• 대한임상검사과학회지
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• 제44권3호
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• pp.136-141
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• 2012

The hearts of highly trained athletes show morphologic and electrocardiographic (ECG) changes that suggest the presence of cardiovascular disease, including sinus bradycardia, a striking increase in precordial R-wave or S-wave voltages, ST segment depression, and T-wave inversions. Despite a number of previous observational surveys, the determinants of abnormal ECG patterns in trained athletes remain largely unresolved. In this study, we compared the electrocardiographic characteristics of athletes to determine any sensitive indicators. Comparison between ECG patterns and cardiac physiology was performed in 21 junior athletes and 25 untrained subjects with no signs of cardiac disease. Sinus bradycardia was detected in a subset of athletes but not statistically significant between the athletes ($69.9{\pm}11.1bpm$) and the control ($72.7{\pm}9.9bpm$) group. The mean values of the PR and QTc intervals in the athletes' group were $149.2{\pm}15.4ms$ and $402.3{\pm}28.8ms$, respectively. Also, there were no significantly differences between control group and the athletes' group. In addition, the athletes demonstrated a spectrum of alterations in the 12-lead ECG pattern, including marked increase in precordial R-wave or S-wave voltages ($$SV_1+RV_5{\geq_-}35mm$$, 23.8%), QRS duration ($${\geq_-}90ms$$, 90.5%), suggestive of left ventricular hypertrophy. However, left axis deviation, ST segment depression, and T-wave changes in V5, V6 were not observed in either the athletes or control group. Our findings suggest that sinus bradycardia, precordial R-wave or S-wave voltages, and QRS duration seem to be more sensitively detected in athletes than in control group. Further researches on the electrocardiographic patterns of athletes should be carried out to improve the sensitivity and specificity of diagnostic criteria.

• 대한임상독성학회지
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• 제8권2호
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• pp.79-87
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• 2010

Purpose: The previous studies on $H_1$ antihistamine overdose have generally been limited to cases of acute doxylamine succinate (DS) poisoning, yet there have been some studies on diphenhydramine (DPH) overdosing. But many clinicians consider the two drugs to be very similar and to have similar ingredients. The purpose of this study was to clarify the toxicologic characteristics and clinical outcomes between DS and DPH poisoning/overdose. Methods: We reviewed the medical and intensive care records of the patients with acute DS or DPH poisoning and who admitted to our emergency department from January 2008 and April 2010. We collected patient information regarding the features of the poisoning and the clinical and demographic characteristics. The patients were assessed for the clinical outcomes, the GCS, the PSS (Poisoning Severity Score) and the SOFA (Sequential Organ Failure Assessment). Results: Fifty seven patients (45 cases of DS poisoning and 12 cases of DPH poisoning) were enrolled. Compared with the DS group, the DPH group had higher incidences of intubation, serious mental change, QTc prolongation and ECG conduction abnormality (p=0.041, <0.001, 0.014 and 0.044, respectively). The DPH group had a higher PSS and a longer ICU stay. The peak CPK time and the CPK normalization time were longer for the patients with rhabdomyolysis due to DS poisoning. Conclusion: Two common $H_1$ antihistamines, doxylamine and diphenhydramine, are in the same ethanolamine-structural class, but the toxico-clinical outcomes are different according to many aspects. Therefore, clinicians could take a careful approach for the differential diagnosis and management between DS and DPH poisoning.

• Clinical Psychopharmacology and Neuroscience
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• 제16권4호
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• pp.505-507
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• 2018

Clozapine may be associated with cardiovascular adverse effects including QTc prolongation and, more rarely, with myocarditis and pericarditis. Although rare, these latter cardiovascular adverse effects may be life-threatening and must be immediately recognized and treated. Several cases of clozapine related-pericarditis have been described and often it has a subtle and insidious onset with symptoms that may be often misdiagnosed with psychiatric manifestations (e.g. anxiety, panic or somatization) leading to a delayed correct diagnosis with potential fatal consequences. In the present report we describe the case of a 27-year-old girl with schizoaffective disorder taking long acting aripiprazole and valproate who developed a sudden onset clozapine-related pericarditis during titration phase that resolved with immediate clozapine discontinuation and indomethacin administration. We underline the importance of an early diagnosis of clozapine-related pericarditis and the need to have monitoring protocols to prevent this potentially fatal adverse effect especially when polypharmacy is administered to patients taking clozapine.

• Clinical and Experimental Pediatrics
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• 제51권11호
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• pp.1232-1235
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• 2008

삼환계 항우울제의 하나인 이미프라민은 우울장애와 야뇨증, 불안장애, 신경성 통증에 쓰인다. 그러나 이미프라민을 포함한 삼환계 항우울제는 많은 부작용이 관찰되는 데, 항콜린성 작용으로 초기에 입이 마르고 동공산대, 소변 정체, 동성빈맥을 보인다. 또한 중추신경계에 작용하여 섬망, 불안, 초조, 환각, 경련, 혼수를 야기할 수 있다. 그러나 앞에서 말한 부작용 보다도 치명적인 것인 삼환계 항우울제에 의해 소디움 채널 차단으로 인한 부정맥이다. QRS파의 연장과 QTc 연장, 넓은 QRS파 빈맥, Brugada 심전도 양상이 나타나며 이런 현상은 중탄산 나트륨을 통해 나트륨을 대량으로 공급하여 회복시킬 수 있다. 이미프라민을 포함한 삼환계 항우울제에는 아직도 널리 쓰이고 있지만 지금까지 소아에서 부정맥이 부작용으로 나타난 증례에 대한 보고가 없었다. 따라서 저자들은 이미프라민 과량복용 후 경련, 넓은 QRS파를 보이는 빈맥, Brugada 심전도 양상, 무뇨를 보인 환아를 경험, 치료하여 이를 보고한다.

• Biomolecules & Therapeutics
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• 제23권4호
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• pp.386-389
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• 2015

Sibutramine is an anorectic that has been banned since 2010 due to cardiovascular safety issues. However, counterfeit drugs or slimming products that include sibutramine are still available in the market. It has been reported that illegal sibutramine-contained pharmaceutical products induce cardiovascular crisis. However, the mechanism underlying sibutramine-induced cardiovascular adverse effect has not been fully evaluated yet. In this study, we performed cardiovascular safety pharmacology studies of sibutramine systemically using by hERG channel inhibition, action potential duration, and telemetry assays. Sibutramine inhibited hERG channel current of HEK293 cells with an $IC_{50}$ of $3.92{\mu}M$ in patch clamp assay and increased the heart rate and blood pressure ($76{\Delta}bpm$ in heart rate and $51{\Delta}mmHg$ in blood pressure) in beagle dogs at a dose of 30 mg/kg (per oral), while it shortened action potential duration (at $10{\mu}M$ and $30{\mu}M$, resulted in 15% and 29% decreases in $APD_{50}$, and 9% and 17% decreases in $APD_{90}$, respectively) in the Purkinje fibers of rabbits and had no effects on the QTc interval in beagle dogs. These results suggest that sibutramine has a considerable adverse effect on the cardiovascular system and may contribute to accurate drug safety regulation.

• 대한임상독성학회지
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• 제8권2호
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• pp.97-105
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• 2010

Purpose: Although cardiac toxicity is a key parameter of significant toxicity, in antidepressant intoxication, there are few studies on the cardiac toxicity of serotonin reuptake inhibitor and the intoxication with the new generation of antidepressants. The aim of this study is to investigate the relative cardiac toxicity of serotonin reuptake inhibitor and intoxication with the new generation of antidepressants as compared with that of tricyclic antidepressant intoxication. Methods: We retrospectively reviewed the medical records of 109 antidepressant intoxicated patients who visited the Emergency Department from January, 2005 to December, 2009 to collect and analyze the demographic and clinical data. Sixteen patients were excluded. The enrolled seventy eight patients were classified into three groups: the tricyclic antidepressant group (TCA) (n=32), the selective serotonin reuptake inhibitor subgroup (SSRI) (n=28) and the new generation antidepressant subgroup (NGA) (n=18). Results: The demographic and clinical data of the SSRI and NGA groups were not significantly different from that of the TCA group. The QRS duration of the SSRI subgroup ($86.4{\pm}12.0$ msec) and the NGA subgroup ($91.8{\pm}11.9$ msec) was not significantly different from that of the TCA group ($90.0{\pm}13.5msec$) (p=0.598). The QTc interval of the SSRI group ($444.5{\pm}33.5msec$) and the NGA group ($434.9{\pm}35.9msec$) (p=0.260) were not significantly different from that of the TCA group ($431.2{\pm}44.1msec$) (p=0.287). Conclusion: Intoxication with SSRI and the new generation antidepressants seemed to show significant cardiac toxicity, like what is seen in tricyclic antidepressant intoxication. Clinicians must pay attention to SSRI and new generation antidepressant intoxication.

• 정신신체의학
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• 제26권2호
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• pp.112-118
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• 2018

연구목적 섬망은 신체 질환과 같은 기저 의학적 상태의 변화에 의해 나타나는 뇌의 기능장애로 환자의 사망률을 높이고 치매의 위험도를 높이는 등 불량한 예후와 연관되어 있다. 기존 섬망의 치료에 주로 사용된 항정신병약제는 치료 효과에 대한 논란이 있으며 추체외로 부작용 등에 대한 우려가 있다. 따라서 수면 주기 조절 및 섬망 예방효과가 있는 것으로 알려진 멜라토닌 투여를 통해 섬망 호전 정도와 안전성을 조사하고자 하였다. 방 법 불면을 동반한 섬망 증상으로 정신건강의학과에 진료 의뢰되어 멜라토닌 2mg을 투여 받은 환자를 대상으로 의무기록을 통해 섬망 증상의 초기 중증도 및 멜라토닌 투여 후의 섬망 증상 변화 여부를 한국판 섬망 평가척도-98 개정판(K-DRS-R-98)과 CGI-S를 통해 확인하였으며 부작용을 검토하였다. 결 과 총 21명의 환자가 불면을 동반한 섬망 증상으로 멜라토닌을 투여받았다. K-DRS-R-98 심각도 점수는 투약 전 $15.24{\pm}2.64$에서 투약 후 $6.57{\pm}5.42$로 감소하였으며 CGI-S 점수는 $4.14{\pm}0.48$에서 $2.81{\pm}0.93$로 감소하였다(p<0.05). 의무기록 상 부작용은 관찰되지 않았다. 결 론 약물의 기전 상 추체외로 증상과 QTc연장 등의 문제를 유발하지 않는 멜라토닌의 사용은 보다 안정성을 강화하면서 불면에 대한 효과와 함께 섬망을 효과적으로 치료할 가능성을 제시할 것으로 생각된다.

• 대한임상독성학회지
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• 제19권2호
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• pp.83-92
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• 2021

Purpose: Glyphosate herbicide (GH) is a widely used herbicide and has been associated with significant mortality as poisoned cases increases. One of the reasons for high toxicity is thought to be toxic effect of its ingredient with glyphosate. This study was designed to determine differences in the clinical course with the salt-type contained in GH. Methods: This was a retrospective study conducted at a single hospital between January 2013 and December 2017. We enrolled GH-poisoned patients visited the emergency department. According to salt-type, patients were divided into 4 groups: isopropylamine (IPA), ammonium (Am), potassium (Po), and mixed salts (Mi) groups. The demographics, laboratory variables, complications, and their mortality were analyzed to determine clinical differences associated with each salt-type. Addtionally, we subdivided patients into survivor and non-survivor groups for investigating predictive factors for the mortality. Results: Total of 348 GH-poisoned patients were divided as follows: IPA 248, Am 41, Po 10, and Mi 49 patients. There was no difference in demographic or underlying disease history, but systolic blood pressure (SBP) was low in Po group. The ratio of intentional ingestion was higher in Po and Mi groups. Metabolic acidosis and relatively high lactate level were presented in Po group. As the primary outcome, the mortality rates were as follows: IPA, 26 (10.5%); Am, 2 (4.9%); Po, 1 (10%); and Mi, 1 (2%). There was no statistically significant difference in the mortality and the incidence of complications. Additionally, age, low SBP, low pH, corrected QT (QTc) prolongation, and respiratory failure requiring mechanical ventilation were analyzed as independent predictors for mortality in a regression analysis. Conclusion: There was no statistical difference in their complications and the mortality across the GH-salt groups in this study.

• 대한조현병학회지
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• 제22권2호
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• pp.21-33
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• 2019

Objectives: The current study covers a secondary revision of the guidelines for the pharmacotherapy of schizophrenia issued by the Korean Medication Algorithm for Schizophrenia (KMAP-SCZ) 2001, specifically for co-existing symptoms and antipsychotics-related side-effects in schizophrenia patients. Methods: An expert consensus regarding the strategies of pharmacotherapy for positive symptoms of schizophrenia, co-existing symptoms of schizophrenia, and side-effect of antipsychotics in patients with schizophrenia was retrieved by responses obtained using a 30-item questionnaire. Results: For the co-existing symptoms, agitation could be treated with oral or intramuscular injection of benzodiazepine or antipsychotics; depressive symptoms with atypical antipsychotics and adjunctive use of antidepressant; obsessive-compulsive symptoms with selective serotonin reuptake inhibitors and antipsychotics other than clozapine and olanzapine; negative symptoms with atypical antipsychotics or antidepressants; higher risk of suicide with clozapine; comorbid substance abuse with use of naltrexone or bupropion/varenicline, respectively. For the antipsychotics-related side effects, anticholinergics (extrapyramidal symptom), propranolol and benzodiazepine (akathisia), topiramate or metformin (weight gain), change of antipsychotics to aripiprazole (hyperprolactinemia and prolonged QTc) or clozapine (tardive dyskinesia) could be used. Conclusion: Updated pharmacotherapy strategies for co-existing symptoms and antipsychotics-related side effects in schizophrenia patients as presented in KMAP-SCZ 2019 could help effective clinical decision making of psychiatrists as a preferable option.

• 한국임상수의학회지
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• 제14권2호
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• pp.319-337
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• 1997

The electrocardiographic (ECG) parameters in the normal Korean black goat have been measured with a 3-channel Electrocardiograph and computed, analyzed. ECG in 243 black goats were made with the limb leads (I, II, III, aVR, aVL, aVF), that were recorded conduction parameters of wave and interval, and were analyzed as to shape and amplitude of the P and T waves and the components of the QRS complex. Heart rate were recorded by the ECG which were a mean of 106.1$\pm $21.8 beats/min. Average conduction times in the PR, the QRS complex and the QTc interval were recorded 103.9$\pm $34.9 msec., 58.3$\pm $23.2 msec. and 302.6$\pm $67.8 msec., in the P and T wave duration recorded 24.8$\pm $6.4 msec. and 51.7$\pm $10.8 msec. respectively. The shape of wave in each leads were observed various types, and any spacial wave type appeared the highest frequency in each lead that ware shown less than 60%, and these frequent rate and average amplitudes as fallow: 1. In P waver the frequent rate and average amplitudes of the positive type showed in leads I, II and aVL that were 54.8% (93.0$\pm $ 33.2 $\mu $V), 50.5% (90.1$\pm $30.5 $\mu $V) and 41.7% (58.5$\pm $ 31.1 $\mu $V). Average amplitude of the negative type showed the frequent rate of 49.8% in lead aVE which was -77.6$\pm$ 25.2 $\mu $V. Biphasic type in leads III and aVF were 46.1% (108.4 $\mu $V, -90.2 $\mu $V.) and 45.7% (137.4 $\mu $V, -105.4 $\mu $V.), and amplitudes between positive and negative of it were significant difference. 2. The highest amplitudes of the QRS complex in all leads were 534.8$\pm $ 232.3 $\mu $V of lead II. The frequent rate and amplitudes of the R wave type in the I, II, III and aVF were 30.2% (277.8 $\pm $131.3 $\mu $V), 45.1% (393.1$\pm $114.2 $\mu $V), 48.5% (349.3$\pm $178.3 $\mu $V) and 54.9% (334.4$\pm $129.7 $\mu $V), and QS ways type in the lead aVL was 49.5% (359.2$\pm $195.5$\mu $V), and RS and QS wave types in the lead a VR were 43.3% (312.4 $\mu $V, -212.7 $\mu $V.) and 41.1% (399.2$\pm $92.2 $\mu $V), respectively. 3. In T wave, the frequent rata and amplitudes of the positive type in the leads I, II, III and aVF were 44.6% (207.9$\pm $ 97.1 $\mu $V), 41.6% (245.1$\pm $92.1 $\mu $V), 46.9% (189.8$\pm $ 82.7 $\mu $V) and 53.0% (195.4197.8 $\mu $V), and the negative in the lead aVR was 41.2% (-230.7$\pm$ 103.1 $\mu $V), respectively. The positive and negative types in the lead aVe appeared with same frequent rate of 43.2%.4. Frontal plane vectors for P, QRS, and T were found to lie at 38.1$\pm $ 21.5, 142.0$\pm $ 57.2, and 117.2$\pm $ 63.9 degrees, respectively. These results in ECG of goats may be served to the limited purposes as to conduction parameters, arrhythmias except abnormal ECG because of waveforms, amplitudes and electrical axis of it were variability.