse
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• v.33 no.4
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• pp.62-85
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• 1994

The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease. The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.339-345
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• 1998

Arrhythmias are common after cardiac surgery and are multifactorial. Intravenous magnesium administration reduces the frequency of ventricular arrhythmias in patient with symptomatic heart failure or acute myocardial infarction. This study was designed to evaluate the role of magnesium in preventing PVCs(premature ventricular contractions) occurred frequently after coronary artery bypass graft(CABG). 50 consecutive patients were prospectively entered into a randomized trial to determine the efficacy of postoperative magnesium therapy on the incidence of cardiac arrhythmias after elective coronary artery bypass graft. The patients underwent coronary angiography, echocardiography, electrocardiography and clinical laboratory study preoperatively. Continuous electrocardiographic monitoring was done and magnesium level was checked 0, 3, 6, 12, 18, 24, 36, 48, 60 and 72 hours postoperatively. Study group of 25 patients were given 4g of magnesium continuously over the first 24 hours and then 2g/24hours from 25 to 72 hours. The clinical characteristics of both groups were similar(p<0.05). The preoperative mean serum magnesium concentration was similar in both study group, 1.59mg/dl and control group, 1.71mg/dl. The mean postoperative serum magnesium concentration in study group elevated significantly over postoperative 12hours through 36hours(p<0.05). The postoperative mean serum magnesium concentration in control group declined and remained significantly depressed over immediate postoperation through 72hours. The mean serum magnesium concentration was significantly greater in the study group compared with the control group over postoperative 3hours through 72hours(p<0.05). There was a significant decrease in the incidence of arrhythmias such as PVCs(p<0.01) which might jeopardize hemodynamics. There were no recognized adverse effects of magnesium Administration. In conclusion, prophylactic magnesium administration seems to lessen the incidence and severity of rrhythmias after coponary artery bypass graft.

• The Korean Journal of Physiology
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• v.26 no.2
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• pp.99-111
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• 1992

Permissive action of thyroid hormone at the level of Ca channel and responsible mechanisms underlying thyroid hormone-induced change in myocardial contractile state and $T_3-induced$ arrhythmias were investigated in rabbit ventricular or atrial myocytes using whole cell patch clamp technique. Single cells were isolated by Langendorff perfusion with collagenase. Cardiac myocytes were incubated in $low-Cl^-,$, $high-K^+$ medium containing $1_{\mu}M\;L-triiodothyronine\;(T_3)$ at $4^{\circ}C$ for 2.10 hours. The calcium currrent $(I_{Ca})$ was increased in $T_3$ loaded cells, however, the shape of current voltage curve and reverse potential did not altered. Cyclic AMP, cyclic GMP, isoprenaline and 3-isobutyl-1-methyl-xanthine increased $I_{Ca}$ in euthyroid and hyperthyroid conditions, and acetylcholine blocked the increase of $I_{Ca}\;in\;T_3$ loaded cells. The amplitude of $I_{Ca}$ was much larger after perfusing cGMP than cGMP in both conditions, whereas the degree of increase of $I_{Ca}$ was greater after perfusing cAMP than cGMP in $T_3$ loaded cells. The degree of increase of $I_{Ca}$ after perfusing isoprenaline or IBMX also was greater in $T_3$ loaded cells than in control cells. Background current induced by isoprenaline also increased in $T_3$ loaded cells. The Ca release dependent inward current was increased in amplitude but its activation and inactivation time course was not changed in $T_3$ loaded cells. Activation of Na pump current was not changed in $T_3$ loaded cells. From the above results it is suggested that thyroid hormone induced increase in the contractile state of cardiac myocytes are accompanied by augmented $I_{Ca}$ and the increase of Ca release from sarcoplasmic reticulum and the permissive action of thyroid hormone to catecholamines could induce arrhythmias through the increase of $I_{Ca}$ and background current.

• Journal of Chest Surgery
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• v.24 no.9
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• pp.843-852
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• 1991

We prospectively studied postoperative cardiac arrhythmia after open heart surgery to analyze the types and incidence of cardiac arrhythmia and to predict preoperative risk factors. And also we evaluated the effectiveness of atrial and ventricular epicardial electrodes which were placed during operation Between March 1990 and August 1990, We had operated on in 211 patients and we studied 201 consecutive patients excluding 10 patients. The study group included 99 males and 102 female patients, ages 1 month to 75 years[Mean$\pm$SD=28.0$\pm$21.7 years]. Postoperatively, all patients were regularly seen by the cardiac surgeon and cardiologist, They had continuous electrocardiographic monitoring for the first 3 days, initially in the intensive care unit and were checked routine electrocardiography on the postoperative 7 days, The postoperative cardiac arrhythmia were analyzed and possible associations of this arrhythmia with various pre, intra, and postoperative factors were studied by univariate and multivariate discriminant analysis, The overall incidence of postoperative cardiac arrhythmia except relative sinus bradycardia was 36.8%;[74/201], The incidence of postoperative cardiac arrhythmia in acyanotic congenital heart disease: 19.4%, cyanotic congenital heart disease: 20.8%, cardiac arrhythmia surgery: 33.3%, acquired valvular heart disease: 60.9% and coronary artery occlusive disease: 38.9%. Both univariate and multivariate studies indicated the pre operative symptom duration[p = 0013], the duration of medication[p=0.003], presence of preoperative arrhythmia[p<0.001] and pre-operative left atrial dimension in echocardiography to be the factor promoting postoperative cardiac arrhythmia. Multivariate discriminant analysis showed that the presence of preoperative cardiac arrhythmia, bypass time and the duration of preoperative symptom duration conveyed considerable risk factor on post-operative arrhythmia. The atrial wire electrodes were used diagnostically in 36 and were used therapeutically in 89 among 201 patients. Atrial pacing were used to treat relative sinus bradycardia, accelerated junctional tachycardia or premature atrial or ventricular contractions in 51 patients. Atrioventricular sequential pacing were used in 16 patients and ventricular pacing were used in 20 patients. Hemodynamics were evaluated in 2 patients of relative sinus bradycardia before and after atrial pacing. The atrial pacing increased the amount of cardiac output to 15% more. Because of their great utility in the diagnosis and treatment of arrhythmias, we conclude that routine placement of atrial and ventricular electrodes at the time of operation is indicated regardless of the nature of the open-heart procedure.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.766-770
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• 2008

Primary tumors of the heart are uncommon among pediatric patients. Rhabdomyoma is the most frequent cardiac tumor in infants and children, which is commonly associated with tuberous sclerosis. Tuberous sclerosis is a neurocutaneous syndrome affecting the brain, heart, skin, and other organs. Cardiac rhadomyomas are reported in 50-64% of infants with tuberous sclerosis. Tuberous sclerosis involves multiple locations in the atrium, ventricle and septum, and may induce mechanical obstruction of the outflow tract and heart failure depending on the location, number, size, and degree of invasion of tumors. Arrhythmias may also develop in infants with cardiac rhadomyomas, but only a few of these patients require prolonged anti-arrhythmic therapy because arrhythmia often disappears with spontaneous regression of the tumors, and the ultimate prognosis may be decided by the cerebral manifestations.