Journal of Cardiology Cases最新文献

{"title":"Thrombosed epic mitral bioprosthesis in the late postoperative period: A case report","authors":"Akito Kuwano MD,&nbsp;Hisashi Sato MD","doi":"10.1016/j.jccase.2026.01.007","DOIUrl":"10.1016/j.jccase.2026.01.007","url":null,"abstract":"<div><div>Bioprosthetic valve thrombosis (BVT) is a rare complication following surgical valve replacement, with a particularly low incidence of 0.3% reported for the Epic bioprosthesis (St. Jude Medical, Inc., St. Paul, MN, USA) in the mitral position. We report a case of late-onset BVT of the Epic mitral bioprosthesis, resulting in significant prosthetic valve dysfunction. A 74-year-old man was admitted with acute heart failure 5.5 years after undergoing mitral valve replacement with a 29-mm Epic bioprosthetic valve. Although he had been taking edoxaban for paroxysmal atrial fibrillation, it was discontinued one year prior to admission. Moreover, daprodustat was initiated for renal anemia six months before admission. Transthoracic echocardiography on admission revealed severe mitral stenosis, with a mitral valve area of 0.8 cm² and a mean transvalvular pressure gradient of 25.5 mmHg, indicating prosthetic valve dysfunction. Redo mitral valve replacement was performed, during which the Epic valve was explanted and replaced with a 25-mm St. Jude Medical prosthesis. The explanted valve was markedly thrombosed, with severely restricted leaflet mobility. Postoperatively, anticoagulation therapy with warfarin was initiated. Over the two-year follow-up period, no evidence of valve thrombosis or hemorrhagic events has been observed, and the clinical course has remained favorable.</div></div><div><h3>Learning objective</h3><div>We report a case of late-onset bioprosthetic valve thrombosis (BVT) of the Epic mitral bioprosthesis. In this case, discontinuation of edoxaban combined with initiation of daprodustat likely contributed to BVT. These findings underscore the importance of maintaining long-term anticoagulation in patients with risk factors for BVT and of carefully monitoring for thrombotic events in patients receiving hypoxia-inducible factor prolyl hydroxylase inhibitors.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 4","pages":"Pages 128-131"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578654","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":"Coronary vasospasm in a patient with RUNX1 mutation in eosinophilic leukemia and hypereosinophilic syndrome: A case report","authors":"Abdullah Abdulrahman AlShamrani MBBS, SBIM ,&nbsp;Ali Muhammad Alqaraishi MBBS, SBIM ,&nbsp;Ahmed Saad Almukhlifi MBBS, SBIM ,&nbsp;Aeshah M. Alharbi MBBS ,&nbsp;Rashed S. Alharbi MBBS ,&nbsp;Rajkumar Rajendram AKC, BSc, MBBS, EDIC","doi":"10.1016/j.jccase.2026.01.001","DOIUrl":"10.1016/j.jccase.2026.01.001","url":null,"abstract":"<div><div>Hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia and the potential for significant organ damage. Cardiac involvement, a frequent complication, may be life-threatening. We describe the case of a 29-year-old male who presented with chest pain and dyspnea and was found to have eosinophilia. A comprehensive workup, including extensive laboratory and imaging studies, bone marrow aspirate and trephine with cytogenetic testing failed to identify a cause for the HES. Thus, the patient was provisionally diagnosed with idiopathic HES and treated with steroids. Although cytogenetic chromosomal analysis and fluorescence in situ hybridization for myeloid genes were negative, next generation sequencing (NGS) revealed a likely pathogenic variant in RUNX1 consistent with myeloid leukemia. RUNX1 also regulates adverse cardiac remodeling after myocardial infarction. Thus, this case highlights the importance of thorough investigation to determine the etiology of HES and the need to define the role of RUNX1 mutations. Early recognition and prompt initiation of appropriate therapy is crucial for mitigating organ damage and improving patient outcomes. When the diagnosis is uncertain, corticosteroids can be used to control eosinophilia which may be lifesaving. Yet, this case underscores the importance of a comprehensive diagnostic approach, including NGS, in patients with unexplained eosinophilia and cardiac involvement.</div></div><div><h3>Learning objectives</h3><div>Hypereosinophilic syndrome should be considered in patients with unexplained eosinophilia and systemic symptoms.</div><div>Eosinophilic myocarditis may mimic acute coronary syndromes and can coexist with coronary vasospasm.</div><div>Early corticosteroid therapy can prevent irreversible organ damage. Comprehensive evaluation is necessary to exclude secondary causes of eosinophilia.</div><div>Detection of somatic mutations such as RUNX1 may indicate an underlying clonal eosinophilic disorder and warrants hematology input and long-term monitoring.</div><div>Multidisciplinary care, including cardiology and hematology input, is vital for optimal management.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 4","pages":"Pages 135-138"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578582","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":"Acute cardiac complication in a patient with antimitochondrial M2 antibody-positive myositis on immunosuppressive therapy","authors":"Shuto Takahashi MD ,&nbsp;Yudai Fujimoto MD ,&nbsp;Takao Kato MD, PhD ,&nbsp;Yuya Matsue MD, PhD ,&nbsp;Tohru Minamino MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.01.011","DOIUrl":"10.1016/j.jccase.2026.01.011","url":null,"abstract":"<div><div>As the emerging disease concept of antimitochondrial M2 antibody (AMA-M2)-positive myositis gains wider recognition, reports of its cardiac complications are increasing. However, the clinical course and optimal management of cardiac involvements in patients with AMA-M2-positive myositis remain unclear. We report the case of a 53-year-old male with AMA-M2-positive myositis who had been receiving immunosuppressive therapy for four years. He presented with cardiogenic shock with an atypical clinical course that responded to corticosteroid pulse therapy. This case report provides valuable insights into the clinical course and potential treatment option for cardiac involvement in patients with AMA-M2-positive myositis.</div></div><div><h3>Learning objectives</h3><div>This case highlights the unique clinical course of cardiac involvement in a patient with antimitochondrial M2 antibody-positive myositis under long-term immunosuppressive therapy, and suggests the potential efficacy of corticosteroid pulse therapy in the setting of acute exacerbations. Physicians should consider abrupt cardiac complications even during maintenance therapy. Rapid recognition and aggressive steroid treatment may yield favorable outcomes even in these complex cases.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 4","pages":"Pages 124-127"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578653","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":"Aconitine poisoning presenting as atrial fibrillation with slow ventricular rate: A case report","authors":"Jianhan Yao (MD) ,&nbsp;Qin Zhang (MD) ,&nbsp;Li Lv (MD) ,&nbsp;Qinghua Cao (MD) ,&nbsp;Xinmiao Huang (MD)","doi":"10.1016/j.jccase.2025.12.001","DOIUrl":"10.1016/j.jccase.2025.12.001","url":null,"abstract":"<div><div>Aconitine is a diterpenoid diester alkaloid primarily found in traditional Chinese herbs. It is rapidly absorbed through the upper gastrointestinal tract and exhibits some beneficial effects. However, due to its toxicity, improper use of aconitine can easily lead to poisoning, primarily characterized by cardiovascular and neurological toxicity. Most cases of aconitine poisoning involve multiple types of arrhythmias, with rapid ventricular arrhythmias being the most common. However, it can also result in bradyarrhythmias. We report a case of aconitine poisoning manifesting as atrial fibrillation with slow ventricular rate and an ST-segment resembling a fishhook pattern on the electrocardiogram, detailing its clinical presentation and treatment approach. This case report highlights the importance of healthcare professionals thoroughly reviewing patients' medical history and medication use to identify and address adverse drug reactions.</div></div><div><h3>Learning objectives</h3><div><ul><li><span>1.</span><span><div>Recognize that aconitine poisoning, while commonly presenting with rapid ventricular arrhythmias, can also manifest as bradyarrhythmias, including atrial fibrillation with slow ventricular response.</div></span></li><li><span>2.</span><span><div>Identify the potential electrocardiographic finding of a fishhook-shaped ST-segment as a clue in suspected aconitine toxicity.</div></span></li><li><span>3.</span><span><div>Emphasize the critical importance of a thorough review of a patient's medication history and use of traditional herbs in the evaluation of unexplained arrhythmias.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 78-81"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367127","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":"Natural history of coronary aneurysms associated with Noonan's syndrome","authors":"Franco J. Cossettini MD ,&nbsp;Daniel Lorenzatti MD ,&nbsp;Annalisa Filtz MD ,&nbsp;Felipe Contreras Yametti MD ,&nbsp;Juan C. Cedeño Serna MD ,&nbsp;Siddarth Ragupathi MD ,&nbsp;Safwan Gaznabi MD ,&nbsp;Nicole J. Sutton MD ,&nbsp;Jeffrey M. Levsky MD, PhD ,&nbsp;Leandro Slipczuk MD, PhD","doi":"10.1016/j.jccase.2025.12.008","DOIUrl":"10.1016/j.jccase.2025.12.008","url":null,"abstract":"<div><div>Coronary artery aneurysms (CAAs) in Noonan syndrome (NS) are rare, and their true prevalence remains unclear. While previous cases have been reported, the natural history of this association and its management have not been described. We present a 31-year-old male followed for over 16 years, who was found to have an uncomplicated thrombus during his most recent coronary computed tomography angiography (CCTA) follow-up. We aim to illustrate the natural history of CAAs in NS by presenting findings from transthoracic echocardiography (TTE) and CCTA, discussing diagnostic challenges, and showing how current Kawasaki disease (KD) guidelines can be extrapolated for management. In conclusion, CCTA and TTE play a pivotal role in monitoring CAA progression and guiding individualized therapeutic strategies, with KD guidelines serving as a reference for management.</div></div><div><h3>Learning objective</h3><div>The association between Noonan syndrome (NS) and giant coronary artery aneurysms (GCAAs) is rare, posing challenges for long-term management. Multimodality imaging, particularly coronary computed tomography angiography, is essential for monitoring GCAA progression, evaluating complications, and guiding thromboprophylaxis and surgery. The potential application of Kawasaki disease guidelines may provide valuable insights into thromboprophylaxis and long-term care in NS patients with GCAAs, helping to address the current lack of condition-specific management strategies.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 93-97"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367142","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":"Overlapping pathologies: Adrenal insufficiency presenting as refractory acute heart failure","authors":"Ran Sumida MD ,&nbsp;Yuko Kato MD, PhD ,&nbsp;Naoharu Yagi MD ,&nbsp;Shunsuke Matsuno MD ,&nbsp;Tokuhisa Uejima MD, PhD ,&nbsp;Yasuo Okumura MD, PhD, FJCC ,&nbsp;Yuji Oikawa MD, PhD","doi":"10.1016/j.jccase.2025.11.005","DOIUrl":"10.1016/j.jccase.2025.11.005","url":null,"abstract":"<div><div>Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare form of secondary adrenal insufficiency that may be unmasked by physiological stress such as rapid atrial fibrillation (AF) or acute heart failure. We report the case of a 69-year-old male patient with tachycardiac AF-induced acute decompensated heart failure (ADHF), in whom persistent hyponatremia and hypotension were unresponsive to inotropic support and fluid resuscitation. Endocrine evaluation revealed markedly decreased ACTH and cortisol levels, with preservation of other pituitary hormones, confirming isolated ACTH deficiency. Prompt administration of hydrocortisone led to rapid improvement in hemodynamics and electrolyte balance. This case highlights the diagnostic challenge posed by overlapping features of adrenal crisis and ADHF. Adrenal insufficiency should be considered in cases of refractory heart failure with persistent hyponatremia and hypotension. Empirical corticosteroid therapy may be lifesaving and should not be delayed while awaiting hormonal confirmation.</div></div><div><h3>Learning objectives</h3><div>Isolated adrenocorticotropic hormone deficiency is a rare form of secondary adrenal insufficiency that can be unmasked by stress conditions such as rapid atrial fibrillation or acute heart failure. In cases of refractory heart failure with persistent hyponatremia and hypotension despite inotropic support and fluid resuscitation, adrenal insufficiency should be considered a critical differential diagnosis. When adrenal crisis is suspected, empirical corticosteroid therapy may lead to rapid hemodynamic improvement, even before hormonal confirmation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 71-74"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367185","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":"Incessant pericarditis due to lung cancer and obstructive pneumonia","authors":"Kanako Nishiyama MD ,&nbsp;Masato Shimizu MD, FJCC ,&nbsp;Harumi Koizumi MD ,&nbsp;Makoto Suzuki MD, FJCC ,&nbsp;Tetsuo Sasano MD, FJCC","doi":"10.1016/j.jccase.2025.12.004","DOIUrl":"10.1016/j.jccase.2025.12.004","url":null,"abstract":"<div><div>An 83-year-old man was admitted to our hospital with chest and back pain accompanied by a high fever. His electrocardiogram showed ST elevation in the inferior leads, and transthoracic echocardiography revealed a moderate amount of pericardial effusion. Contrast-enhanced computed tomography revealed lung cancer adjacent to the pericardial sac and obstructive pneumonia. Emergent cardiac catheterization was performed; however, no coronary artery occlusion was detected. Based on these findings, a diagnosis of acute pericarditis was made. The patient was treated with colchicine, ibuprofen, and antibiotics. By the third day of hospitalization, his fever, chest pain, pericardial effusion, and ST elevation had improved. However, on the sixth day, his chest pain recurred, ST elevation reappeared, and the pericardial effusion increased. These findings gradually improved with conservative management. Our final diagnosis was incessant pericarditis. As the patient and his family declined invasive treatment, he was discharged on the 28th day of hospitalization under a policy of best supportive care. Incessant pericarditis with rapid alternation between improvement and exacerbation within a short period is considered uncommon. In the present case, the fluctuations in pericarditis were thought to be associated with obstructive pneumonia and pericardial invasion by lung cancer.</div></div><div><h3>Learning objective</h3><div><ul><li><span>✓</span><span><div>Incessant pericarditis is rare, but some cases of acute pericarditis may follow an incessant inflammatory course.</div></span></li><li><span>✓</span><span><div>In addition to common viral infections, other causes of pericarditis such as obstructive pneumonia and lung cancer should also be considered and investigated.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 89-92"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367164","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 large-vessel giant cell arteritis onset in a patient over 90 years old: Diagnostic challenge in differentiating from an infectious aneurysm","authors":"Yushi Oyama MD,&nbsp;Keishiro Okawa MD,&nbsp;Takahiro Sakai MD, PhD,&nbsp;Kyuhachi Otagiri MD, PhD,&nbsp;Hiroshi Kitabayashi MD, PhD","doi":"10.1016/j.jccase.2025.11.007","DOIUrl":"10.1016/j.jccase.2025.11.007","url":null,"abstract":"<div><div>Giant cell arteritis (GCA) is a large-vessel vasculitis that can involve extracranial arteries, such as the aorta, leading to aneurysm formation. However, differentiating aneurysms caused by large-vessel GCA (LV-GCA) from infectious aortic aneurysms remains a diagnostic challenge. We report a rare case of a 91-year-old man with anorexia, weight loss, and low-grade fever. Laboratory findings revealed elevated inflammatory markers, and contrast-enhanced computed tomography (CT) showed saccular aneurysms of the descending and abdominal aorta with periaortic soft tissue mass. Although empirical antibiotic therapy was initiated for suspected infectious aortic aneurysm, there was no clinical or laboratory improvement, and blood cultures remained negative. Positron emission tomography-CT demonstrated intense fluorodeoxyglucose uptake at aneurysmal sites. After multidisciplinary discussion, a diagnosis of LV-GCA was made, and prednisolone 40 mg/day was initiated, resulting in rapid symptom resolution and normalization of inflammatory markers. Despite initial improvement, relapse occurred during glucocorticoid tapering, and the patient unfortunately suffered aneurysmal rupture and died. This case underscores the difficulty in differentiating LV-GCA from infectious aneurysms and highlights the importance of considering early initiation of biologic therapy, such as interleukin-6 receptor inhibitors, in LV-GCA to prevent relapse and potentially life-threatening complications.</div></div><div><h3>Learning objective</h3><div>This case highlights the diagnostic challenges in distinguishing large-vessel giant cell arteritis (LV-GCA) from infectious aortic aneurysms, as both can present with similar imaging and clinical features. It also underscores the importance of considering early initiation of biologic therapy, such as interleukin-6 receptor inhibitors, in LV-GCA to prevent relapse and potentially life-threatening complications.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 63-66"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367089","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 progression of constrictive pericarditis due to primary malignant pericardial mesothelioma: A case report","authors":"Yuta Inoue MD ,&nbsp;Takayoshi Kato MD ,&nbsp;Susumu Endo MD ,&nbsp;Genki Naruse MD, PhD ,&nbsp;Takafumi Okubo MD ,&nbsp;Kosuke Mori MD ,&nbsp;Kazuhiro Kobayashi MD, PhD ,&nbsp;Masayuki Sato MD ,&nbsp;Ryo Fujii MD ,&nbsp;Hiroki Ogura MD ,&nbsp;Etsuji Umeda MD ,&nbsp;Osamu Sakai MD, PhD ,&nbsp;Tatsuhiko Miyazaki MD, PhD ,&nbsp;Hiroyuki Okura MD, PhD, FJCC ,&nbsp;Kiyoshi Doi MD, PhD","doi":"10.1016/j.jccase.2025.12.002","DOIUrl":"10.1016/j.jccase.2025.12.002","url":null,"abstract":"<div><div>Primary malignant pericardial mesothelioma (PMPM) is a rare malignancy, accounting for 0.7% of all mesotheliomas and has non-specific clinical features such as dyspnea and chest pain. A 66-year-old man visited a referring physician with a chief complaint of worsening dyspnea on exertion. Imaging revealed irregular pericardial thickening and hemorrhagic effusion. Despite initial empirical management with antibiotics and steroids under the diagnosis of constrictive pericarditis (CP) of unknown etiology, his condition deteriorated rapidly; he was transferred to our hospital for advanced therapy. However, on the night of referral, the patient experienced cardiac arrest due to atrial arrhythmia and required percutaneous cardiopulmonary circulatory support. Based on the rapid progression of clinical features and imaging findings, we considered that his CP was caused by a malignancy, in which case, his condition did not warrant radical pericardiectomy. Intraoperative frozen section analysis from an open biopsy via a small subxiphoid incision confirmed malignancy, and the patient was transitioned to palliative care. The patient died eight days after admission. Histopathological examination revealed sarcomatoid PMPM. This case highlights the importance of considering PMPM in rapidly progressive CP, emphasizing the diagnostic challenge and the need for early recognition especially when imaging reveals irregular pericardial thickening and hemorrhagic effusion.</div></div><div><h3>Learning objective</h3><div>Primary malignant pericardial mesothelioma can closely mimic constrictive pericarditis, leading to delays in diagnosis and management. This case underscores the necessity of early suspicion of malignancy in patients with rapidly progressive constrictive pericarditis presenting with hemorrhagic pericardial effusion and irregular pericardial thickening.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 82-85"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367093","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 to identify masked pulmonary hypertension associated with hyperthyroidism","authors":"Yu Noguchi MD ,&nbsp;Makoto Miyake MD, PhD ,&nbsp;Hibiki Mima MD ,&nbsp;Hayato Matsutani ,&nbsp;Shoko Nakagawa MD, PhD ,&nbsp;Jiro Sakamoto MD, PhD ,&nbsp;Hirokazu Kondo MD, PhD ,&nbsp;Toshihiro Tamura MD, PhD","doi":"10.1016/j.jccase.2025.11.006","DOIUrl":"10.1016/j.jccase.2025.11.006","url":null,"abstract":"<div><div>Hyperthyroidism is recognized as a cause of pulmonary hypertension (PH). Exercise stress echocardiography (ESE) can assess changes in cardiovascular function during exercise and plays an important role in the noninvasive evaluation of patients with suspected PH. We herein report a case involving a 51-year-old woman with exertional dyspnea who was diagnosed with Graves' disease. Resting transthoracic echocardiography showed normal left ventricular systolic and diastolic function, no significant valvular disease, and a tricuspid regurgitation pressure gradient (TRPG) of 34 mmHg. ESE revealed an elevated maximum TRPG of 61 mmHg during exercise, associated with dyspnea. We presumed that the cause of exertional dyspnea was PH associated with hyperthyroidism. Following treatment with thiamazole, euthyroid status was achieved and her symptoms improved. Post-treatment ESE showed improvement, with a maximum TRPG of 38 mmHg during exercise. ESE has the potential to identify PH associated with hyperthyroidism and to serve as a noninvasive tool for monitoring the therapeutic course after treatment.</div></div><div><h3>Learning objective</h3><div>Pulmonary hypertension (PH) should be suspected in patients with hyperthyroidism who present with unexplained exertional dyspnea. Exercise stress echocardiography (ESE) can noninvasively reveal masked PH and should be considered in patients with hyperthyroidism and exertional dyspnea when resting echocardiography does not identify a clear cause. ESE can also be used to monitor the therapeutic course of PH following treatment for hyperthyroidism.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 3","pages":"Pages 75-77"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367132","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}