Hypertension in middle-aged or elderly women is often accompanied with various symptoms, which may be related to climacteric. The symptoms of post-menopausal women are suggested to be derived in part from instability of the sympathetic nerve system due to a low estrogen state. An angiotensin-receptor blocker, candesartan cilexetil (candesartan), is known to suppress sympathetic nerve activity by inhibiting the reninangiotensin system in the brain, suggesting that it may be effective for ameliorating these symptoms. The

A 63-year-old man was prescribed bepridil for paroxysmal atrial fibrillation in May 2011. He was referred to our hospital with the chief complaint of slight dyspnea in October 2012. Radiography and computed tomography indicated diffuse bilateral peribronchial infiltration. Since an examination of the bronchial alveolar lavage fluid revealed inflammatory lymphocytes and a drug lymphocyte stimulation test was strongly positive for bepridil, he was diagnosed with bepridil-induced interstitial pneumonia. In our case, the patient developed dyspnea 517 days after beginning bepridil treatment. Here, we describe an extremely rare case of late onset interstitial pneumonia induced by bepridil.

In Takotsubo cardiomyopathy (TCM), ST‐segment elevation, T‐wave inversion, and QTc prolongation are the most common electrocardiography (ECG) findings during acute and subacute periods. Right ventricular apical (RVA) pacing produces a left ventricular electrical activation sequence resembling a left bundle‐branch block, and the ST–T segment changes are usually discordant from the QRS complex. Several cases have reported that abnormal ECG manifestations in TCM could be detected even in patients with a paced ventricular rhythm. However, ECG manifestations in TCM have not been well characterized in patients with RVA pacing. Here, we report a case of a 76‐year‐old woman with RVA pacing who was diagnosed with TCM after she experienced acute bronchitis. To the best of our knowledge, this is a rare case, showing that significant QTc prolongation and concordant T‐wave inversions during full RVA pacing were longer and deeper when compared with ECG findings in past reports. The ECG findings eventually improved with a similar course as those in TCM patients without RVA pacing.

No abstract