Vasospastic angina resulting in sudden cardiac arrest, initially misdiagnosed as a psychiatric disorder

AbstractA 51-year-old-woman with a history of ablation therapy due to Wolff–Parkinson–White syndrome had been suffering from ambiguous chest pain, prompting investigation by several cardiologists. After being dissatisfied with a psychiatric disorder diagnosis, she was admitted to our hospital for further investigation. She lost her consciousness due to a sudden cardiac arrest shortly after admission. A provocation test indicated vasospastic angina associated with a diffuse spastic pattern of her left anterior descending artery.<Learning objective: This case demonstrates that implantation of a cardioverter defibrillator may be avoided if the angiographic pattern of the vasospasm is recognized, the condition is correctly diagnosed, and appropriate medications are prescribed.

Successful transition from Treprostinil to Selexipag in patient with severe pulmonary arterial hypertension

Abstract Background In this report, we describe the first successful case of transition from subcutaneous administration of treprostinil to selexipag in a patient with severe pulmonary arterial hypertension (PAH), by evaluating hemodynamic changes and exercise tolerance. Case presentation A 38-year-old female with idiopathic PAH (IPAH) had received initial triple combination therapy (macitentan PO, tadalafil PO, and treprostinil SC) and achieved excellent improvement in hemodynamics. Afterwards, due to the development of side effects from subcutaneous administration, we replaced treprostinil therapy with oral selexipag, resulting in stable hemodynamic parameters and exercise capacities. Conclusions We report the first case of successful replacement of treprostinil (20.1 ng/kg/min) with selexipag (1600 μg BID) as a component of triple combination therapy, which provides incentive to perform a larger, prospective exchange study