RESUMO
A 78-year-old woman with hypertension was admitted to our hospital with palpitation and chest discomfort. She had been nervous since she learned about a severe earthquake on the news. An electrocardiogram showed ST-segment elevation in leads I, aVL, and V2-6. Emergency coronary angiography demonstrated no significant coronary stenosis and left ventriculography revealed marked akinesis of apical left ventricle with hyperkinesis of the basal segments, indicating typical takotsubo cardiomyopathy. On day 24, an electrocardiogram showed diffuse T-wave inversion, but ST-segment elevation remained in V3-6. Cardiac magnetic resonance imaging revealed left ventricular apical aneurysm and epicardial late gadolinium enhancement in the apex, indicating takotsubo-inflicted myocardial injury. Although many previous reports show takotsubo cardiomyopathy is a reversible left ventricular systolic dysfunction with less significant complications, it should be reconsidered as benign disease with long-term complications. Learning objective: Although many previous reports show takotsubo cardiomyopathy (TC) is a reversible left ventricular (LV) systolic dysfunction with less significant complications, our patient is a rare case of TC which led to LV apical aneurysm. It was believed that lack of late gadolinium enhancement (LGE) was necessary to diagnose TC, however we detected epicardial LGE in the LV apical wall and this finding might indicate nonreversible change in this case.
RESUMO
Patent ductus arteriosus-associated infective endarteritis (PDA-IE) is an extremely rare complication of PDA in recent years. In this report, we describe a case of PDA-IE complicated by septic pulmonary embolism who was successfully treated with only antibiotics.
RESUMO
Whether malnutrition during the early phase of recovery from acute myocardial infarction (AMI) could be a predictor of mortality or morbidity has not been ascertained. We examined 289 AMI patients. All-cause mortality and composite endpoints (all-cause mortality, nonfatal stroke, nonfatal acute coronary syndrome, and hospitalization for acute decompensated heart failure) during the follow-up duration (median 39 months) were evaluated. There were 108 (37.8%) malnourished patients with GNRIs of less than 98 on arrival; however, malnourished patients significantly decreased to 91 (31.4%) during the convalescence period (p < 0.01). The incidence rates of mortality and primary composite endpoints were significantly higher in the malnourished group than in the well-nourished group both on arrival and during the convalescence period (All p < 0.05). Nutrition guidance significantly improved GNRI in a group of patients who were undernourished (94.7 vs. 91.0, p < 0.01). Malnourished patients on admission who received nutritional guidance showed similar all-cause mortality with well-nourished patients, whereas malnourished patients without receiving nutritional guidance demonstrated significantly worse compared to the others (p = 0.03). The assessment of GNRI during the convalescence period is a useful risk predictor for patients with AMI. Nutritional guidance may improve the prognoses of patients with poor nutritional status.