scholarly journals P704 Mechanical complications of acute myocardial infarction in the era of early reperfusion therapy: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Proenca ◽  
R Alves Pinto ◽  
M Martins Carvalho ◽  
A Nunes ◽  
P M Araujo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
Mechanical Complication ◽  
Heart Team ◽  
Inferior Wall ◽  
Early Reperfusion ◽  
Mechanical Complications ◽  
Biventricular Function ◽  
Risk Of Rupture

Abstract Introduction Left ventricular pseudoaneurysm is a rare mechanical complication of myocardial infarction, and its incidence has decreased with the widespread use of reperfusion therapies. Pseudoaneurysm is the result of a free wall rupture contained by pericardial adherences and mural thrombi, which contain the bleeding and prevent cardiac tamponade. Clinical Presentation A 68-year-old woman who had hypertension, diabetes mellitus and chronic kidney disease (caused by diabetic nephropathy) was first admitted with acute myocardial infarction of the inferior wall. Emergent coronary angiography revealed proximal occlusion of the right coronary artery. Primary angioplasty was performed with three stents implantation. However due to transitory no reflow, verapamil, nitrate and intracoronary abciximab were administered with recovery of coronary flow. Patient remained stable, without recurrence of symptoms. Echocardiography, at discharge, showed normal biventricular function and no mechanical complications. Two months later, the patient was readmitted in the emergency room with constant chest pain, fatigue, prostration and loss of appetite beginning ten days earlier and an episode of syncope. Physical examination revealed fever, cardiac auscultation was rhythmic and without murmurs or pericardial friction rub, and pulmonary auscultation revealed crackles in inferior hemithorax. 12-lead electrocardiogram showed sinus rhythm, Q waves and negative T waves in inferior leads. Blood tests revealed leucocytosis, high sensibility troponin I was 28,8 ng/L and brain natriuretic peptide was 264,9 pg/mL. Chest-X-ray demonstrated enlargement of the cardiac silhouette and echocardiography showed moderate to large pericardial effusion with large amounts of fibrin close to right cardiac chambers and a basal inferior pseudoaneurysm with 23 mm x 24 mm; intracavitary contrast was administered without opacification of pericardial space; biventricular function remained normal. Patient was promptly admitted on Cardiac Intensive Care Unit with diagnosis of pseudoaneurysm due to myocardial infarction. Therapeutic with ticagrelor was suspended and surgical correction was proposed, after discussion in Heart Team. False aneurysm correction was performed with a bovine pericardial patch without complications, and the patient was discharged asymptomatic eight days later. Conclusion Even with lower incidence, pseudoaneurysms remains as a potential life-threatening due to its high risk of rupture. Prompt diagnosis, usually with echocardiography and surgical referral are crucial. Abstract P704 Figure. Inferior Pseudoaneurysm

scholarly journals Conservative Management of Subacute Contained Left Ventricular Rupture after Acute Myocardial Infarction

2018 ◽  
Vol 03 (01) ◽  
pp. 034-038
Author(s):  
Bharat Goud C ◽  
Johann Christopher
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Color Doppler ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Mechanical Complication ◽  
Inferior Wall ◽  
Early Reperfusion ◽  
St Segment Elevation ◽  
Myocardial Wall

AbstractLeft ventricular free wall rupture (LVFWR) is a near-fatal mechanical complication of acute myocardial infarction in which an early diagnosis and emergency surgery should be of utmost priority for successful treatment. LVFWR is generally perceived to be universally fatal. Majority of LVFWR patients developing cardiac tamponade die rapidly, while in minority of cases the development of tamponade may be sufficiently slow to allow for diagnosis and successful intervention. In this article, the authors report a case of a 63-year-old male patient diagnosed with an inferoposterior wall myocardial infarction treated with early reperfusion thrombolytic therapy presenting 3 days later with diagnosis of subacute LVFWR. Patient had a history of relapse of chest pain which was severe and prolonged with 2 to 3 mm saddle-shaped ST-segment elevation in lateral leads, detected on a routine electrocardiogram, which led to an urgent bedside transthoracic echocardiogram (TTE). TTE showed regional wall motion abnormality in form of akinetic basal inferior-wall, a small echodense pericardial effusion, and a canalicular tract from endocardium to pericardium, through which color-Doppler examination suggested blood crossing the myocardial wall. A cardiac magnetic resonance imaging further reinforced the possibility of contained LVFWR.

scholarly journals P262 Left ventricular pseudoaneurism due to a non-reperfused myocardial infarction: multi-modality cardiac imaging approach

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J A Fuentes Mendoza ◽  
O A Mondaca Garcia ◽  
N G Espinola Zavaleta
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Left Ventricular ◽  
Medical Attention ◽  
Inferior Wall ◽  
Risk Of Rupture ◽  
The Right

Abstract Introduction Cardiac rupture has been one of the most frequent fatal complications of acute myocardial infarction in cases series reported since 1977. However, in exceptional cases, the rupture of the left ventricle is contained by the pericardium and by fibrous tissue, forming a pseudoaneurysm, which is characterized by the absence of myocardial tissue in its wall and a relatively narrow neck between the ventricle and the ventricular chamber. Although there is no estimated time for rupture, it is well established that the risk of rupture is 30 to 40% and mortality up to 10%. Pseudoaneurysm is a rarer entity than rupture and is usually diagnosed incidentally by imaging methods in up to 48% of cases. The most frequent imaging method for their diagnosis is 2D echocardiography, followed by cardiac catheterization and finally cardiac magnetic resonance. The most frequent location of the pseudoaneurysm secondary to acute myocardial infarction is the inferior wall and the posterolateral wall of the left ventricle. Case Report We present 72-year-old male patient with a history of type 2 diabetes and smoking, who started symptoms with sudden onset of oppressive chest pain of 20 minutes duration, he did not attend medical attention. A month later, he went for a valuation with a first-contact physician, who referred him to our institution with a diagnosis of acute myocardial infarction without reperfusion therapy. At the initial assessment, it was found asymptomatic, in the resting ECG was found QS pattern with reversal of the T wave in leads DII, DIII and AVF. Cardiac SPECT was performed and showed an inferior transmural infarction, which extended as non-transmural to the inferolateral and inferoseptal walls, without ischemia. (Img. 1 and 2). A 2D and 3D transthoracic echocardiogram was performed, in which akinesia of the inferoseptal and apical walls was documented, as well as a saccular pseudoaneurysm of 5.6 X 4.7 cm in the basal and middle segment of the inferior and inferolateral walls, with an entrance orifice. 2.6 X 2.4 cm, as well as pericardial effusion. (Fig. 3 and 4). Coronary angiography was performed, demonstrating chronic total occlusion of the right coronary in its proximal segment and ostial obstruction of the left anterior descending. Cardiac magnetic resonance revealed inferior infarction and the presence of a pseudoaneurysm with lamellar thrombus was corroborated. (Img. 5). The patient was taken to surgical treatment, by reconstruction of the left ventricle with the Dor technique and CABG of the right coronary artery and the anterior descending artery. Receives medical treatment and a 1-month follow-up is in class I of the NYHA. Conclusion It is a clinical case about a potentially fatal complication of acute myocardial infarction, which in our case was detected incidentally since the patient had remained asymptomatic, there lies the importance of obtaining an accurate diagnosis in order to impact on the patient survival. Abstract P262 Figure. Pseudoaneurysm multi-modality images

scholarly journals Left Ventricular and adjacent Right ventricular Pseudoaneurysms post acute myocardial infarction communicating via a Ventricular Septal Defect

2020 ◽  
Author(s):  
Kevin Kang ◽  
John Wilson ◽  
Jeffrey Friedel ◽  
Angel Flores
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Color Doppler ◽  
Fatal Outcome ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Papillary Muscle Rupture ◽  
Mechanical Complications ◽  
Muscle Rupture ◽  
Echocardiographic Images

The rare but deadly post myocardial infarction (MI) mechanical complications are categorized as ventricular free wall rupture, ventricular septal rupture (VSD) and papillary muscle rupture in decreasing order of incidence. The incidence of the mechanical complications has been mitigated by early revascularization in recent years but mortality remains high. The cardiac rupture if contained by clot, scar and pericardium leads to a LV pseudoaneurysm that delays or diminishes the fatal outcome. Mechanical complications and pseudoaneurysm are recognized by echocardiography. We report a previously unreported occurrence of a pseudoaneurysm involving the adjacent walls of both the ventricles, LV basal and inferoseptal walls and the adjacent right ventricular inferior wall (RV). The LV and RV communicated via a hole in the pseudoaneurysmal wall. The echocardiographic images initially showed the LV pseudoaneurysm bulging into the RV rather than into the pericardium. The color Doppler showed shunting through the LV pseudoaneurysm into the RV creating an unusual VSD. The CT angiograms corroborated the echo findings. The LV pseudoaneurysm had a tear in it and this led to bleeding not into pericardium but into the adjacent RV pseudoaneurysm, hence creating a very unusual VSD. Subsequently, our patient went for surgical repair of pseudoaneurysm and the surgical findings confirmed the imaging findings that there was a massive LV pseudoaneurysm from the inferior and inferoseptal walls, the adjacent RV wall was involved with the pseudoaneurysm and a communication between LV pseudoaneuysm sac and the RV was seen. Such pathology has not been described in the past.

scholarly journals Ventricular Septal Rupture following Anterior Acute Myocardial Infarction: A Challenge to a Sub-District Physician

2021 ◽  
Vol 7 (1) ◽  
pp. 48-53
Author(s):  
Aditya Doni Pradana ◽  
Jarot Widodo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Rare Complication ◽  
Hemodynamic Instability ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Anterior Myocardial Infarction ◽  
Mortality And Morbidity ◽  
Mechanical Complications ◽  
Resource Setting

Background: Ventricular septal rupture (VSR) is one of the most serious mechanical complications following acute myocardial infarction (AMI). Although a rare complication, it is associated with significant mortality and morbidity. The purpose of this report was to present a case of VSR following anterior AMI in our hospital. Case Description: A 54-year old Javanese male presented persistent episode of breathlessness and lower limb swelling for the last two days with prior chest pain 7 days ago. Physical examination revealed a grade 3/6 holosystolic murmer loudest over the apex, S3 gallop, rales bibasally of the lung. Electrocardiographic evidence revealed for a recent anterior myocardial infarction. Chest X-Ray showed a cardiomegaly and pulmonary congestion. Transthoracic echocardiography revealed VSR at mid-anteroseptal with estimated length of 8-10 mm, preserved LVEF 51% with mid-apicoseptal akinesis. Multiple readmissions were noted for this patient in the follow-up with worsened conditions. Discussion: This is a challenging case report since our hospital is an incapable cath-lab sub-district hospital and far from PCI-capable center. It is critical that all patients with AMI have a brief evaluation for mechanical complications such as VSR. All patients who developed hemodynamic instability during AMI should be comprehensively examined for the murmur and any other heart sound that may provide valuable information. Conclusion: Every clinician especially in the low-resource setting should be aware of this potentially fatal mechanical complication as the mortality remains significantly high. Early prompt diagnosis and treatment is the key of achieving an optimal outcome.

scholarly journals Plasma Brain Natriuretic Peptide (BNP) as an Indicator of Left Ventricular Function, Early Outcome and Mechanical Complications after Acute Myocardial Infarction

2011 ◽  
Vol 5 ◽  
pp. CMC.S7189 ◽  
Author(s):  
A. Fazlinezhad ◽  
M. Khadem Rezaeian ◽  
H. Yousefzadeh ◽  
K. Ghaffarzadegan ◽  
M. Khajedaluee
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Natriuretic Peptide ◽  
Significant Relationship ◽  
Left Ventricular ◽  
Control Group ◽  
Cross Sectional ◽  
Mechanical Complications

Aims This study investigated the prognostic value of B type natriuretic peptide (BNP) in acute myocardial infarction (AMI) patients and its relation with left ventricular function and post-myocardial infarction complications. Methods In this cross-sectional study, plasma BNP level was measured for 42 consecutive patients (mean ± SD: 61.6 ± 10.85 years old) with acute ST elevation myocardial infarction (MI) and 42 healthy, age and gender matched subjects. Result BNP level in AMI patients were significantly higher than control group (@ P < 0.001). Regarding to infarct location, the highest BNP level measured in inferoposterior MI (BNP = 4436.63 ± 6188.159 pg/ml) and the lowest one indicated in standalone inferior MI (BNP = 598.83 ± 309.867 pg/ml ( P = 0.071). There was significant reverse relation between BNP and EF ( P = 0.006, OR = −0.47) and a significant relationship between BNP and killip classification ( P = 0.036). There was no significant relation between diastolic and right-ventricular function and BNP level ( P = 0.61, P = 0.21). The highest BNP level was detected in LV septal rupture and false aneurysm ( P = 0.02) and in ventricular tachycardia, but without significant relationship ( P = 0.25). Conclusion After the onset of AMI, BNP blood level can be used as an important predictor for left ventricular dysfunction, killip classification, early mechanical complications and cardiac death.

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