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Acute Myocardial Infarction Caused by Coronary Artery Dissection Following Blunt Chest Trauma
윤세정,권혁문,김동수,홍범기,김동연,조윤형,강병승,김현승 연세대학교의과대학 2003 Yonsei medical journal Vol.44 No.4
Chest trauma can lead to various cardiac complications ranging from simple arrhythmias to myocardial rupture. An acute myocardial infarction (AMI) is a rare complication that can occur after chest trauma. We report a case of 66-year-old male who suffered a blunt chest trauma from a traffic accident resulting in an AMI. The coronary angiography revealed an eccentric 50% narrowing of the ostium of left anterior descending artery (LAD) by a dissection flap with calcification. Intravascular ultrasonography (IVUS) revealed eccentric calcified plaque (minimal luminal diameter [MLD]=3.5mm) with a dissection flap. Intervention was not performed considering the MLD and calcified flap, and he has been conservatively managed with aspirin and losartan for 2 years. The follow-up coronary angiography showed an insignificant luminal narrowing of the proximal LAD from the ostium without evidence of a dissection. An early coronary evaluation including an IVUS study should be considered for managing patients who complain of ongoing, deep-seated chest pain with elevated cardiac enzyme levels and an abnormal electrocardiogram (ECG) after a blunt chest trauma. Based on this case, some limited cases of traumatic coronary artery dissections can be healed with conservative management and result in a good prognosis. Chest trauma can lead to various cardiac complications ranging from simple arrhythmias to myocardial rupture. An acute myocardial infarction (AMI) is a rare complication that can occur after chest trauma. We report a case of 66-year-old male who suffered a blunt chest trauma from a traffic accident resulting in an AMI. The coronary angiography revealed an eccentric 50% narrowing of the ostium of left anterior descending artery (LAD) by a dissection flap with calcification. Intravascular ultrasonography (IVUS) revealed eccentric calcified plaque (minimal luminal diameter [MLD]=3.5mm) with a dissection flap. Intervention was not performed considering the MLD and calcified flap, and he has been conservatively managed with aspirin and losartan for 2 years. The follow-up coronary angiography showed an insignificant luminal narrowing of the proximal LAD from the ostium without evidence of a dissection. An early coronary evaluation including an IVUS study should be considered for managing patients who complain of ongoing, deep-seated chest pain with elevated cardiac enzyme levels and an abnormal electrocardiogram (ECG) after a blunt chest trauma. Based on this case, some limited cases of traumatic coronary artery dissections can be healed with conservative management and result in a good prognosis.
An Atypical Mitral Valve Prolapse in a Patient With Behçet’s Disease
윤세정,최의영,정재헌,임세중 대한심장학회 2011 Korean Circulation Journal Vol.41 No.4
We report the case of a 42-year-old male who was admitted to the hospital with progressive dyspnea. Cardiomegaly and diffuse pulmonary edema were visible on chest X-ray and multiple oral and genital ulcers on physical examination. On admission, echocardiography revealed mitral valve prolapse (MVP) predominantly involving a basal portion of the posterior leaflet, with severe mitral regurgitation. A successful mitral valve replacement with St. Jude #29 was performed, after pre-treatment with prednisolone for 2 weeks. Fifteen months following the operation, the patient expired from severe pulmonary edema and secondary pneumonia. This case demonstrates, for the first time in the literature, an unusual feature of mitral prolapse in the basal portion with severe mitral regurgitation in a patient with Behçet’s disease. As suggested by this case, we should consider an atypical type of MVP as a possible inflammatory involvement of the heart in patients with Behçet’s disease.
윤세정,서혜선,박수정,정욱진 한국심초음파학회 2016 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.24 No.1
Background: Function of right ventricle (RV) influences on symptoms and prognosis in various diseases. However the regional RV function analyzed with 2-dimensional (2D) strain echocardiography before and just after treadmill test has not been evaluated. The aim of this study was to show the change of regional RV function just after treadmill exercise with strain analysis. Methods: A total of thirty eight patients who visited hospital for hypertension, chest pain or dyspnea between January 2007 and December 2010 were retrospectively analyzed (men, 47.4%; mean age, 54.9 ± 7.2 years). Treadmill exercise test and pre and post echocardiography were performed. 2D strain echocardiography was analyzed off line in RV free wall and septum. Results: Mean exercise duration was 737 ± 132 sec. Tissue velocity in lateral tricuspid annulus is significantly increased in post exercise (initial, 10.5 ± 2.4 cm/sec vs. post exercise, 12.2 ± 1.8 cm/sec, p = 0.006). Systolic strain of RV free wall apex and mid portion were significantly changed in post exercise stage (free wall apex, -18.2 ± 7.6% vs. -22.3 ± 5.8%, p = 0.010; free wall mid, -14.1 ± 6.7% vs. -22.6 ± 6.8%, p = 0.022). Conclusion: 2D strain imaging provides a precise tool to quantify regional RV function and reveals a characteristic regional pattern of RV after treadmill exercise.
종량제의 재구성 효과: 디커플링 지각의 매개효과를 중심으로
윤세정 한국소비자학회 2022 소비자학연구 Vol.33 No.3
본 연구는 종량제의 재구성 효과를 설명하는 매개변수를 검증하였다. 기존의 재구성된 종량제의 선호를 밝힌 연구는 소비자가 요금제의 평가에 사용하는 현저한 준거점의 차이를 중심으로 일반적인 종량제와 재구성된 종량제의 상대적인 선호를 논의하였다. 그러나, 재구성된 종량제의 선호를 설명하는 심리적인 프로세스에 대한 검증은 충분하게 이루어지지 않았다. 본 연구의 목적은 종량제의 제시방법이 소비자 선호에 미치는 영향이 소비경험과 지불경험이 디커플링되어 지각되는 정도에 의해서 설명될 수 있음을 제시하는 것이다. 본 연구는 재구성된 종량제에 대한 소비자의 평가가 실제 사용량과 기본 허용량과의 비교에 의해서 이루어지는 것에 주목하여 디커플링 지각이 일반적인 종량제와는 다르게 나타날 것으로 기대한다. 구체적으로, 소비자들이 재구성된 종량제의 기본 허용량에 해당하는 금액을 심리적으로 미리 지불하여 소비의 즐거움을 비용지불에 대한 고통으로부터 분리하여 지각하는 정도가 높아질 것으로 예측하였다. 나아가, 디커플링 지각의 차이가 소비자들이 재구성된 종량제를 일반적인 종량제보다 선호하는 현상을 설명할 것으로 예측하였다. 연구 1은 국제전화 요금제에 대한 소비자 평가를 비교하였다. 연구 결과, 재구성된 종량제에서 일반적인 종량제보다 디커플링 지각이 높게 나타났다. 또한, 종량 요금제의 제시방법이 소비자 선호에 미치는 영향은 디커플링 지각에 의해서 매개되는 것으로 나타났다. 연구 2는 스마트폰 데이터 요금제 이용 상황에서 선행 연구에서 제안한 다양한 심리적인 요인들의 잠재적인 매개효과를 검증하였다. 분석 결과, 본 연구에서 제시하는 디커플링 지각만이 종량제의 재구성 효과를 설명하는 것으로 나타났다.