No abstract

No abstract

No abstract

Maintenance of sinus rhythm after successful CA improved the QOL, EP, and plasma BNP level in patients with asymptomatic persistent AF. CA may be primarily applicable in such patients with previously unrecognized impairment in their QOL and EP.

cute myocardial infarctions (AMI) are usually caused by the rupture of coronary atheromatous plaque, which can evolve to a completely occlusive thrombus. 1 There have been a few reports of thrombus located close to the ostium of the coronary artery leading to myocardial infarction, 2-7 and we report an unusual case of AMI caused by a giant organized thrombus occupying the entire left sinus of Valsalva and intermittently obstructing the ostium of the left coronary artery (LCA). Case ReportA 48-year-old Japanese man came to the emergency room by ambulance in December 1999 because of an initial episode of left anterior chest pain lasting 2 h. He had a history of smoking (30 cigarettes per day) and diabetes mellitus (hemoglobin A1c 7.1%), but he did not have a history of heart disease. He was not taking any medications.In the emergency room, the patient's pulse was regular at 100 beats/min, and his blood pressure was 124/91 mmHg. Auscultation of the heart and lungs indicated nothing abnormal. Chest X-ray examination showed mild enlargement of the heart, with a cardiothoracic ratio of 54%, but no apparent pulmonary congestion. Electrocardiography showed sinus rhythm, left axis deviation, and ST-segment depression in leads I, II, aVL and V3-6, indicative of an acute coronary syndrome (Fig 1).Emergency cardiac catheterization revealed neither organic stenosis nor thromboembolism in either coronary

AimsThere seems to be two distinct patterns in the presentation of acute heart failure (AHF) patients; early- vs. gradual-onset. However, whether time-dependent relationship exists in outcomes of patients with AHF remains unclear.MethodsThe Tokyo Cardiac Care Unit Network Database prospectively collects information of emergency admissions via EMS service to acute cardiac care facilities from 67 participating hospitals in the Tokyo metropolitan area. Between 2009 and 2011, a total of 3811 AHF patients were registered. The documentation of symptom onset time was mandated by the on-site ambulance team. We divided the patients into two groups according to the median onset-to-hospitalization (OH) time for those patients (2h); early- (presenting ≤2h after symptom onset) vs. gradual-onset (late) group (>2h). The primary outcome was in-hospital mortality.ResultsThe early OH group had more urgent presentation, as demonstrated by a higher systolic blood pressure (SBP), respiratory rate, and higher incidence of pulmonary congestion (48.6% vs. 41.6%; P<0.001); whereas medical comorbidities such as stroke (10.8% vs. 7.9%; P<0.001) and atrial fibrillation (30.0% vs. 26.0%; P<0.001) were more frequently seen in the late OH group. Overall, 242 (6.5%) patients died during hospitalization. Notably, a shorter OH time was associated with a better in-hospital mortality rate (odds ratio, 0.71; 95% confidence interval, 0.51−0.99; P = 0.043).ConclusionsEarly-onset patients had rather typical AHF presentations (e.g., higher SBP or pulmonary congestion) but had a better in-hospital outcome compared to gradual-onset patients.

ATP-induced AF was strongly associated with clinical AF, and ATP is useful for identifying arrhythmogenic sites.

Wereport a case of eosinophilic gastroenteritis, which has features of the predominant subserosal type presented as an ileus and ascites. A 48-year-old Japanese womanwas admitted to our hospital because of epigastralgia, lower abdominal pain and vomiting. She had a past history of allergic disorders. The computedtomographic scan revealed ascites, and marked*wall thickening and dilatation of the intestine. This patient showed eosinophilic ascites without marked peripheral eosinophilia. Histologic examination demonstrated eosinophilic infiltrates did not predominate in the gastrointestinal tract. Conservative treatment of intravenous infusion of antibiotics and Ringer's solution was effective in this case. (Internal Medicine 35: 779-782, 1996)