PMC9286935_01
Photographs of the lower extremities. (a) Severe edema of the lower extremities. (b) Pitting edema in a magnified area of (a). (c) Tolvaptan reduced edema without side effects, leading to a body weight decrease of 12 kg.
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Physical examination was notable for pitting edema on both lower extremities (Figures 1(a) and 1(b)). When we tried the active vasopressin V2 receptor antagonist tolvaptan at 7.5 mg per day, his urine output increased and his edema gradually resolved (Figure 1(c)).
Electrocardiography findings. (a) ST-segment elevation in leads V2-4 during a heart attack. (b) After lingual nitroglycerin therapy, ST-segment elevations resolved.
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Two months prior, he was diagnosed with vasospastic angina because of transient ST-segment elevation on an electrocardiogram during a heart attack, which was relieved by sublingual nitroglycerin (Figures 2(a) and 2(b)).
Coronary angiography findings. Left coronary angiography before (a) and after (b) nitroglycerin injection via a catheter, which dilated the stenosis in the middle of the left anterior descending coronary artery.
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Coronary angiography showed stenosis of the left anterior descending artery, which improved with nitroglycerin injection into the left coronary artery via a catheter (Figures 3(a) and 3(b)).