Asunto(s)
Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interatrial/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/etiología , Anciano de 80 o más Años , Fibrilación Atrial/etiología , Angiografía Coronaria , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Femenino , Humanos , Síncope/etiologíaAsunto(s)
Medios de Contraste/administración & dosificación , Ecocardiografía , Cardiopatías/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Anciano de 80 o más Años , Femenino , Cardiopatías/terapia , Neoplasias Cardíacas/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Microburbujas , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Trombosis/terapia , Resultado del TratamientoRESUMEN
An 83-year-old woman with a possible history of myocardial infarction presented with acute chest pain and dyspnoea. The electrocardiogram showed no signs of acute coronary syndrome, but Q waves in the anteroseptal leads. The blood tests showed an important elevation of troponin T level. Emergency coronary angiography revealed normal epicardial arteries, but the left ventriculogram demonstrated anterior akinesis and ballooning with normal apical and basal function. An atypical takotsubo cardiomyopathy was suspected and the patient received beta blocker and ACE inhibitor treatment. Two days later the echocardiogram evolved to a classical pattern of apical ballooning with normalization on the follow-up examination 5 weeks from the acute episode. To our knowledge, this is the first case report describing an evolving pattern of wall motion abnormality from an anterior wall ballooning to an apical form.
Asunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Ventrículos Cardíacos , Cardiomiopatía de Takotsubo , Anciano de 80 o más Años , Angiografía Coronaria/métodos , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Cardiomiopatía de Takotsubo/sangre , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/tratamiento farmacológico , Cardiomiopatía de Takotsubo/fisiopatología , Resultado del Tratamiento , Troponina T/sangreRESUMEN
Transoesophageal echocardiography is often recommended in the evaluation of cryptogenic stroke, especially in those patients with no or few risk factors. We report the case of 66-year-old male with a history of multiple ischaemic strokes, admitted to our stroke unit following the discovery of multiple and diffuse new ischaemic lesions on a cerebral magnetic resonance imaging. Transoesophageal echocardiography led to the discovery of a very small mass attached to the tissue fold between the left superior pulmonary vein and the left atrial appendage (often referred to as"coumadin ridge"). The three-dimensional acquisition allowed detailed characterization of this mass. No other source of emboli was detected.The mass was considered to be most likely a tumour and was probably the cause of the multiple strokes. Due to the already advanced neurological disease and the small dimensions of the mass surgery was considered inappropriate. The patient was initiated on oral anticoagulants. This case highlights the importance of three-dimensional ultrasound in the detection and evaluation of intracardiac masses.