• 대한영상의학회지
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• 제82권5호
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• pp.1163-1185
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• 2021

급성 심장사는 증상이 시작된 후 한 시간 이내에 발생하는 심장 원인으로 인한 사망이다. 급성 심장사의 원인은 주로 부정맥이지만 동반할 수 있는 기저 심질환들을 사전에 진단하는 것은 장기적 위험을 예측하는 데 중요하다. 심장 CT와 심장 MR은 구조적 심질환을 진단하고 평가하는데 중요한 정보를 제공하여 급성 심장사의 위험을 예측하고 대비할 수 있게 한다. 따라서 임상적으로 중요한 급성 심장사의 위험을 증가시키는 다양한 원인과 영상 소견의 중요성에 대하여 중점적으로 살펴보고자 한다.

• 한국학교보건학회지
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• 제19권1호
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• pp.1-15
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• 2006

Purpose : This study was to identify the incidence, trend, and situation of the unexpected sudden death of elementary, middle, and high school students in school for 17 years from 1988 to 2004 in seoul. Methods : We used the data of The Seoul Safety Mutual aid Association in seoul. Subjects were 53 unexpected sudden death in school from elementary, middle, and high school students, and we explored the gender, month, a day of the week, year, contents of situation, and medical certificate of death. Statistic analysis were chi-square test, Cochran-Armitage trend test, and the tool was SAS 9.1.Results : There were 53 unexpected sudden death students(male 42 and female 11). The incidence of male students was higher than that of female during 16 years except in 1995. The incidence occurred in middle school students were 31 (58.5%) of 53 and were also most frequent in middle school students in both of male and female students. In 1990, the incidence was 8(15.1%) students, 6(11.3%) in 1992 , and 5(9,4%) in 2000 respectively. The frequency of unsuspected sudden death in March was 11(20.8%) of 53 students, 11 (20.8%) in September, 7(13.2%) in October. In Thursday, it was 12(22.6%) of 53 students. Only 14(26.4%) students of 53 died during general life, but 39(73.6%) were related to excercise. The diagnosis of 14 students died during general life were cardiac arrest 7(50.5%), brain disorder 3(21.4%) which were based on medical certificate. But the diagnosis of 39 students died during or after excercise were brain disorder including cerebral hemorrhage 9(23.1%), heart disease 9(23.1%), cardiac arrest 8(20.5%), and unknown 6(15.4%), respectively. Conclusion : The incidence of unexpected sudden death were more frequent in male students, in middle school, and in excercise-related situation and the trend was similar for 17 years. Therefore, to prevent the unexpected sudden death, it needs to further study substantially the risk factors of unexpected sudden death including past history, life-style, nutrition and development, family history, and learning environment.

• Korean Circulation Journal
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• 제52권4호
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• pp.251-264
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• 2022

Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of all heart failure (HF) cases. The prevalence of HFpEF is increasing due to an aging population with hypertension, diabetes mellitus, and obesity. HFpEF remains a challenging clinical entity due to a lack of effective treatment options. Traditional HF medications have not been shown to reduce mortality of patients with HFpEF, and an implantable cardioverter-defibrillator is not indicated due to normal ejection fraction. Sudden death is the most common mode of death in patients with HFpEF; however, the underlying mechanisms of sudden death are not fully elucidated. Although ventricular arrhythmias are responsible for the majority of sudden deaths in general, their contribution to sudden deaths in HFpEF patients is likely less significant. The mechanisms of ventricular arrhythmias in HFpEF are 1) reduced conduction velocity due to ventricular hypertrophy, 2) delayed repolarization due to potassium current down-regulation, 3) calcium leakage due to altered excitation-contraction coupling, and 4) increased ventricular fibrosis caused by systemic inflammation. Hypertension and subsequent ventricular hypertrophy reduce the conduction velocity in HFpEF hearts via heterogeneous distribution of connexin 43. Delayed repolarization caused by potassium current down-regulation in HFpEF hearts provides a window for early afterdepolarization to trigger ventricular arrhythmias. Altered excitation-contraction coupling in HFpEF can cause calcium to leak and trigger delayed afterdepolarization. Increased systemic inflammation and subsequent ventricular fibrosis provide substrates for re-entry. Further research is warranted to investigate the detailed mechanisms of ventricular arrhythmias in HFpEF.

• 대한임상검사과학회지
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• 제49권2호
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• pp.108-113
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• 2017

급성심장사는 돌연 예기치 못한 심장질환에 의해 갑자기 사망하는 것으로, 법의부검 실시 전 초기 변사현장에서 외피 검시 과정 중 육안적으로 법의학적 사인 추정을 위한 명확한 소견 관찰이 어려운 점으로 인해 법의부검에서 심근 조직의 현미경적 변화 관찰을 통한 진단이 제안되고 있다. 그러나 검사시간, 비용, 편의성 등 변사사건 현장 외표 검시를 통한 사인추정 실무현장에 적용하는데 문제점을 드러내고 있다. 이에 본 연구에서는 임상 병원 진단검사의학에서 급성심근경색 환자의 진단 검사에 이용하는 심장표지물질 간이 검사 키트를 이용하여 사후 혈액에서 심장표지물질 myoglobin, CK-MB, cTn I를 측정하는 간이 검사가 내인성급사인 급성심장사를 사후 진단하는데 유용하게 이용될 수 있는지를 알아보고자 하였다. 외피 검시 및 간이검사 결과 비외상성 급성심장사로 추정되는 실험군 30예를 법의 부검 결과와 비교한 결과 23예(76.7%)에서 양성, 대조군 10예 중 뇌혈관질환 추정 4예 모두 음성, 알코올 및 약물 중독 1예, 산소결핍 질식사 1예에서 양성을 보였다. 심장표지물질 간이 검사의 민감도와 특이도는 각각 76.7%, 80.0%의 유의한 결과를 보여 변사사건 현장에서 변시체의 과거병력, 현장상황 및 사후시간 등을 종합적으로 고려하여 사후 급성심장사의 의심, 추정 진단에 보조적 방법의 하나로 유용하게 이용될 수 있을 것으로 사료된다. 향후 심장표지물질(myoglobin, CK-MB, cTn I)의 개별물질 특성에 의한 혈액 내 최초 발현 및 소멸시간, 시간 경과에 따른 농도 차이 등에 대한 선행연구 결과를 기초로 사망원인 규명 등 사건 해결에 필요한 사후경과시간 추정을 위한 사후 시간대 별 심장표지물질 농도에 대한 추가적인 연구가 계속 되어야 할 것이다.

• Molecules and Cells
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• 제37권3호
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• pp.241-247
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• 2014

Sudden cardiac death (SCD), which is primarily caused by lethal heart disorders resulting in structural and arrhythmogenic abnormalities, is one of the prevalent modes of death in most developed countries. Myocardial ischemia, mainly due to coronary artery disease, is the most common type of heart disease leading to SCD. However, postmortem diagnosis of SCD is frequently complicated by obscure histological evidence. Here, we show that certain mRNA species, namely those encoding hemoglobin A1/2 and B (Hba1/2 and Hbb, respectively) as well as pyruvate dehydrogenase kinase 4 (Pdk4), exhibit distinct postmortem expression patterns in the left ventricular free wall of SCD subjects when compared with their expression patterns in the corresponding tissues from control subjects with non-cardiac causes of death. Hba1/2 and Hbb mRNA expression levels were higher in ischemic SCD cases with acute myocardial infarction or ischemic heart disease without recent infarction, and even in cardiac death subjects without apparent pathological signs of heart injuries, than control subjects. By contrast, Pdk4 mRNA was expressed at lower levels in SCD subjects. In conclusion, we found that altered myocardial Hba1/2, Hbb, and Pdk4 mRNA expression patterns can be employed as molecular signatures of fatal cardiac dysfunction to forensically implicate SCD as the primary cause of death.

• 대한유전성대사질환학회지
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• 제13권2호
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• pp.75-80
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• 2013

Specific genetic conditions may lead to sudden unexpected deaths in infancy, such as inborn errors of fatty acid oxidation and genetic disorders of cardiac ion channels. The disease may present dramatically with severe hypoketotic hypoglycemia, Reye syndrome or sudden death, typically with a peak of frequency around 3-6 month, whilst neonatal sudden death is quite rare. When undetected, approximately 20-25% of infants will die or suffer permanent neurologic impairment as a consequence of the first acute metabolic decompensation. Meanwhile, the advent of newborn screening for metabolic diseases has revealed populations of patients with disorders of fatty acid oxidation (FAO), the most frequent of which is medium chain acyl-CoA dehydrogenase (MCAD) deficiency. Without this screening, affected individuals would likely succumb to sudden infant death syndrome (SIDS). Here we describe an overview of sudden infant death syndrome and inherited metabolic disorder.

• Journal of Yeungnam Medical Science
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• 제35권1호
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• pp.121-126
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• 2018

Coronary spasm generally occurs in patients with minimal atherosclerotic plaque lesion, and it has a rather favorable prognosis. However, in some cases, coronary spasm may induce myocardial infarction and even sudden cardiac death (SCD). Here, we report a case in which multi-vessel intractable coronary vasospasm suddenly occurred in a diffuse atherosclerotic lesion after percutaneous coronary intervention (PCI) in a patient with aborted SCD. We identified the characteristics of the spasm portion in intravascular ultrasound (IVUS) images and conducted percutaneous cardiopulmonary bypass support-PCI with stenting as treatment. Intima and media thickening and a large attenuated plaque burden with rupture were identified in IVUS images at the obstructive spasm portion.

• 한국임상수의학회지
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• 제21권2호
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• pp.219-228
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• 2004

심장 전도계에 관련된 심장 질환은 심장 전도계의 원발성 결함이나 형태학적 심장 질환 및 약물 중독 같은 속발성 원인에 의해 발생한다. 특히 선천성 심장 전도 장애의 경우, 이온 채널, 이온 채널에 관련한 세포질성 단백질, gap-junction 단백질, transcription factors (심장 발생에 관련된 유전자들) 및 kinase subunit을 전사하는 유전자의 돌연변이가 원발성 선천성 심장 전도장애의 원인으로 밝혀지고 있다. 사람의 부정맥 발생에 관련된 발병기전에 커다란 진보가 이루어지고 있음에도 불구하고, 개의 경우, 저먼 세퍼드의 급사 증후군 (sudden death syndrome)을 제외한 다른 전도 장애에 대한 연구는 극히 미비한 상태이다. 본 종설에서는 지금까지 밝혀진 심장 부정맥 발생의 분자 유전학적 고찰과 이와 관련된 사람의 유전학적 질환들과 이와 유사한 개의 선천성 심장 전도 장애에 대해 연구 고찰하였다.

• 대한신경과학회지
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• 제36권4호
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• pp.310-313
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• 2018

The causes of sudden death after medullary infarction involve arrhythmia, central respiratory failure, and dysautonomia. Sudden cardiac arrest in a medullary infarction is uncommon. Most of these cases experienced sudden cardiopulmonary arrest within 2 weeks from stroke onset as the extent of lesion increased. Here, we report two cases of medullary infarction presenting as sudden cardiac arrest. These cases indicate that medullary infarction could be one of the causes of sudden cardiac arrest.

• 대한치과의사협회지
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• 제40권9호통권400호
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• pp.703-708
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• 2002

Cardiac arrhythmia is irregular heart rate. It's one of the reason of unpredictable sudden death. Accurate diagnosis and management of cardiac arrhythmia are the most important factors for the life of patient. To obtain a good prognosis, Dentist should be know and manage the multi-types of cardiac arrhythmia during dental treatment with the cooperation of medical doctor majored in cardiac circulation medicine. We casually found the cardiac arrhythmia in mandible prognathism patient during preparation for orthognathic surgery. Orthognathic surgery for cardiac arrhythmia patient was done successfully under general anesthesia with the temporary cardiac pace-maker.