Pub Date : 2021-10-01DOI: 10.3904/kjm.2021.96.5.432
Jinmo Kim, Ju Yeop Lee, W. Yoo, M. Lee, Hyun-Kyung Chung
Diabetic ketoacidosis (DKA) is an acute complication related to severe hyperglycemia. While the mortality rate for DKA is low with appropriate therapy, several complications may lead to deterioration of the clinical course. Here, we report a case of a 23-year-old patient with DKA who suffered from a rare but hemodynamically unstable cardiac arrhythmia, polymorphic ventricular tachycardia with prolonged QT interval, or Torsades de Pointes. During the recovery phase of DKA, three episodes of Torsades de Pointes suddenly occurred, and were recovered by immediate defibrillation. The patient did not have structural heart disease or a genetic predisposition. To the best of our knowledge, this is the first report of an adult with DKA complicated with QT prolongation related to Torsades de Points after correction of ketosis. To manage DKA, more attention may be needed on changes in the QT interval as well as risk factors for Torsades de Points.
{"title":"Cardiac Arrest Related to Torsades de Pointes in a Patient Recovering from Diabetic Ketoacidosis","authors":"Jinmo Kim, Ju Yeop Lee, W. Yoo, M. Lee, Hyun-Kyung Chung","doi":"10.3904/kjm.2021.96.5.432","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.5.432","url":null,"abstract":"Diabetic ketoacidosis (DKA) is an acute complication related to severe hyperglycemia. While the mortality rate for DKA is low with appropriate therapy, several complications may lead to deterioration of the clinical course. Here, we report a case of a 23-year-old patient with DKA who suffered from a rare but hemodynamically unstable cardiac arrhythmia, polymorphic ventricular tachycardia with prolonged QT interval, or Torsades de Pointes. During the recovery phase of DKA, three episodes of Torsades de Pointes suddenly occurred, and were recovered by immediate defibrillation. The patient did not have structural heart disease or a genetic predisposition. To the best of our knowledge, this is the first report of an adult with DKA complicated with QT prolongation related to Torsades de Points after correction of ketosis. To manage DKA, more attention may be needed on changes in the QT interval as well as risk factors for Torsades de Points.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"51 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91494584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.3904/kjm.2021.96.5.390
Jiwon Lyu, T. Shim
The most important thing for the management of drug susceptible pulmonary tuberculosis is to diagnose active pulmonary tuberculosis as soon as possible and prevent the occurrence of new patients through appropriate treatment. Therefore, it should be a priority to quickly detect tuberculosis mycobacterium and quickly exclude drug-resistant tuberculosis before treatment begins. To this end, recent guidelines recommend the general use of Mycobacterium tuberculosis (MTB) polymerase chain reaction (PCR) tests, Xpert MTB/RIF tests, and rapid sensitivity tests through line probe assay (LPA). In addition, if the results of the test are positive, it is important to establish an in-hospital reporting system so that rapid reporting can be made. The treatment principle for drug susceptible pulmonary tuberculosis is 2 months of initial intensive phase (isoniazid, rifampin, ethambutol, pyrazinamide) followed by 4 months of maintenance phase (isoniazid, rifampin). Despite global efforts to shorten the duration of the treatment, the treatment of drug susceptible pulmonary tuberculosis has not changed for more than 35 years, and problems such as increased side effects and reduced drug adherence are serious obstacles to tuberculosis management. Therefore, efforts have been steadily made to shorten the treatment period through the combination of new drugs worldwide, and after many failures, they are finally paying off. A recently published Study 31/A5349 study found that 4 months short-term regimen using rifapentine (RPT) and moxifloxacin (MFX) demonstrated non-inferiority in existing standard regimen, as the result, a revision of World Health Organization guidelines is scheduled that 4 months short-term regimen using RPT and MFX may be an alternative. However, it is unlikely that RPT/MFX 4 months short-term regimen will be applied immediately in Korea because the use of RPT is currently limited in Korea due to the high frequency of side effects.
{"title":"Recent Advances in Drug Susceptible Pulmonary Tuberculosis Diagnosis and Treatment","authors":"Jiwon Lyu, T. Shim","doi":"10.3904/kjm.2021.96.5.390","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.5.390","url":null,"abstract":"The most important thing for the management of drug susceptible pulmonary tuberculosis is to diagnose active pulmonary tuberculosis as soon as possible and prevent the occurrence of new patients through appropriate treatment. Therefore, it should be a priority to quickly detect tuberculosis mycobacterium and quickly exclude drug-resistant tuberculosis before treatment begins. To this end, recent guidelines recommend the general use of Mycobacterium tuberculosis (MTB) polymerase chain reaction (PCR) tests, Xpert MTB/RIF tests, and rapid sensitivity tests through line probe assay (LPA). In addition, if the results of the test are positive, it is important to establish an in-hospital reporting system so that rapid reporting can be made. The treatment principle for drug susceptible pulmonary tuberculosis is 2 months of initial intensive phase (isoniazid, rifampin, ethambutol, pyrazinamide) followed by 4 months of maintenance phase (isoniazid, rifampin). Despite global efforts to shorten the duration of the treatment, the treatment of drug susceptible pulmonary tuberculosis has not changed for more than 35 years, and problems such as increased side effects and reduced drug adherence are serious obstacles to tuberculosis management. Therefore, efforts have been steadily made to shorten the treatment period through the combination of new drugs worldwide, and after many failures, they are finally paying off. A recently published Study 31/A5349 study found that 4 months short-term regimen using rifapentine (RPT) and moxifloxacin (MFX) demonstrated non-inferiority in existing standard regimen, as the result, a revision of World Health Organization guidelines is scheduled that 4 months short-term regimen using RPT and MFX may be an alternative. However, it is unlikely that RPT/MFX 4 months short-term regimen will be applied immediately in Korea because the use of RPT is currently limited in Korea due to the high frequency of side effects.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75267624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.3904/kjm.2021.96.5.408
Young Saing Kim, Soon-Tae Lee
Cancer of unknown primary (CUP) is a heterogenous group of cancers for which the anatomical site of origin is unidentifiable on the basis of standard evaluation and imaging. CUPs account for 2-5% of all malignancies and are characterized by early metastatic dissemination, aggressive clinical course, and poor response to palliative chemotherapy. It is important to identify favorable-risk CUP patients (10-20%), as they harbor chemo-sensitive and potentially curable tumors, and may require long-term disease control. Empirical combination chemotherapy has traditionally been the standard first-line therapy for most patients (80-90%), who do not belong to favorable-risk subsets; however, this approach has only modest benefits, with a median overall survival of < 1 year. Evidence supporting the clinical use of molecular tissue of origin (TOO) tests is still lacking. Two recent randomized clinical trials failed to show the benefit of TOO-based site-specific therapy over empirical chemotherapy. In an era of precision medicine, the use of comprehensive molecular profiling will provide opportunities to identify patient subsets who are susceptible to targeted therapies and immunotherapies.
{"title":"Cancer of Unknown Primary: Diagnosis and Treatment","authors":"Young Saing Kim, Soon-Tae Lee","doi":"10.3904/kjm.2021.96.5.408","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.5.408","url":null,"abstract":"Cancer of unknown primary (CUP) is a heterogenous group of cancers for which the anatomical site of origin is unidentifiable on the basis of standard evaluation and imaging. CUPs account for 2-5% of all malignancies and are characterized by early metastatic dissemination, aggressive clinical course, and poor response to palliative chemotherapy. It is important to identify favorable-risk CUP patients (10-20%), as they harbor chemo-sensitive and potentially curable tumors, and may require long-term disease control. Empirical combination chemotherapy has traditionally been the standard first-line therapy for most patients (80-90%), who do not belong to favorable-risk subsets; however, this approach has only modest benefits, with a median overall survival of < 1 year. Evidence supporting the clinical use of molecular tissue of origin (TOO) tests is still lacking. Two recent randomized clinical trials failed to show the benefit of TOO-based site-specific therapy over empirical chemotherapy. In an era of precision medicine, the use of comprehensive molecular profiling will provide opportunities to identify patient subsets who are susceptible to targeted therapies and immunotherapies.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"410 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78383144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.3904/kjm.2021.96.4.352
Junyoung Seo, Ju Sang Park
Esophageal stent complications include stent migration, tumor ingrowth, perforation, a broncho-esophageal fistula, and gastroesophageal reflux. Development of a new stricture at a flange site after stent removal has been predicted but not yet reported. We experienced the first case of a recurrent esophageal stricture induced by a stent flange after stent removal. A fully covered metallic stent, which had been inserted 2 months ago for treatment of an anastomotic stricture, triggered another stricture at the flange site. Although endoscopic balloon dilatations were repeated several times and then the 2nd stent for rescue therapy was inserted, the stricture was refractory to all treatment. Thus, we prescribed oral prednisolone with repeated endoscopic balloon dilation; the stricture eventually improved. The oral steroid seemed to suppress stricture development. If a stent flange-induced refractory stricture is encountered, an oral steroid combined with endoscopic balloon dilation may be helpful.
{"title":"Stent Flange-Induced Esophageal Stricture Treated with an Oral Steroid","authors":"Junyoung Seo, Ju Sang Park","doi":"10.3904/kjm.2021.96.4.352","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.4.352","url":null,"abstract":"Esophageal stent complications include stent migration, tumor ingrowth, perforation, a broncho-esophageal fistula, and gastroesophageal reflux. Development of a new stricture at a flange site after stent removal has been predicted but not yet reported. We experienced the first case of a recurrent esophageal stricture induced by a stent flange after stent removal. A fully covered metallic stent, which had been inserted 2 months ago for treatment of an anastomotic stricture, triggered another stricture at the flange site. Although endoscopic balloon dilatations were repeated several times and then the 2nd stent for rescue therapy was inserted, the stricture was refractory to all treatment. Thus, we prescribed oral prednisolone with repeated endoscopic balloon dilation; the stricture eventually improved. The oral steroid seemed to suppress stricture development. If a stent flange-induced refractory stricture is encountered, an oral steroid combined with endoscopic balloon dilation may be helpful.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90808527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.3904/kjm.2021.96.4.264
You Mi Hwang, Hong Euy Lim, Dae In Lee, Hee Tae Yu, Yae Min Park, Boyoung Joung
Optimized management of atrial fibrillation requires patient-oriented decision making with a multidisciplinary approach. This report incorporates recent authoritative studies to provide detailed recommendations for managing atrial fibrillation in specific clinical settings. The principles of the Atrial fibrillation Better Care (ABC) pathway apply in these clinical settings. In addition, specific considerations are discussed for each of these conditions and populations.
{"title":"2021 Korean Heart Rhythm Society Guidelines: Management of Atrial Fibrillation in Specific Clinical Settings","authors":"You Mi Hwang, Hong Euy Lim, Dae In Lee, Hee Tae Yu, Yae Min Park, Boyoung Joung","doi":"10.3904/kjm.2021.96.4.264","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.4.264","url":null,"abstract":"Optimized management of atrial fibrillation requires patient-oriented decision making with a multidisciplinary approach. This report incorporates recent authoritative studies to provide detailed recommendations for managing atrial fibrillation in specific clinical settings. The principles of the Atrial fibrillation Better Care (ABC) pathway apply in these clinical settings. In addition, specific considerations are discussed for each of these conditions and populations.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73055546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.3904/kjm.2021.96.4.341
Soo Been Park, M. Moon, Hyun Hwa Kim, Ga-Yoon Park, D. Kang, Ju-Yeun Lee, Y. Cho, H. Kang, Sang-Heon Cho
Background/Aims: Despite proper use of pharmaceuticals, adverse drug reactions (ADRs) can lead to problems related to patient safety. We analyzed the characteristics of ADRs, particularly serious adverse events (SAEs), in a single tertiary medical institution. Methods: Spontaneous ADR report data collected from 2010 to 2019 in Seoul National University Hospital were assessed. Causality was evaluated according to the World Health Organization-Uppsala Monitoring Centre criteria. Age, sex, onset, severity, seriousness, and system organ class (SOC) of ADRs and SAEs were analyzed. Results: During the study period, a total of 49,955 individual case safety reports were assessed as possible, probable, or certain. Although the number of gastrointestinal ADR reports was high (25.9%), severe cases were uncommon (2.6%). By contrast, the number of hematologic disorders was low (6.6%) but 39.2% of them were severe. Among ADRs, 10.2% were assessed as SAEs, the proportion of which was high at extreme ages and in males. Body as a whole-general disorders were the most frequently reported SOC for SAEs, followed by skin and appendage disorders. Antineoplastic agents and antibiotics were the most common causative agents of SAEs and ADRs. Anaphylactic reaction was the most frequent SAE (6.5%). Conclusions: The proportion of SAE differs according to SOC and drug. Attention should be paid to SAEs in children and older adults because the rate of SAEs is significantly higher at extreme ages.
{"title":"A 10-Year Single-Center Experience of Adverse Drug Reaction Monitoring","authors":"Soo Been Park, M. Moon, Hyun Hwa Kim, Ga-Yoon Park, D. Kang, Ju-Yeun Lee, Y. Cho, H. Kang, Sang-Heon Cho","doi":"10.3904/kjm.2021.96.4.341","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.4.341","url":null,"abstract":"Background/Aims: Despite proper use of pharmaceuticals, adverse drug reactions (ADRs) can lead to problems related to patient safety. We analyzed the characteristics of ADRs, particularly serious adverse events (SAEs), in a single tertiary medical institution. Methods: Spontaneous ADR report data collected from 2010 to 2019 in Seoul National University Hospital were assessed. Causality was evaluated according to the World Health Organization-Uppsala Monitoring Centre criteria. Age, sex, onset, severity, seriousness, and system organ class (SOC) of ADRs and SAEs were analyzed. Results: During the study period, a total of 49,955 individual case safety reports were assessed as possible, probable, or certain. Although the number of gastrointestinal ADR reports was high (25.9%), severe cases were uncommon (2.6%). By contrast, the number of hematologic disorders was low (6.6%) but 39.2% of them were severe. Among ADRs, 10.2% were assessed as SAEs, the proportion of which was high at extreme ages and in males. Body as a whole-general disorders were the most frequently reported SOC for SAEs, followed by skin and appendage disorders. Antineoplastic agents and antibiotics were the most common causative agents of SAEs and ADRs. Anaphylactic reaction was the most frequent SAE (6.5%). Conclusions: The proportion of SAE differs according to SOC and drug. Attention should be paid to SAEs in children and older adults because the rate of SAEs is significantly higher at extreme ages.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73765203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.3904/kjm.2021.96.4.253
Jiho Yoo, Aaron Su, Seunghyun Yoo
Correspondence to Jiho Yoo, M.D. Youth Bio Global. Co., Ltd., 44 Seonggyungwan-ro, Jongno-gu, Seoul 03069, Korea Tel: +82-2-459-8484, Fax: +82-2-6455-8487, E-mail: jiho@youthbioglobal.com Copyright c 2021 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Perspectives
与Jiho Yoo, M.D. Youth Bio Global的通信。03069韩国首尔钟路区城庆湾路44号电话:+82-2-45 59-8484传真:+82-2-64 455-8487电子邮件:jiho@youthbioglobal.com版权所有c 2021韩国内科医学协会这是一篇根据知识共享署名非商业许可(http://creativecommons.org/licenses/by-nc/3.0/)条款发布的开放获取文章，该许可允许在任何媒体上不受限制的非商业使用，分发和复制，只要正确引用原始作品。视角
{"title":"Untact Management of Patients with Chronic Kidney Diseases","authors":"Jiho Yoo, Aaron Su, Seunghyun Yoo","doi":"10.3904/kjm.2021.96.4.253","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.4.253","url":null,"abstract":"Correspondence to Jiho Yoo, M.D. Youth Bio Global. Co., Ltd., 44 Seonggyungwan-ro, Jongno-gu, Seoul 03069, Korea Tel: +82-2-459-8484, Fax: +82-2-6455-8487, E-mail: jiho@youthbioglobal.com Copyright c 2021 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Perspectives","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87827685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.3904/kjm.2021.96.4.363
Y. Ha, So Yeong Jung, Seong Geun Lee, C. Park
Aquagenic urticaria is a rare form of physical urticaria in which a 1-2 mm wheal is produced by contact with water. Treatment options include antihistamines, ultraviolet monotherapy, topical barrier creams, and acetylcholine antagonists. Despite these pharmacologic measures, the symptoms are frequently refractory to therapy. Aquagenic urticaria lowers the patient’s quality of life and causes daily discomfort. Recently, a patient with aquagenic urticaria treated with omalizumab was reported. Here, we describe a 22-year-old man with a 3-year history of aquagenic urticaria confirmed by a water immersion test. Because he showed no improvement with antihistamines, the patient began omalizumab treatment and demonstrated an excellent response. This case provides new information for clinicians.
{"title":"Aquagenic Urticaria Treated with Omalizumab","authors":"Y. Ha, So Yeong Jung, Seong Geun Lee, C. Park","doi":"10.3904/kjm.2021.96.4.363","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.4.363","url":null,"abstract":"Aquagenic urticaria is a rare form of physical urticaria in which a 1-2 mm wheal is produced by contact with water. Treatment options include antihistamines, ultraviolet monotherapy, topical barrier creams, and acetylcholine antagonists. Despite these pharmacologic measures, the symptoms are frequently refractory to therapy. Aquagenic urticaria lowers the patient’s quality of life and causes daily discomfort. Recently, a patient with aquagenic urticaria treated with omalizumab was reported. Here, we describe a 22-year-old man with a 3-year history of aquagenic urticaria confirmed by a water immersion test. Because he showed no improvement with antihistamines, the patient began omalizumab treatment and demonstrated an excellent response. This case provides new information for clinicians.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80061764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.3904/kjm.2021.96.4.296
K. Lee, Jin-Bae Kim, S. Shin, B. Joung
Atrial fibrillation (AF) is a strong risk factor for ischemic stroke and systemic embolism. To prevent thromboembolic events in patients with AF, anticoagulation therapy is essential. The anticoagulant strategy is determined after stroke and bleeding risk assessments using the CHA2DS2-VASc and HAS-BLED scores, respectively; both consider clinical risk factors. Vitamin K antagonists (VKAs) are the sole anticoagulant option in AF patients with a prosthetic mechanical valve or moderate-severe mitral stenosis; in all other AF patients VKA or non-vitamin K antagonist oral anticoagulants are therapeutic options. However, antiplatelet therapy should not be used for stroke prevention in AF patients. Anticoagulation is not needed in AF patients with low stroke risk but strongly recommended in those with a with low bleeding risk. Left atrial appendage (LAA) occlusion offers an alternative in AF patients in whom long-term anticoagulation is contraindicated. Surgical occlusion or the exclusion of LAA can be considered for stroke prevention in AF patients undergoing cardiac surgery. In this article, we review existing data for stroke prevention and suggest optimal strategies to prevent stroke in AF patients.
{"title":"2021 Korean Heart Rhythm Society Guidelines for Stroke Prevention in Atrial Fibrillation","authors":"K. Lee, Jin-Bae Kim, S. Shin, B. Joung","doi":"10.3904/kjm.2021.96.4.296","DOIUrl":"https://doi.org/10.3904/kjm.2021.96.4.296","url":null,"abstract":"Atrial fibrillation (AF) is a strong risk factor for ischemic stroke and systemic embolism. To prevent thromboembolic events in patients with AF, anticoagulation therapy is essential. The anticoagulant strategy is determined after stroke and bleeding risk assessments using the CHA2DS2-VASc and HAS-BLED scores, respectively; both consider clinical risk factors. Vitamin K antagonists (VKAs) are the sole anticoagulant option in AF patients with a prosthetic mechanical valve or moderate-severe mitral stenosis; in all other AF patients VKA or non-vitamin K antagonist oral anticoagulants are therapeutic options. However, antiplatelet therapy should not be used for stroke prevention in AF patients. Anticoagulation is not needed in AF patients with low stroke risk but strongly recommended in those with a with low bleeding risk. Left atrial appendage (LAA) occlusion offers an alternative in AF patients in whom long-term anticoagulation is contraindicated. Surgical occlusion or the exclusion of LAA can be considered for stroke prevention in AF patients undergoing cardiac surgery. In this article, we review existing data for stroke prevention and suggest optimal strategies to prevent stroke in AF patients.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85580732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.3904/KJM.2021.96.3.218
J. Ahn, Y. Hong
Stable angina is a chronic, systemic disease with a wide range of associated symptoms and clinical outcomes. Prompt diagnosis can be challenging for clinicians. Typical chest pain caused by stable angina occurs when the myocardium receives inadequate oxygen, resulting in myocardial ischemia. Various diagnostic tools including non-invasive tests such as coronary computed tomographic angiography and image-based stress tests have evolved over the last decade. An important factor in the selection of the proper diagnostic test for stable angina is assessment of the pre-test probability in the event of possible coronary arterial stenosis.
{"title":"Diagnostic Approach to Angina Pectoris","authors":"J. Ahn, Y. Hong","doi":"10.3904/KJM.2021.96.3.218","DOIUrl":"https://doi.org/10.3904/KJM.2021.96.3.218","url":null,"abstract":"Stable angina is a chronic, systemic disease with a wide range of associated symptoms and clinical outcomes. Prompt diagnosis can be challenging for clinicians. Typical chest pain caused by stable angina occurs when the myocardium receives inadequate oxygen, resulting in myocardial ischemia. Various diagnostic tools including non-invasive tests such as coronary computed tomographic angiography and image-based stress tests have evolved over the last decade. An important factor in the selection of the proper diagnostic test for stable angina is assessment of the pre-test probability in the event of possible coronary arterial stenosis.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76951337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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