Asunto(s)
Lesiones Accidentales/complicaciones , Insuficiencia de la Válvula Aórtica , Válvula Aórtica , Procedimientos Quirúrgicos Cardíacos/métodos , Ecocardiografía Transesofágica/métodos , Procedimientos de Cirugía Plástica/métodos , Traumatismos Torácicos/complicaciones , Accidentes de Tránsito , Adulto , Válvula Aórtica/lesiones , Válvula Aórtica/fisiopatología , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/cirugía , Ecocardiografía Doppler en Color/métodos , Ecocardiografía Tridimensional/métodos , Femenino , Humanos , Traumatismo Múltiple , Pericardio/trasplante , Índices de Gravedad del Trauma , Resultado del TratamientoAsunto(s)
Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/efectos adversos , Ventrículos Cardíacos , Trombosis/etiología , Adolescente , Angiografía por Tomografía Computarizada , Ecocardiografía , Cardiopatías/diagnóstico , Cardiopatías/etiología , Humanos , Imagenología Tridimensional , Masculino , Trombosis/diagnósticoRESUMEN
INTRODUCTION: Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction, typically mimicking an anterior wall myocardial infarction (MI), without obstructive coronary artery disease. In the few published reports assessing myocardial deformation in TTS and MI, no consistent differences have been described between the two entities. We sought to characterize global and regional function in TTS and to compare it with a population with MI. METHODS: Clinical data, including echocardiography, were gathered from 17 TTS patients and 20 anterior wall ST-segment elevation myocardial infarction (STEMI) controls. Peak systolic longitudinal strain was determined for each LV segment using speckle tracking imaging, and global and mean apical, midventricular and basal longitudinal strain were calculated from these. RESULTS: Both TTS and STEMI patients presented significant LV systolic dysfunction, and there were no significant differences in ejection fraction or global longitudinal strain. Regional longitudinal strain was more severely impaired in basal inferolateral and mid anterolateral segments in the TTS group and in apical anteroseptal segments in the STEMI group. Mean longitudinal strain was worse in the basal segments of TTS patients (-9.8±2.9 vs. -12.4±4.1%, p=0.010), with no significant differences in mid and apical segments. The basal/apical ratio was significantly lower in this group as well (1.51±0.86 vs. 2.94±1.88, p=0.006). CONCLUSIONS: While both TTS and STEMI feature significantly impaired global systolic function, we found a regional pattern of worse basal longitudinal strain and a lower basal/apical ratio in the former. These suggest generalized myocardial impairment in TTS, providing new clues about its pathophysiology and possible specific echocardiographic changes.
Asunto(s)
Cardiomiopatías/etiología , Ventrículos Cardíacos/fisiopatología , Cardiomiopatía de Takotsubo/complicaciones , Función Ventricular Izquierda/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Cardiomiopatías/diagnóstico , Cardiomiopatías/fisiopatología , Ecocardiografía/métodos , Electrocardiografía , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sístole , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/fisiopatologíaAsunto(s)
Paro Cardíaco/etiología , Enfermedad Relacionada con Inmunoglobulina G4/complicaciones , Isquemia Miocárdica/complicaciones , Miocardio/patología , Biopsia , Diagnóstico Diferencial , Electrocardiografía , Paro Cardíaco/diagnóstico , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XAsunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Ecocardiografía/métodos , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Persona de Mediana EdadAsunto(s)
Humanos , Femenino , Persona de Mediana Edad , Válvula Aórtica/anomalías , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Ecocardiografía/métodos , Implantación de Prótesis de Válvulas CardíacasRESUMEN
Giant coronary artery aneurysms larger than 50 mm are rare and associated with important complications: namely, rupture. Its workup requires comprehensive imaging and standard treatment is surgical exclusion. We present a 60-year-old patient with previous ostium secundum atrial septal defect surgical closure diagnosed with a giant proximal right coronary artery aneurysm (70 x 62 mm) fistulizing into the right atrium. Percutaneous closure of its aortic origin with an atrial septal occluder was successfully performed, and thrombosis of the aneurysm confirmed on angiography and echocardiogram. This case depicts an innovative, minimally invasive approach to this worrisome entity.
Asunto(s)
Aneurisma Coronario , Vasos Coronarios/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Fístula Vascular , Procedimientos Quirúrgicos Vasculares , Angiografía por Tomografía Computarizada/métodos , Aneurisma Coronario/congénito , Aneurisma Coronario/diagnóstico , Aneurisma Coronario/cirugía , Angiografía Coronaria/métodos , Ecocardiografía Transesofágica/métodos , Femenino , Humanos , Persona de Mediana Edad , Imagen Multimodal/métodos , Dispositivo Oclusor Septal , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugía , Procedimientos Quirúrgicos Vasculares/instrumentación , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Patients with severely depressed left ventricular ejection fractions (LVEFs) receive implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden death. However, in some patients, LVEFs may improve or even normalize over time, and these patients would no longer be qualified for ICD implantation based on the original criteria for which they have initially received an ICD. We report a patient with idiopathic dilated cardiomyopathy whose LVEF recovered to normal values after pharmacological therapy. Meanwhile, the patient had life-threatening ventricular fibrillation, aborted by the ICD. We reflect on the pathological features of left ventricular reverse remodelling and ventricular arrhythmogenesis, where the myocardial substrate appears to play an important role. Also, after LVEF improvement in a patient with a cardiac device, there is still a debate on whether we should perform a battery replacement.
Asunto(s)
Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/terapia , Desfibriladores Implantables , Fibrilación Ventricular/terapia , Remodelación Ventricular , Anciano , Remodelación Atrial , Cardiomiopatía Dilatada/complicaciones , Muerte Súbita Cardíaca/prevención & control , Ecocardiografía Doppler en Color , Electrocardiografía , Femenino , Humanos , Imagen por Resonancia Cinemagnética , Volumen Sistólico , Fibrilación Ventricular/etiología , Función Ventricular IzquierdaRESUMEN
In idiopathic dilated cardiomyopathy (DCM), myocardial deformational parameters and their relationships remain incompletely characterized. We measured those parameters in patients with DCM, during left ventricular reverse remodeling (LVRR). Prospective study of 50 DCM patients (in sinus rhythm), with left ventricular ejection fraction (EF) <40%. LVRR was defined as an increase of ten units of EF and decrease of diastolic left ventricular diameter (LVDD) in the absence of resynchronization therapy. Performed morphological analysis, myocardial performance quantification (LV and RV Tei indexes) and LV averaged peak systolic longitudinal strain (SSR long) and circumferential strain (SSR circ). At baseline, mean EF was 25.4 ± 9.8%, LVDD was 62.4 ± 7.4 mm, LVDD/BSA of 34.2 ± 4.5 mm/m2 and 34% had MR grade >II/IV. LVRR occurred in 34% of patients within 17.6 ± 15.6 months and was associated with a reduced rate of death or heart failure hospitalization (5.9% vs. 33.3; p = 0.03). Patients with LVRR had a final EF of 48.9 ± 7.9% (Δ LV EF of 22.4%) and there was a significant decrease (p < 0.05) in: LVDD/BSA, LV systolic diameter/BSA, LV diastolic volume, LV systolic volume, LV mass; an increase (p < 0.05) in sphericity index. However, measures of diastolic function (LA volume/BSA, e'velocity and' E/e'ratio), final LV and RV Tei indexes were not significantly different from baseline. Additionally, final SSR circ and SSR long values were not different from basal. Patients who recovered EF >50% (n = 10), SSR circ and SSR long were inferior to normal. Improvement in EF occurred in one-third of DCM pts and was associated with a decrease of major cardiac events. There was an improvement of diastolic and systolic volumes and in sphericity index, confirming truly LV reverse reshaping. However, myocardial performance indexes, SSR long and SSR circ in reverse-remodeled DCM were still abnormal, suggesting a maintained myocardial systolic and diastolic dysfunction.
Asunto(s)
Cardiomiopatía Dilatada/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda , Remodelación Ventricular , Adulto , Anciano , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/tratamiento farmacológico , Fármacos Cardiovasculares/uso terapéutico , Diástole , Progresión de la Enfermedad , Ecocardiografía Doppler de Pulso , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Volumen Sistólico , Sístole , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/etiología , Función Ventricular Izquierda/efectos de los fármacos , Remodelación Ventricular/efectos de los fármacosRESUMEN
Young athletes are considered the healthiest group in society. Although rare, there are still reports of sudden death or cardiac arrest on the playing fields. Clinical evaluation is of paramount importance for the identification of possible pathological states that confer increased risk of these events. Interpretation of the electrocardiogram of young athletes can help identify changes associated with heart disease that might preclude the participation in sports. In this context, it is essential to recognize the electrocardiographic patterns that represent the structural and electrical remodeling resulting from continued adaptation to exercise, and which thus do not increase the risk of adverse events during exercise. The European Society of Cardiology (ESC) and the American Heart Association (AHA) have issued consensus documents summarizing which electrocardiographic abnormalities should be considered 'physiological', resulting from adaptation to exercise ('athlete's heart'), and which should be considered pathological and thus require further study. However, the two societies have different approaches with respect to the electrocardiographic screening of athletes. This paper provides a brief review of current evidence regarding the electrocardiographic findings considered normal and abnormal in athletes, and presents the arguments of the ESC and AHA for electrocardiographic screening in this population.
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Atletas , Muerte Súbita Cardíaca/epidemiología , Electrocardiografía , Tamizaje Masivo , Adolescente , Cardiomegalia , Niño , Muerte Súbita Cardíaca/prevención & control , Humanos , Deportes , Adulto JovenRESUMEN
Right ventricular thrombosis is a rare yet potentially fatal condition. It has been described in association with hypercoagulability states, autoimmune diseases and dilated cardiomyopathy. Echocardiography constitutes the election tool for diagnosis and characterization of these entities, allowing for the differentiation between the various types of thrombi. We present a case of a patient with alcoholic dilated cardiomyopathy admitted for congestive heart failure and lower respiratory infection. In the diagnostic approach, a routine echocardiography revealed a large mural right ventricular thrombus in association with severe biventricular dysfunction. The patient was proposed for anticoagulation strategy, which he refused.
A formação de trombos no ventrículo direito corresponde a uma situação rara porém potencialmente fatal. Tem sido descrita em associação a estados de hipercoagulabilidade, doenças autoimunes e cardiopatia dilatada. A ecocardiografia constitui o método de eleição para o diagnóstico e caracterização destas estruturas, permitindo, inclusive, a diferenciação entre os diversos tipos de trombos possíveis. Apresentamos o caso de um doente com miocardiopatia dilatada de etiologia alcoólica que foi admitido por insuficiência cardíaca congestiva e infeção respiratória baixa. Durante a marcha diagnóstica, o ecocardiograma de rotina revelou a presença de um volumoso trombo mural no ventrículo direito, em associação a disfunção sistólica biventricular de grau severo. Foi proposto o início de hipocoagulação oral, estratégia que o doente recusou.
Asunto(s)
Cardiopatías/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Ventrículos Cardíacos , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
Prosthetic valve thrombosis (PVT) refers to the presence of non infective material in valvular apparatus, interfering with its function. It is a potentially fatal complication of valvular replacement surgery. Treatment options include surgery, fibrinolysis and anticoagulation optimisation. The authors present the case of a young man, carrier of an aortic prosthetic mechanical valve, who didn't take his anticoagulant medicine, admitted for an acute obstructive PVT, with evidence of a large thrombotic mass on the aortic valve (> 1cm(2)). The patient refused surgical treatment and eventually presented a complete resolution of the acute PVT with anticoagulation optimisation.
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Válvula Aórtica , Prótesis Valvulares Cardíacas/efectos adversos , Trombosis/tratamiento farmacológico , Trombosis/etiología , Adulto , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Fibrinolíticos/uso terapéutico , Heparina/uso terapéutico , Humanos , Masculino , Cumplimiento de la Medicación , Falla de Prótesis , Trombosis/diagnóstico por imagen , UltrasonografíaAsunto(s)
Aneurisma , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Válvula Mitral , Aneurisma/diagnóstico por imagen , Aneurisma/etiología , Ecocardiografía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , RadiografíaRESUMEN
Spontaneous coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death. The clinical presentation is highly variable and prognosis varies widely, depending mainly on how rapidly it is diagnosed. Prompt treatment is also essential, and includes medical management, percutaneous coronary intervention and surgical revascularization. We describe the case of a young woman presenting with spontaneous coronary artery dissection of the left main coronary artery, first diagnosed as coronary thrombus, who underwent successful percutaneous coronary stenting. This report highlights the need to include spontaneous coronary artery dissection in differential diagnosis of chest pain in young women and that distinguishing between coronary thrombus and coronary artery dissection is not always straightforward. To our knowledge this is the fourth case of left main stenting in a patient with spontaneous coronary artery dissection described in the literature.
Asunto(s)
Anomalías de los Vasos Coronarios/cirugía , Intervención Coronaria Percutánea , Enfermedades Vasculares/congénito , Adulto , Femenino , Humanos , Enfermedades Vasculares/cirugíaRESUMEN
Cardiac metastases are more common than primary tumors. Several types of malignant tumors have been reported to metastasize to the heart, mainly lung cancer, but in the setting of esophageal cancer, myocardial metastasis is comparatively rare. We report a case of a cardiac metastasis from esophageal squamous cell carcinoma detected 9 months after surgically curative esophagectomy, which presented mimicking acute myocardial infarction. The use of different imaging modalities was fundamental to a correct diagnosis considering the challenging presentation.
Asunto(s)
Carcinoma de Células Escamosas/secundario , Neoplasias Esofágicas/patología , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/secundario , Infarto del Miocardio/diagnóstico , Anciano de 80 o más Años , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
We present a case of a patient with known complete congenital atrioventricular block (CAVB) since the age of 7 years old that developed dilated cardiomyopathy ten years after VVI-R pacemaker implantation. He presented severe biventricular dysfunction and was symptomatic despite optimal medical therapy. Cardiac resynchronization therapy was used, and he showed clinical and electrocardiographic improvement a month later.