Acute heart failure (AHF) requires immediate intervention, with diuretics central to managing volume overload. We conducted a prospective single-arm study to explore changes in diuretic and renal outcomes following initiation of combined angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 (SGLT2) inhibitors therapy in AHF patients. We enrolled 120 patients with left ventricular ejection fraction ≤40% and signs of fluid overload, initiation of combined ARNI and SGLT2 inhibitor therapy post-hemodynamic stabilization. Urine volume, renal function, and cardiovascular biomarkers were assessed over 9 days. Urine volume and diuretic response increased significantly on day 1, stabilizing above baseline levels. Cardiovascular biomarkers showed improvements, with decreased NT-proBNP and increased LVEF, without affecting eGFR. Increased diuresis and improved cardiac function parameters were observed during combination therapy. These hypothesis-generating findings support the need for randomized controlled trials to evaluate the clinical utility of this combination in AHF management. The short-term nature of the study and lack of a control group are limitations, which preclude definitive causal attribution of the observed effects. This study has been registered with the Chinese Clinical Trial Registry under registration number ChiCTR2600118845. Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR2600118845).

Introduction: Variegate porphyria (VP) is a rare metabolic disorder. Its diagnosis is challenging when cutaneous features are absent and symptoms overlap with common conditions like diabetic neuropathy. Case presentation: We report a 71-year-old female with a 30-year history of type 2 diabetes and a 3-year history of mild chronic abdominal pain and psychiatric symptoms. Extensive workup for common abdominal pathologies was negative. A positive urine sun exposure test prompted genetic analysis, which identified a heterozygous pathogenic variant in the PPOX gene (c.567A>C, p.Gln189His), confirming VP. Her mild acute attack was managed successfully with intravenous glucose and safe psychotropic agents, alongside adjusted glycemic targets to prevent catabolism. Conclusion: This case underscores that VP can present atypically without skin lesions. It highlights the importance of considering VP in diabetic patients with unexplained neurovisceral symptoms and demonstrates that mild attacks can be managed with tailored supportive care.

Introduction: Primary Sjögren’s syndrome (pSS) is a heterogeneous autoimmune disorder that may be associated with systemic manifestations such as pulmonary or articular involvement.Compared to other autoimmune diseases, vascular injury and accelerated atherosclerosis in pSS are less studied. Case presentation: A 51-year-old woman presented with a 2-month history of dizziness, chest tightness, and exertional dyspnea. Vascular imaging revealed multifocal stenoses in the left anterior descending coronary artery (70%), bilateral middle cerebral arteries, right anterior cerebral artery, and left posterior cerebral artery. Her only traditional cardiovascular risk factor was hypertension, and she reported only mild xerostomia. Serology showed anti-SSA positivity. Schirmer’s test was abnormal, and a labial gland biopsy confirmed focal lymphocytic sialadenitis (≥1 foci/4 mm²), leading to a pSS diagnosis per 2016 ACR-EULAR criteria. She responded favorably to a combination of immunomodulators (hydroxychloroquine and total glucosides of paeony), antiplatelet therapy, and statins, with symptom resolution at follow-up. Conclusion: This case represents an exceptionally rare documented instance of pSS simultaneously affecting both cerebral and coronary arterial systems. It underscores that severe multifocal arterial stenosis can present as the initial manifestation of this disease, even in the absence of prominent dryness symptoms. This highlights the necessity for vascular assessment in pSS patients and the urgency of conducting autoimmune evaluations in cases of unexplained multivessel arteriopathy.

Diffuse coronary artery spasm (DMV-CAS) is a serious vascular condition characterized by prolonged narrowing of two or more major coronary arteries or their main branches, leading to significant stenosis or blockage (≥70%). This can result in myocardial ischemia, heart attacks, and dangerous arrhythmias. A 68-year-old male with a four-year history of recurrent angina presented with acute-onset chest tightness, palpitations, and syncope. During transport, the patient experienced prehospital cardiopulmonary arrest, with transient return of spontaneous circulation (ROSC) achieved in the emergency department. Electrocardiographic evaluation revealed atrial fibrillation with rapid ventricular rate, pathological Q waves in the inferior, anterior, and anterior septal territories, along with dynamic ST-T abnormalities, including ST elevation in leads II, III, aVF, and V1-6, and ST depression in leads I and aVL. Emergent coronary angiography identified critical multivessel stenoses, with the most significant narrowing observed in the left anterior descending artery. The diagnosis of DMV-CAS was corroborated through angiographic evidence, demonstrating resolution of the spasm following the administration of intracoronary nitroglycerin (200 μg administered bilaterally to the coronary arteries). Despite the implementation of targeted vasodilator therapy, the patient progressed to refractory cardiogenic shock and succumbed in the intensive care unit 1 h after the procedure. This case underscores the rare and severe cardiovascular implications of DMV-CAS, emphasizing the critical need for early and accurate diagnosis of DMV-CAS and the necessity for standardized pharmacological intervention.