Type 2 Myocardial Infarction Following Generalized Tonic-Clonic Seizure

Myocardial infarction is diagnosed when blood levels of biomarkers are increased in the clinical setting of acute myocardial ischemia. Among the biomarkers, troponin I is the preferred biomarker indicative of myocardial necrosis. It is tissue specific for the heart. Myocardial infarction is rarely reported following seizure. We report a case of elevated troponin I in a patient after an episode of generalized tonic-clonic seizure. The diagnosis was type 2 myocardial infarction

Recurrent Infective Endocarditis Associated With Pyogenic Spondylodiskitis

Infective endocarditis is a life-threatening condition caused by microbial infection of the heart's endocardial surface. This condition can also be associated with bacterial infections of other organs. We experienced an unusual case of recurrent infective endocarditis associated with pyogenic spondylodiskitis. A 70-year-old man presented with persistent fever and lower back pain visited our hospital. The patient had a past history of recurrent infective endocarditis. He was diagnosed with infective endocarditis again based on clinical symptoms and echocardiographic findings. Magnetic resonance imaging was used to evaluate lower back pain, which showed acute spondylodiskitis on L3 and L4 vertebrae. The patient completely recovered following four weeks of antibiotic therapy

Non-Dipper Pattern is a Determinant of the Inappropriateness of Left Ventricular Mass in Essential Hypertensive Patients

Background and Objectives: Inappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass. Subjects and Methods: Using the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day. Results: Daytime, nighttime and 24 hours BP in hypertensive patients was 140.4 +/- 14.8 mmHg, 143.7 +/- 15.2 mmHg and 129.4 +/- 20.0 mmHg, respectively. OPR was 106.3 +/- 19.9% and nocturnal dipping was 10.2 +/- 10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (beta=0.097, p=0.043) and nocturnal dipping (beta=-0.098, p=0.046) were independent determinants of OPR as well as age (beta=0.130, p=0.025) and body mass inde

Bone Mineral Density is an Independent Determinant of Left Ventricular Mass Index in the General Female Population

Background and Objectives: Left ventricular hypertrophy (LVH) is a well known cardiovascular prognostic predictor. Osteoporosis has been suggested to be associated with cardiovascular disease. According to studies of primary hyperparathyroidism, a pathophysiological association between calcium metabolism and LVH has been suggested but is not yet fully understood. This study was performed to investigate the association between bone mineral density (BMD) and left ventricular mass index (LVMI) in a general population. Subjects and Methods: Data from 460 subjects among 543 subjects sampled from a general population in a rural area in Korea were analyzed. BMD, echocardiography, brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (IMT) measurement as well as the measurements of blood pressure, blood chemistry and metabolic parameters were analyzed. BMD was measured using the Sahara Clinical Bone Sonometer (Hologic Inc., Mass., USA). Results: Age of the subjects was 59.4??12.4 years. Males were 42.2% (n=194). In a simple correlation analysis on female subjects, age and waist circumference showed negative correlation, and body mass index (BMI) showed positive correlation with BMD. However, only age showed negative correlation with BMD in male subjects. After adjusting baPWV and carotid IMT, we found that BMD was an independent determinant of LVMI in female subjects (??=-13.703, p=0.016), but not in male subjects (??=-1.235, p=0.841). Conclusion: BMD is a consistent and independent determining factor of LVMI, BMI and carotid IMT in postmenopausal women. Copyright ?? 2010 The Korean Society of Cardiology

The Relationship Between Ambulatory Arterial Stiffness Index and Blood Pressure Variability in Hypertensive Patients

Background and Objectives: Ambulatory arterial stiffness index (AASI) is well known as a predictor of cardiovascular mortality in hypertensive patients. Mathematically, AASI reflect the standard deviation (SD) of blood pressure (BP) variation. AASI is measured higher levels in non-dipper than dipper. Thus, AASI has a possibility of not only reflecting arterial stiffness but also BP variability and/or autonomic nervous dysfunction. Subjects and Methods: Consecutive data from 418 untreated hypertensive patients were analyzed retrospectively. We examined the association between the 24-hour ambulatory BP monitoring (ABPM) parameters and AASI. Results: AASI had a simple correlation with age (R=0.189, p<0.001), relative wall thickness (RWT) (R=0.115, p=0.019), left ventricular mass index (LVMI) (R=0.192, p<0.001), average systolic BP (SBP) (R=0.232, p<0.001), average pulse pressure (PP) (R=0.363, p<0.001), SD of diastolic BP (DBP) (R=-0.352,p<0.001), SD of PP (R=0.330, p<0.001), SD of heart rate (HR) (R=-0.268, p<0.001), and nocturnal dipping (R=-0.137, p=0.005). In multiple linear regression analysis model including clinical parameters and 24 hour-ABPM parameters, independent predictors of AASI were SD of PP (beta=1.246, p<0.001), SD of DBP (beta=-1.067, p<0.001), SD of SBP (beta=-0.197, p<0.001), and non-dipper (beta=0.054, p=0.033). Conclusion: AASI is closely correlated with BP variability. The result of this study shows that AASI is not only a parameter for arterial stiffness, but also a parameter for BP variability

Association Between Inappropriateness of Left Ventricular Mass and Left Ventricular Diastolic Dysfunction: A Study Using the Tissue Doppler Parameter, E/E'

Background and Objectives: The structural significance of the inappropriateness of left ventricular mass (iLVM) is known to be an important prognostic factor for cardiovascular events; however, the functional changes associated with iLVM have not been established. This study was performed to determine if diastolic dysfunction is associated with iLVM using a tissue Doppler technique. Subjects and Methods: Three hundred sixty consecutive subjects, including 221 hypertension patients from the echocardiography database, were analyzed. Regarding the appropriateness of left ventricular (LV) mass, an observed/predicted ratio of IV mass (OPR) > 130% was defined as inappropriate. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), isovolumetric relaxation time (IVRT), and E/early mitral annulus velocity (E'), were compared between the appropriate LV mass (aLVM) group and the iLVM group. Results: Among transmitral flow parameters, only the E velocity was negatively correlated with the OPR when adjusted for age (adjusted r=-0.107, p=0.04). Based on multiple regression analysis, the OPR (??=0.163, p=0.003), as well as age (??=0.286, p=0.0001), systolic blood pressure (??=0.120, p=0.019), fasting blood glucose (??=0.098, p=0.042), and male gender (??=0.157, p=0.002) were independent factors determining E/E'. The cholesterol level was not an independent factor (??=-0.059, p=0.355). In the iLVM group (n=105), the adjusted E/E' was higher than in the aLVM group (n=255; 11.7 ?? 3.4 vs. 10.8 ?? 3.1, p=0.02), while the peak E flow velocity was significantly lower than in the aLVM group (70.9 ?? 15.1 vs. 75.5 ?? 17.6, p=0.03). Conclusion: Inappropriateness of LV mass is independently associated with increased E/E'. Thus, E/E' may be a useful parameter for the evaluation of diastolic dysfunction. Copyright ?? 2009 The Korean Society of Cardiology