Shinichiro Yamagami

Plasma Levels of Brain Natriuretic Peptide Increase in Patients with Idiopathic Bilateral Atrial Dilatation

Idiopathic bilateral atrial dilatation (IBAD) is an extremely rare anomaly and is usually associated with atrial fibrillation. Plasma levels of atrial natriuretic peptide (ANP) have been shown to increase in patients with atrial fibrillation. However, secretion of ANP and brain natriuretic peptide (BNP) in patients with IBAD remains unclear. We investigated the clinical features of 9 patients with IBAD and 16 age- and sex-matched patients with lone atrial fibrillation (LAF). Plasma levels of ANP and BNP were measured, and echocardiographic parameters were followed. Left (LAV) and right atrial volumes (RAV) were significantly higher in patients with IBAD than in patients with LAF (both p < 0.01). There were no differences between patients with IBAD and LAF in other echocardiographic parameters. The percent increases in LAV and RAV in patients with IBAD exceeded those in patients with LAF (both p < 0.01). Plasma levels of BNP and the BNP/ANP ratios in patients with IBAD were significantly higher than those in patients with LAF (both p < 0.01), but there was no significant difference in plasma levels of ANP. Regarding the clinical course of the patients with IBAD compared with those with LAF, the atrial volume increased gradually, and plasma levels of BNP were significantly higher. These findings suggested that IBAD was not only influenced by long-term atrial fibrillation, but also by subclinical left ventricular dysfunction.

Usefulness of Prominently Projected Aortic Arch on Chest Radiograph to Predict Severe Tortuosity of the Right Subclavian or Brachiocephalic Artery in Patients Aged >44 Years Undergoing Coronary Angiography With a Right Radial Artery Approach

Although it is well known that certain characteristics, such as older age, female gender, hypertension, and high body mass index, are closely associated with severe arterial tortuosity among patients undergoing transradial coronary angiography, few data are available regarding useful predictors of severe arterial tortuosity among geriatric patients. The purpose of the present study was to evaluate the characteristics of geriatric patients with severe tortuosity of the right subclavian artery or brachiocephalic artery. The coronary angiographic reports of patients with severe tortuosity of the right subclavian artery or brachiocephalic artery and age- and gender-matched control patients were retrospectively evaluated. A total of 847 consecutive patients underwent right transradial coronary angiography. Of these patients, 48 (5.7%) had severe tortuosity (29 women, age 73.4 ± 8.6 years). The factors associated with severe arterial tortuosity were greater body mass index (odds ratio 1.17, p = 0.02), the presence of a prominently projected aortic arch on a chest radiograph (odds ratio 5.62, p <0.01), and lower serum creatinine value (odds ratio 0.05, p <0.01). In conclusion, the presence of a prominently projected aortic arch on the chest radiograph is a useful predictor of severe arterial tortuosity.

Left Atrial Myxoma Incidentally Discovered on Transesophageal Echocardiography

A 77-year-old woman with congestive heart failure due to rapid atrial fibrillation (AF) was admitted to our hospital. Although we were unable to detect a tumor on transthoracic echocardiography, transesophageal echocardiography (TEE) performed to evaluate a thrombus in the left atrium (LA) incidentally disclosed a cardiac mass measuring 10×8 mm (Picture). Suspecting the lesion to be a myxoma, we referred the patient to the Division of Cardiovascular Surgery at our related hospital, where tumor resection was performed. The cardiac tumor was pathologically diagnosed as a myxoma. A previous study reported that myxomas in the elderly are difficult to diagnose based on their clinical presentation (1). The number of patients with AF is expected to increase in Japan due to the rapidly aging population (2). The increased use of TEE to evaluate suspected thrombi in the LA in elderly AF patients may help to improve the rate of discovery of atrial myxomas.

Esophageal ulcer of unknown origin complicated by left atrial myxoma.

Myxoma induces the onset of paraneoplastic syndromes by excreting various humoral mediators and is therefore known to present with diverse symptoms. A 40-year-old woman was admitted to our hospital for the treatment of an esophageal ulcer, the cause of which could not be identified on various examinations. Notably, a left atrial tumor was incidentally found on chest enhanced computed tomography. The esophageal ulcer, which was intractable to conventional therapy, improved with the administration of 5-aminosalicylate, a drug known to inhibit IL-1β. This inhibitory action effectively suppressed the development of myxoma-induced paraneoplastic syndrome.

Watching National Team Matches in World Cup Soccer 2014 on Television was Associated with Increasing Frequency of Premature Ventricular Contractions

Objective: Psychological triggers, such as emotional stress, increase the incidence of acute cardiovascular events. The association between soccer championships and risk of cardiovascular events remains controversial. A World Cup Soccer (WCS) match involving a national team might be a strong enough trigger to induce cardiovascular events. However, there are no reports of a multicenter study that has investigated the relationship between watching WCS and cardiac arrhythmia. Methods: We assessed 25 patients who were evaluated for ischemic changes and/or arrhythmia using 24-h Holter electrocardiography in four cardiology divisions during WCS 2014. The patients were divided into two groups: the watching (W) group consisted of 7 patients who watched WCS on live television and the Non-Watching (NW) group consisted of 18 patients who did not watch WCS. Heart rates, arrhythmia, and ischemic changes were evaluated. Results: There were no differences in the clinical characteristics, heart rates, premature atrial contraction frequencies, and ischemic changes between the two groups. Although there were no differences in total Premature Ventricular Contractions (PVCs), the frequency of PVCs during matches (61 ± 101 vs. 7 ± 8, P = 0.03) and 1 hour before matches (15 ± 17 vs. 3 ± 5, P = 0.01) were significantly higher in the W group than in the NW group. No sustained ventricular tachycardia or fibrillation was observed. Conclusions: A significant association between watching WCS and frequency of PVCs was observed in patients with/or suspected of having cardiovascular disease. Received Date: February 13, 2016 Accepted Date: March 28, 2016 Published Date: April 01, 2016 Citation: Shimada, K., et al. Watching National Team Matches in World Cup Soccer 2014 on Television was Associated with Increasing Frequency of Premature Ventricular Contractions. (2016) J Heart Cardiol 2(1): 17-21. DOI: 10.15436/2378-6914.16.022 Journal of Heart and Cardiology Open Access Review Article Copyrights:

Reactive Arthritis Caused by Urinary Tract Infection

We report the case of a 58-year-old man presenting with chest pain who underwent percutaneous coronary intervention (PCI). The patient subsequently developed a fever over 38°C, pain on micturition, and cloudy urine 3 days following PCI. Urine cultures were positive for Escherichia coli and Enterococcus faecalis, whereas blood cultures were negative. Arthritis occurred two weeks following urinary tract infection (UTI). We herein present a rare case of reactive arthritis caused by UTI following PCI.

Chronic Aortic Dissection Presenting as Aphasia

Acute aortic dissection (AAD) is a fatal disease and delay in diagnosis results in deteriorated prognosis. A 55‐year‐old man presented to our hospital with aphasia because of a suspected stroke. Although the lack of pain made diagnosis difficult, we diagnosed Stanford type A AD as the underlying cause of his stroke. Two possible explanations were considered for the lack of pain. First, although the stroke was caused by AD, the stroke itself prevented the patient from feeling the pain. Second, the aphasia prevented him from complaining about the pain. Therefore, we believe that physicians require a high clinical index of suspicion for AD considering the possibility of painless AD or miscommunication secondary to aphasia.

Tracheal stenosis caused by severe tortuosity of the brachiocephalic artery

A 94-year-old woman admitted to Juntendo Tokyo Koto Geriatric Medical Center located in Tokyo, Japan, with impaired consciousness was diagnosed with seizures on electroencephalography and treated with an anticonvulsant. During hospitalization, she developed transient desaturation. Chest computed tomography, magnetic resonance imaging and chest radiograph showed tracheal stenosis caused by severe tortuosity of the brachiocephalic artery (BCA; Fig. 1a–c). The desaturation improved with the administration of a beta-adrenergic stimulant and an expectorant. We inferred that the desaturation was caused by tracheal stenosis, which deteriorated by viscous sputum. On account of the patient’s advanced age, we opted for conservative rather than invasive management; this comprised inhalation of salbutamol sulfate and bromhexine, oral ambroxol, and a tulobuterol patch. The conservative approach was effective and desaturation did not recur. Although we discussed tracheal stenting, it was considered too invasive. Advanced age is listed as one of the factors associated with arterial tortuosity, which can become so severe that it causes tracheal stenosis in super-elderly patients, as observed in the present case. Apart from advanced age, the presence of a prominently projected aortic arch, as observed on chest radiography, can reportedly function as a predictor of severe tortuosity of the BCA. A prominently projected aortic arch is confirmed when the distance from the neck of the aortic arch to the left edge of the aortic arch is at least 10 mm. In the present case, a chest radiograph showed a prominently projected aortic arch, which is indicated by an arrow in Figure 1c. In conclusion, in super-elderly patients such as the present patient, tracheal stenosis caused by severe tortuosity of the BCA should be included in the differential diagnosis of desaturation. Physicians should suspect possible tracheal stenosis when a prominently projected aortic arch is discovered on a chest radiograph.