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이기훈 ( Gi Hoon Lee ),정명호 ( Myung Ho Jeong ),안영근 ( Young Keun Ahn ),김주한 ( Ju Han Kim ),홍영준 ( Young Joon Hong ),강정채 ( Jung Chaee Kang ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1
본 증례는 지네 교상 후 전신적 부작용의 하나로서 미만성 관상동맥 연축에 의한 심한 흉통을 보였으며, 혈관 확장제의 투여 후 호전되었던 예로서 문헌고찰과 함께 보고하는 바이다. The centipede is an elongated and multi-segmented arthropod with a venom apparatus that consists of modified legs on either side of the body just behind the head. Generally, centipede envenomation causes local tissue swelling, redness, pruritus, swollen and painful lymph nodes, headache, nausea, vomiting and anxiety. Adverse systemic reactions such as acute renal failure, rhabdomyolysis and acute myocardial infarction have been associated with centipede bite. We experienced a case of a 57-year-old man who complained of severe chest pain after a centipede (20 cm in length) bite. The electrocardiogram recorded at the emergency medical center showed ST-T changes in the precordial leads. The levels of cardiac enzyme were not elevated [creatine kinase (CK) 101 U/L (35~172), CK-MB 5.1 U/L (2.3~9.5), troponin I 0.06 ng/mL (0~0.05), troponin T 0.02 ng/mL (0~0.1)]. He had a history of percutaneous coronary intervention in the left circumflex artery under the diagnosis of acute myocardial infarction 4 years ago. The emergency coronary angiogram revealed severe diffuse coronary artery spasm in the left coronary artery, which was improved after intracoronary nitroglycerin injection, and patent previously placed stent in the left circumflex artery was noted. He improved after medical treatment and was discharged on the eleventh day without any remained subjective symptoms.(Korean J Med 73:92-95, 2007)
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요골동맥을 이용한 관상동맥 조영술시 고용량 Nicorandil의 요골동맥 확장 및 임상적 효과
조용찬,김원,김종태,정안덕,조상철,강원유,황선호,김완 대한심장학회 2008 Korean Circulation Journal Vol.38 No.4
Background and Objectives: A spasm of the radial artery is one of the most common complications of coronary angiography (CAG) via the transradial approach (TR), and this spasm sometimes disturbs the procedure. Nicorandil has recently shown dose-dependent dilatation of the blood vessels and ischemic preconditioning. This study was designed to evaluate the clinical effects and radial artery vasodilation of high dose nicorandil solution during CAG via the radial artery. Subjects and Methods: This study was a prospective, randomized study to compare the effects of 12 mg of nicorandil (the Nicorandil group) and 10 mL of a cocktail solution (nitroglycerine 200 μg mixed with verapamil 100 μg) (the Cocktail group) in 146 patients. Vasospasms, which were expressed as the stenosis of the radial artery were examined at 2 parts of the radial artery. Results: There were no significant difference of gender, age and risk factors for the 2 groups of patients. The reductions in the systolic and diastolic blood pressure (BP) 1 minute after drug administration were 33.6±11.4/10.4±7.7 mmHg in the Nicorandil group and 12.8±9.8/3.8±5.3 mmHg in the Cocktail group (p<0.001). Both vasodilating agents showed significant radial artery vasodilation after administration of the drugs (p<0.005 for all). The minimal luminal diameter (MLD) after drug administration was more dilated in the Nicorandil group than that in the Cocktail group (0.63±0.25 mm vs. 0.48±0.19 mm, respectively, p=0.013). Conclusion: Nicorandil solution was more effective for inducing vasodilation of the radial artery, but it was not clinical superior to the cocktail solution. Background and Objectives: A spasm of the radial artery is one of the most common complications of coronary angiography (CAG) via the transradial approach (TR), and this spasm sometimes disturbs the procedure. Nicorandil has recently shown dose-dependent dilatation of the blood vessels and ischemic preconditioning. This study was designed to evaluate the clinical effects and radial artery vasodilation of high dose nicorandil solution during CAG via the radial artery. Subjects and Methods: This study was a prospective, randomized study to compare the effects of 12 mg of nicorandil (the Nicorandil group) and 10 mL of a cocktail solution (nitroglycerine 200 μg mixed with verapamil 100 μg) (the Cocktail group) in 146 patients. Vasospasms, which were expressed as the stenosis of the radial artery were examined at 2 parts of the radial artery. Results: There were no significant difference of gender, age and risk factors for the 2 groups of patients. The reductions in the systolic and diastolic blood pressure (BP) 1 minute after drug administration were 33.6±11.4/10.4±7.7 mmHg in the Nicorandil group and 12.8±9.8/3.8±5.3 mmHg in the Cocktail group (p<0.001). Both vasodilating agents showed significant radial artery vasodilation after administration of the drugs (p<0.005 for all). The minimal luminal diameter (MLD) after drug administration was more dilated in the Nicorandil group than that in the Cocktail group (0.63±0.25 mm vs. 0.48±0.19 mm, respectively, p=0.013). Conclusion: Nicorandil solution was more effective for inducing vasodilation of the radial artery, but it was not clinical superior to the cocktail solution.
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김형섭 ( Hyung Seop Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.6
Acute heart failure (HF) is commonly encountered in the emergency department and thus, the hospital admissions for worsening HF are increasing. However, the patients presenting with acute HF are heterogenous and complex at high risk of morbidity and mortality. The main goals of treatment for hospitalized patients with HF are to restore euvolemia and to maintain the hemodynamic status without causing adverse events. Currently, the recommendations are usually based on a clinical factor considering the initial systolic blood pressure and other symptoms. Accordingly, initial managements in the hospital generally include diuretics, vasodilators, morphine, and inotropic agents, all of which have been considered as traditional therapies. These agents should mainly increase cardiac output and improve symptoms, and importantly it should improve the clinical outcomes. The aim of this review is to describe the available and new pharmacologic drugs for patients presenting with acute HF.
ScienceON
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