Background: Acute decompensated heart failure (ADHF) is the most common cause of readmissions in the hospital. ADHF patients are associated with polypharmacy. It is a common problem among elderly patients due to frequently occurring multiple morbidities and is associated with the use of potentially inappropriate medications (PIMs). The aim of this study was to examine the association between PIMs and all-cause mortality in elderly ADHF patients. Methods: This retrospective study included ADHF patients who were admitted to the Showa University Fujigaoka Hospital between January 2015 and August 2016. We investigated the proportion of patients taking at least one PIM at admission and the characteristics of patients at admission. PIMs were defined based on the Screening Tool of Older People's potentially inappropriate Prescriptions (STOPP). Multiple Cox regression analysis was performed to examine the association between PIM use and all-cause mortality. Results: A total of 193 elderly patients (median age 81 years, interquartile range (IQR) 65-99 years) were included in the study. Allcause death occurred in 30 patients. The median number of medications at admission was 7 (IQR 0-18). The number of medications (greater than or equal to six) at admission was associated with mortality. Multivariate Cox regression analysis revealed that systolic blood pressure (SBP) < 100 mm Hg at admission, chronic obstructive pulmonary disease (COPD), and use of non-steroidal anti-inflammatory drugs (NSAIDs) at admission were independent predictors for allcause mortality. Conclusions: The medical staff should attempt to stop unnecessary medications that are prone to be inappropriate prescribing. In particular, prescription of NSAIDs should be carefully assessed and monitored.

cardiac events than measurements with 2DE. Methods Study Design Participants We retrospectively analyzed the data from 704 randomly selected patients who had undergone both clinically indicated 2DE and 3DSTA examinations for heart disease between March 19, 2010 and December 14, 2015. Clinical records were also retrospectively reviewed in 2016 to determine the presence of MACE (cardiac death, nonfatal myocardial infarction [MI], stroke, and admission for heart failure [HF]). Patients were excluded from analysis if they met the following criteria: (1) atrial fibrillation or a history of pulmonary vein isolation (n=108); (2) frequent premature ventricular (PVCs) or atrial contractions (PACs) (n=7); (3) moderate to severe mitral or aortic regurgitation (n=16); and (4) mitral stenosis and mitral valve replacement (n=13). Furthermore, 41 patients were excluded

A 54-year-old male bodybuilder who was abusing anabolic steroids developed an acute ST-segment elevation myocardial infarction after strenuous strength training. Despite optimal use of dual antiplatelet therapy, on day 4 after primary coronary stenting, the patient suffered another acute coronary event due to subacute thrombosis, potentially pre-disposed by anabolic steroid use. ( Level of Difficulty: Intermediate. )