Naoki Nozawa

Doppler Index and Plasma Level of Atrial Natriuretic Hormone Are Improved by Optimizing Atrioventricular Delay in Atrioventricular Block Patients with Implanted DDD Pacemakers

TODA, N., et al.: Doppler Index and Plasma Level of Atrial Natriuretic Hormone Are Improved by Optimizing Atrioventricular Delay in Atrioventricular Block Patients with Implanted DDD Pacemakers. Doppler index is the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time and has clinical value as an index of combined systolic and diastolic myocardial performance. This crossover study compared the Doppler index and atrial natriuretic hormone (atrial natriuretic peptide) [ANP] between optimal (AV) delay and prolonged AV delay in patients with DDD pacemakers. The study included 14 patients (6 men, 8 women, age 78.4 ± 9.3 [SD] years) with AV block with an implanted DDD pacemaker. AV delay was prolonged in a 25‐ms, stepwise fashion starting from 125 ms to 250 ms. Pacing rate was set at 70 beats/min. Cardiac output (CO) was assessed by pulsed Doppler echocardiography, and optimal AV delay was defined as the AV delay at which CO was maximum, and an AV delay setting of 250 ms as prolonged AV delay. Plasma level of ANP and Doppler index determined by echocardiography were measured 1 week after programming. AV delay was switched to another AV delay and measurements were repeated after 1 week. Optimal AV delay was 159 ± 19 ms. Doppler index was significantly lower at optimal AV delay than at prolonged AV delay (0.68 ± 0.26 vs 0.92 ± 0.30, P < 0.05). The plasma ANP level was significantly lower at optimal AV delay than at prolonged AV delay (29.0 ± 30.7 vs 52.6 ± 44.9 pg/mL, P < 0.05). In conclusion, the Doppler index and the plasma ANP level were significantly lower at optimal AV delay than at prolonged AV delay. This study shows the importance of the optimal AV delay setting in patients with an implanted DDD pacemaker, the Doppler index and plasma ANP levels are good indicators for optimizing AV delay.

Acute myocardial infarction with isolated conus branch occlusion

There are few reports of acute myocardial infarction (AMI) relating to the occlusion of the conus branch, most of which are iatrogenic in nature. So far as we are concerned, this is the first case of spontaneous AMI with isolated conus branch occlusion. Electrocardiogram (ECG) showed mild elevation of ST segment in leads V(1) through V(3). Cardiac makers of myocardial infarction were positive. Right coronary angiography revealed an isolated occlusion of the conus branch. Penetration of the guidewire in the occluded lesion was attempted, and recanalization was successfully achieved. The patient was discharged without any adverse events.

Acute pulmonary embolism induced by renal obstruction with benign prostatic hyperplasia: Case report

Background We report a rare case of acute pulmonary embolism (PE) induced by urinary retention and bladder distention with benign prostatic hyperplasia (BPH). Case report A 76-year-old male with BPH presented to the hospital with anuria of 24 h duration and abdominal distention. Physical examination revealed tenderness and distention of the lower abdomen and a swollen right leg. Echocardiography after urethral catheterization showed a large free-floating thrombus traversing back and forth through the tricuspid orifice. Computed tomographic angiography demonstrated filling defects at the level of the right inter lobar pulmonary artery and the segmental branches of both pulmonary arteries, indicating acute PE. The patient was treated with heparin and warfarin for three weeks to ensure the resolution of the pulmonary embolus. After the resolution of all symptoms, the patient was discharged without further complication. Conclusion This case suggested that a distended bladder is a potential risk factor for the development of deep vein thrombosis and PE.