Journal of Cardiology Cases最新文献

{"title":"A case of cardiogenic shock due to ventricular dyssynchrony resolved by atrial pacing","authors":"Teja S. Chakrala MD ,&nbsp;Roshni O. Prakash MD ,&nbsp;Sahil Prasada MD ,&nbsp;Wytch R. Rigger MD ,&nbsp;Juan Vilaro MD","doi":"10.1016/j.jccase.2023.10.006","DOIUrl":"https://doi.org/10.1016/j.jccase.2023.10.006","url":null,"abstract":"<div><p>We present a case of a man with ischemic cardiomyopathy and single chamber implantable cardioverter-defibrillator who developed sinus arrest creating sudden dependence on right ventricular (RV) pacing. He presented with cardiogenic shock secondary to abrupt onset ventricular dyssynchrony from RV pacing, which required emergent stabilization and completely resolved with atrial pacing.</p></div><div><h3>Learning objective</h3><p>To establish a basic understanding of cardiogenic shock management. To reinforce the adverse effects associated with right ventricular pacing.</p></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 4","pages":"Pages 149-152"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S187854092300124X/pdfft?md5=7add2c5c8e6611cac427f4b1762d94fc&pid=1-s2.0-S187854092300124X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of coronary artery compression syndrome resulting from peri-valvular regurgitation and long-standing atrial fibrillation","authors":"Keisuke Suzuki MD, PhD,&nbsp;Yoshiaki Mibiki MD, PhD,&nbsp;Mai Suzuki MD,&nbsp;Hiroshi Nakagata MD, PhD,&nbsp;Kosuke Aoki MD,&nbsp;Eiji Sato MD, PhD,&nbsp;Yoshihiro Yamashina MD, PhD,&nbsp;Takehiko Miyashita MD, PhD,&nbsp;Akihiko Ishida MD,&nbsp;Tetsuo Yagi MD, PhD","doi":"10.1016/j.jccase.2023.12.003","DOIUrl":"10.1016/j.jccase.2023.12.003","url":null,"abstract":"<div><p>A man in his 70s with a history of mitral valve replacement<span> (MVR) and long-standing persistent atrial fibrillation<span><span> (AF) presented with effort angina. Coronary angiography revealed severe stenosis of the left main </span>coronary artery<span><span><span> (LMCA). As it was an emergent case, PCI (percutaneous coronary intervention) was selected for treatment<span>. Intravascular ultrasonography revealed no atherosclerotic lesions in the LMCA. The LMCA was effectively dilated by the drug-eluting stent. No elevation in intracardiac pressure was observed in </span></span>cardiac catheterization<span> after PCI. Computed tomography scan<span> indicated potential compression of the LMCA by the surrounding structures. In cases of long-standing persistent AF and an enlarged atrium after MVR, the possibility of </span></span></span>LMCA stenosis due to anatomical changes should be considered.</span></span></span></p></div><div><h3>Learning Objectives</h3><p></p><ul><li><span>◾</span><span><p>Peri-valvular regurgitation and long-standing persistent atrial fibrillation can potentially cause atrial enlargement.</p></span></li><li><span>◾</span><span><p>Coronary artery stenosis without atherosclerosis can occur due to compression from surrounding structures or shifting of the coronary artery.</p></span></li><li><span>◾</span><span><p>Stent therapy provides a temporary solution and coronary artery bypass grafting or switching should be considered if re-stenosis occurs.</p></span></li></ul></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 4","pages":"Pages 157-160"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139395990","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}

{"title":"Paradoxical septic embolism in an Ebstein's anomaly patient leading to brain abscess: A case report","authors":"Ankur Singla MBBS ,&nbsp;Archana Gautam MD ,&nbsp;Amandeep Goyal MD ,&nbsp;Tarun Dalia MD","doi":"10.1016/j.jccase.2023.12.001","DOIUrl":"10.1016/j.jccase.2023.12.001","url":null,"abstract":"<div><p>Ebstein's anomaly (EA), a congenital cardiac anomaly, is characterized by apical displacement of the tricuspid valve leaflet(s) into the right ventricle. We present the case of a 61-year-old female with a history of EA, Wolff-Parkinson-White syndrome, and patent foramen ovale (PFO), who presented with worsening hypoxia and confusion, in the setting of left lower extremity cellulitis and abscess. The computed tomography (CT) scan of the head showed a cerebellar infarct with hemorrhagic conversion. Magnetic resonance imaging of the head showed a satellite lesion raising concern for the embolic nature of infarcts. After ruling out cardioembolic causes of cerebellar infarction, her presenting symptoms were attributed to paradoxical septic emboli from the left leg abscess (demonstrated on CT scan of the leg). She was deemed a poor candidate for surgical closure of PFO due to contraindication to use heparin (due to the presence of hemorrhagic stroke) and underlying comorbidities. Septic embolization is a rare but dreaded complication in EA patients with PFO.</p></div><div><h3>Learning objective</h3><p></p><ul><li><span>•</span><span><p>Paradoxical emboli can occur in patients with Ebstein's anomaly (EA) and patent foramen ovale (PFO).</p></span></li><li><span>•</span><span><p>The mainstay of management in case of paradoxical embolism lies with the identification and treatment of the underlying cause, such as infective endocarditis, deep vein thrombosis, or infectious source, as in the present case.</p></span></li><li><span>•</span><span><p>The surgical correction of PFO in EA patients should be considered when the patient becomes symptomatic with cyanosis, hypoxia, or manifestations of paradoxical emboli.</p></span></li></ul></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 4","pages":"Pages 161-164"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1878540923001494/pdfft?md5=82117238f9c0770de7ebb7bd450130d9&pid=1-s2.0-S1878540923001494-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal aortic mural thrombus in association with active ulcerative colitis","authors":"Yushi Oyama MD ,&nbsp;Satoshi Koiwa MD ,&nbsp;Takuya Maruyama MD ,&nbsp;Ayako Kozuka MD, PhD ,&nbsp;Seiichi Hiramori MD ,&nbsp;Takahiro Kobayashi MD ,&nbsp;Kumiko Yahikozawa MD ,&nbsp;Takuya Miyagi MD ,&nbsp;Takahiro Sakai MD, PhD ,&nbsp;Kyuhachi Otagiri MD, PhD ,&nbsp;Hiroshi Kitabayashi MD, PhD","doi":"10.1016/j.jccase.2023.12.006","DOIUrl":"10.1016/j.jccase.2023.12.006","url":null,"abstract":"<div><p><span><span>Aortic mural thrombus (AMT) in the absence of aneurysm or </span>atherosclerosis is a rare clinical finding and an uncommon cause of peripheral </span>arterial embolization<span><span>. AMT in a normal artery is usually attributed to systemic hypercoagulability<span>. We describe a case of subacute lower limb ischemia due to AMT associated with active </span></span>ulcerative colitis<span><span><span> (UC). A 46-year-old man with active UC was referred to our hospital for the evaluation and treatment of left leg pain. Ultrasound and contrast </span>computed tomography showed occlusion of the left </span>popliteal artery<span>, and an AMT in the abdominal aorta<span><span> between the inferior mesenteric artery and the </span>aortic bifurcation<span><span><span>. We started anticoagulant therapy, intravenous </span>infliximab, and </span>cytapheresis. Four weeks after initiating anticoagulation therapy, we were able to successfully treat the AMT with anticoagulation therapy without surgical thrombectomy. The inflammatory status of ulcerative colitis was also under control, and AMT had not recurred at 1 year after treatment. Invasive therapies are often selected to treat AMT. However, if a patient's hypercoagulable state is controlled, AMT can safely be treated with anticoagulation therapy alone without recurrence.</span></span></span></span></span></p></div><div><h3>Learning objective</h3><p>Aortic mural thrombus (AMT) in the absence of aneurysm or atherosclerosis is a rare clinical finding and an uncommon cause of peripheral arterial embolization. AMT in a normal artery is usually attributed to systemic hypercoagulability. We describe a case of subacute lower limb ischemia due to AMT associated with active ulcerative colitis. We controlled the ulcerative colitis condition and successfully treated the AMT with anticoagulation therapy alone.</p></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 4","pages":"Pages 170-173"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139538330","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}

{"title":"V stenting technique with covered stents for the management of ostial circumflex perforation: Good or bad idea?","authors":"Tom Denimal MD ,&nbsp;Flavien Vincent MD, PhD ,&nbsp;Francis Juthier MD, PhD ,&nbsp;Thibault Pamart MD ,&nbsp;Mouhamed D. Moussa MD, PhD ,&nbsp;Guillaume Schurtz MD ,&nbsp;Francois Pontana MD, PhD ,&nbsp;Eric Van Belle MD, PhD ,&nbsp;Cédric Delhaye MD","doi":"10.1016/j.jccase.2023.11.003","DOIUrl":"10.1016/j.jccase.2023.11.003","url":null,"abstract":"<div><p><span>We report the case of a redo Ross surgery complicated by an ostial left circumflex occlusion requiring emergent percutaneous coronary intervention. The latter was complicated by coronary perforation<span> treated by two covered stents with V-stenting technique. After immediate success, the clinical course was marked by acute stent thrombosis requiring emergent </span></span>coronary bypass.</p></div><div><h3>Learning objectives</h3><p>Ostial left circumflex perforation is a rare and potentially fatal complication that is challenging to manage. V stenting technique with two covered stents could be used as a life-saving procedure, but is associated with a high thrombotic risk.</p></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 3","pages":"Pages 116-119"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139295693","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}

{"title":"Peripartum cardiomyopathy in patients with psychiatric disorders successfully treated with bromocriptine: Two case reports","authors":"Haruka Takanaka MD ,&nbsp;Ryohei Ono MD, PhD ,&nbsp;Hirotoshi Kato MD, PhD ,&nbsp;Togo Iwahana MD, PhD ,&nbsp;Tomoki Miyahara MD ,&nbsp;Hidehisa Takahashi MD, PhD ,&nbsp;Yasuhiko Hori MD, PhD ,&nbsp;Kenichi Fukushima MD, PhD ,&nbsp;Yoshio Kobayashi MD, PhD, FJCC","doi":"10.1016/j.jccase.2023.11.014","DOIUrl":"10.1016/j.jccase.2023.11.014","url":null,"abstract":"<div><p><span><span>Peripartum cardiomyopathy<span> (PPCM) is a rare disorder<span> in which left ventricular systolic dysfunction and heart failure </span></span></span>symptoms<span><span> occur during the peripartum period<span>. Inhibition of prolactin secretion<span> by bromocriptine mediates beneficial effects on cardiac function in PPCM. </span></span></span>Mental disorders<span> are also associated with the onset of PPCM. Psychiatric medications for mental disorders would affect serotonin production and tryptophan and dopamine metabolism<span>, and they are associated with PPCM. Conversely, bromocriptine affects psychiatric symptoms; therefore, the treatment of PPCM complicated by mental disorders using bromocriptine may be difficult. Herein, we report cases of two patients with PPCM and mental disorders successfully treated with bromocriptine therapy. The first case involved a 33-year-old woman with a history of </span></span></span></span>atypical depression<span> and anxiety disorder, who developed PPCM with a left ventricular ejection fraction (LVEF) of 19 %. The second case was that of a 42-year-old woman with a history of bipolar and panic disorders who developed PPCM with an LVEF of 18 %. Both patients were administered bromocriptine; however, psychiatric symptoms did not worsen and cardiac function improved. We also review the literature on the relationship between PPCM and mental disorders.</span></p></div><div><h3>Learning objective</h3><p>Mental disorders and psychiatric medications may be associated with the onset of peripartum cardiomyopathy (PPCM). Although bromocriptine has beneficial effects on PPCM, it has also been reported to increase the risk of worsening psychiatric symptoms; therefore, the efficacy and safety of bromocriptine in PPCM patients with mental disorders is controversial. Our cases showed that bromocriptine can be used safely without worsening psychiatric symptoms in PPCM with mental disorders.</p></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 3","pages":"Pages 136-139"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138992260","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}

{"title":"Thrombolytic therapy after cardiac arrest in patients with mechanical aortic valve thrombosis","authors":"Kazunari Asada MD,&nbsp;Yuichi Saito MD,&nbsp;Yoshio Kobayashi MD, FJCC","doi":"10.1016/j.jccase.2023.11.007","DOIUrl":"10.1016/j.jccase.2023.11.007","url":null,"abstract":"<div><p>A 68-year-old woman with history of aortic valve<span><span><span> replacement developed severe heart failure and cardiac arrest. Transesophageal echocardiography and </span>cardiac computed tomography showed mechanical aortic valve thrombosis. Low-dose, ultraslow infusion of tissue-plasminogen activator was performed while the patient was in a critically ill condition, resulting in the improvement of </span>thrombus<span> burden and structural valve deterioration.</span></span></p></div><div><h3>Learning objectives</h3><p>Mechanical valve thrombosis<span> can be an underlying mechanism of severe heart failure, in which systemic thrombolytic therapy in a low-dose, ultraslow, and prolonged manner may improve clinical outcomes, even in critically ill patients.</span></p></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 3","pages":"Pages 112-115"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138627627","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}

{"title":"A case of cardiac sarcoidosis mimicking acute phase of takotsubo cardiomyopathy evaluated by multimodality cardiac imaging","authors":"Yasuyuki Takada MD,&nbsp;Satoshi Hida MD, PhD, FJCC,&nbsp;Masatsune Fujii MD, PhD,&nbsp;Yoshinao Yazaki MD, PhD,&nbsp;Kazuhiro Satomi MD, PhD","doi":"10.1016/j.jccase.2023.11.013","DOIUrl":"10.1016/j.jccase.2023.11.013","url":null,"abstract":"<div><p>The patient was a 68-year-old woman who experienced loss of consciousness owing to a seizure while walking and bruised her face. Twelve‑lead electrocardiography displayed a complete atrioventricular block. Transthoracic echocardiography displayed hypokinesis from the middle to apex of the myocardium. Emergency coronary angiography displayed no clear stenosis of the coronary arteries, and left ventriculography displayed takotsubo-like abnormal left ventricular wall motion. ^99mTc-sestamibi/¹²³I-beta-methyl iodophenyl pentadecanoic acid dual single-photon emission computed tomography displayed a perfusion/metabolism mismatch in the left apex, anterior segment, and inferior segment of the myocardium in the acute phase, which improved in the chronic phase. Similar mismatch findings were observed in the ventricular septum, which persisted in the chronic phase. Blood biomarkers of sarcoidosis were positive. Myocardial delayed enhancement was observed in the mid layer of the basal septum and inferior wall on cardiac magnetic resonance imaging. Fluorodeoxyglucose-positron emission tomography displayed signal accumulation in the basal septum. The clinical course of the patient suggested the possibility of cardiac sarcoidosis combined with takotsubo cardiomyopathy. This is a valuable case in which changes over time were detected by multimodality cardiac imaging.</p></div><div><h3>Learning objective</h3><p>Cardiac manifestations of both takotsubo cardiomyopathy and sarcoidosis are similar, with both causing abnormal left ventricular wall motion. The co-occurrence of these conditions has been seldomly reported to date. The similarity of the characteristics of each condition poses a challenge in the diagnostic process. The utilization of multimodality cardiac imaging techniques, as demonstrated in the present case, is an effective means of establishing a diagnosis.</p></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 3","pages":"Pages 132-135"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1878540923001469/pdfft?md5=9025f132d57c49dd4d2d8a844fa4d11f&pid=1-s2.0-S1878540923001469-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-onset prosthetic aortic valve stenosis caused by pannus formation","authors":"Nicholas Roma MD ,&nbsp;Kashyap Shah DO ,&nbsp;Ketul Patel DO ,&nbsp;Joshua Elmer ,&nbsp;Bruce Ferraro MD ,&nbsp;Prarthana Patel ,&nbsp;Michael Durkin MD","doi":"10.1016/j.jccase.2023.11.011","DOIUrl":"10.1016/j.jccase.2023.11.011","url":null,"abstract":"<div><p><span><span>Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to an open surgical aortic valve replacement (SAVR) for treating severe symptomatic </span>aortic stenosis. Despite gaining widespread acceptance and approval for use </span>in patients<span><span> with high, moderate, and low surgical risk, the increasing use of TAVR has raised concerns about potential short- and long-term complications. We present the case of a 69-year-old female who underwent TAVR and subsequently presented to our outpatient cardiology<span> clinic with progressively worsening dyspnea, orthopnea, and </span></span>paroxysmal nocturnal dyspnea<span> two years after the procedure. Echocardiography<span><span> and stress testing revealed a recurrence of aortic stenosis, leading to a diagnosis of structural valve deterioration. The patient was subsequently scheduled for SAVR, which revealed commissural fusion, scarring, and unusual </span>pannus formation that significantly narrowed the effective valve area, necessitating valve replacement. Despite requiring SAVR, two years after TAVR, the patient had a favorable postoperative course and outcome on follow-up. This case underscores the importance of continued surveillance and evaluation of patients who undergo TAVR, as they remain at risk for long-term complications such as structural valve deterioration. Proper management, including timely diagnosis and intervention, can lead to successful outcomes in such patients.</span></span></span></p></div><div><h3>Learning objective</h3><p>This case underscores the importance of continued surveillance and evaluation of patients who undergo transcatheter aortic valve replacement, as they remain at risk for long-term complications such as structural valve deterioration. Proper management, including timely diagnosis and intervention, can lead to successful outcomes in such patients.</p></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 3","pages":"Pages 140-143"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139021285","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}

{"title":"Takotsubo syndrome associated with coronary microvascular dysfunction: A case study","authors":"Shohei Ikeda MD, PhD,&nbsp;Morihiko Takeda MD, PhD,&nbsp;Koichi Sato MD, PhD,&nbsp;Mariko Shinozaki MD,&nbsp;Satomi Watanabe MD,&nbsp;Keita Miki MD, PhD,&nbsp;Michinori Hirano MD, PhD,&nbsp;Koji Fukuda MD, PhD, FJCC,&nbsp;Nobuyuki Shiba MD, PhD","doi":"10.1016/j.jccase.2023.11.005","DOIUrl":"10.1016/j.jccase.2023.11.005","url":null,"abstract":"<div><p><span><span><span><span><span>The patient, a 68-year-old man, presented to our emergency room with chest pain, prompting an emergency </span>cardiac catheterization due to elevated cardiac troponin-I levels. While no obvious </span>coronary artery stenosis<span><span> was found, there was evidence of apical ballooning wall motion in the </span>left ventricle<span>, leading to a diagnosis of takotsubo syndrome. Three months later, he occasionally experienced chest pain at rest, prompting us to conduct another cardiac catheterization. Left ventriculography showed normal contraction. Suddenly, he experienced chest pain accompanied by ST elevation, which occurred spontaneously. Subsequently, slow-flow phenomenon was observed in the intermediate part of left anterior descending artery (LAD). We promptly administered nitroglycerin to alleviate the </span></span></span>symptoms<span>. Following the diagnosis of coronary microvascular dysfunction<span><span> (CMD), he started calcium-channel blocker therapy and remained asymptomatic. One year later, we re-performed cardiac catheterization to further explore his condition. </span>Acetylcholine provocation test was performed, which showed no epicardial </span></span></span>coronary spasm. However, lactic acid elevation was observed in the </span>coronary sinus<span> blood sample. Additionally, a coronary physiological measurement in the LAD revealed a high index of microcirculatory resistance and low coronary flow reserve. Based on this series of clinical events, we inferred a significant contribution of CMD to the patient's condition.</span></p></div><div><h3>Learning objective</h3><p>Coronary microvascular dysfunction (CMD) is increasingly recognized as an important cardiovascular disease, leading to myocardial ischemia<span>, which is occasionally associated with takotsubo syndrome (TTS). In this report, we present a case of spontaneous CMD associated with TTS. This case emphasizes the significance of accurate diagnosis and appropriate treatment, highlighting the importance of recognizing CMD in patients with TTS.</span></p></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"29 3","pages":"Pages 124-127"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138614903","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}