How to Bail Out Patients with Severe Acute Myocardial Infarction.

Cardiogenic shock (CS) is the most serious complication of acute myocardial infarction (AMI). The practice of early revascularization by percutaneous coronary intervention, and advances in pharmacotherapy have reduced the rate of complications of CS. However, when CS is combined with AMI, mortality from AMI is still high, and many clinicians are wondering how to treat CS with AMI. In recent years, mechanical circulatory support (MCS) devices have improved the clinical outcome in AMI patients with CS. For best outcome, treatment of AMI with CS should always consider treatments that improve the prognosis of the patients.

Change in Ankle-Brachial Index Over Time in a Screened Japanese Cohort　- The Okinawa Peripheral Arterial Disease Study.

BACKGROUND: The temporal change in ankle-brachial index (ABI) in the general population, especially in those aged <40 years, remains unclear. METHODS AND RESULTS: ABIs of 23,673 individuals were measured in 1-day health checkups between 2003 and 2010. Among them, 1,117 participants aged 28-76 years (mean 53±9 years) whose ABI was measured at least twice within an interval of ≥4 years (mean: 4.9 years) were selected for this study. Baseline ABI was the lowest at age <40 years and increased with age. ABI significantly increased in participants aged <40 and 40-49 years, but not in participants aged 50-59 and ≥60 years. ABI increased in participants with borderline-low baseline ABI (0.9

Human leukocyte antigen-DQ risk heterodimeric haplotypes of left ventricular dysfunction in cardiac sarcoidosis: an autoimmune view of its role.

Cardiac sarcoidosis (CS) is the scarring of heart muscles by autoimmunity, leading to heart abnormalities and patients with sarcoidosis with cardiac involvements have poor prognoses. Due to the small number of patients, it is difficult to stratify all patients of CS by human leukocyte antigen (HLA) analysis. We focused on the structure of antigen-recognizing pockets in heterodimeric HLA-class II, in addition to DNA sequences, and extracted high-affinity combinations of antigenic epitopes from candidate autoantigen proteins and HLA. Four HLA heterodimer-haplotypes (DQA1*05:03/05:05/05:06/05:08-DQB1*03:01) were identified in 10 of 68 cases. Nine of the 10 patients had low left ventricular ejection fraction (< 50%). Fourteen amino-acid sequences constituting four HLA anchor pockets encoded by the HLA haplotypes were all common, suggesting DQA1*05:0X-DQB1*03:01 exhibit one group of heterodimeric haplotypes. The heterodimeric haplotypes recognized eight epitopes from different proteins. Assuming that autoimmune mechanisms might be activated by molecular mimicry, we searched for bacterial species having peptide sequences homologous to the eight epitopes. Within the peptide epitopes form the SLC25A4 and DSG2, high-homology sequences were found in Cutibacterium acnes and Mycobacterium tuberculosis, respectively. In this study, we detected the risk heterodimeric haplotypes of ventricular dysfunction in CS by searching for high-affinity HLA-class II and antigenic epitopes from candidate cardiac proteins.

A case of aortic valve laceration after balloon aortic valvuloplasty with morphological features.

A 71-year-old man suffered from congestive heart failure due to severe aortic stenosis. We performed balloon aortic valvuloplasty (BAV) as a bridge to transcatheter aortic valve replacement using transesophageal echocardiogram (TEE) by the retrograde approach. Balloon dilatation was carefully performed using an 18 mm balloon. After balloon dilation, TEE showed right coronary cusp (RCC) laceration and severe aortic regurgitation. We discontinued the procedure despite the incomplete result. Aortic valve laceration is a rare complication considered to be mainly caused by the use of large balloon or by balloon slipping. In the present case, TEE showed that the commissure of RCC fused strongly with both the other cusps by thick calcification, and the center of RCC had a spotty low echoic area with soft tissue. The force of the balloon dilatation concentrated to soft tissue area and lacerated the center of RCC. We verified the finding in the operative specimen. When performing BAV, we should pay attention to the morphology of the aortic valve using TEE to avoid aortic valve laceration as a fatal complication. .

Penicillin G-induced hemorrhagic cystitis with hydronephrosis.

Irritable urological symptoms with gross hematuria and bilateral lumbar pain developed when the patient received penicillin G for endocarditis. These symptoms were followed by renal insufficiency. A contrast-enhanced abdominal computed tomography (CT) scan revealed a thickened bladder wall, bilateral hydroureter and hydronephrosis, suggesting hemorrhagic cystitis complicated with urinary tract obstruction. Urine culture was negative. After discontinuation of penicillin G, all symptoms subsided and renal function recovered; hence, penicillin G seems to have been associated with hemorrhagic cystitis and acute kidney injury. Positive findings in the drug lymphocyte stimulation test (DLST) for penicillin G were consistent with this diagnosis.