Journal of Cardiology Cases最新文献

{"title":"Cardiac arrest in an (apparently) healthy heart: A case report of an undiagnosed arrhythmogenic cardiomyopathy","authors":"Paolo Pollice MD, PhD ,&nbsp;Antonio Gianluca Robles MD, PhD ,&nbsp;Domenico Riccardo Rosario Chieppa MD ,&nbsp;Saverio Pollice MD ,&nbsp;Francesco Bartolomucci MD, PhD","doi":"10.1016/j.jccase.2025.03.005","DOIUrl":"10.1016/j.jccase.2025.03.005","url":null,"abstract":"<div><div>Arrhythmogenic cardiomyopathy is a rare and insidious disease that can be misdiagnosed with the common first-line diagnostic techniques. It can also primarily debut with sustained ventricular arrhythmias that can lead to cardiac arrest. We report the case of a 49-year-old triathlon athlete who during strenuous physical exercise experimented cardiac arrest. After successful resuscitation he was admitted to our unit: electrocardiogram, emergency echocardiogram, and coronary angiography did not show anything abnormal. Holter monitoring showed premature ventricular complexes with two different morphologies and cardiac magnetic resonance allowed us to make diagnosis of biventricular arrhythmogenic cardiomyopathy previously unrecognized. A subcutaneous implantable cardiac defibrillator was positioned for secondary prevention. Our case shows that in athletes a deep process of diagnostic screening is mandatory and this must include also cardiac magnetic resonance in case of element of clinical suspicion such as premature ventricular complexes at Holter monitoring and/or low voltages on limb leads in baseline 12‑lead electrocardiogram. A network of basic life emergency support measures is fundamental in every setting in which sport at competitive and non-competitive levels is performed.</div></div><div><h3>Learning objectives</h3><div>A deep diagnostic cardiologic screening for young athletes is important especially in case of premature ventricular complexes at electrocardiographic Holter monitoring and/or in clinical suspicion of an underlying cardiomyopathy. In selected cases the execution of cardiac magnetic resonance imaging is essential to permit the correct diagnostic assessment of a previously undiagnosed cardiomyopathy as the arrhythmogenic cardiomyopathy preventing dangerous (also lethal) clinical presentation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 178-181"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184436","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":"Rapid regression of marked left ventricular septal hypertrophy following immunosuppressive therapy in cardiac sarcoidosis","authors":"Ayaka Fujita MD ,&nbsp;Masashi Amano MD, PhD ,&nbsp;Yurie Tamai MS ,&nbsp;Makoto Amaki MD, PhD ,&nbsp;Hideaki Kanzaki MD, PhD, FJCC ,&nbsp;Yoshiaki Morita MD, PhD ,&nbsp;Takeshi Kitai MD, PhD ,&nbsp;Chisato Izumi MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.02.008","DOIUrl":"10.1016/j.jccase.2025.02.008","url":null,"abstract":"<div><div>A 46-year-old man presented with asymmetric remarkable left ventricular (LV) septal hypertrophy (maximal wall thickness: 24 mm) and complete atrio-ventricular block. Systemic sarcoidosis with a cardiac lesion was diagnosed by a supraclavicular lymph node biopsy. Following pacemaker implantation, the patient received immunosuppressive therapy with corticosteroids and methotrexate. One week after starting treatment, echocardiography and cardiac magnetic resonance (CMR) imaging showed reduced LV septal hypertrophy. At the 6-month follow-up, further thinning of the basal septal wall and enlargement of the LV with a decreased ejection fraction were observed, despite resolution of abnormal uptake in ¹⁸F-fluorodeoxyglucose positron emission tomography. A reduction in T2 values on CMR indicated that the initial hypertrophy was associated with edematous and inflammatory changes. Our findings suggest that there were heterogeneous lesions in the myocardium, such as edematous lesions responsive to immunosuppressive therapy and fibrotic lesions progressing to LV wall thinning.</div></div><div><h3>Learning objective</h3><div>Cardiac sarcoidosis with asymmetrical and remarkable hypertrophy is rare in the clinical setting, and using multimodality imaging in addition to histological findings is necessary for diagnosing this condition. Multimodality imaging including echocardiography and cardiac magnetic resonance are useful for evaluating myocardial characterization and confirming remarkable changes in left ventricular wall thickness and dysfunction after immunosuppression therapy.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 174-177"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184435","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":"Fatal coronary vasospasm following oral triptan intake","authors":"Idir-Yanis Djellal MD,&nbsp;Sohaïb Mansour MD,&nbsp;Brahim Berdaoui MD,&nbsp;Sophie Samyn MD,&nbsp;Jose Castro Rodriguez MD,&nbsp;Georgiana Pintea Bentea MD","doi":"10.1016/j.jccase.2025.02.007","DOIUrl":"10.1016/j.jccase.2025.02.007","url":null,"abstract":"<div><div>Triptans, commonly used for migraine treatment, induce vasoconstriction by activating 5HT1B/1D and 5HT1F receptors. Although several cases of coronary vasospasm associated with sumatriptan have been reported, few describe life-threatening arrhythmias and cardiac arrest. We present a case of fatal coronary vasospasm caused by triptan use in a young patient with minimal cardiovascular risk. A 30-year-old man with morbid obesity was admitted for unstable angina. He reported chest pain episodes starting one month earlier, coinciding with the initiation of oral sumatriptan for migraines. On the second day of hospitalization, he took 100 mg of sumatriptan. Ninety minutes later, he developed recurrent chest pain that progressed to cardiac arrest caused by a ventricular arrhythmia storm. Left anterior descending artery vasospasm with ST-segment elevation myocardial infarction was identified, and intracoronary nitrate and adenosine relieved the spasm. However, resuscitation was ineffective due to morbid obesity, leaving the patient in profound cardiogenic shock, followed by distributive shock from prolonged low-flow time. Despite maximal hemodynamic support, he succumbed to multiorgan failure. This case highlights the potentially fatal cardiovascular risk of triptans, even in low-risk patients, and underscores the need to discontinue triptans at the first sign of chest pain.</div></div><div><h3>Learning objectives</h3><div>Coronary vasospasm, a rare but severe complication of triptans, can lead to life-threatening arrhythmias and cardiac arrest, even in patients with low cardiovascular risk. Diagnosing vasospasm is challenging, as angiograms may appear normal during symptom-free intervals. This case highlights the need for heightened clinical suspicion when chest pain follows triptan use, emphasizing the importance of recognizing this risk to ensure prompt management and avoid fatal outcomes.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 170-173"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184701","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":"Usefulness of exercise stress echocardiography in a patient with unilateral pulmonary branch stenosis","authors":"Ryohei Yokoyama MD ,&nbsp;Yoshihiko Kodama MD, PhD ,&nbsp;Kazunari Takamura MD ,&nbsp;Masako Takahashi MD ,&nbsp;Miyo Tanaka MT ,&nbsp;Nozomi Watanabe MD, PhD, FJCC ,&nbsp;Hiroshi Moritake MD, PhD","doi":"10.1016/j.jccase.2025.02.003","DOIUrl":"10.1016/j.jccase.2025.02.003","url":null,"abstract":"<div><div>Exercise stress echocardiography (ESE) is a feasible and valuable tool for evaluating subclinical pulmonary hypertension (PH). However, its utility in patients with unilateral pulmonary branch stenosis remains unclear. We present a case involving a 17-year-old patient with left pulmonary branch stenosis who exhibited exercise-induced PH in the contralateral pulmonary artery as detected by ESE. Standard echocardiography was unable to visualize the left pulmonary artery clearly; therefore, computed tomography was performed, revealing a left pulmonary branch stenosis with a minimum diameter of 4.2 mm. Resting echocardiography showed a pressure gradient of 17 mmHg, calculated using the tricuspid regurgitant velocity. During ESE with a prone ergometer, the slope of the mean pulmonary arterial pressure to systemic cardiac output was 3.1 mmHg/L/min, meeting the diagnostic criteria for exercise-induced PH. The patient underwent stent implantation to treat the left pulmonary branch stenosis. Follow-up ESE demonstrated improvement, with the slope of the mean pulmonary arterial pressure to systemic cardiac output decreasing to 1.5 mmHg/L/min. These findings underscore that ESE is both feasible and effective for assessing subclinical unilateral pulmonary branch stenosis.</div></div><div><h3>Learning objective</h3><div>Patients with congenital unilateral peripheral branch pulmonary artery stenosis usually do not have pulmonary hypertension at rest, and identifying patients who require treatment is challenging. Exercise stress echocardiography can detect latent pulmonary hypertension of the contralateral pulmonary artery in some patients, providing valuable insights for determining treatment indications and evaluating the efficacy of catheter interventions for the stenotic lesion.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 155-157"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184689","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 with combination of pyoderma gangrenosum and cardiac sarcoidosis successfully implanted with a dual-chamber pacemaker","authors":"Toshihiko Akasaka MD, PhD ,&nbsp;Aiko Takami MD ,&nbsp;Ryo Higuchi MD ,&nbsp;Kazuyoshi Ogura MD, PhD ,&nbsp;Hiroshi Nasu MD ,&nbsp;Kazuhiro Yamamoto MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.02.005","DOIUrl":"10.1016/j.jccase.2025.02.005","url":null,"abstract":"<div><div>A patient with ulcerated skin lesions of unknown etiology on his left leg underwent pacemaker implantation for atrioventricular block caused by cardiac sarcoidosis (CS). After initiation of corticosteroid for CS, his skin lesions improved. The lesions were diagnosed as pyoderma gangrenosum (PG) from the findings of a skin biopsy and the reaction to corticosteroid. PG causes skin necrosis associated with immune system disorders after slight stimulation. Although we worried about wound healing after pacemaker implantation, the wound healed well under the corticosteroid treatment. This is the first report of successful pacemaker implantation in a patient with both PG and CS.</div></div><div><h3>Learning objective</h3><div>Conventional transvenous pacemakers can be implanted for pyoderma gangrenosum patients by early initiation of corticosteroid.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 166-169"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184700","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":"","authors":"Takuya Nishimura MD,&nbsp;Yuri Ochi MD,&nbsp;Naoki Arima MD,&nbsp;Kenta Sugiura MD,&nbsp;Takayoshi Hirota MD,&nbsp;Toru Kubo MD, FJCC,&nbsp;Naohito Yamasaki MD,&nbsp;Hiroaki Kitaoka MD, FJCC","doi":"10.1016/j.jccase.2025.02.009","DOIUrl":"10.1016/j.jccase.2025.02.009","url":null,"abstract":"","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 5","pages":"Page 153"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892213","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":"Mixed shock after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: Impella in crisis management","authors":"Junya Matsuda MD, PhD ,&nbsp;Jun Nakata MD ,&nbsp;Takeshi Yamamoto MD, PhD, FJCC ,&nbsp;Kuniya Asai MD, PhD","doi":"10.1016/j.jccase.2025.01.005","DOIUrl":"10.1016/j.jccase.2025.01.005","url":null,"abstract":"<div><div>Alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) can lead to complex hemodynamic challenges. This report describes a case of a 79-year-old woman who developed mixed cardiogenic and distributive shock following ASA. Cardiogenic shock occurred due to complete atrioventricular block with insufficient cardiac output despite temporary right ventricular pacing. Concurrently, distributive shock developed secondary to bacterial pneumonia and exacerbation of polymyositis-associated interstitial lung disease. Fluid resuscitation, antibiotics, vasopressors, and hydrocortisone were ineffective. Inotropes, intra-aortic balloon pump, and veno-arterial extracorporeal membrane oxygenation were contraindicated because of the risk of worsening left ventricular outflow tract obstruction. An Impella 2.5 (Abiomed Inc., Danvers, MA, USA) was deployed, achieving hemodynamic stabilization without worsening left ventricular outflow tract obstruction. The patient recovered successfully through comprehensive intensive care and was discharged. This case highlights the potential efficacy of Impella support in managing complex mixed shock states after ASA. It emphasizes the multiple challenges in HOCM management, including addressing hemodynamic complexities due to left ventricular outflow tract obstruction, managing ASA-related complications, and simultaneously treating concurrent distributive shock. This comprehensive approach is crucial for developing effective individualized management strategies for patients with HOCM when dealing with postprocedural complications.</div></div><div><h3>Learning objective</h3><div>This case illustrates complex hemodynamic complications following alcohol septal ablation for hypertrophic obstructive cardiomyopathy. It emphasizes the importance of recognizing and managing mixed cardiogenic and distributive shock when standard treatments fail. The case highlights the potential role of Impella (Abiomed Inc., Danvers, MA, USA) support in stabilizing hemodynamics without exacerbating left ventricular outflow tract obstruction.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 5","pages":"Pages 134-138"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892159","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":"Histopathological findings of biodegradable polymer sirolimus eluting stent 7 years after stent implantation","authors":"Yo Kawahara MD ,&nbsp;Sho Torii MD, PhD ,&nbsp;Yasutomo Sekido MD ,&nbsp;Gaku Nakazawa MD, PhD","doi":"10.1016/j.jccase.2025.01.007","DOIUrl":"10.1016/j.jccase.2025.01.007","url":null,"abstract":"<div><div>This report analyzes a biodegradable polymer coated drug-eluting stent (DES), Ultimaster (Terumo, Tokyo, Japan), seven years after implantation in a 73-year-old man who died from acute myocardial infarction after discontinuing his medications. Autopsy revealed no in-stent thrombosis or restenosis. Two stents exhibited neoatherosclerosis with calcifying necrotic core and foamy macrophages, indicating a lesser risk of very late stent thrombosis. The findings support the notion that third-generation DES might result in healthier long-term vessel healing and reduced neoatherosclerosis compared to earlier generations, consistent with prior animal studies. This suggests a sustained benefit and safety of the biodegradable polymer coated DES over an extended period.</div></div><div><h3>Learning objectives</h3><div>A 65-year-old male received three 3rd generation biodegradable polymer coated drug-eluting stents (BP-DES), Ultimaster (Terumo, Tokyo, Japan), during percutaneous coronary intervention. Seven years post-implantation, post-mortem histopathological analysis revealed well-healed arterial tissue with near-complete endothelialization and minimal neoatherosclerosis. No significant inflammation or late stent thrombosis was observed, with stent struts embedded in the neointima, indicating favorable long-term vessel healing. This case underscores the long-term biocompatibility of BP-DES, highlighting reduced risks of late stent thrombosis and neointimal hyperplasia over extended follow-up periods.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 5","pages":"Pages 142-144"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892210","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":"Switching antiplatelet therapy based on P2Y12 reaction unit monitoring for recurrent acute thrombosis due to prasugrel resistance: A case report","authors":"Tomomi Watanabe MD, PhD,&nbsp;Satoshi Kobara MD,&nbsp;Ryosuke Amisaki MD,&nbsp;Kazuhiro Yamamoto MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.01.006","DOIUrl":"10.1016/j.jccase.2025.01.006","url":null,"abstract":"<div><div>Dual antiplatelet therapy including P2Y12 inhibitor is mandatory to prevent stent thrombosis in acute coronary syndrome and prasugrel is more frequently used in Japanese patients than clopidogrel due to its poor metabolizer profile. We describe a case of a patient with prasugrel resistance who was switched to an appropriate antiplatelet therapy based on platelet function testing. Although prasugrel resistance is rare and platelet function test is not common in daily practice, it is important to be familiar with alternative drugs for prasugrel resistance and how to suspect and treat these patients.</div></div><div><h3>Learning objective</h3><div>Effects of antiplatelet therapy can be assessed by platelet function test (platelet aggregation test, VerifyNow, etc.).</div><div>Although routine use of platelet function test has not been recommended, it might be useful in cases with repeated thrombotic events.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 5","pages":"Pages 139-141"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892160","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":"Transient accessory pathway conduction block caused by internal electrical cardioversion","authors":"Tetsuya Kishigami MD,&nbsp;Iwanari Kawamura MD,&nbsp;Tasuku Yamamoto MD, PhD,&nbsp;Takashi Ikenouchi MD, PhD,&nbsp;Kentaro Goto MD, PhD,&nbsp;Takuro Nishimura MD, PhD,&nbsp;Susumu Tao MD, PhD,&nbsp;Masateru Takigawa MD, PhD,&nbsp;Shinsuke Miyazaki MD, PhD, FJCC,&nbsp;Tetsuo Sasano MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.01.003","DOIUrl":"10.1016/j.jccase.2025.01.003","url":null,"abstract":"<div><div>Pulsed field ablation (PFA) has been in the spotlight as an alternative to conventional thermal energy ablation given its unique tissue selectivity. The concept of current-day PFA is based on traditional direct electric current catheter ablation, creating nanopores in the cell membrane and resulting in cell death. Membrane pores that are created via electroporation can be either permanent, if the electric field is high enough, or only temporary if the fields are sub-threshold. We report a transient block of the accessory pathway after internal electrical cardioversion via a multipolar catheter placed along the tricuspid annulus.</div></div><div><h3>Learning objective</h3><div>We report a rare case that exhibited a transient accessory pathway conduction block after internal electrical cardioversion via a multipolar catheter placed along the tricuspid annulus. Transient conduction block may be observed by internal electrical cardioversion due to reversible electroporation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 5","pages":"Pages 125-128"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892322","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}