Journal of Yeungnam Medical Science

Case Report

Cardiology and Cardiovascular Medicine
Acute upper limb ischemia in a patient with newly diagnosed paroxysmal atrial fibrillation: Dong Shin Kim, Seunghwan Kim, Hyang Ki Min, Chiwoo Song, Young Bin Kim, Sae Jong Kim, Ji Young Park, Sung Kee Ryu, Jae Woong Choi; Yeungnam Univ J Med. 2017;34(2):242-246. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.242

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Abstract PDF: Acute limb ischemia (ALI) due to an embolism is associated with high mortality rate and poor prognosis, and early diagnosis with prompt revascularization is required to reduce the risk of limb amputation or even death. The etiologies of ALI are diverse, and it includes an embolism from the heart and thrombotic occlusion of the atherosclerotic native vessels, stents, or grafts. An uncommon cause of ALI is acute arterial thromboembolism, and atrial fibrillation (AF) is the single most important risk factors for systemic thromboembolism. It is important to correctly identify the source of ALI for secondary prevention, as it depends on the underlying cause. Percutaneous transluminal angioplasty (PTA) has been proven to be a safe and effective treatment for focal atherosclerotic and thrombotic occlusive diseases of the aorta and its major extremity branches. Herein, we report on a 77-year-old female patient with acute upper limb ischemia, treated by PTA using a catheter-guided thrombectomy. He was newly diagnosed with paroxysmal AF (PAF) while evaluation the cause of his acute arterial thromboembolism. We recommend that cardiologists always consider PAF as a possible diagnosis even in patients without any history of AF under ALI because it is possible to develop thromboembolism in clinical practice.

Original Article

Cardiology and Cardiovascular Medicine
Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment: Hyang Ki Min, Ji Young Park, Jae Woong Choi, Sung Kee Ryu, Seunghwan Kim, Chang Sup Song, Dong Shin Kim, Chi Woo Song, Se Jong Kim, Young Bin Kim; Yeungnam Univ J Med. 2017;34(2):191-199. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.191

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Abstract PDF: BACKGROUND
This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI). METHODS: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared. RESULTS: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level (68.1±66.62 vs. 141.6±154.3 mg/dL, p=0.007) and high density lipoprotein level (44.6±10.3 vs. 39.5±8.1 mg/dL, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group (71.5±114.2 vs. 35.9±59.9 ng/mL, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p < 0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317–1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes. CONCLUSION: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shorter-symptom-to-door time.

Case Report

Cardiology and Cardiovascular Medicine
Lower limb ischemia after bee sting.: Hee Yun Ryu, Min Seok Yoo, Ji Young Park, Jae Woong Choi, Sung Kee Ryu, Seunghwan Kim, Se Jin Lee, Young Bin Kim; Yeungnam Univ J Med. 2016;33(2):134-137. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.134

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1 Crossref

Abstract PDF

Bee sting causes mild symptoms such as urticaria and localized pain, and severe symptoms including anaphylaxis, cardiovascular collapse, and death. We reported on a patient with arterial thrombotic occlusion and severe ischemia in the lower limb after multiple bee stings. The patient was stung 5 times and complained of pallor, pain, and coldness in the left toe, and did not have dorsalis pedis pulsation. Computed tomography angiography showed multiple thrombotic occlusion of the anterior and posterial tibial artery below the knee. Local thrombolytic therapy using urokinase was administered and the occluded arteries were successfully recanalized.

Citations

Citations to this article as recorded by

A Rare Case of Acute Lower Limb Ischemia following Bee Sting
Jayesh Patel, Arya Patel, Shivangi Jha, Ketul S Barot, Pratiksha Patel, Dwisha Poptani
Indian Journal of Vascular and Endovascular Surgery.2023; 10(3): 231. CrossRef

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