介入および一般心臓学ジャーナル

Dual left anterior descending coronary artery is well-known as a congenital phenomenon of coronary artery anatomy. It may be confronted during daily coronary angiography and in unaware operators it may be misjudged as a chronic total occlusion lesion in short LAD branch. And in another concept if in a real chronic total occlusion situation of LAD what will be the strategy.

Vogt-Koyanagi-Harada (VKH) disease is a multisystemic autoimmune disease which targets pigmented tissues, especially the eyes, in a genetically susceptible individual (HLA-DR4 carrier). It is characterized by a bilateral, visionthreatening uveitis that evolves in 4 phases and by extraocular manifestations in other tissues containing melanin.
We report an association of complete VKH disease, vitamin B-deficient macrocytic anemia and a large, circumferential pericardial effusion in an 82-year old woman.
Although there is no known report, to the best of our knowledge, of cardiac manifestations in VKH disease, we argue that the inflammatory pericardial effusion we found is a cardiac manifestation of VKH disease since this disease is directed against melanin cells which can be found in the heart, and because we ruled out other common causes of pericardial effusion such as tuberculosis and neoplasm. Since genetic susceptibility to autoimmune diseases is a fertile environment for the development of auto-immune diseases, which frequently coexist, we suggest that our patient presents pernicious anemia associated with VKH disease.
In the light of the above observations, we suggest a systematic screening of VKH patients (Electrocardiogram, transthoracic echocardiography) for possible, potentially lethal cardiac manifestations before beginning VKH therapy.

Atrial fibrillation (AF) is the most common supraventricular arrhythmia in clinical practice. Rapid, unordered atrial electroactivity is the characteristic of AF. The main manifestations of the electrocardiogram are P wave disappeared and RR interval irregular absolutely (except for the three degree atrioventricular block). Atrial irregular contractions cause atrial thrombosis. The irregular contraction of ventricle leading to a decrease in cardiac pump function, which can seriously affect ventricular systolic and diastolic function. In 2010, about 33.5 million people suffered from AF around the world. In the European Union, there are an estimated 14 million to 17 million people with AF by 2030. In the United States, there are about 27 million to 61 million AF patients. With the trend of population aging in recent years, the incidence of AF increases gradually. AF is not only a great challenge for cardiologists, but also a hot research topic. The following review is in the treatment progress of AF in recent years.

In official medicine, it’s nowhere said that uncontrolled leakage of arterial blood through arteriovenous anastomoses (AVA) is very dangerous for human health. The purpose of AVA, apparently, is the regulation of heat exchange of the human body, limiting the maximum blood pressure, regulating the flow of arterial and venous blood by opening a direct communication between the arterial and venous basins. Because of the high pressure difference between the basins (an average of about 50-60 mmHg or 680-820 mm H2O), the blood flows intensively from the arteries to the veins. Depending on stress and charges, the AVA lumen may change, i.e., AVA periodically can be in both open and closed positions. The very presence of AVA of different calibers in the cardiovascular system of man is not denied by anyone, but no one has studied in details the effect of AVA on blood circulation in various organs of man. At least until 2011.

Introduction: Carotid plaques are often reported in association with carotid intima-media thickness studies, both considered as a marker of atherosclerosis. But its detailed description is most often neglected.
Methodology: In a follow-up review of a carotid intima-media thickness study. Results were used to compare clinical characteristics, laboratory characteristics and 2D echocardiographic characteristics of patients with and without carotid plaque.
Results: Systolic blood pressure, fasting blood sugar, high HDL and carotid intima-media thickness were significantly higher in patient with plaque.
Conclusions: Carotid plaque formation a marker of atherosclerosis is probably more likely to occur in the presence of local vascular factors.

Objectives: Clinical application of #ACC17 highlights towards State-of-Art cardiology practice is the motive for this article. The novel new therapeutic pathway thru inhibition of PCSK9 is the current breakthrough in lowering LDLCholesterol (LDL-C) to desired levels, however, robust clinical cardiovascular outcomes evidence is still at large.
Methods: Extraction and analysis of the documented published medical literature on LDL-C in view of novel therapeutic PCSK9. Inhibitors capability in lowering LDL cholesterol that has been remarkably shown by FOURIER trial investigators to be safe and effective.
Results: LDL-C is reduced to very low levels of 20-30 mg/dL in patients with high risk for vascular thrombosis. Two percent (~2%) absolute risk reduction is observed in clinical outcomes. In patients treated to very low levels of LDL-C, 2.9% developed acute coronary syndrome (ACS) compared to 4% in the placebo arm.
Conclusion: PCSK9 inhibition is effective and safe in lowering LDL-C to very low levels in high risk patients with modest reduction in clinical outcomes despite control of other risk factors.