13) Although we think that this patient should be diagnosed as ACS according to current diagnostic criteria, which includes absence of obstructive coronary

artery disease or angiographic evidence of acute plaque rupture, regional cardiac function seemed to indicate atypical SICM on initial presentation. There’s also possibility of although PCI was performed Inhibitors,research,lifescience,medical on LAD according to coronary angiography and IVUS findings, RCA was also involved such as coronary spasm or intracoronary thrombus, which were resolved selleckchem spontaneously later Finally, although typical history and echocardiogram may suggest SICM, this case demonstrates that cautious evaluation using coronary angiography, IVUS, serial echocardiogram and laboratory workup is Inhibitors,research,lifescience,medical essential to rule out ACS at the time of diagnosis.13)

Hypertrophic osteoarthropathy is characterized by the coexistence of digital clubbing and periosteal proliferation of the tubular bones. Pachydermoperiostosis or primary hypertrophic osteoarthropathy is clinically similar to acromegaly and is manifested by finger clubbing, hypertrophic skin changes and periosteal bone formation. Pachydermoperiostosis is a rare genodermatosis and occurs predominantly in men, who usually show a more severe phenotype. Three forms of pachydermoperiostosis are Inhibitors,research,lifescience,medical described: complete, incomplete and fruste form. The major diagnostic criteria include digital clubbing, periostosis and pachydermia.1) There

is no previous report documenting pachydermoperiostosis accompanied by heart failure. Here we report the case of the complete form of pachydermoperiostosis,

who accompanied by heart failure. Case A 34-year-old male presented with complaints of exertional dyspnea since 5 days ago. He Inhibitors,research,lifescience,medical presented with 3 years history of hypertension. There was not any specific past medical history. On arrival in the emergency department, he had a pulse rate of 100 beats per minutes, blood pressure of 150/100 Inhibitors,research,lifescience,medical mmHg and respiration rate of 22 breaths per minutes. His electrocardiogram on admission showed left ventricular hypertrophy and normal sinus rhythm. A chest X-ray showed an increased cardiothoracic ratio in association with mild pulmonary congestion. Suplatast tosilate Cardiac enzyme were normal, N-terminal pro B-type natriuretic peptide was increasing with 1143 pg/mL. At initial physical examination, his acromegalic-look make to evaluate endocrine study. Results of laboratory analyses, including growth hormone, insulin-like growth factor 1, 75 g oral glucose tolerence test, thyroid-stimulating hormone, free-triiodiothyronine, free-thyroxine, were normal. His facial skin was greasy and thickening (deep frontal folds and heavy eyelids) (Fig. 1). His both hands had broad hands, clubbing of fingers, swollen interphalangeal joints and round turtle-back-shaped nails (Fig. 2). X-ray of bones showed periosteal new bone formation in the lower end of tibia, talus and calcaneus (Fig. 3).