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순환기 : 심한 좌심방 석회화와 반복적인 좌심방 혈전 및 액와부 혈종
성석우 ( Seok Woo Seong ),안계택 ( Kye Taek Ahn ),김혜진 ( Hye Jin Kim ),천신혜 ( Shin Hye Cheon ),진선아 ( Seon Ah Jin ),신성균 ( Sung Kyun Sin ),정진옥 ( Jin Ok Jeong ) 대한내과학회 2012 대한내과학회지 Vol.82 No.6
저자들은 23년 전에 류마티스성 승모판 협착증, 좌심방 혈전이 동반되어 기계 판막을 이용한 승모판 치환술 및 좌심방 혈전 제거술을 시행한 뒤에 진행하는 좌심방의 심한 심내막 석회화와 좌심방 혈전 및 액와부의 혈종이 발생한 1예를 경험하였다. Left atrial wall calcification is frequently observed in patients with rheumatic valvular heart disease. However, massive left atrial wall calcification, so called porcelain or coconut atrium, with left atrium thrombi is very rare. Here, we describe the case of a 67-year-old male patient with porcelain atrium, recurrent left atrial thrombi, and a spontaneous axillary hematoma after mitral valve replacement and surgical thrombectomy due to rheumatic valvular heart disease. The patient underwent two valvular surgeries 20 years prior; therefore, we determined not to perform additional surgeries because of a high risk of morbidity, mortality, and the recurrence of atrial thrombi. The patient has been maintained on daily warfarin as an anti-thrombic therapy for more than 5 years without major embolic complications.
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증례 : 갑상샘항진증에서 우심부전을 동반한 중증 삼첨판 폐쇄부전증 1예
장원일 ( Won Il Jang ),김은미 ( Eun Mi Kim ),안계택 ( Kye Taek Ahn ),박재형 ( Jae Hyeong Park ),최시완 ( Si Wan Choi ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2
결론적으로 갑상샘항진증과 연관된 좌심부전의 소견이 없이 우심부전을 동반한 삼첨판 폐쇄 부전증을 보였던 예에서 항갑상샘제제 및 소량의 이뇨제 치료로 호전되었다. 폐동맥 고혈압을 동반한 우심부전과 삼첨판 폐쇄부전이 있을 경우 갑상샘항진증은 이의 가능한 원인으로서 고려되어야 한다. Left-sided heart failure can be complicated in the patient suffering with thyrotoxicosis; however, predominantly right heart failure in thyrotoxic patients is a rare condition. We present here a case of reversible right-heart failure with severe tricuspid regurgitation associated with thyrotoxicosis. A 71-year-old woman was admitted to the hospital because of a 10-day history of shortness of breath and indigestion. On echocardiography, there was a normal-sized left ventricle with preserved systolic and diastolic function. However, the right atrium and ventricle were dilated, and there was incomplete systolic coaptation of the tricuspid leaflets, resulted in severe tricuspid regurgitation. The maximal velocity of tricuspid regurgitation was 3.7 m/sec and the estimated pressure gradient between the right two chambers was 55 mmHg. After treatment that included diuretics and antithyroid drug (methimazole), the symptoms of right heart failure resolved. Four weeks later, a second echocardiogram was obtained revealing a normalized right atrium and ventricle, trivial tricuspid regurgitation and the resting pulmonary hypertension had disappeared.(Korean J Med 73:206-209, 2007)
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ST분절 상승 심근경색 환자의 일차적 관동맥중재술까지 시간 지연 인자
김정애 ( Jeong Ai Kim ),정진옥 ( Jin Ok Jeong ),안계택 ( Kye Taek Ahn ),박형서 ( Hyung Seo Park ),장원일 ( Won Il Jang ),김민수 ( Min Soo Kim ),짐준형 ( Jun Hyung Kim ),박재형 ( Jae Hyeong Park ),이재환 ( Jae Hwan Lee ),최시완 ( S 대한내과학회 2010 대한내과학회지 Vol.78 No.5
Background/Aims: The time delay for a patient from the onset of disease symptoms until the reperfusion therapy is one of the biggest interruptions in early reperfusion therapy in patients with acute ST-segment elevation myocardial infarction (STEMI). Here, we evaluated both the duration and nature of these time delays to facilitate early patient reperfusion therapy. Methods: Patients with acute STEMI who were undergoing primary percutaneous coronary intervention (PCI) were prospectively enrolled in the Chungnam National University Hospital from January 2005 to December 2007. Results: From a total 364 patients (mean age: 64±12 years) the mean time interval from the onset of symptoms to the decision to visit a hospital was 101.4±10.6 (median: 50.0) minutes. The mean time interval for the onset of disease symptoms to the patient arrival at the emergency room (ER) (pre-hospital delay) was 222.1±12.4 (median: 171.5) minutes. The mean time interval from the ER to reperfusion (door to balloon time) was 89.0±6.0 (median 65.0) minutes. The mean time interval from the onset of symptoms to successful reperfusion therapy (pain to balloon time) was 311±13.6 (median: 250) minutes. The factors associated with these significant time delays were mainly: residency in rural areas, the use of private transport in preference to an ambulance and finally the transferal of patients from other hospitals. As a result of multivariate analysis the latter was found to be the most significant causative factor. Conclusions: This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI. Thus, a media campaign explaining STEMI symptoms, the importance of early visits to the emergency department, the use of an ambulance, and the activation of the base hospital for efficient patient transfer (particularly in rural areas) may reduce this time delay in patients with STEMI and avoid interruptions to otherwise efficient reperfusion therapies. (Korean J Med 78:586-594, 2010)
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