Journal of Cardiology Cases最新文献

A comprehensive literature review was conducted to explore the link between COVID-19 and coronary spasms. The findings from the review strongly suggest a significant association between COVID-19 and coronary spasms, as well as related heart diseases.

We encountered a case of coronary angina refractory to multiple medications, including a calcium channel blocker, nitroglycerin, fasudil (a Rho kinase inhibitor), left stellate ganglion block, thoracic sympathetic ganglion blockade, steroids, and denopamine. During the course of treatment, ventricular tachycardia (VT) occurred due to ST-segment elevation, and an implantable cardioverter-defibrillator was implanted; however, the patient had recurrent VT. A 12‑lead electrocardiogram showed ST elevation localized to leads II, III, and a Vf, and stenting was performed in all main trunks of the right coronary artery. After stenting, the daily angina attacks stopped, VT disappeared, and the chronic phase was controlled with her existing drug therapy, although she had mild chest pain attacks. There is limited evidence regarding the treatment of refractory angina pectoris. In this case, a patient with coronary angina pectoris refractory to various therapies underwent stenting, and the potentially fatal arrhythmia disappeared.

Learning objective

Management of refractory coronary angina pectoris poses a challenge. Despite attempting conventional therapies, our initial efforts were met with unsuccessful outcomes. Finally, we succeeded in treating the patient with stenting. This case report underscores the challenge of managing refractory coronary angina and explores diverse therapeutic approaches, including conventional medications, sympathetic nerve interventions, and stent placement.

Non-typhoid endocarditis is uncommon. Non-typhoid Salmonella paratyphi A endocarditis is even more rare. Although the spectrum of available antibiotics is adequate for treatment, the importance of this condition stresses its rarity of occurrence and presentation. Here, we present the case of a middle-aged male suffering from S. paratyphi A endocarditis.

Learning objective

Salmonella paratyphi A endocarditis is extremely rare, mostly affecting the mitral valve. There is an increasing trend of S. paratyphi A infection in the Indian subcontinent. S. paratyphi A endocarditis should be suspected in all patients who have recurrent fever with chills for >3 to 4 weeks, associated with dyspnea on exertion and weight loss. Newer mutations with antibiotic resistance are becoming more common, which might pose serious problems.

Myocarditis presents with a broad spectrum of clinical severity, ranging from subclinical illness to sudden death. Children with fulminant myocarditis often require inotropic or mechanical circulatory support; however, recurrent acute myocarditis is extremely rare. There is limited evidence to guide the management of recurrent acute myocarditis because the relevant literature is sparse. Here, we present a rare pediatric case of recurrent acute myocarditis. This patient experienced two episodes of fulminant myocarditis and two episodes of suspected myocarditis over an eight-year period; each episode fully resolved with preserved cardiac function. Three episodes were associated with influenza virus infection. During each episode, the electrocardiography, echocardiogram, and laboratory findings improved. Autoimmune and chronic myocarditis were not suspected because of the rapid onset of myocarditis associated with viral infection. Genetic testing by next-generation sequencing was performed; however, no underlying genetic illnesses were identified. Human leukocyte antigen genotyping was performed, and the results determined the genotype to be HLA-DQB1*0302/0303, which reports indicate might be involved in the development of myocarditis in mice or humans. The combination of these genotypes in myocardial cells may be associated with susceptibility to influenza infection or acute myocarditis.

Learning objective

There is little evidence regarding susceptibility to myocarditis. We present a pediatric patient who experienced two episodes of fulminant myocarditis and two episodes of suspected myocarditis associated with influenza infection and a specific human leukocyte antigen genotype. This case highlights the importance of understanding myocarditis susceptibility.

A 65-year-old man with no-option chronic limb-threatening ischemia underwent percutaneous deep venous arterialization (pDVA). An arteriovenous fistula (AVF) was created using a modified venous arterialization simplified technique. During the balloon dilation of the AVF site, the venous puncture site was accidentally also dilated, resulting in massive bleeding. The angiographic bleeding was controlled by stent graft deployment, and the final angiography revealed good DVA flow. Two weeks post-pDVA, the patient developed right shin pain. Suspecting a subcutaneous hematoma and infection, extensive debridement was performed. The patient’s wounds completely healed approximately 7 months after the pDVA.

Learning Objective

Modified venous arterialization simplified technique (m-VAST) is a feasible technique for percutaneous deep venous arterialization; however, it may lead to unexpected complications. When performing m-VAST, the possibility of puncture site complications should be carefully considered.

A 75-year-old man with hypertrophic obstructive cardiomyopathy underwent placement of a long-sensing vector implantable loop recorder (ILR) for unexplained syncope. One month later, ILR remote monitoring revealed unstable R-wave amplitudes ranging from very high (>1.9 mV) to very low (<0.2 mV) values. During an in-hospital clinic visit, the only site to establish communication with the ILR was the left posterior axillary area. Chest computed tomography confirmed ILR migration into the anterior costophrenic recess. The device was retrieved with forceps during video thoracoscopy without further complications.

Learning objective

This is the first case report of migration of an implantable loop recorder diagnosed by remote monitoring.

An 82-year-old man with a secundum atrial septal defect (ASD) underwent transcatheter closure. The patient had a wide area of aortic and superior rim deficiency, with left ventricular diastolic dysfunction and moderate mitral regurgitation. These findings suggested the risk of both cardiac erosion and increased left atrial pressure after closure. To avoid cardiac erosion, a GORE® CARDIOFORM ASD (GCA) occluder (W.L. Gore & Associates, Flagstaff, AZ, USA) was considered an appropriate device in this patient. However, the possibility of excessively high left atrial pressure due to complete defect closure was a concern. Thus, we created a 4.5-mm fenestration using a surgical punch in the fabric membrane of a 44-mm GCA. The device was deployed in an appropriate position, and no significant elevation of pulmonary capillary wedge pressure was observed. One month after the closure, marked improvement in clinical symptoms and continuous flow through the fenestration were observed. This novel fenestration technique may contribute to expansion of the indications for transcatheter ASD closure in patients who require a GCA owing to an anatomically high risk of erosion accompanied by left ventricular diastolic dysfunction.

Learning objective

In elderly patients with left ventricular diastolic dysfunction, transcatheter atrial septal defect (ASD) closure is difficult because rapid resolution of an ASD shunt can cause an increase in left atrial pressure. Previous reports described the creation of a fenestration in the closure device. The use of a GORE® CARDIOFORM ASD (GCA) occluder can reduce the erosion risk; however, creating a stable fenestration is difficult. We developed a novel technique to create a stable fenestration in a GCA.

A 73-year-old female patient was diagnosed with lumbar spinal stenosis by an orthopedic surgeon. During admission for further evaluation, she was found to have hypoxemia. Contrast-enhanced computed tomography revealed a 43-mm ascending aortic aneurysm, but there were no signs of pulmonary embolism, and no abnormalities were detected in the lung fields. Upon initiating rehabilitation in the standing position, respiratory distress and hypoxemia worsened. Careful observation revealed that hypoxemia worsened in the seated position but normalized while lying down. We considered the possibility of platypnea-orthodeoxia syndrome (POS), in which hypoxemia worsens in the seated position. Transesophageal echocardiography revealed that a patent foramen ovale (PFO), which was hardly noticeable while lying down, worsened in the seated position. A pulmonary perfusion scan showed a 27 % right-to-left shunt. Cardiac catheterization confirmed the presence of right-to-left shunting during right atrial injection. Consequently, it was diagnosed that the ascending aortic aneurysm aggravated the PFO in the seated position, leading to POS. The PFO was unsuitable for transcatheter treatment. Consequently, the patient underwent direct closure surgery in the cardiac surgery department. Postoperatively, the patient's hypoxemia and respiratory distress in the seated position improved, and subsequent progress has been favorable.

Learning objective

Diagnosing platypnea-orthodeoxia syndrome in patients with poor activities of daily living (ADL) is challenging. Careful observation of the percutaneous oxygen saturation in both supine and seated positions is crucial, and a transesophageal echocardiogram in the supine and seated positions is inevitable. Lung perfusion scintigraphy is often used to evaluate the cause of hypoxemia; however, whole-body scans are important for detecting the presence and number of right-left shunts. This case report highlights the pitfalls of diagnosis in patients with poor ADL.