Haruki Tanaka

Acute Effects of Isosorbide Dinitrate and Nicorandil on the Coronary Slow Flow Phenomenon

BackgroundMicrovascular dysfunction has been proposed as the most likely mechanism of the coronary slow flow phenomenon (CSFP).ObjectiveTo determine the effects of isosorbide dinitrate and nicorandil on the CSFP.MethodsChanges in thrombolysis in myocardial infarction (TIMI) frame count following the intracoronary administration of isosorbide dinitrate and nicorandil were assessed in 11 patients with the CSFP.ResultsAfter the administration of isosorbide dinitrate, the median TIMI frame count decreased to 32 (range 20–60) [p = 0.003], which was lower than that of the control [43 (29–73)]. The count decreased further to 25 (12–34) [p = 0.041] after the administration of nicorandil. The count after the subsequent administration of contrast medium was increased to 32 (20–49) [p = 0.03].ConclusionsThese angiographic findings indicate that the intracoronary administration of nicorandil is superior to isosorbide dinitrate with regard to improving the CSFP. These findings suggest that micro-vascular spasm is the main factor in the pathogenesis of the CSFP.

Diffuse alveolar hemorrhage as a complication of dual antiplatelet therapy for acute coronary syndrome

Diffuse alveolar hemorrhage after percutaneous coronary intervention is a rare complication that has been mostly reported in association with glycoprotein IIb/IIIa inhibitors. We herein report a case of a 64-year-old male who developed a diffuse pulmonary hemorrhage after coronary stent implantation for ST-elevation myocardial infarction. Diagnostic bronchoscopy determined the hemorrhage to be a bland pulmonary hemorrhage, and this pattern suggested that combination therapy with aspirin and ticlopidine was therefore the most likely cause. The combination of aspirin and thienopyridine agents is a routine therapeutic protocol for patients after coronary stent implantation. Therefore, physicians should be aware that this dual antiplatelet therapy might sometimes induce fatal complications.

DOES EATING FAST CAUSE OBESITY AND METABOLIC SYNDROME

Metabolic syndrome (Mets) is one of the risk factor for cardiovascular diseases. Several reports have showed associations between eating speed and incidence of weight gain. Limited information, however, is available concerning the relation between eating speed and the risk of prevalence of Mets. The

A case of paroxysmal pheochromocytoma concurrent with coronary artery aneurysm presenting as acute coronary syndrome

A 51-year-old man recently diagnosed with preclinical Cushings syndrome complained of chest oppression concomitant with back pain. Following contrast-enhanced computed tomography (CT) to rule out acute aortic dissection, he developed chest symptoms accompanied by elevation of blood pressure to 240/120 mmHg and ischemic electrocardiographic change. Urgent coronary angiography revealed a coronary artery aneurysm (15 mm × 6 mm) in the distal portion of the left anterior descending artery concomitant with coronary flow delay. Re-analysis of the blood sample taken at admission showed elevated plasma catecholamine concentrations, leading to a diagnosis of paroxysmal pheochromocytoma. An adrenal tumor was excised laparoscopically and histologically shown to be a pheochromocytoma. These findings show that coronary artery aneurysm may be a rare complication of pheochromocytoma, and indicate that monitoring of blood pressure or analysis of stored blood samples, if necessary, is essential to detect pheochromocytoma when using contrast medium or glucagon in patients known to have an adrenal incidentaloma. It should be noted that pre-treatment with an α-blocker is necessary when patients who are likely to have pheochromocytoma need to undergo contrast-enhanced CT. <Learning objective: Coronary artery aneurysm may be a rare complication of pheochromocytoma. Monitoring of blood pressure or analysis of stored blood samples, if necessary, is essential to detect pheochromocytoma when using contrast medium or glucagon in patients known to have an adrenal incidentaloma. It should be noted that pre-treatment with an α-blocker is necessary when patients who are likely to have pheochromocytoma need to undergo contrast-enhanced CT.>.