Journal of Yeungnam Medical Science

Case Report

Severe chest pain with mid-ventricular obstruction in a patient with hyperthyroidism: Jong Ho Nam, Jang Won Son, Geu Ru Hong; Yeungnam Univ J Med. 2017;34(1):128-131. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.128

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Abstract PDF: Mid-ventricular obstruction (MVO) rarely occurs in patients without hypertrophic cardiomyopathy. Increased cardiac contractility may play an important role in causing MVO. We experienced a case of severe chest pain and MVO in a 50-year-old female patient. She had hypertension, diabetes, stroke and peripheral artery disease. Her blood pressure was very high (222/122 mmHg) with severe fluctuation. The transthoracic echocardiography revealed MVO accompanied by hyper-dynamic left ventricular systolic function. We regarded her chest pain and MVO as secondary findings related to other diseases. Coronary angiography and several tests for uncontrolled hypertension were performed, and those evaluations revealed that she had coronary artery disease and hyperthyroidism. We considered that the increase in the myocardial oxygen demand in response to the increase in cardiac contractility and workload associated with hyperthyroidism aggravated her symptoms and MVO. She was treated with methimazole and beta blockers and her symptoms dramatically improved.

Review

Clinical Application of Cardiac Hybrid Imaging in Coronary Artery Disease.: Ihn Ho Cho, Eun Jung Kong; Yeungnam Univ J Med. 2009;26(1):15-23. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.15

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Abstract PDF: Constant technological developments in coronary artery disease have contributed to the assessment of both the presence of coronary stenosis and its hemodynamic consequences. Hence, noninvasive imaging helps guide therapeutic decisions by providing complementary information on coronary morphology and on myocardial perfusion and metabolism. This can be done using single photon emission computed tomography(SPECT) or positron emission tomography(PET) and multidetector CT(MDCT). Advances in image-processing software and the advent of SPECT/CT and PET/CT have paved the way for the combination of image datasets from different modalities, giving rise to hybrid imaging. Three dimensional cardiac hybrid imaging helped to confirm hemodynamic significance in many lesions, add new lesions such as left main coronay artery disease, exclude equivocal defects, correct the corresponding arteries to their allocated defects and identify culprit segment. Cardiac hybrid imaging avoids the mental integration of functional and morphologic images and facilitates a comprehensive interpretation of coronary lesions and their pathophysiologic adequacy by three dimensional display of fused images, and allows the best evaluation of myocardial territories and the coronary-artery branches that serve each territory. This integration of functional and morphological information were feasible to intuitively convincing and might facilitate developmnt of a comprehensive non-invasive assessment of coronary artery disease.

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