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.

Macrophage HIF-1α increases liver tumor

Aims/Introduction: Chronic inflammation of the liver is often observed with obesity or type 2 diabetes. In these pathological conditions, the immunological cells, such as macrophages, play important roles in the development or growth of liver cancer. Recently, it was reported that hypoxia‐inducible factor‐1α (HIF‐1α) is a key molecule for the acquisition of inflammatory M1 polarity of macrophages. In the present study, we examined the effects of altered macrophage polarity on obesity‐ and diabetes‐associated liver cancer using macrophage‐specific HIF‐1α knockout (KO) mice. Materials and Methods: To induce liver cancer in the mice, diethylnitrosamine, a chemical carcinogen, was used. Both KO mice and wild‐type littermates were fed either a high‐fat diet (HFD) or normal chow. They were mainly analyzed 6 months after HFD feeding. Results: Development of liver cancer after HFD feeding was 45% less in KO mice than in wild‐type littermates mice. Phosphorylation of extracellular signal‐regulated kinase 2 was also lower in the liver of KO mice. Those effects of HIF‐1α deletion in macrophages were not observed in normal chow‐fed mice. Furthermore, the size of liver tumors did not differ between KO and wild‐type littermates mice, even those on a HFD. These results suggest that the activation of macrophage HIF‐1α by HFD is involved not in the growth, but in the development of liver cancer with the enhanced oncogenic extracellular signal‐regulated kinase 2 signaling in hepatocytes. Conclusions: The activation of macrophage HIF‐1α might play important roles in the development of liver cancer associated with diet‐induced obesity and diabetes

Successful treatment of a coronary cameral fistula secondary to elective sirolimus-eluting stent implantation

Coronary cameral fistulae, communications between the coronary tree and the chambers of the heart, are a rare complication of percutaneous coronary intervention. The functional significance and management of these fistulae remain uncertain. We report such a case in a patient undergoing elective sirolimus-eluting stent implantation and provide a review of the literature.3 page(s

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