Circulation journal : official journal of the Japanese Circulation Society
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The aim of the present study was to assess the clinical significance of spectral analysis of plethysmographic waveform in patients with coronary artery disease (CAD) and after coronary artery bypass graft (CABG) surgery. ⋯ The increase in the total power of both pulses, the shift of the normalized power of harmonics of the right pulse from high- to low-frequency, and the decrease in the right-to-left ratio of the total power of both pulses are the 3 significant changes in the power spectra of the pulses in CAD patients after CABG. The plethysmographic waveform of normal controls and CAD patients may be modulated by the autonomic nervous system, and in CAD patients the CABG surgery may have diminished the effect of autonomic nervous modulation on the pulse waveforms.
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Iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). This complication is usually diagnosed by angiography and treated with aortocoronary bypass surgery. ⋯ The incidence of ICOS after AVR is low. Noninvasive MDCT is useful for early diagnosis and PCI is a possible alternative treatment. ICOS may be caused by fibrous tissue formation, and therefore be distinct from conventional atherosclerosis.
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A young woman presented with takotsubo cardiomyopathy after a syncopal attack caused by torsades de pointes. Two-dimensional echocardiography on admission showed left ventricular apical akinesis (ballooning) and basal hyperkinesis, compatible with takotsubo cardiomyopathy. This gradually normalized in 2 months. ⋯ Coronary angiography revealed no organic stenosis; however, acetylcholine provocation test caused the QT interval to again become prolonged. During treadmill exercise stress testing, the QT interval shortened as heart rate increased. Therefore, without genetic analysis, this patient was considered to have sporadic long QT syndrome in which takotsubo cardiomyopathy developed after the syncopal attack caused by torsades de pointes.
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Little is known about the long-term outcome of implantable cardioverter defibrillator (ICD) therapy in survivors of out-of-hospital cardiac arrest (OHCA). ⋯ The results suggest that ICD implantation for survivors of OHCA with favorable neurological recovery might be effective for preventing recurrence of cardiac arrest.
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Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) in congestive heart failure (CHF) is generally considered a poor prognostic indicator, but treatment of CSR-CSA using an adaptive servo-ventilation (ASV) device has been developed. This is the first evaluation of its use in the management of CSR-CSA in Japanese CHF patients. ⋯ ASV markedly improved CSR-CSA in patients with CHF. It is a promising treatment for Japanese patients with CHF.