Background: Thiazide‐induced hyponatremia (TIH) is a well‐recognized adverse effect of thiazide diuretics, typically occurring in elderly individuals. Severe acute hyponatremia presenting with seizures in middle‐aged adults is uncommon. Combination therapy with spironolactone and hydrochlorothiazide (Aldactazide) may increase susceptibility to rapid electrolyte shifts. We report a case of early‐onset, symptomatic hyponatremia leading to generalized seizure shortly after initiation of Aldactazide. Case Presentation: A 52‐year‐old woman with hypertension presented after experiencing a generalized tonic–clonic seizure at home. She had started Aldactazide (spironolactone + hydrochlorothiazide 25 mg daily) 3 days earlier, in addition to perindopril/amlodipine and captopril. Two weeks before symptom onset, her serum sodium level was 131 mmol/L. On admission to the intensive care unit, she was alert and hemodynamically stable, with a Glasgow Coma Scale score of 15. Laboratory evaluation revealed severe hyponatremia (115 mmol/L), hypokalemia (3.3 mmol/L; ionized 2.7 mmol/L), and hypochloremia (76 mmol/L). Lactate was transiently elevated at 8.3 mmol/L, consistent with postictal physiology. Renal, thyroid, and adrenal functions were normal. Brain CT and MRI showed no acute abnormalities. Controlled correction with 3% hypertonic saline resulted in progressive normalization of serum sodium (115 ⟶ 121 ⟶ 125 ⟶ 131 mmol/L) without overcorrection. The patient experienced complete neurological recovery and was transferred to the nephrology ward for continued monitoring. Aldactazide was discontinued. Conclusion: This case demonstrates that TIH can develop rapidly in middle‐aged individuals and may lead to life‐threatening neurological complications, including seizures. Clinicians should closely monitor serum sodium during the early phase of thiazide‐containing diuretic therapy, particularly when combination regimens such as Aldactazide are prescribed.

Stable angina pectoris is a common manifestation of chronic coronary syndrome, and simple physical examination findings may provide additional information for cardiovascular risk assessment. This study investigated the association between bilateral anterior tragal crease (ATC) and coronary revascularization in patients presenting with stable angina pectoris. A total of 862 consecutive patients underwent standardized assessment for bilateral ATC. Coronary angiography and subsequent management were performed according to contemporary guidelines when clinically indicated. The primary outcome was coronary revascularization. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed. Coronary revascularization was performed in 134 patients (15.5%). Bilateral ATC was significantly more common among patients who underwent revascularization and remained independently associated with revascularization after adjustment for conventional cardiovascular risk factors (odds ratio [OR] 1.67, 95% confidence Interval [CI] 1.02- 2.73; P = .041). ATC alone demonstrated modest discrimination (area under the curve [AUC] 0.614). A clinical model showed good discrimination (AUC 0.744), with a minimal improvement after adding ATC (AUC 0.746; P = .732). ATC may represent a simple physical examination finding associated with coronary atherosclerotic burden, although its clinical utility requires further validation.

Coronary slow flow (CSF) is delayed distal contrast transit on angiography without flow-limiting stenosis; disturbed sleep may impair vascular control through autonomic, endothelial, inflammatory, and metabolic pathways. We evaluated Pittsburgh Sleep Quality Index (PSQI)-based sleep quality in relation to TIMI frame count (TFC)-defined CSF. This cross-sectional study enrolled 307 adults with nonobstructive coronary arteries undergoing angiography for chest pain; PSQI referenced the preceding month, and CSF was defined by corrected TFC > 27 frames in any major vessel; 132 participants had CSF and 175 normal flow. Global PSQI score was higher in CSF (median 7.0 vs. 5.0) and poor sleep quality (score > 5) was more frequent (75.8% vs. 49.7%; both p < 0.001). The global score correlated with mean TFC overall but not within flow groups. Each PSQI point independently raised CSF odds, including after STOP-Bang adjustment, although discrimination was modest. Sleep latency and short duration raised CSF odds; poor efficiency did not. Poorer sleep quality was independently linked to this angiographic slow-flow phenotype, mainly differentiating flow categories rather than tracking frame-count burden. Because coronary microvascular function was not measured directly, these hypothesis-generating findings should prompt systematic sleep assessment and prospective studies integrating objective sleep measures with invasive coronary physiology.

Background and Objectives: Left ventricular global longitudinal strain (LV GLS) has prognostic relevance in hypertrophic cardiomyopathy (HCM), but its incremental value for identifying nonsustained ventricular tachycardia (NSVT) documented on ambulatory monitoring is uncertain. We examined whether signed LV GLS was independently associated with documented NSVT and whether it improved a fixed clinical and conventional echocardiographic model. Materials and Methods: This retrospective, single-centre cross-sectional study included 201 patients with HCM. Transthoracic echocardiography was performed on the day that 24-h ambulatory electrocardiographic monitoring was initiated. A reference logistic regression model included age, sex, maximal septal thickness, maximal left ventricular outflow tract (LVOT) gradient, and ejection fraction; signed LV GLS was then added. Discrimination and calibration were internally validated using 2000 bootstrap samples with coefficient refitting. Six secondary mechanical measures were analysed with false discovery rate control. Results: NSVT was documented in 115 patients (57.2%). Median LV GLS was −11.3% [interquartile range, −14.3 to −9.0] with NSVT and −10.9% [−14.3 to −9.2] without NSVT (p = 0.819); the 0.4-percentage-point difference lies within the measurement variability of LV GLS, and the two distributions overlapped almost completely. The adjusted odds ratio (OR) for LV GLS per 1-percentage-point increase was 0.962 (95% confidence interval [CI], 0.884–1.047; p = 0.372). The apparent area under the curve was 0.645 (95% CI, 0.564–0.724) for the reference model and 0.644 (95% CI, 0.564–0.723) after adding LV GLS (paired difference, −0.001; 95% CI, −0.029 to 0.027; likelihood-ratio p = 0.370); optimism-corrected values were 0.606 and 0.598. In exploratory analyses, higher global radial strain was associated with lower odds of NSVT (OR per standard deviation, 0.619; 95% CI, 0.449–0.852; q = 0.020). Conclusions: LV GLS was not independently associated with documented NSVT and did not improve its discrimination beyond conventional clinical and echocardiographic variables. The exploratory radial strain association requires independent confirmation.

Aims: Acute heart failure (AHF) is a major cause of hospitalization, and prolonged hospitalization may reflect greater disease severity and poorer prognosis. We aimed to identify predictors of prolonged hospitalization (≥5 days) and evaluate its association with clinical outcomes.Methods: This retrospective study included 197 consecutive patients hospitalized with AHF. Patients were classified into short stay (