Journal of Cardiology Cases最新文献

{"title":"Clinical and diagnostic challenges in a case of hyperacute left ventricular rupture attributed to takotsubo syndrome","authors":"Sakuya Sudo, Teruhiko Imamura MD, PhD","doi":"10.1016/j.jccase.2026.03.007","DOIUrl":"10.1016/j.jccase.2026.03.007","url":null,"abstract":"","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 1","pages":"Pages 40-41"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377860","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":"Leadless pacemaker tine fracture resulting in device migration to the pulmonary artery: A case report","authors":"Yoshikazu Ohara MD,&nbsp;Yuki Yoshimura MD,&nbsp;Ryotaro Kitadai MD,&nbsp;Yoko Fukuoka MD,&nbsp;Satoshi Kawada MD","doi":"10.1016/j.jccase.2026.04.003","DOIUrl":"10.1016/j.jccase.2026.04.003","url":null,"abstract":"<div><div>A 96-year-old woman underwent implantation of a leadless pacemaker (Micra™ AV2; Medtronic, Inc., Minneapolis, MN, USA) for sick sinus syndrome. One month after implantation, pacing failure due to an elevated pacing threshold was observed, and the pacing output was increased. At routine follow-up one year after implantation, recurrent pacing failure was detected. Chest radiography revealed migration of the device into the left pulmonary artery. At least two of the four fixation tines were missing from the device body, and one fractured tine remained embedded in the right ventricular myocardium. Because the patient was asymptomatic, ventricular pacing dependency was low, and considering her advanced age and comorbidities, device retrieval or reimplantation was not performed. Although leadless pacemakers reduce complications associated with conventional transvenous systems, device-specific mechanical complications have been reported. We present a rare case of tine fracture of a Micra™ AV2 device resulting in migration into the pulmonary artery.</div></div><div><h3>Learning objective</h3><div>Tine fracture is a rare but potentially serious mechanical complication of leadless pacemakers. When pacing thresholds increase or pacing failure occurs, careful assessment of device position and fixation, including detailed imaging review, is essential.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 1","pages":"Pages 32-35"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377926","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":"From fragmented clinical clues to a final diagnosis: A case of unexplained exertional dyspnea due to latent left ventricular outflow tract obstruction","authors":"Akari Odagi MD,&nbsp;Kensuke Matsumoto MD, PhD,&nbsp;Shinnosuke Tsukamoto MD,&nbsp;Yusuke Hirao MD,&nbsp;Yuto Shinkura MD, PhD,&nbsp;Ryo Nishio MD, PhD,&nbsp;Masahiko Hoshijima MD, PhD,&nbsp;Satoru Kawasaki MD, PhD,&nbsp;Hogara Nishisaki MD, PhD","doi":"10.1016/j.jccase.2026.03.011","DOIUrl":"10.1016/j.jccase.2026.03.011","url":null,"abstract":"<div><div>We report a 65-year-old man with years of unexplained exertional dyspnea. Transthoracic echocardiography showed a bulging of the mildly hypertrophied interventricular septum into the left ventricular outflow tract (LVOT), slight systolic anterior motion (SAM) of the mitral leaflets, and flow acceleration at the tip of the mitral valves; however, even with combined provocative test using nitroglycerin spray in the sitting position with the Valsalva maneuver could not expose hemodynamically significant LVOT obstruction. After twists and turns, ultimately, low-dose dobutamine stress echocardiography induced profound SAM, in which the mitral leaflets completely closed the LVOT, and significant obstruction (pressure gradient of 226 mmHg). As a result, moderate to severe mitral regurgitation was also induced, accompanied by the identical symptom of chest discomfort. After cessation of the vasodilator, introduction of a beta-blocker, and self-management education, his symptoms resolved completely. From a pathophysiological perspective, dynamic LVOT obstruction results from the complex interaction among three components: anatomical, hemodynamic, and precipitating factors. These components interact in a multifaceted manner, inducing a dynamic LVOT obstruction in the non-hypertrophic cardiomyopathy patient. This case highlights the importance of meticulous clinical reasoning based on careful history taking and physical examination, combined with stress testing for <em>latent</em> LVOT obstruction.</div></div><div><h3>Learning objective</h3><div><em>Latent</em> LVOT obstruction can be a cause of exertional dyspnea, which may go undiagnosed for years, and in most cases, no stress testing may be performed. Meticulous history taking and a pathophysiology-oriented physical examination contributed to guiding the clinical reasoning, maintaining a high index of suspicion for <em>latent</em> LVOT obstruction. Robust clinical reasoning coupled with thoughtful consideration of the underlying hemodynamics remains a cornerstone even in contemporary cardiology.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 1","pages":"Pages 28-31"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377852","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":"Cardiac arrest due to ST-elevation myocardial infarction in young woman with antiphospholipid syndrome on combined oral contraceptives","authors":"Takuma Koike MD, PhD,&nbsp;Kenji Yaginuma MD, PhD,&nbsp;Kikuo Isoda MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.04.004","DOIUrl":"10.1016/j.jccase.2026.04.004","url":null,"abstract":"<div><div>A 35-year-old woman taking a low-dose combined oral contraceptive (COC) for uterine fibroids presented by ambulance to a referring hospital with nausea. During the initial evaluation, she suddenly became unresponsive and developed cardiac arrest, prompting immediate cardiopulmonary resuscitation. Electrocardiography (ECG) documented ventricular fibrillation (VF), and external defibrillation restored spontaneous circulation. After return of spontaneous circulation, ECG showed ST-segment elevation in leads II, III, and aVF. She was transferred to our hospital. Emergency coronary angiography demonstrated 90% stenosis of the proximal right coronary artery (RCA) and total occlusion of the mid RCA. During percutaneous coronary intervention, VF storm occurred, necessitating initiation of veno-arterial extracorporeal membrane oxygenation. Intravascular ultrasound (IVUS) revealed a plaque-containing culprit lesion, and drug-coated balloon angioplasty was performed. Subsequent thrombophilia testing disclosed anti-β2-glycoprotein I IgG positivity, establishing antiphospholipid syndrome (APS). Notably, despite the absence of conventional risk factors (e.g. dyslipidemia, diabetes), IVUS demonstrated an atherosclerotic-appearing lesion in the prothrombotic milieu of COC use and APS.</div></div><div><h3>Learning objectives</h3><div>In young women, it is important to consider non-atherosclerotic causes such as antiphospholipid syndrome (APS) and combined oral contraceptive use as differential diagnoses for acute coronary syndrome. Although embolic mechanisms are often implicated in such settings, the present case demonstrated an atherosclerotic-appearing lesion on intravascular ultrasound despite the absence of conventional coronary risk factors, suggesting the possibility of APS-related vascular injury contributing to plaque formation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 1","pages":"Pages 36-39"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377902","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 lymphangioma: diagnosis suggested by cardiac CT and MRI and successful conservative management","authors":"Eiji Kurosaka MD,&nbsp;Junji Matsuda MD,&nbsp;Naota Yanagiya MD,&nbsp;Ai Hosokawa MD,&nbsp;Naoki Tadaoka MD,&nbsp;Kotono Ikeguchi MD,&nbsp;Shin Meguro MD,&nbsp;Kentaro Nakata MD,&nbsp;Yuhei Isonaga MD,&nbsp;Shunichi Kato MD,&nbsp;Shinichi Tachibana MD,&nbsp;Hiroaki Ohya MD,&nbsp;Yasuaki Hada MD,&nbsp;Takamitsu Takagi MD,&nbsp;Miki Kanoh MD,&nbsp;Yukihiro Inamura MD,&nbsp;Tsunehiro Yamato MD,&nbsp;Ken Negi MD,&nbsp;Osamu Inaba MD,&nbsp;Yutaka Matsumura MD","doi":"10.1016/j.jccase.2026.03.009","DOIUrl":"10.1016/j.jccase.2026.03.009","url":null,"abstract":"<div><div>Cardiac lymphangioma is an exceptionally rare benign tumor, as lymphangiomas typically occur in the head and neck region. Owing to its rarity, there are no standardized diagnostic or therapeutic protocols for this condition. We describe the case of a 78-year-old woman diagnosed with cardiac lymphangioma, in which multimodality imaging played a decisive role. Cardiac computed tomography (CCT) revealed a lobulated, non-enhancing mass situated along the right coronary artery, while cardiac magnetic resonance imaging (CMR) demonstrated a multilocular cystic lesion with high signal intensity on T2-weighted images—findings characteristic of lymphangioma. Given the lesion's benign appearance, absence of hemodynamic impact, and lack of clinical symptoms, a conservative, noninvasive management approach was adopted. During follow-up, the patient remained asymptomatic, with no evidence of tumor growth or complications. This case emphasizes the critical role of advanced imaging modalities such as CCT and CMR in the precise identification and characterization of rare cardiac tumors. It also supports the feasibility and safety of a conservative management strategy for asymptomatic patients with benign imaging features, helping to avoid unnecessary surgical procedures while ensuring adequate clinical monitoring.</div></div><div><h3>Learning objective</h3><div>This case illustrates the importance of multimodality imaging in accurately diagnosing rare benign cardiac tumors such as lymphangioma. It emphasizes that recognizing characteristic features on cardiac computed tomography and cardiac magnetic resonance imaging can guide appropriate noninvasive management and prevent unnecessary surgical intervention. Clinicians should understand that conservative follow-up may be a safe and reasonable option for asymptomatic patients with benign imaging findings.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 1","pages":"Pages 5-8"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377863","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 unilateral pulmonary edema in the acute on chronic mitral regurgitation","authors":"Keisuke Suzuki MD, PhD,&nbsp;Yu Wakatsuki MS,&nbsp;Akihiko Ishida MD,&nbsp;Tetsuo Yagi MD, PhD","doi":"10.1016/j.jccase.2026.03.006","DOIUrl":"10.1016/j.jccase.2026.03.006","url":null,"abstract":"<div><div>Unilateral pulmonary edema (UPE) is a rare manifestation of mitral regurgitation (MR) and may be misdiagnosed as pneumonia. We report a 63-year-old man with a history of mitral valve repair who presented with dyspnea and right-sided pulmonary edema (PE). Despite initial antibiotic therapy, the PE did not improve. Echocardiography revealed severe MR due to pseudo-prolapse of the anterior mitral leaflet, with the regurgitant jet directed toward the right pulmonary veins. Right heart catheterization demonstrated a prominent V wave on the right pulmonary capillary wedge pressure. This case highlights the diagnostic value of echocardiography and catheterization in acute-on-chronic MR-induced UPE.</div></div><div><h3>Learning objective</h3><div>・Differential diagnosis of unilateral pulmonary edema is often necessary to distinguish it from pneumonia or heart failure due to mitral regurgitation.</div><div>・Echocardiographic evaluation of flow direction and mechanism, combined with bilateral pressure waveform confirmation by right heart catheterization, is crucial for diagnosis.</div><div>・Unilateral pulmonary edema can occur not only in acute but also in acute-on-chronic mitral regurgitation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 1","pages":"Pages 15-18"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377890","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":"Needed on mapping findings and bipolar electrogram interpretation in double tachycardia","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.12.005","DOIUrl":"10.1016/j.jccase.2025.12.005","url":null,"abstract":"","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 6","pages":"Pages 210-211"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148192322","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":"Left atrial dominant cardiac sarcoidosis presenting with supraventricular tachycardia and left atrial myocardial damage: A case report","authors":"Ayaka Fujita MD ,&nbsp;Takahiro Sakamoto MD, PhD ,&nbsp;Shinichi Kurashima MD ,&nbsp;Yuki Irie MD ,&nbsp;Kenji Moriuchi MD ,&nbsp;Atsushi Okada MD, PhD ,&nbsp;Masashi Amano MD, PhD, FJCC ,&nbsp;Makoto Amaki MD, PhD ,&nbsp;Hideaki Kanzaki MD, PhD, FJCC ,&nbsp;Takeshi Kitai MD, PhD ,&nbsp;Chisato Izumi MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.03.002","DOIUrl":"10.1016/j.jccase.2026.03.002","url":null,"abstract":"<div><div>A 61-year-old woman presented to our hospital with palpitations and dyspnea persisting for several months. Electrocardiography revealed atrial tachycardia, and X-ray revealed bilateral hilar enlargement. Computed tomography (CT) was performed for suspected sarcoidosis of the respiratory system, which revealed hilar lymph node enlargement in the bilateral lungs. ¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG)-positron emission tomography-CT revealed abnormal ¹⁸F-FDG uptake in the hilar lymph nodes, liver, and left atrium (LA), but not in the left ventricle. Contrast-enhanced cardiac magnetic resonance imaging revealed late gadolinium enhancement (LGE) in the LA. Mediastinal lymph node, transbronchial lung, and right ventricular biopsies were performed, but no specific pathological findings were observed. Echocardiography-guided liver biopsy was also performed, which revealed non-caseating epithelioid granulomas. We definitively diagnosed systemic sarcoidosis, including cardiac lesions. Following the initiation of immunosuppressive therapy, abnormal ¹⁸F-FDG uptake in the liver, lymph nodes, and LA resolved, and atrial tachycardia improved, likely owing to the suppression of atrial inflammation. However, LGE in the LA persisted after immunosuppressive therapy, suggesting that structural damage had persisted. In this case, multimodality imaging helped us understand the disease state and post-treatment course.</div></div><div><h3>Learning objective</h3><div>The main site of cardiac sarcoidosis involvement is the left ventricle, and cases in which inflammation is confined to the left atrium are rare. In left atrial dominant cardiac sarcoidosis, clinical manifestations are often limited to supraventricular tachycardia. Although immunosuppressive therapy controlled the arrhythmia, multimodality imaging revealed that left atrial structural damage persisted, even after inflammation had improved. These findings highlight the clinical importance of recognizing left atrial dominant cardiac sarcoidosis, as irreversible atrial damage may persist despite adequate treatment.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 6","pages":"Pages 206-209"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148192263","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 sinus of Valsalva–right ventricle fistula without an aneurysm complicated by aortic regurgitation","authors":"Hiroki Okamoto MD, PhD ,&nbsp;Hiroki Bansho MD ,&nbsp;Kentaro Matsuoka MD ,&nbsp;Misato Kodama MD ,&nbsp;Kohei Hachiro MD, PhD ,&nbsp;Atsushi Hayashi MD, PhD ,&nbsp;Tomoaki Suzuki MD, PhD ,&nbsp;Yoshihisa Nakagawa MD, PhD","doi":"10.1016/j.jccase.2026.02.001","DOIUrl":"10.1016/j.jccase.2026.02.001","url":null,"abstract":"<div><div>A 70-year-old man with significant aortic regurgitation and a suspected ventricular septal defect presented with exertional dyspnea. Multimodality imaging showed a rare fistulous connection between the right ventricle and the sinus of Valsalva without aneurysmal formation. Surgical aortic valve replacement and patch closure of the fistula were successfully performed. Intraoperative and pathological findings showed no evidence of inflammation. This case highlights the utility of advanced imaging in diagnosing a rare case of sinus of Valsalva–right ventricle fistula and guiding appropriate surgical management.</div></div><div><h3>Learning objective</h3><div>Comprehensive multimodality imaging, particularly transesophageal echocardiography and cardiac computed tomography, enables precise diagnosis and optimal surgical planning for periaortic fistula and aortic regurgitation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 6","pages":"Pages 186-189"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148192323","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":"Unexpected presentation of post-implantation syndrome in a patient following aortoiliac aneurysm endovascular repair","authors":"Dung Duc Doan MD, PhD ,&nbsp;Hoa Quynh Nguyen MD, MSc ,&nbsp;Khuyen Kim Thi Hoang MD, MSc ,&nbsp;Tinh Van Vo MD","doi":"10.1016/j.jccase.2026.03.005","DOIUrl":"10.1016/j.jccase.2026.03.005","url":null,"abstract":"<div><div>Surgery and endovascular repair remain the standard treatments for those at high risk of aneurysm rupture. Early detection and timely intervention, such as surgery or endovascular aortic repair (EVAR), are critical. EVAR is preferred due to its lower mortality compared to open surgery, but complications such as endoleaks, device migration, and post-implantation syndrome (PIS) are common. PIS affects 14% to 60% of EVAR patients, especially with polyester stent grafts. It typically presents with fever and elevated inflammatory markers, although other symptoms are less documented. An 84-year-old male with ischemic stroke, chronic coronary syndrome, and atrial fibrillation underwent stent graft placement for abdominal and iliac artery aneurysms. Discharged asymptomatic, he returned eight days later with fever, limb pain, and systemic inflammatory response syndrome. No infection or autoimmune disease was found through laboratory and imaging studies. Antibiotics failed, but magnetic resonance imaging of the limbs revealed edema in muscles, fascia, and subcutaneous tissues, indicating PIS. He improved rapidly with corticosteroids, confirming the diagnosis. This is the first case of PIS involving muscle, subcutaneous, and peri-vessel edema. It emphasizes the importance of recognizing atypical PIS presentations and using corticosteroids early to improve outcomes and avoid unnecessary investigations.</div></div><div><h3>Learning objective</h3><div>Post-implantation syndrome (PIS) commonly presents with fever and elevated inflammatory markers after aortic endovascular repair. However, muscle, subcutaneous, and peri-vessel edema have not been previously linked to PIS in the literature. This case highlights the diagnostic challenge posed by this atypical presentation, with PIS diagnosed through exclusion. Notably, the patient responded positively to corticosteroid therapy, demonstrating its therapeutic value in managing the condition.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 6","pages":"Pages 195-198"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148192325","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}