A case of syncope after exertion due to sigmoid septum evaluated by exercise stress echocardiography.

A sigmoid septum is associated with sharp angulation and aging of the aortic root; however, it does not affect the pressure gradient in the left ventricular outflow tract and is generally asymptomatic. This report describes a 73-year-old woman who presented with syncope after exertion. Echocardiography revealed that the cause was left ventricular outflow tract stenosis associated with a sigmoid septum; her symptoms improved with beta-blocker therapy. Exercise stress echocardiography was performed to determine treatment efficacy. Sigmoid septum causes syncope on exertion; however, drug therapy is effective. Exercise stress echocardiography is effective in determining treatment efficacy. If syncope is present, a sigmoid septum should be considered as a cause. Learning objectives: 1.A sigmoid septum is part of or resembles hypertrophic cardiomyopathy, resulting in left ventricular outflow tract (LVOT) stenosis that is exacerbated by exertion and may cause syncope.2.A sigmoid septum is a differential diagnosis for the cause of syncope and is diagnosed using cardiac echocardiography.3.LVOT stenosis due to a sigmoid septum can be improved with drug therapy such as beta-blockers.4.The effects of beta-blocker therapy can be determined by exercise stress echocardiography.

Serum zinc concentration in patients with myocardial infarction: a retrospective study.

BACKGROUND: Zinc regulates the oxidative stress and inflammatory signaling cascade and affects the development and deterioration of cardiovascular disease. We investigated the prognosis of developing heart failure in patients with myocardial infarction. METHODS: Patients with myocardial infarction (n = 243) were divided using the median value of zinc concentration on admission into low (< 66 µg/dL at admission, n = 111) and high zinc group (≥ 66 µg/dL at admission, n = 132). During follow-up (mean ± SD: 734 ± 597 days; median 691 days), admission due to heart failure was observed in 12 patients: 10 and 2 cases in the low and high zinc groups, respectively. RESULTS: The risk of admission due to heart failure was significantly higher in the low zinc than in the high zinc group (P = 0.0043). Relative to the high zinc group, the hazard ratio for admission due to heart failure was 15.7 (95% confidence interval 1.11-221, P = 0.042) via adjusted Cox proportional hazards analysis. Even after propensity score matching, the risk of admission due to heart failure was significantly higher in the low zinc than in the high zinc group (P = 0.048). CONCLUSION: Low serum zinc concentration may be a risk factor for admission due to heart failure after myocardial infarction.

Effect of constipation on readmission for heart failure in patients with acute heart failure.

AIMS: Constipation is a common gastrointestinal disorder that is associated with a high cardiovascular event rate in the general population. Although constipation is common in patients with cardiovascular diseases, only a few studies have examined the relationship between constipation and the prognosis of patients with heart failure. This study aimed to evaluate the effects of constipation on the prognosis of patients with acute heart failure. METHODS AND RESULTS: We investigated 397 patients admitted to our hospital from December 2020 to December 2022 with acute heart failure (mean age, 81 ± 13 years; 54% men). Patients with constipation were defined as those either taking laxatives regularly or diagnosed with constipation according to the International Statistical Classification of Diseases and Related Health Problems. During the follow-up periods (median, 173 days), 35 patients died, and 74 experienced readmission due to heart failure. Kaplan-Meier analysis before and after propensity score matching using 14 variables revealed that the risk of readmission due to heart failure was significantly higher in patients with constipation than in those without (before: log-rank P = 0.014, after: log-rank P = 0.0027). The adjusted Cox proportional hazards analysis revealed that the hazard ratio for readmission due to heart failure was 2.61 (95% confidence interval, 1.38-4.94, P = 0.0032). The risk of all-cause death was not significantly different between the two groups (hazard ratio, 1.76; 95% confidence interval, 0.61-5.06; P = 0.30). CONCLUSIONS: Constipation status was strongly associated with a higher risk of readmission for heart failure in patients with acute heart failure.

Higher Recurrence Rate of Acute Coronary Syndrome in Patients with Multiple-Time Myocardial Infarction.

The recurrence rate of acute coronary syndrome (ACS) in patients after first-time myocardial infarction (MI) is over ten times higher than in the general population. However, it is unclear whether patients with multiple-time MI have an even higher recurrence rate of MI. This study aimed to compare the recurrence rate in patients with multiple-time MI with the rate in patients after first-time MI. We retrospectively studied 794 consecutive MI patients who were discharged. Recurrent ACS was investigated in patients with previous MI (n = 46) and without previous MI (n = 748). During the follow-up periods (mean ± SD: 757 ± 733 days), recurrent ACS occurred in 47 cases without previous MI and in 7 cases with previous MI. Kaplan-Meier analysis revealed that the risk of recurrent ACS was significantly higher in patients with previous MI than in patients without previous MI. ACS recurrence rates one year from the onset were 4.2% in patients without previous MI and 11.9% in patients with previous MI. Landmark analysis revealed that the higher recurrence rate in patients with previous MI was as high as 14.1% from 1 year after the onset to 2 years. In conclusion, the risk of recurrent ACS may be significantly higher in patients with multiple-time MI than in patients after first-time MI.