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완전 방실차단에서 His 속 전기도로 확인한 전도장애의 위치
노태호(Tai Ho Rho),이숙영(Sook Young Lee),백상홍(Sang Hong Paek),김종진(Chong Jin Kim),김철민(Chul Min Kim),김종상(Chong Jin Kim),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1992 대한내과학회지 Vol.43 No.4
Background: The His bundle recording has proved useful in determining the sites of AV conduction disturbances not discernable in the standard ECG. And the clinical behaviour of patients with conduction disturbance may be partially related to the site of block. Methods: In 27patients with complete AV block, electrophysiologic studies were done to delineate the sites of conduction block. Three multipolar electrodes were located to record the simultaneous electrograms from the right atrium, the His bundle and the right ventricle. Results & Conclusion: lnfraHis location was the most frequent site, accounting for 52% of total cases. When QRS complexes were narrower than 100msec, the localizations of block were divided between supraHis (45%) and infraHis (36%). But complete AV blcok with wider QRS complexes most often corresponded to infraHis block (75%), Mean ages of patients with supra-, intra- and infra- His block were 58, 65 and 55 respectively. All those with intrahis block were female. Definite causes of conduction disturbance were not certain in 24among 27patients. In the remaining three patients, underlying causes were acute myocardia1 infarction in two and dilated cardiomyopathy in one.
김희열(Hee Yeol Kim),노태호(Tai Ho Rho),이만영(Man Young Lee),김진일(Jin Il Kim),최종영(Jong Young Choi),김종진(Chong Jin Kim),김종상(Chong Sang Kim),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1995 대한내과학회지 Vol.48 No.1
Intraatrial reentrant tachycardia (IART) which accounts for less than 5% of the cases of clinical supraventricular tachycardia (SVT), can be induced and terminated by programmed electrical stimulation. Ventricular activation occurs via the AV node, thus narrow QRS complexes follow the P waves, which conduct antegrade and are of different contour from the sinus P wave. The IART has a rate ranging from 100 to 150 bpm. Although it is generally regular, AV block may cause irregularity without interrupting the tachycardia. The presence of organic heart disease with or without atrial enlargement in these patients suggests that diseased atrial tissue and/or stretched atrium might predispose to paroxysmal atrial tachycardia. An IART generally responds to treatment with type Ia antiarrhythmic agents. Transesophageal atrial pacing (TAP) can be used to induce and terminate SVT for diagnostic or therapeutic purposes and provides a convenient way to access repeatedly the efficacy of long-term drug therapy and to screen patients for preexitation syndromes. This technique offers virtually noninvasive access to the atrium: it can be performed in an outpatient setting with minimal discomfort. We report a case of intraatrial reentrant tachycardia in a 54-year-old woman that was reproducibly induced and terminated by TAP with a brief review of literature.
Bioimpedance 를 이용한 심박출량의 측정 ; 열희석법과의 비교
박경선(Kyoung Sun Park),노태호(Tai Ho Rho),최재철(Jae Chul Choi),전승석(Seung Sok Chon),김종상(Chong Sang Kim),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1989 대한내과학회지 Vol.36 No.4
N/A Changes in bioimpedance during the cardiac cycle are inversely related to the volume of blood within the heart and great vessels. Estimating cardiac output from changes in the bioimpedance is a safe, painless, and noninvasive alternative which should be useful for repeated bedside determinations in individual patients. Cardiac output determined by the bioimpedance method using NCCOM3® (noninvasive continuous cardiac output monitor) was compared with that of the thermodilution method in 22 patients who underwent cardiac catheterization. Twenty-two patients, 7 males and 15 females ranging in age from 22 to 56 (mean 41.4), had various cardiac diseases. Coronary heart disease was present in 5 and valvular heart disease in 17. The cardiac rhythm was sinus rhythm in 4 and atrial fibrillation in 18. The results were as follows: 1) Bioimpedance provided a noninvasive, continuous and simple method to monitor cardiac output. 2) Cardiac output measured by bioimpedance and the thermodilution method correlated well (r=0.827 as a whole, r=0.902 in those with sinus rhythm). 3) Bioimpedance can be used in the clinical setting when the thermodilution method is not readily feasible and when continuous monitoring of cardiac output is indicated.
경피적 관상동맥 확장술 전후의 QT 간격분산 ( QT dispersion ) 비교
한혁준(Hyeok Jun Han),노태호(Tai Ho Rho),이만영(Man Young Lee),김희열(Hee Yeol Kim),윤호중(Ho Joong Youn),김종진(Jong Jin Kim),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1997 대한내과학회지 Vol.52 No.6
Objectives: QT dispersion(QTd) is defined as the difference between the maximum and minimum average QT interval in any of the 12 leads of the surface ECG. QTd has been shown to reflect regional variations in ventricular repolarization. It was reported previously that QTd was dependent on the degree of reperfusion in myocardial infarction. The purpose of this study is to investigate the effects of percutaneous transluminal coronary angioplasty(PTCA) on QTd. Methods: We studied in 21 patients(15 men and 6 women: mean age, 53±7.5 years: 14 acute myocardial infaction, 4 angina pectoris and 3 unstable angina). All standard 12-lead ECGs were recorded at a paper speed of 25mm/sec and examined retrospectively by single observer. QT interval was measured from 11.3±1.1 leads using a computerized program interfaced with digitizer. QTd corrected for heart rate(QTcd) was calculated by Bazett`s formula. Each cases were divided to 2 stages, before and after PTCA(mean obsevation duration, 16.8±9.7 days vs. 22.5±21.9 hours). The difference of QT dispersions was assessed by comparing by paired t-test. Results: There were significant difference in QTd (mean 110.2±37.4 vs. 90.4±37.6 msec, p<0.05). Results did not change when Bazett`s QTc was substituted for QT(QTcd: mean 125.5±38.3 vs. 97.9±29.8 msec, p<0.05). Conclusion: Successful PTCA is associated with less QTd after PTGA. The results are equally significant when either QT or QTc is used for analysis. In our limited study, measurement of QT dispersion, an easily accessible, resonably accurate, noninvasive method, may be a valuable tool in assessment of patients before and after PTCA. However, this study must be confirmed in prospective trial.
만성 혈액투석환자에서 발생한 Corynebacterium에 의한 생체인공판막 심내막염
김의형 ( Eui Hyung Kim ),조은주 ( Eun Ju Cho ),심건호 ( Kon Ho Shim ),조진만 ( Jin Man Cho ),김종진 ( Chong Jin Kim ),노태호 ( Tai Ho Rho ),김재형 ( Jae Hyung Kim ) 대한내과학회 2005 대한내과학회지 Vol.69 No.3
There has been a number of reports recently describing the pathogen potential of irregular asporogenous gram positive rods (IGPR), also referred as coryneforms or diphtheroids. This may be due to a greater number of opportunistic infections occurring in patients who are immunosuppressed or implanted with prostheses. The documentation of endocarditis caused by IGPR is difficult. Because all the result of culture is not always positive and these cultures need long-period incubation, and there are sometimes pseudo-positive cases due to the contamination in blood sampling. An early diagnosis and adequate treatment are important for the better result. We describe the case of bio prosthetic valve endocarditis in a 61-year-old woman who enduring chronic hemodialysis. This is the first case reported of bioprosthetic valve endocarditis by Corynebacterium in Korea. (Korean J Med 69:322-325, 2005)
흰쥐의 재관류시킨 심근경색증에 대한 Verapamil 의 영향
김철민(Chul Min Kim),전승석(Seung Sok Chun),노태호(Tai Ho Rho),박인수(In Soo Park),김종상(Chong Sang Kim),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1990 대한내과학회지 Vol.39 No.1
N/A Calcium channel blockers have proved effective in angina pectoris. However, despite a strong theoretical rationale for their use and promising experimental data, these agents have not reduced infarct size in acute myocardial infarction in the clinical trials performed to date. But treatment of calcium channel blockers before, at the time of, or shortly after the onset of coronary occlusion can increase the quantity of ischemic myocardium tha1 can be salvaged by repertusion. This agent appears to act by delaying cell death and may leave a larger quantity of viable cells which can be rescued by timely repertusion. This study was designed to investigate whether intervention with verapamil in reperfused myocardial infarction might reduce infarct size, infarct expansion and mortality in rats. An experimental model of myocardial infarction was produced in open chest rats by ligation of the left main coronary artery. After 30 minutes of ischemic time, reperfusion was done by cutting the ligated silk. The rats were administered an intraperitoneal injection of 20 mg/kg verapamil 30 minutes before ligation (treatment group 1, Tx 1)and 15 minutes after ligation (treatment group 2, Tx 2) in each treatment group. The control rats were administered an intraperitoneal injection of 8 ml kg 0.9% psaline 30minutes before ligation. On the seventh day, a topographic measurement of the left ventricle was obtained by planimeter. The infarct size was assessed by percetage of the left ventricular tissue area and by percentage of the left ventricular circumference of myocardial infarction. The infarct expansion was assessed by the left ventricular cavity area and thickness of the infarcted wall. The results were as follows: 1) The number of deaths during the experimental procedure was six out of 15 rats in the control group, 20 out of 40 rats in treatment group 1(Tx 1), and 20 out of 32 rats in treatment group 2(Tx 2). There was no difference in death rate. 2) By the left ventricular tissue area method, the infarct size of the control group (five rats) was 19.2±6.2%, treatment group 1 (11 rats) 24.3±9.4%, and treatment group 2 (seven rats) 30.3±5.7%. By the left ventricular circumference method, the infarct size of the control group was 23.7+4.6%p, treatment group 124.5±9.7%, and treatment group 233.1±7.3% There was no difference between treatment group 1 and the control group. But the infarct size of treatment group 2 was larger than that of the contro group (p<0.01, p<0.05). 3) There was no difference in infarct thickness and infarct expansion between the treatment groups and the control group. It was concluded that the administration of verapamil in experimental myocardial infarction with reperfusion may increase the size of the infarct. So it was suggested to limit the use of calcium channel blockers in acute myocardial infarction.
개에서 인공 심조율로 조성된 상실성 빈맥의 혈역학적 변화
조은주(Eun Ju Cho),김재형(Jae Hyung Kim),노태호(Tai Ho Rho),진승원(Seung Won Jin),김희열(Hee Yeol Kim),이만영(Man Young Lee),김종진(Chong Jin Kim),채장성(Jang Seong Chae),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 2002 대한내과학회지 Vol.62 No.1
Background: Tachyarrhythmias have various clinical features according to their tachycardia rates, systolic function of the left ventricle, the origin site and the mechanisms. Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) might cause different hemodynamic changes due to their different mechanisms. Methods: To evaluate the hemodynamic differences of supraventricular tachycardias, atrial tachycardia (atrial pacing with AOO mode, 180/min, group I), AVRT (VA pacing interval 80 msec with DOO mode, 180/min, group II) and AVNRT (VA pacing interval 0 msec, 25 msec with DOO mode, 180/ min, group III) were simulated in eleven dogs. Hemodynamic parameters were systemic arterial pressure including systolic, mean and diastolic arterial pressure (SAP, MAP, DAP respectively), mean pulmonary arterial wedge pressure (MPAWP) and cardiac output (CO). Results: The MAP was highest in group I (87.0±20.4mmHg) and decreased with decreasing VA interval of no significance. The SAP was higher in group II (109.8±22.6mmHg) than in group III (95.3±27.1mmHg) (p <0.05). The level of MPAWP had no significant differences among three groups and showed no peculiar pattern with changes of VA interval. The CO was higher in group I (1.18 ±0.32 L/ min) than in other two groups with significant difference (p <0.01) and decreased with shortening of VA interval without significance. Conclusion: Above result s suggested that the AVRT and AVNRT have different effects on hemodynamic changes, those from different timing of atrial contraction, especially on SAP and CO. So hemodynamic compromise during tachycardia could be more severe in AVNRT than in AVRT inspite of their similar QRS morphology and tachycardia rate.(Korean J Med 62:35- 41, 2002)
경식도 심초음파상의 흉부대동맥 죽상경화증의 관찰과 그 의의
이만영(Man Young Lee),정욱성(Wook Seong Chung),승기배(Kie Bae Seung),김종진(Jong Jin Kim),전승석(Seung Seok Chun),노태호(Tai Ho Rho),채장성(Jang Seong Chae),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1994 대한내과학회지 Vol.46 No.6
Objectives: Atherosclerosis has been suggested to be a generalized disease process. Thus, the pressence of an atherosclerotic cardiovascular event can predict the occurrence of a subsequent event located elsewhere. From a preventive point of view, it would be desirable to have an indicator before the clinical appearance of disease. Ultrasonography has the necessary accuracy, precision, and repeatability to serve as measurement tools of quantitative imaging of large vessel atherosclerosis. Aorta can be examined with relative ease using transesophageal echocardiography. We performed this study to find the prevalence of atherosclerosis of thoracic aorta using transesophageal echocardiography and also to evaluate the association of known atherosclerotic risk factors with its development and clinical significance. Methods: We evaluated the descending thoracic aorta of 548 patients (male 248, female 300: mean age 52±15 yrs), those underwent clinically indicated transesophageal echocardiography. We classified the patients into 4 groups: normal group (270 pts), thin atherosclerotic group (159 pts), thick athrosclerotic group (109 pts) and thick protruded plaque group (17 pts) according to the morphology and thickness of atherosclerotic plaque. Results: 1) Transesophageal echocardiography is a valuable diagnostic tool to assess the severity of atherosclerosis in thoracic aorta and the atherosclerosis of variable degree was commonly encountered in 278 patients of total 548 study subjects. 2) Among the well known atherosclerotic risk factors, the age and the prescnece of hypertension were most strongly related to atherosclerotic process of thoracic aorta. 3) The relations between the atherosclerosis of descending thoracic aorta and the coronany artery disease and cerebral infaction were thought to be weak and need further study. Conclusion: Atherosclerotic lesion of thoracic aorta could be accurately assessed by transesophageal echocardiography. There were close associations between age and hypertension as atherosclerotic risk factors and the atherosclerotic progression of thoracic aorta. Although there are somewhat weak relationships between the degree of atherosclerosis of thoracic aorta and other cardiovascular disease. To elucidate the precise relationship needs further study.