RESUMEN
A 64-year-old woman presented for chest pain and was diagnosed with anteroseptal ST segment elevation myocardial infarction (STEMI). Emergent angiography showed 95% stenosis at the ostium of the second septal branch, consistent with thrombus, and no other significant lesions. The lesion was not amenable to intervention due to small caliber. Post angiography, the patient's electrical rhythm deteriorated into ventricular fibrillation. Following resuscitation, repeat angiography confirmed same findings. Electrophysiology study at 3 months was positive for inducing fibrillation. Due to patient risk factors, she had placement of a dual chamber defibrillator. A 5-month follow-up echocardiogram showed a small area of ventricular septal wall bowing, consistent with blood supply from septal territory.
RESUMEN
Right and left heart failure are very common clinical syndromes with close correlation. Right-sided or right ventricular heart failure usually occurs as a result of left-sided failure. We report a very rare case of transition from right heart failure due to pulmonary embolism, followed by its resolution, to left heart failure due to Tako-tsubo syndrome within 48 h of hospitalization.
Asunto(s)
Insuficiencia Cardíaca/etiología , Embolia Pulmonar/complicaciones , Cardiomiopatía de Takotsubo/etiología , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico , Disfunción Ventricular DerechaRESUMEN
Floating right heart thrombus, also known as "emboli in transit" is a potentially fatal condition, of varying etiology and usually coexisting with massive pulmonary embolism. Although the mortality rate is as high as 40%, there are no established therapeutic guidelines. A case is presented of an 84 year old female with a history of colon cancer and coronary artery disease who presented with sudden onset unresponsiveness. She was intubated in the ED and started on intravenous pressor support. A free floating large right ventricular thrombus and dilated right ventricle were noted on transthoracic echocardiogram (TTE). She was managed medically with good short term outcome. Floating right heart thrombus is a rare occurrence. Recognition of signs and symptoms along with early TTE is critical for diagnosis and consideration of treatment modality. The existing literature does not offer a clear consensus for management of pulmonary embolism with co-existing mobile intra-cardiac thrombus. Choice of treatment is crucial and should be considered on a case-by-case basis after careful assessment of indications, contraindications, risks and benefits.
Asunto(s)
Cardiopatías/tratamiento farmacológico , Terapia Trombolítica , Trombosis/tratamiento farmacológico , Anciano de 80 o más Años , Ecocardiografía , Femenino , Cardiopatías/diagnóstico por imagen , Cardiopatías/cirugía , Humanos , Trombosis/diagnóstico por imagen , Trombosis/cirugíaRESUMEN
Isolated noncompaction of the left ventricle is a congenital cardiomyopathy, which has been described recently, with literature limited to case reports and case series. Even though various complications have been reported with noncompaction cardiomyopathy, among them severe mitral regurgitation has been reported recently in a few cases. There is no great evidence in the literature about its management, apart from some cases of mitral valve repair and replacement in young patients. We are reporting a case of an elderly lady with isolated left ventricular noncompaction cardiomyopathy associated with severe mitral regurgitation treated with mitral valve replacement with one and half year of follow up demonstrating significant myocardial recovery.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas/métodos , No Compactación Aislada del Miocardio Ventricular/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Anciano , Femenino , Humanos , EsternotomíaRESUMEN
Isolated noncompaction of the ventricular myocardium has often been misdiagnosed as other cardiomyopathies because it is a relatively recently described cardiomyopathy with literature limited to case reports and case series and little awareness among physicians. We are reporting a case of isolated left ventricular noncompaction cardiomyopathy that was misdiagnosed for over two decades.