경피적 관동맥중재술을 받은 급성관동맥증후군 노인의 회복기 건강관련 삶의 질

황은희,신미경,신수진 노인간호학회 2009 노인간호학회지 Vol.11 No.1

Purpose: The purpose of this study was to identify health related quality of life in elders during the recovery period after a percutaneous coronary intervention. Method: The participants were 73 adults over 65 years of age in the month after a percutaneous coronary intervention. The questionnaire included the Global Registry of Acute Coronary Events (GRACE) used to assess severity and Quality of Life SF-36 (Short Form-36). The collected date were analyzed with the SPSS 14.0 program. Results: Among the SF-36 scores, the item with the highest score was in functional status for role limitation- emotional (82.42) in well-being for psychological health (68.90). Quality of life was statistically significant according to gender and severity in functional status, well-being, and general health status. Conclusion: The results indicate a need to develop follow-up programs for elders based on personal disposition.

급성 관동맥 증후군

박승정 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.12

증례 : 순환기 ; 발열을 동반한 폐렴환자에서 발견된 특발성 Brugada 심전도 패턴 1예

이재범 ( Jae Beom Lee ),이만영 ( Man Young Lee ),이성진 ( Sung Jin Lee ),황희정 ( Hui Jeong Hwang ),박현근 ( Hyun Keun Park ),최윤석 ( Yun Seok Choi ),박철수 ( Chul Soo Park ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

저자 등은 44세의 남자 환자에서 늑막염을 동반한 폐렴으로 인한 급성 흉통과 발열과 동반된 ST분절 상승으로 급성심근 경색으로 오인하였고, flecainide 유발검사로 특발성 Brugada 심전도 pattern이 진단되었던 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. We present the case of a 44-year-old man who presented with continuous chest pain and fever with pneumonia. Additionally, idiopathic Brugada ECG patterns were observed. The patient`s initial electrocardiogram showed ST-segment elevation at the right precordial and lateral leads. An emergency coronary angiography showed that there was no significant stenosis or thrombus in the coronary arteries. ECG findings showed Brugada ECG patterns, which were exaggerated by high fever. The diagnosis was confirmed with a flecainide provocation test that allowed us to document ECG changes consistent with type 1 Brugada ECG patterns. This case report reveals how dynamic ST-segment elevations may look similar in cases of acute coronary syndrome and Brugada syndrome. Additionally, we showed that Brugada ECG patterns can be exaggerated by fever. (Korean J Med 2011;80:S166-S171)

급성 관동맥증후군에서 예후평가를 위한 NT-proBNP, troponin 1, hs-CRP의 유용성

오병천 ( Pyung Chun Oh ),한승환 ( Seung Hwan Han ),정욱진 ( Wook Jin Chung ),강웅철 ( Woong Chol Kang ),서일혜 ( Yiel Hea Seo ),엄영실 ( Young Sil Eom ),문찬일 ( Chan Il Moon ),봉정민 ( Jeong Min Bong ),신미승 ( Mi Seung Shin ) 대한내과학회 2009 대한내과학회지 Vol.77 No.2

Background/Aims: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. Methods: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a an of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. Results: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87; HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). Conclusions: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation. (Korean J 77:200-210, 2009)

발열을 동반한 폐렴환자에서 발견된 특발성 Brugada 심전도 패턴 1예

이재범,이만영,이성진,황희정,박현근,최윤석,박철수 대한내과학회 2011 대한내과학회지 Vol.80 No.-

We present the case of a 44-year-old man who presented with continuous chest pain and fever with pneumonia. Additionally, idiopathic Brugada ECG patterns were observed. The patient’s initial electrocardiogram showed ST-segment elevation at the right precordial and lateral leads. An emergency coronary angiography showed that there was no significant stenosis or thrombus in the coronary arteries. ECG findings showed Brugada ECG patterns, which were exaggerated by high fever. The diagnosis was confirmed with a flecainide provocation test that allowed us to document ECG changes consistent with type 1 Brugada ECG patterns. This case report reveals how dynamic ST-segment elevations may look similar in cases of acute coronary syndrome and Brugada syndrome. Additionally, we showed that Brugada ECG patterns can be exaggerated by fever. (Korean J Med 2011;80:S166-S171) 저자 등은 44세의 남자 환자에서 늑막염을 동반한 폐렴으로 인한 급성 흉통과 발열과 동반된 ST분절 상승으로 급성심근경색으로 오인하였고, flecainide 유발검사로 특발성 Brugada 심전도 pattern이 진단되었던 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

종설 : 급성 관동맥 증후군 치료의 최신 지견

우종신 ( Jong Shin Woo ),김명곤 ( Myeong Kon Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.6

Acute coronary syndrome (ACS) represents a broad spectrum of ischemic myocardial events, including unstable angina, non-ST elevation myocardial infarction, and acute ST elevation myocardial infarction, which are associated with high morbidity and mortality. Early diagnosis and risk stratification are essential for initiation of optimal medical and invasive management. Randomized clinical trials over the past decade have revolutionized the care of patients with ACS. Therapeutic measures consist of administration of aggressive antiplatelet, antithrombotic, and antiischemic agents. In addition, patients with high-risk features, notably positive troponin, ST segment changes, and diabetes, benefit from early invasive intervention as compared to conservative strategies. Lifestyle interventions, modification of risk factor profile, and long-term medical treatment are of pivotal importance in reducing the long-term risk of recurrence. (Korean J Med 76:661-676, 2009)

종설 : 급성관동맥 증후군과 취약성 경화반

배장호 ( Jang Ho Bae ),송인걸 ( In Geol Song ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3

Acute coronary syndrome (ACS) consists of unstable angina, non-ST segment elevation myocardial infarction (NSTEMI), and STEMI. The pathology underlying ACS is acute thrombosis in a coronary artery, which is usually caused by plaque rupture in a mild stenotic lesion. A rupture-prone plaque is known as a vulnerable plaque (VP), although recently the definition of VP has been expanded to include rapidly progressive plaque. Although no single method can predict future cardiac events in mild stenotic lesions, there have been big advances in detecting VP, such as virtual histology-intravascular ultrasound and optical coherence tomography. These techniques look for thin cap fibroatheromas, which is the most common type of VP, characterized by a thin fibrous cap <65 μm, a large necrotic core, and marked macrophage infiltration of the fibrous cap. The recent concept of VP, the methods for detecting VP, and the treatment of VP are discussed. (Korean J Med 79:241-249, 2010)

최근 개발된 항혈소판제제

강민규 ( Min Kyu Kang ),장기육 ( Kiy Uk Chang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.1

Antiplatelet agents play an essential role in the treatment of acute coronary syndrome (ACS). Aspirin and thienopyridines comprise the major classes of antiplatelet therapies demonstrated to be of benefit in the treatment of ACS. Thienopyridines are a class of drugs that function via inhibition of the adenosine diphosphate (ADP) P2Y12 platelet receptors. While clopidogrel remains in extensive use in clinical practice, it cannot meet the needs in many clinical conditions because of its pharmacological limitations. In recent years, newly developed P2Y12 antagonists, such as prasugrel and ticagrelor, have proven to be of higher efficacy and less resistance. As a third generation thienopyridine, prasugrel exerts a much more rapid and consistent inhibitory effect on platelet aggregation than clopidogrel. Treatment with ticagrelor, nonthienopyridine oral antiplatelet drug, significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding as compared with clopidogrel. The present review aims to discuss the current knowledge on the safety and efficacy of new oral antiplatelet agents including prasugrel and ticagrelor. (Korean J Med 2013;85:10-14)