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.

급성 심근경색증의 정맥 혈전용해요법에 대한 임상적 관찰

채장성(Jang Seong Chae),전승석(Seung Sok Chun),김종상(Jong Sang Kim),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi),김학중(Hak Joong Kim) 대한내과학회 1987 대한내과학회지 Vol.34 No.1

N/A Progress in reducing mortality and morbidity has been slow in spite of increased understanding of the pathophysiology af myocardial infarction. By the use of coronary care units together with improved therapy for life threatening arrhythmias, cardiac pump failure has emerged as the principal cause of in-hospital death. The objectives of thrombolytic therapy are to lyse coronary thrombi during the early phase of transmural myocardial infarction to salvage jeopardized myocardium, preserves ventricular function and may enhance survival by lysing thrombotic coronary artery occlusion which is commonest cause of transmural myocardial infarction. To evaluate the usefulness of thrombolytic agents (Urokinase : UK) for acute myocardial infarction, we analized 51 patiens who admitted within 6 hours after symptoms developed and treated with UK (0.3 million u bolus and daily 0.3 million u continuous IV infusion for 3-4 days) in case who did not have any evidence of contraindication of thrombolytic therapy and compared with 57 patients who were treated by conventional method. The results were as follows: 1) The annual cases of acute myocardial infarction showed increasing tendency and peak frequency of onset was from 6 a.m. to noon throughout the day. 2) The ratio of male to female for acute myocardial infarction was 3:1 and the average age was 59. 3) The common preceding disease were hypertension (31 cases), angina pectoris (21 cases) and diabetes mellitus (12 cases). The cholesterol level over 201 mg/dl was 40% of patients. 4) Anterior wall infarctions were observed in 59 cases, inferior wa11 infarctions in 46 ca and subendocardial infarctions were 3 cases. In anterior myocardial infarction, 20% and 29.4% expired with thrombolytic and conventional therapy respectively. In inferior myocardial infarction, 31.8% expired with conventional therapy but there was none with thrombolytic therapy, 5) Arrhythmias were observed in 83.6% of all cases and ventricular arrhythmia (60.2%) was the msot common. Conduction disturbances were observed in 24.1% and more frequent in inferior than anterior myocardial infarction. 6) Five of 51 patients (9.8%) were expired with thrombolytic therapy and 17 of 57 patients (29.8%) with conventional therapy were expired (P<0.01), and overall mortality was 20.4% 7) The mortality for killip classification III k IV was 38.5% and 66.7% with thrombolytic and conventional therapy respectively (P<0.1). The mortality who had Norris coronary prognostic index over 10 were 25% and 69.2% with thrombolytic and conventional therapy respectively (P <0.05). 8) Only one case of tarry stool was observed as a complication of thrombolytic therapy, In conclusion, intravenous thrombolytic therapy in early phase of acute myocardial infarction improved survival.

D.D.D. 형 인공심박동기 시술 환자에서 심방심실 연속자극간격 변화가 수축기와 이완기에 미치는 영향

이만영(Man Young Lee),승기배(Ki Bae Seung),전승석(Seung Sok Chun),채장성(Jang Seong Chae),김종상(Jong Sang Kim),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

N/A Background: Although the duration of the atrioventricular delay is known to affect ventricular diastolic filling time, the hemodynamic effects have been controversial. Several recent studies attempted to clarify the issue of optimal AV delay and have come to different conclusions. So we performed this study to evaluate the hemodynamic effects of varying A-V delays in A-V sequential pacing by echocardiography. Methods: 9 patients of this study had D,D.D. pace- makers because of complete atrioventricular block or sick sinus syndrome. The mean age of 5 male and 4 female patients was 49±22 years. Using the programming device, the pacing rate was set at 70/min, and at 5 different A-V delays (100, 125, 150, 175, 200, 250 ms), we measured the changes of various time intervals during systolic and diastolic phase by recording the M-mode echocardiogram of aortic and mitral valve, ECG, and phonocardiogram simultaneously. Results: In systolic phase, preejection periods were significantly shortened at A-V delay 200ms, 250 ms comparing to those of A-V delays below l75 ms. Left ventricular ejection times showed no statistically significant changes between various A-V delays. Systolic time intervals showed significant decrements at A-V delay 200 ms, 250 ms comparing to those of A-V delays below 175 ms. Changing the A-V delay from 100 ms to 250 ms, isovolumic contraction times were significantly pro- longed and isovolumic contraction time/preejection period ratios were significantly increased. And in diastolic phase, mitral valve opening times were significantly shortened at A-V delay 200 ms, 250 ms comparing to those of A-V delays below 175 ms. A spike-Mc intervals were significantly prolonged as changing the A-V delay from 100 ms to 250 ms. Conclusion: These data suggest that the change of A-V delay in D.D.D. pacemakers had variable effects on various time intervals of systolic and diastolic phase. Considering the close relationship between the systolic time interval and cardiac function, relatively long A-V delay such as 200 ms or 250 ms was thought to be more desirable in patients of this study. And measurement of systolic time interval by echocardiography could be used as an useful, noninvasive guideline for determining the optimal A-V delay in individual patient.