Dynamicity of J waves during coronary intervention and angiography in a patient with non-Q inferior myocardial infarction

Slurs or notches at the terminal portion of the QRS complexes are called J waves, which may be associated with myocardial ischemia. We describe our experience with a case of a patient with acute inferior myocardial infarction in whom J waves were observed in the inferior leads with ST-segment elevation. The coronary artery was completely occluded, and during percutaneous intervention, ST-segment elevation was normalized first, followed by the disappearance of the J waves after full revascularization. On follow-up coronary angiography (CAG), the J waves in the inferior leads reappeared during the right CAG. The J waves were associated with an alteration of the electrical axis. J waves developing in association with myocardial ischemia seemed to be more sensitive to ischemia and might represent a depolarization abnormality

Outpatient rehabilitation for an older couple in a repopulated village 10 years after the Fukushima nuclear disaster: An embedded case study

BackgroundLittle information is available on the role of community-based rehabilitation after a nuclear disaster. Here, we report the case of an older couple living in an area repopulated after the Fukushima nuclear disaster of 2011 who received outpatient rehabilitation.Case presentationAn 84-year-old woman underwent total hip arthroplasty (THA) after she fell and sustained a trochanteric fracture while caring for her husband with Alzheimer's disease. The 85-year-old husband experienced worsening behavioral and psychological symptoms of dementia (BPSD) following his wife's hospitalization. The couple received rehabilitation at an outpatient facility in a nearby village using a shuttle service. The woman's postoperative anxiety was relieved and her physical function improved. Moreover, the husband's BPSD symptoms decreased.ConclusionA wife and husband showed improvement in physical function after THA and alleviation of BPSD, respectively, following rehabilitation. In post-disaster, resource-scarce areas, older adults may benefit from utilizing the outpatient rehabilitation services available in the surrounding area

Long-term PT-INR levels and the clinical events in the patients with non-valvular atrial fibrillation: A special reference to low-intensity warfarin therapy

AbstractBackgroundAnticoagulation therapy is essential in atrial fibrillation (AF), and in Japan, less intense control is popular.PurposeTo assess the efficacy and safety with a special reference to low intensity warfarin therapy.Subjects and methodsIn 488 out of 508 patients with non-valvular AF, prothrombin time-international normalized ratio (PT-INR) was kept at 1.6–2.59, and they were followed for 49.5 months: 2098 person-years. The mean age was 73.7±9.9 years and 62% were male. The patients were divided by age: ≥70 years and <70 years, and by the intensity of warfarin therapy: PT-INR at 1.6–1.99 and at 2.0–2.59, respectively. The clinical data and event rates, ischemic stroke and major bleeding, were compared among the subgroups.ResultsHeart failure, previous stroke, and higher CHADS2 score were more often reported in patients ≥70 years while males were involved more often as younger patients. A total of 166 of 339 patients ≥70 years and 69 of 149 patients <70 years belonged to the low intensity group.Ischemic stroke and major bleeding occurred in 1.47%/year and 1.27%/year, respectively but there was no difference between the two age groups and between the two intensities of warfarin therapy. Time in therapeutic range was a predictor for ischemic stroke. A fall of PT-INR to <1.6 was found in 41.9% with ischemic stroke and a rise >2.61 in 40.0% with major bleeding at the time of the events. Blunt trauma and concomitant use of antiplatelets were risks for intracranial hemorrhage in the patients ≥70 years.ConclusionsThe event rates were similar between the low- (1.6–1.99) and high- (2.0–2.59) intensity warfarin therapy groups in aged patients: <70 years and ≥70 years. Time in therapeutic range and a transient fall or rise in PT-INR were risks for clinical events. Blunt head trauma and concomitant use of antiplatelets were risks for intracranial hemorrhage