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Case 3-2025: A 54-Year-Old Man with Exertional Dyspnea and Chest Pain.

N Engl J Med

January 2025

From the Department of Medicine, Northwestern Memorial Hospital, Chicago (C.W.Y.); and the Departments of Medicine (J.S.G., A.J.Y.), Radiology (B.G.G.), and Pathology (B.M.H.), Massachusetts General Hospital, the Departments of Medicine (J.S.G., R.H.F., A.J.Y.), Radiology (B.G.G.), and Pathology (B.M.H.), Harvard Medical School, and the Department of Medicine, Brigham and Women's Hospital (R.H.F.) - all in Boston.

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Aims: Coronary microvascular dysfunction (CMD) is a heterogeneous condition defined by reduced coronary flow reserve (CFR). The new index 'microvascular resistance reserve' (MRR) has been developed, but its role is unclear. We investigate the relationships between functional indices in ANOCA (angina and non-obstructive coronary arteries) patients and evaluate the hemodynamic features of different CMD subtypes.

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We present a case of an 80-year-old female who presented with chest pain, vomiting and night sweats a few weeks post thoracic endovascular aortic aneurysm repair (TEVAR). A computed tomography (CT) scan demonstrated a type 1B endoleak for which she underwent a repeat TEVAR. Postoperatively, she developed fever, dysphagia, haematemesis and melaena.

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Objectives: Achalasia is an esophageal motility disorder of unknown etiology. However, no studies have determined the populations in which sleep problems occur and whether they are improved by peroral endoscopic myotomy (POEM). We investigated the rate of sleep problems assessed by GERD-Q (AGQ) in achalasia patients, evaluated whether POEM improves these issues, and identified factors associated with sleep improvement after POEM.

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