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1.
Circ J ; 85(8): 1329-1337, 2021 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-33867407

RESUMO

BACKGROUND: An association between atrial high-rate episode (AHRE) and stroke has been reported, although data for the Asian population are limited. This study aimed to investigate the role of AHRE in ischemic and major bleeding events in patients who underwent a cardiac implantable electronic device (CIED) procedure.Methods and Results:This single-center historical cohort study included 710 patients (age: 78±11 years, 374 women) who underwent a CIED-related procedure between October 2009 and September 2019 at Shimane Prefectural Central Hospital (median follow-up period: 4.5 [2.5, 7] years, 3439 person-years). Based on the maximum AHRE burden, patients were divided into: (1) <6 min; (2) ≥6 min to 24-h; and (3) ≥24-h groups. The cumulative incidence of ischemic (ischemic stroke, systemic embolism, and transient ischemic attack) and major bleeding (≥3 Bleeding Academic Research Consortium bleeding criteria) events after the procedure were compared. Uni- and multivariate analyses were performed to identify factors associated with these events. The incidence of both events increased with the rising AHRE burden, being significantly higher in the ≥24-h group than in the <6 min group. Multivariate analysis found age ≥85 years to be the only independent factor associated with both events. CONCLUSIONS: Longer AHRE duration is associated with a high number of major bleeding and ischemic events. Monitoring these bleeding risks is mandatory when clinicians are considering anticoagulation therapy for such patients.


Assuntos
Fibrilação Atrial , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Eletrônica , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
2.
Ann Nucl Med ; 31(8): 629-635, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28695497

RESUMO

BACKGROUND: Cadmium-zinc-telluride (CZT) cameras have improved the evaluation of patients with chest pain. However, inferior/inferolateral attenuation artifacts similar to those seen with conventional Anger cameras persist. We added prone acquisitions and CT attenuation correction (CTAC) to the standard supine image acquisition and analyzed the resulting examinations. METHODS AND RESULTS: Seventy-two patients referred for invasive coronary angiography (CAG), and who also underwent rest/stress myocardial perfusion imaging (MPI) on a CZT camera in the supine and prone positions plus CTAC imaging, to examine known or suspected CAD between April 2013 and March 2014 were included. A sixteen-slice CT scan acquired on a SPECT/CT scanner between rest and stress imaging provided data for iterative reconstruction. Sensitivity, specificity, accuracy, and positive and negative likelihood ratios (LRs) were calculated to compare MPI with CAG on a per-patient basis. Per-patient sensitivity, specificity, and accuracy of supine images to predict coronary abnormalities on CAG were 35% [95% confidence interval (CI) 19-52], 86% (95% CI 80-92), and 74% (95% CI 66-82); those of prone imaging were 65% (95% CI 45-81), 82% (95% CI 76-87), and 78% (95% CI 68-85); and those of CTAC were 59% (95% CI 41-71), 93% (95% CI 87-97), and 85% (95% CI 76-91), respectively. CONCLUSIONS: Prone acquisition and CTAC images improve the ability to assess the inferior/inferolateral area.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Câmaras gama , Aumento da Imagem/instrumentação , Aumento da Imagem/métodos , Posicionamento do Paciente/métodos , Cintilografia/instrumentação , Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Idoso , Cádmio , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Decúbito Ventral , Cintilografia/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Telúrio , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Zinco
3.
Intern Med ; 55(18): 2635-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27629959

RESUMO

Coronary artery fistulas are rare and the feeding artery is ectatic and tortuous. It is not well-known whether coronary artery ectasia (CAE) is a risk factor of acute coronary syndrome (ACS) in the puerperal periods. A 40-year-old woman with a coronary artery fistula and an ectatic right coronary artery (RCA) had delivered twins. A month later, she had chest pain and coronary angiography revealed thrombogenesis in the RCA. She had no risk factors of cardiovascular disease or thrombogenesis. We should recognize that CAE is a risk factor for ACS in women in the perinatal and puerperal periods.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Anticoagulantes/uso terapêutico , Fístula Arteriovenosa/fisiopatologia , Dor no Peito/diagnóstico por imagem , Vasos Coronários/patologia , Dilatação Patológica/fisiopatologia , Fístula/patologia , Varfarina/uso terapêutico , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Dor no Peito/fisiopatologia , Angiografia Coronária , Circulação Coronária , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/terapia , Eletrocardiografia , Feminino , Fístula/diagnóstico por imagem , Humanos , Período Pós-Parto , Fatores de Risco , Resultado do Tratamento
4.
Intern Med ; 55(17): 2351-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27580533

RESUMO

Objective The recognition of clinical symptoms is critical to developing an effective therapeutic strategy for aortic valve stenosis (AS). Although AS is common, little is known about the factors influencing the natural history of AS patients who are 80 years of age older in advanced aging societies. We investigated the natural history and indications for valve procedures in AS patients of 80 years of age or older. Methods The medical records of 108 consecutive AS patients (moderate grade or higher) who are 80 years of age or older (mean age, 84.2±3.9 years; female, 65 patients) were reviewed to investigate their symptoms, the development of congestive heart failure, the incidence of referral for aortic valve replacement and death. The median duration of follow-up was 9 months (interquartile range, 2 to 25 months). Results The probability of remaining free of events (valve replacement and death) was 29±13% in all patients. There was no significant difference in the aortic valve area of the symptomatic and asymptomatic patients (0.85±0.28 cm(2) vs. 0.88±0.25 cm(2), p=0.59). The aortic valve (AV) velocity and AV area index were predictors of subsequent cardiac events (p<0.05). Conclusion The severity of AS was the only factor to affect the prognosis of AS patients who were 80 years old of age or older. It is necessary to frequently monitor the subjective symptoms of such patients and to objectively measure the AV area.


Assuntos
Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Fatores Etários , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Feminino , Insuficiência Cardíaca/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico
5.
Intern Med ; 55(17): 2419-22, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27580543

RESUMO

A 76-year-old woman was hospitalized repeatedly due to unexplained heart failure. On admission, she had hypertensive acute heart failure. Her symptoms disappeared promptly after the initial treatment; however, her systolic blood pressure remained at over 160 mmHg despite her taking three antihypertensive drugs. Closer examination revealed hemodynamically significant right renal artery stenosis and a lack of left kidney function. We performed percutaneous transluminal renal angioplasty using CO2 angiography in combination with iodinated contrast agents. The patient's renal function and blood pressure improved, however, CO2 gas-induced mild ischemic colitis occurred. We discuss the possibility of the use of combined iodinated contrast angiography and CO2 angiography to avoid contrast-induced nephropathy and the complications peculiar to CO2 angiography.


Assuntos
Angiografia/métodos , Angioplastia/métodos , Obstrução da Artéria Renal/cirurgia , Stents , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Meios de Contraste/administração & dosagem , Humanos , Rim/fisiopatologia , Testes de Função Renal , Masculino
6.
Intern Med ; 55(1): 49-54, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26726085

RESUMO

Myxoma is a common benign cardiac tumor that may rarely cause an acute myocardial infarction. A 77-year-old woman was admitted to our hospital with chest pain. Electrocardiography showed an ST elevation in leads V3-6. Transthoracic echocardiography revealed an ovoid mass with fragmentation in the left atrium and hypokinesia of the left ventricular apex. Coronary angiography indicated the presence of a coronary embolism that was suspected to be from the left atrial mass. The mass was removed by emergency surgical resection to avoid a further systemic embolism and was diagnosed pathologically as a myxoma. The patient was discharged after 13 days with no complications.


Assuntos
Infarto Miocárdico de Parede Anterior/diagnóstico , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Doença Aguda , Idoso , Infarto Miocárdico de Parede Anterior/etiologia , Infarto Miocárdico de Parede Anterior/patologia , Dor no Peito/etiologia , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Átrios do Coração/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Mixoma/complicações , Mixoma/cirurgia , Resultado do Tratamento
7.
Intern Med ; 54(13): 1627-31, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26134195

RESUMO

Myocardial calcification is rare. An 88-year-old man who had previously been diagnosed with apical hypertrophic cardiomyopathy exhibited left ventricular asynergy on echocardiography before undergoing cholecystectomy. Computed tomography revealed severe calcification in the apical region of the left ventricular myocardium, although the coronary arteries were intact and the hemodynamics on right heart catheterization were normal. The cause of the left ventricular asynergy appeared to be myocardial calcification, thought to be the result of rheumatic fever based on the patient's past history. Stress echocardiography showed a latent risk for the development of heart failure due to the distensibility of the calcified left ventricular myocardium.


Assuntos
Calcinose/patologia , Cardiomiopatia Hipertrófica/diagnóstico , Insuficiência Cardíaca/diagnóstico , Miocárdio/patologia , Idoso de 80 Anos ou mais , Calcinose/complicações , Calcinose/diagnóstico por imagem , Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/fisiopatologia , Vasos Coronários/fisiopatologia , Eletrocardiografia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Humanos , Masculino , Tomografia Computadorizada por Raios X/efeitos adversos
8.
J Cardiol Cases ; 11(3): 96-99, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30546540

RESUMO

Streptococcus pneumoniae is the most common cause of community-acquired bacterial meningitis in adults. Pneumococcal endocarditis coexisting with meningitis is rare, especially in healthy individuals. A 66-year-old woman was admitted with pneumococcal bacteremia, meningitis, and arthritis. She was in good condition before admission. Because of typical presentation of bacterial meningitis characteristics and normal echocardiographic findings, the patient was administered antibiotics for meningitis and arthritis. On hospitalization day 59, she developed a fever, and echocardiography showed severe aortic regurgitation, perforation, and vegetation of the aortic valve. She was diagnosed with pneumococcal endocarditis and underwent aortic valve replacement surgery. In general, invasive pneumococcal infections occur in debilitated middle-aged men with predisposing factors such as chronic alcoholism, chronic obstructive pulmonary disease, and immunosuppressive conditions. In this case, regardless of the appropriate treatment and no risk of invasive pneumococcal infections, infective endocarditis occurred. .

9.
Clin Exp Hypertens ; 37(5): 388-92, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25496382

RESUMO

OBJECTIVES: The Japanese guidelines for hypertension management recommend reducing salt intake to <6 g/day for hypertensive patients. However, it is not currently known whether hypertensive patients' awareness of the recommended reduced salt diet correlates with their actual intake. Therefore, the purpose of this study was to investigate the relationship between actual salt intake of Japanese hypertensive patients and their awareness of the recommended guidelines for reduced dietary salt intake. METHODS: In total, 236 outpatients (146 males and 90 females) with a mean age 69.7 ± 12.5 years were included in this study. Daily dietary salt intake was estimated using sodium and creatinine concentrations detected in spot urine samples. The patients filled out a questionnaire regarding their awareness of recommended salt restriction for hypertension management. The questionnaire distinguished the patients' awareness of recommended salt restriction in four levels (low, moderate, high and very high). RESULTS: The mean estimated salt intake was 9.72 ± 2.43 g/day. Patients' awareness regarding salt intake in all levels provided in the questionnaire did not correlate with actual salt intake (p = 0.731). CONCLUSION: Our results demonstrated that Japanese hypertensive outpatients consumed higher levels of salt than the target value recommended by Japanese guidelines. There was no correlation between actual salt intake and patients' awareness of the recommended reduction in salt. These results suggest that monitoring salt intake and informing patients of their actual salt intake are necessary for effective hypertension management.


Assuntos
Conscientização , Dieta Hipossódica/métodos , Hipertensão/dietoterapia , Cloreto de Sódio na Dieta/farmacologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Creatinina/urina , Feminino , Seguimentos , Humanos , Hipertensão/epidemiologia , Hipertensão/urina , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Retrospectivos , Sódio/urina , Inquéritos e Questionários
10.
Int Heart J ; 55(6): 555-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25297504

RESUMO

Giant cell arteritis (GCA) is an autoimmune disease characterized by granulomatous inflammation in the wall of medium-sized and large-sized arteries, and it usually occurs in patients over 50 years of age.(1)) Symptoms are nonspecific, and include fatigue, fever, and headache.(2)) It is occasionally combined with aortic complications, and ruptures resulting in death. These complications occur as late events, usually several years after diagnosis and often after other symptoms have subsided.(3)) Physicians should therefore be alert for complications of the large arteries in GCA. Here we present a case of GCA combined with ascending aortic dissection and rupture 3 weeks after diagnosis.


Assuntos
Ruptura Aórtica/etiologia , Arterite de Células Gigantes/complicações , Idoso , Aorta/patologia , Feminino , Arterite de Células Gigantes/diagnóstico , Humanos , Artérias Temporais/patologia
11.
J Dermatol Sci ; 74(1): 88-92, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24388047

RESUMO

BACKGROUND: Carbamazepine (CBZ), which is widely used in management of epilepsy or neuropathic pain, causes fatal severe cutaneous adverse reactions (SCARs). CBZ-induced SCARs are known to occur in strong association with human leukocyte antigen (HLA)-A*31:01 in Japanese and European populations. HLA genotyping is currently used to detect human HLA-A*31:01. OBJECTIVE: To establish a simple and rapid screening assay specific for HLA-A*31:01, the loop-mediated isothermal amplification (LAMP) method was employed on a sample Japanese population. METHODS: A set of LAMP primers targeting exon 2 of HLA-A*31:01 were designed. Thirty-two clinical samples including the representative HLA-A allele in Japan were used to assess the specificity of LAMP primers in the detection of HLA-A*31:01. RESULTS: The HLA-A*31:01-specific LAMP assay showed consistency with polymerase chain reaction reverse sequence-specific oligonucleotide probe (PCR-rSSO) and polymerase chain reaction-sequence based typing (PCR-SBT) results. CONCLUSION: High sensitivity and specificity of the HLA-A*31:01 LAMP assay was confirmed. Considering its convenience, the assay can be widely used to screen patients at high genetic risk of CBZ-induced SCARs.


Assuntos
Carbamazepina/efeitos adversos , Hipersensibilidade a Drogas/genética , Antígenos HLA-A/análise , Técnicas de Amplificação de Ácido Nucleico , Alelos , Anticonvulsivantes/efeitos adversos , Sequência de Bases , Primers do DNA/genética , Hipersensibilidade a Drogas/mortalidade , Frequência do Gene , Genótipo , Humanos , Japão , Dados de Sequência Molecular , Reação em Cadeia da Polimerase , Análise de Sequência de DNA , Pele/efeitos dos fármacos
12.
J Med Ultrason (2001) ; 41(1): 73-6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27277636

RESUMO

A 70-year-old man was admitted because of syncope and dyspnea. Two months before admission, exertional dyspnea occurred with syncope. Ventricular tachycardia with a monomorphic left bundle-branch block configuration was detected. An echocardiographic examination showed severe dilatation and diffuse, severe hypokinesis of the right ventricle, with thrombus formation in the right ventricular apex. Based on the clinical picture, the patient was diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC). This case emphasizes the need for early identification of RV abnormalities in patients with ARVC to determine appropriate therapy.

13.
J Cardiol Cases ; 10(1): 13-15, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30534213

RESUMO

Left ventricular (LV) myxomas are rare. We present a case of a LV myxoma arising from the interventricular septum of the LV outflow tract in a 76-year-old woman. General examination of the patient did not reveal any abnormality except for a grade 3/6 systolic murmur in the left parasternal area. Transthoracic echocardiography revealed a round pedunculated mass (size, 23 mm × 11 mm × 10 mm) at the interventricular septum with a broad pedicle. The mass was successfully removed and was pathologically confirmed to be a myxoma. .

14.
Echocardiography ; 31(8): 936-40, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24372958

RESUMO

BACKGROUND: Left atrial volumes (LAVs) have been suggested to represent long-term exposure to elevated pressures. This study examined the recurrence of heart failure (HF) based on LAV in patients initially diagnosed with congestive HF (CHF). METHODS: This study comprised 77 patients (age, 75 ± 8 years) with well-documented, clinically defined HF, and complete two-dimensional echocardiographic examinations. The echocardiographic examinations were performed on admission and after medical treatment (90 ± 43 days after initial examination). Patients with atrial fibrillation, flail mitral valve, or mitral valve replacement were excluded from this study. RESULTS: The initial left ventricular ejection fraction (LVEF) was 44 ± 17% and the indexed LAV (LAVI) was 61 ± 22 mL/m(2) . After medical treatment, a decreased LAVI was observed in 38 patients and an increased LAVI (LA remodeling) was observed in 39 patients. With median follow-up periods of 454 days, compared to patients with decreased LAVI, patients with LA remodeling had a significantly higher incidence of CHF recurrence (P = 0.008). Patients with LA remodeling had a CHF-free survival rate of 36 ± 13% vs. 81 ± 9% (those without LA remodeling). A multivariate analysis indicated that, follow-up LV end-systolic volume (P = 0.04), LVEF (P = 0.005) and LAVI (P = 0.04) independently predicted CHF recurrence. CONCLUSIONS: Patients initially diagnosed with CHF follow divergent courses based on their LAV. LA remodeling after medical treatment can be useful for predicting CHF recurrence during follow-up.


Assuntos
Remodelamento Atrial , Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Idoso , Diagnóstico Diferencial , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Recidiva , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Volume Sistólico , Resultado do Tratamento , Disfunção Ventricular Esquerda/terapia
15.
Intern Med ; 52(12): 1353-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23774546

RESUMO

This paper aims to describe the usefulness of transthoracic echocardiography in the follow-up of recurrent nonbacterial thrombotic endocarditis (NBTE) associated with neoplastic conditions. A 60-year-old woman with advanced uterine cancer developed recurrent areas of aseptic vegetation on the mitral valve along with cerebral, renal and splenic embolisms. Echocardiographic assessments revealed vegetation and thrombotic events on three occasions. In this case, transthoracic echocardiography was effective in following the decreased frequency of attachment of the NBTE vegetation to the mitral valve and reductions in the size of the area of vegetation following treatment with unfractionated heparin infusion, hysterectomy and chemotherapy.


Assuntos
Endocardite não Infecciosa/complicações , Neoplasias Uterinas/complicações , Ecocardiografia , Endocardite não Infecciosa/diagnóstico por imagem , Endocardite não Infecciosa/terapia , Feminino , Heparina/uso terapêutico , Humanos , Histerectomia , Infarto/complicações , Infarto/terapia , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Síndromes Paraneoplásicas/complicações , Recidiva , Síndrome , Neoplasias Uterinas/terapia
16.
J Cardiol ; 62(3): 171-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23731924

RESUMO

BACKGROUND: Recent reports revealed the presence of acquired von Willebrand syndrome type 2A in patients with aortic valve stenosis (AS). von Willebrand factor (vWF) has been shown to play a vital role in platelet adhesion. Therefore, we measured the platelet retention rates, which reflect platelet adhesion, in patients with severe AS. METHODS: In addition to echocardiography, routine blood screening tests were performed and the platelet retention rates were measured using collagen-coated bead columns in 21 patients with severe AS and in 21 control subjects. RESULTS: Patients with severe AS showed the maximum aortic valve pressure gradients of 110.9±22.7 mmHg, and effective orifice areas of 0.59±0.20 cm2. The results of routine blood tests in patients with severe AS were comparable to those of control subjects; however, the platelet retention rates in the AS patients (7.3±5.0%) were significantly lower than those in control subjects (30.5±11.8%, p<0.001). A significant negative correlation was observed between maximum aortic valve pressure gradients and platelet retention rates (r = -0.81, p<0.001). In 8 patients with severe AS, the platelet retention rates increased from 5.8±3.6% to 16.0±2.4% after aortic valve replacement (p<0.001). CONCLUSION: These findings suggest that impairment of platelet retention rate is seen in almost all patients with severe AS. Clinicians should be aware of the possibilities of vWF-mediated platelet dysfunction and bleeding tendency in patients with severe AS.


Assuntos
Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/complicações , Transtornos Plaquetários/sangue , Transtornos Plaquetários/etiologia , Adesividade Plaquetária , Doença de von Willebrand Tipo 2/sangue , Doença de von Willebrand Tipo 2/complicações , Fator de von Willebrand/fisiologia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Fenômenos Biomecânicos , Pressão Sanguínea , Feminino , Implante de Prótese de Valva Cardíaca , Hemorragia/sangue , Hemorragia/etiologia , Humanos , Masculino , Índice de Gravidade de Doença , Resistência ao Cisalhamento , Estresse Mecânico
18.
J Cardiol Cases ; 6(6): e170-e172, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30533098

RESUMO

Long QT syndrome (LQTS) is a hereditary ion channelopathy resulting in prolonged cardiac repolarization and abnormal prolongation of the QT interval on the electrocardiogram (ECG). The patients are likely to develop ventricular arrhythmias and sudden cardiac death. Molecular biology and basic electrophysiology studies revealed an approach to the management of patients with LQTS, which includes genotype-based risk stratification. A 16-year-old-woman with QT prolongation on ECG had frequent syncopal episodes and an attack of ventricular tachycardia followed by ventricular fibrillation. The SCN5A mutation (intravene sequence 4-1 c/t) in addition to the KCNH2 mutation (Arg56Gln) was identified. Her mother and older sister were also diagnosed as having LQTS, but had only a single mutation (KCNH2). Her older sister had an episode of syncope, but her mother did not. Genetic analysis sometimes reveals 2 or more mutations in LQTS patients with clinical phenotypes of the Romano-Ward syndrome. Compound mutations in different LQTS-related genes are likely to modify clinical characteristics. In addition, comprehensive screening of LQTS-related genes might be needed when facing family members with different clinical manifestations. .

19.
Am J Case Rep ; 13: 72-4, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23569493

RESUMO

BACKGROUND: Although rare, bloodstream infections caused by Aeromonas tend to be very severe and progress rapidly. CASE REPORT: We report a case of an 81-year-old man with fetal septicemia and endotoxin shock caused by Aeromonas hydrophila. The patient had dilated cardiomyopathy, paroxysmal atrial fibrillation, interstitial pneumonitis and renal dysfunction was admitted to our hospital with chest pain and dyspnea. Transthoracic echocardiography demonstrated impaired left ventricular wall motion and severe mitral regurgitation due to tethering. Cardiac catheterization revealed severe stenotic lesions in the left anterior descending artery and the right coronary artery. Surgery for coronary artery bypass grafts and mitral annuloplasty were performed. However, 2 days after surgery, he suddenly developed a high-grade fever and his hemodynamics deteriorated rapidly. His blood cultures revealed gram-negative Bacillus and the endotoxin concentration in the blood was elevated. Despite intensive support efforts, the patient died 1 day after the sudden change. His blood culture revealed A. hydrophila. CONCLUSIONS: Whenever Aeromonas is found in a patient's bloodstream, clinicians should start appropriate and intensive treatment immediately.

20.
Med Sci Monit ; 17(7): CS81-4, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21709638

RESUMO

BACKGROUND: Takayasu arteritis and ulcerative colitis are immune-mediated inflammatory diseases; genetic factors are assumed to play an important role in the pathogenesis of these 2 diseases. However, the coexistence of these 2 diseases has rarely been reported. CASE REPORT: In this report, we present a rare case of a 29-year-old man with a 4 years history of ulcerative colitis who developed Takayasu arteritis. He was found to carry the following human leukocyte antigens (HLA): A11, A24, B52, B62, DR4, and DR9. CONCLUSIONS: We present a case report and review of the pertinent literature on serological analysis of HLA haplotype of the patients who exhibit both these diseases. In patients with both Takayasu arteritis and ulcerative colitis, high frequency of HLA-A24, B52, and DR 2 is observed. The pathological relevance of HLA-A24, B52, and DR2 to concomitant Takayasu arteritis and ulcerative colitis requires further investigation.


Assuntos
Colite Ulcerativa/genética , Antígenos HLA-A/sangue , Antígenos HLA-B/sangue , Antígeno HLA-DR2/sangue , Arterite de Takayasu/genética , Adulto , Colite Ulcerativa/complicações , Colite Ulcerativa/patologia , Ecocardiografia , Eletrocardiografia , Estudo de Associação Genômica Ampla , Antígeno HLA-A24 , Antígeno HLA-B52 , Haplótipos/genética , Humanos , Japão , Angiografia por Ressonância Magnética , Masculino , Testes Sorológicos/métodos , Arterite de Takayasu/complicações , Arterite de Takayasu/patologia , Tomografia Computadorizada por Raios X
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