A Case of ST-elevated myocardial infarction resulting from obstructive intramural coronary amyloidosis.

A 49-year-old man presenting with ST-elevated myocardial infarction was brought to our emergency department with AL amyloidosis. Baseline coronary angiography showed no significant stenosis of the epicardial coronary arteries, however, coronary artery angiography in response to acetylcholine and coronary flow reserve in response to papaverine were abnormal, which suggested impairment of vascular endothelial function. Myocardial biopsy revealed amyloid deposition exclusively in intramural coronary arteries.

A case of early phase dialysis associated effusive constrictive pericarditis with distinct surgical findings.

A 55-year-old male patient with a 10 year history of hemodialysis was admitted for examination of pericardial effusion. Specific echocardiography, MRI, and cardiac catheterization findings strongly suggested a diagnosis of effusive constrictive pericarditis. Pericardiectomy showed the following distinct findings.

A one-year study of the antiatherosclerotic effect of the angiotensin-II receptor blocker losartan in hypertensive patients. A comparison with angiotension-converting enzyme inhibitors.

Angiotensin receptor blockers (ARB) have been emerging as drugs to treat atherosclerosis. The effectiveness of the ARB losartan at reducing atherosclerosis was compared with that of ACE inhibitors in hypertensive patients. A total of 50 patients with hypertension were divided into 3 groups: a control group receiving neither an ARB nor an ACE inhibitor (n = 14), a losartan group (n = 22) receiving 50 mg/day of losartan, and an ACE inhibitor group (n = 14) receiving either 5 mg/day of enalapril or 5 mg/day of imidapril.

Beneficial effects of pitavastatin, a 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, on cardiac function in ischemic and nonischemic heart failure.

HMG-CoA reductase inhibitors (statins) have recently been reported to improve cardiac function, and decrease the incidence of heart failure (HF) in hyperlipidemic patients. However, evidence for statin treatment in patients with HF remains a subject of debate. Thus, a study was initiated to examine the effects of pitavastatin on cardiac function evaluated by echocardiographic findings and plasma brain natriuretic peptide (BNP) levels in patients with HF.

A case of almost-exclusively atria-dominant cardiac amyloidosis related with hemodialysis.

We report a case of a 68-year-old man who had dialysis-related amyloidosis. The patient underwent neck surgery due to spondyloarthritis. Unfortunately he died after the surgery in sepsis.

[Atrial wall hematoma after mitral valvuloplasty and maze procedure: a case report].

A 66-year-old male patient with mitral regurgitation and atrial fibrillation underwent mitral valvuloplasty with a modified maze procedure. Follow-up echocardiography performed on the 4th postoperative day revealed a high echoic mass of 6.7 x 3.

Upregulation of heat shock transcription factor 1 plays a critical role in adaptive cardiac hypertrophy.

Exercise-induced cardiac hypertrophy has been reported to have better prognosis than pressure overload-induced cardiac hypertrophy. Cardiac hypertrophy induced by exercise was associated with less cardiac fibrosis and better systolic function, suggesting that the adaptive mechanisms may exist in exercise-induced hypertrophy. Here, we showed a critical role of heat shock transcription factor 1 (HSF1), an important transcription factor for heat shock proteins, in the adaptive mechanism of cardiac hypertrophy.

A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress-induced cardiomyopathy or takotsubo cardiomyopathy.

We experienced a case with severe acute heart failure showing "takotsubo"-like left ventricular asynergy. Subsequently, he was found to have pheochromocytoma, and underwent emergent adrenalectomy, which almost completely reversed his cardiac function and symptoms. His clinical course, supports the pathogenetic role of catecholamines in "takotsubo cardiomyopathy".

A case of transient 2:1 atrioventricular block, resolved by thyroxine supplementation for subclinical hypothyroidism.

A 42-year-old man was admitted to our hospital with palpitation attacks. Holter ECG showed 2:1 atrioventricular block and bradycardia with the minimum heart rate of 44 beats/min. There was a possible indication of electrophysiological study and cardiac pacemaker implantation.

A case of graft infection 10 years after ascending aorta replacement.

A 52-year-old man was admitted with anemia and slight fever, which he had for the last 2 months. He had undergone replacement of the ascending aorta for acute aortic dissection 10 years previously. Echocardiography demonstrated a flailing thin structure in the anterior wall of the ascending aorta corresponding to the proximal portion of the prosthetic graft.

A case of heparin-induced thrombocytopenia with sepsis and congestive heart failure--first autopsy report on Japan--.

An 84-year-old man was referred to the emergency department with severe dyspnea. Based on his physical findings, electrocardiogram, X-ray and echocardiographic findings, congestive heart failure was suspected and drip infusion of prophylactic heparin against intracardiac thrombosis was commenced together with dopamine, nitroglycerin and furosemide. Diuresis occurred and the pulmonary congestion ameliorated remarkably.

[Differential diagnosis in GERD and cardiovascular disease].

In substantial portion of patients referred to the coronary care unit (CCU) with a tentative diagnosis of acute coronary syndrome (ACS), gastro-esophageal diseases are the origins of their symptoms such as chest pain. The differential diagnosis is difficult and the coronary angiography (CAG) and the gastro-esophageal endoscopy are often required. We recently evaluated our 100 consecutive cases that underwent CAG as ACS.

["Chestnut-shaped" transient regional left ventricular hypokinesis with abnormal myocardial fatty acid metabolism, not corresponding to the coronary artery territories: a case report].

A 79-year-old female patient, who was initially suspected to have pneumonia, was admitted to the respiratory department of our hospital. She experienced chest pain on the second admission day. Electrocardiography showed ST-segment elevation in leads V3 through V6, and echocardiography revealed hypokinetic left ventricular wall motion.

Common carotid intima-media thickness is correlated with myocardial flow reserve in patients with coronary artery disease: a useful non-invasive indicator of coronary atherosclerosis.

Background: The common carotid intima-media thickness (IMT) is correlated with the angiographically determined coronary artery stenosis. However, their correlation is weak, which limits the clinical application of the IMT as a predictor of coronary artery stenosis. The IMT reflects diffuse early-phase atherosclerosis, whereas the angiographically determined coronary artery stenosis is a late-phase phenomenon.

[Coronary risk factor management in primary practice in Shibuya, Tokyo].

Objectives: Many large-scale clinical trials have confirmed that coronary risk factors such as hypertension, hyperlipidemia and diabetes mellitus predict a higher incidence of cardiovascular events and that control of these risk factors reduces the incidence. However, the actual management of such risk factors and the resultant improvement of the cardiovascular events in primary practice remains unclear. The Heart Care Network Shibuya, a voluntary study group of regional primary physicians, surveyed the management of coronary risk factors and the clinical outcomes.

Caveolin-3 is Up-Regulated in the Physiological Left Ventricular Hypertrophy Induced by Voluntary Exercise Training in Rats.

Various substances have been introduced in relation with cardiac hypertrophy almost always with controversy in their roles in signal transduction. Those controversies may attribute to the diversity of cardiac hypertrophy. We previously showed that calcineurin was activated in physiological left ventricular hypertrophy (LVH) induced by voluntary exercise training, but not in decompensated pressure-overload LVH.

Osteopenia and male-specific sudden cardiac death in mice lacking a zinc transporter gene, Znt5.

We isolated a mammalian gene whose expression transiently increased in response to intimal denudation of rabbit aorta. It was identical to a gene encoding a zinc transporter, ZNT5, reported very recently by others. Mice deficient for this gene showed poor growth and a decrease in bone density due to impairment of osteoblast maturation to osteocyte.

Effusive constrictive pericarditis due to rheumatoid arthritis revealed by pericardiocentesis with simultaneous pressure recording--a case report.

A 59-year-old man had a history of rheumatoid arthritis. He presented with incurable pericardial effusion. He was repeatedly treated with pericardiocentesis with only transient attenuation of his symptoms because the underlying pericardial constriction had been overlooked.

A case of severe respiratory depression due to cibenzoline overdosage induced by a transient renal dysfunction.

A 69-year-old man was transferred to our hospital because of severe general fatigue and progressive systemic muscle weakness. He had taken 300 mg/day of cibenzoline for his sustained ventricular tachycardia (VT) for years. At the end of June 2001 he began to feel general fatigue, which slowly progressed to systemic muscle weakness and walking disturbance.

Reduced myocardial flow reserve in anatomically normal coronary arteries due to elevated baseline myocardial blood flow in men with old myocardial infarction.

Background: Decreased myocardial flow reserve (MFR) in angiographically normal coronary arteries in patients with old myocardial infarction (OMI) has been reported.

Methods And Results: To clarify factors for the reduced MFR in OMI and to compare them with those in angina pectoris (AP), baseline myocardial blood flow (MBF) and MBF during dipyridamole administration were measured with nitrogen 13 ammonia positron emission tomography, after which MFR was calculated for 13 men with AP, 18 men with OMI, and 15 age-matched male control subjects. MFR was compared among the 3 groups in segments perfused by nonstenotic arteries.