We report a 55-year-old man who experienced proximal muscle weakness accompanied by the atrial flutter (AFL) with 1:1 conduction. Detailed examination revealed elevated antimitochondrial antibodies (AMA) and creatine kinase (CK). AFL was converted to sinus rhythm by cardioversion. He was diagnosed as AMA-positive myositis-associated AFL and was treated by prednisolone. Although his muscle weakness and CK level improved, AFL with 1:1 conduction reappeared. Therefore, radiofrequency catheter ablation (RFCA) was needed to treat the AFL, resulting in maintenance of sinus rhythm. This case report describes cardiac involvement in a patient with AMA-positive myositis.

We herein report an adult case of unicommissural unicuspid aortic valve (UAV). A 59-year-old man, who was noted to have a cardiac murmur at 31 years of age, was admitted to our hospital due to acute heart failure. Severe calcification in the aortic valve with severe low-flow/low-gradient aortic stenosis and moderate aortic regurgitation was observed and thought to be the cause of heart failure, however, the etiology of aortic valve dysfunction was not clear. Aortic valve replacement was subsequently performed, and unicommissural UAV was diagnosed according to the intraoperative findings. UAV is very rare congenital aortic valve disease which is rarely diagnosed preoperatively.

Infection with the varicella zoster virus (VZV) causes two distinct clinical syndromes, varicella and herpes zoster. Primary infection with VZV results in varicella, characterized by viremia with a diffuse rash and seeding of multiple sensory ganglia, where the virus establishes lifelong latency. Endogenous reactivation of latent VZV typically results in a localized skin infection known as herpes zoster. VZV may cause various complications such as secondary bacterial infection, pneumonia, acute cerebellar ataxia, meningitis, encephalitis, and Reye syndrome [1,2]. In contrast, the occurrence of myopericarditis is extremely rare [2]. The occurrence of concurrent myopericarditis with herpes zoster, as in the present case, is extremely rare [3-5]. This article describes a case of pericarditis caused by herpes zoster. Case report We report the case of a 53-year-old immunocompetent male who developed pericarditis caused by herpes zoster. The patient had no particular past history except for varicella in his childhood. Six hours prior to consultation, the patient suddenly noticed chest pain at rest without physical disorders before chest pain developed. At the time of consultation, the patient had a blood pressure of 134/92 mmHg, heart rate of 110 beats per minute, and body temperature of 37.6 C. There was no paradoxical pulse observed. Heart sounds were slightly distant and muffled with no sound of pericardial friction. The jugular venous distension was not observed, and there was no edema of the legs. No rash was observed on the body surface. However, the chest pain persisted. The 12-lead electrocardiography (ECG) revealed concave upward ST segment elevation in the leads of I, II, aVL, aVF, and V1-6 without mirror-image changes and PR segment depression (Fig. 1A). Blood tests revealed a white blood cell count of 11.5 Â 10 3 /mL [normal range (NR), 3.6-8.7 Â 103/mL] and C-reactive protein (CRP) of 1.27 mg/dL (NR, 0.00-0.17 mg/dL) both of which were slightly elevated. Myocardial enzyme was normal with the creatine kinase/ creatine kinase-myocardial band level of 158/80 IU/L (NR, 110-318/ 0-12 IU/L) and troponin I level of 0.02 ng/mL (NR, 0.00-0.04 ng/ mL). Renal function was normal with a creatinine level of 0.78 mg/ dL (NR, 0.65-1.07 mg/dL). The human immunodeficiency virus antibody (types 1, 2) and antigen (type p24) evaluated by chemiluminescent enzyme immunoassay test were negative (NR, negative). Transthoracic echocardiography (TTE) revealed left ventricular ejection fraction of 67%, indicating normal left

We herein report the case of a 55 year-old male who underwent pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation. From 8 months after PVI, exertional dyspnea rapidly appeared. When he was referred to our hospital, massive pericardial effusion was observed by transthoracic echography. The pericardiocentesis revealed bloody pericardial effusion, and improved symptoms. Although aortic dissection, autoimmune disease, infection, metastatic pericardial tumor, primary pericardial tumor, and malignant neoplasm were considered as differential diagnosis, the cause of pericardial effusion failed to be found. From these findings, the cause of hemorrhagic pericardial effusion was considered delayed cardiac tamponade induced by PVI performed 8 months earlier.

IntroductionLarge vessel damage caused by radiation therapy is considered relatively rare, and there have been not many case reports. It is also pointed out that arterial injury in the limbs after mastectomy can be overlooked because symptoms resemble postoperative lymphedema and nerve disorders.We report on a case in which symptoms of high-degree subclavian artery (SCA) stenosis appeared 26 years after radiation therapy, and in which percutaneous transluminal angioplasty (PTA) was performed to treat the condition. Case reportA 76-year-old female, who had undergone standard radical mastectomy and radiation therapy (50 Gy) to treat right breast cancer at 50-year old, started to experience fatigue and a sense of coldness in the right upper arm about 1 month before the admission.Physical examination revealed that right upper arm was cold and that pulsation in the radial, ulnar or brachial artery of the right arm was not palpable. The noninvasive blood pressure (NIBP) in the right arm was 70/40 mmHg while it was 125/65 mmHg in the left arm and pattern of pulse wave in ankle brachial index (ABI) was dull in the right arm (Fig. 1A). A high-grade calcified plaque and stenosis of the right SCA was observed with computed tomography (CT) scan (Fig. 1B) and also with angiography ( Fig. 1C and D). The symptoms in the right arm were thought to be caused by this lesion. In addition, a high degree of right common carotid artery (CCA) stenosis (peak systolic velocity: 511 m/s and 93% stenosis) without cerebral infarction was observed with carotid echocardiography, CT, and angiography.These findings suggested that the patient was eligible for intervention to treat the right CCA and right SCA. At first, the patient underwent carotid artery stenting at another hospital. About A B S T R A C TWe report on a female patient who underwent a standard radical mastectomy and radiation therapy for right breast cancer at the age of 50 years without recurrence. At the age of 76 years, she started to experience fatigue in the right upper limb. The symptom gradually worsened and she was admitted to our hospital for further investigation. With computed tomography scan and angiography, we observed a high degree of subclavian artery (SCA) stenosis and asymptomatic right common carotid artery (CCA) stenosis. After undergoing carotid artery stenting to the right CCA stenosis at another hospital, we performed percutaneous transluminal angioplasty to SCA. Although we chose to treat the highly calcified lesion only with a balloon and slightly decreased the degree of stenosis, her symptoms clearly improved. Since arterial severely stenotic lesions were limited in the area of radiation exposure while other part of the arteries looked smooth and relatively free of sclerosis, it was highly suspected that arterial injury was induced by radiation. There are few reports of radiation-induced injury of upper limbs. However, this case suggests that we need to consider the possibility of radiation-induced arterial injury in patients with a history of radiation th...