scholarly journals Intramyocardial dissecting haematoma mimicking left ventricular clot, a rare complication of myocardial infarction: a case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Tjen Jhung Lee ◽  
Aslannif Roslan ◽  
Khai Chih Teh ◽  
Azmee Ghazi
Keyword(s):  
Myocardial Infarction ◽  
Case Reports ◽  
Rare Complication ◽  
Case Series ◽  
Left Ventricular ◽  
Pump Failure ◽  
Case Summary ◽  
Risk Of Mortality ◽  
Endocardial Layer ◽  
Supportive Management

Abstract Background Intramyocardial dissecting haematoma is a rare complication of myocardial infarction (MI) associated with high mortality rates. Studies and research of this occurrence are limited largely to isolated case reports or case series. Case summary We report a case of late presenting MI, where on initial echocardiogram had what was thought to be an intraventricular clot. However, upon further evaluation, the patient actually had an intramyocardial haematoma, with the supporting echocardiographic features to distinguish it from typical left ventricular (LV) clot. While this prevented the patient from receiving otherwise unnecessary anticoagulation, this diagnosis also put him at a much higher risk of mortality. Despite exhaustive medical and supportive management, death as consequence of pump failure occurred after 2 weeks. Discussion This report highlights the features seen on echocardiography which support the diagnosis of an intramyocardial haematoma rather than an LV clot, notably the various acoustic densities, a well visualized myocardial dissecting tear leading into a neocavity filled with blood, and an independent endocardial layer seen above the haematoma. Based on this report, we wish to highlight the importance of differentiating intramyocardial haematomas from intraventricular clots in patients with recent MI.

scholarly journals Computed tomography assessment of saw-tooth cardiomyopathy: a case series

2021 ◽  
Author(s):  
Joaquin Berarducci ◽  
Javier Ivan Armenta-Moreno ◽  
Nilda Espinola-Zavaleta ◽  
Roberto Cano-Zarate ◽  
Ana-Valentina Gutiérrez-Solana-Ossa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Cardiac Ct ◽  
Case Reports ◽  
Case Series ◽  
Left Ventricular ◽  
Shortness Of Breath ◽  
Imaging Studies ◽  
History Of ◽  
Unusual Type

Abstract Background Saw tooth cardiomyopathy (STC) is an unusual type of left ventricular dysplasia. To our knowledge, six cases have been reported in the literature. Two new cases are presented with a review of all the case reports that have been published. Case summaries Two patients with STC were examined. The first one was a 69-year-old woman with shortness of breath on mild exertion and chest pain, and the second was a 49-year-old man with a history of myocardial infarction who required stent implantation and is now asymptomatic. Both patients revealed findings of STC in the cardiac CT. Discussion When analyzing the cases and comparing them to the ones reported in literature; STC is a generally benign heart disease, although the clinical spectrum can range from asymptomatic to heart failure. Imaging studies such as CMR and cardiac CT are essential for the diagnosis.

Left Ventricular Pseudoaneurysm as a Complication of Myocardial Infarction; A Case Series and Review of the Literature

2021 ◽  
Author(s):  
Haleh Ashraf ◽  
Azadeh Sadatnaseri ◽  
Arya Aminorroaya ◽  
Zahra Kuhi ◽  
Nadia Zandi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Rare Complication ◽  
Case Series ◽  
Left Ventricular ◽  
Left Ventricular Pseudoaneurysm ◽  
Parietal Pericardium ◽  
Cardiac Evaluation ◽  
Post Operation ◽  
History Of ◽  
Lost To Follow Up

Introduction: Pseudoaneurysm may occur as a rare complication of myocardial infarction (MI) when a hemorrhagic process is covered by adherence of the visceral or parietal pericardium or of both, preventing the formation of cardiac tamponade. Pseudoaneurysm is prone to rupture because they are not easy to diagnose. Case presentation: Here, we report three cases of left ventricular pseudo-aneurysm (LVP) that all were related to MI. Two patients were managed conservatively, one of them was lost to follow-up, and the other one expired one month later. One patient underwent surgery, but he expired during post-operation period. Conclusions: High mortality rate of LVP emphasizes the importance of looking for it in cardiac evaluation of patients with history of MI. Due to available non-invasive modalities, the ability to differentiate LVP from other cardiac pathologies is improving. Still, the most recommended management of LVP is early surgery.

scholarly journals Rapid resolution of left ventricular thrombus with apixaban therapy

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774521 ◽  
Author(s):  
Abeer Berry ◽  
Daniel Brancheau ◽  
Marcel Zughaib
Keyword(s):  
Myocardial Infarction ◽  
Case Reports ◽  
Oral Anticoagulants ◽  
Case Series ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Male Physician ◽  
Rapid Resolution ◽  
Ventricular Thrombus

It is a common medical practice to anticoagulate an asymptomatic left ventricular mural thrombus following an ST-elevation myocardial infarction using a vitamin K antagonist. Novel oral anticoagulants have not been studied extensively in this context, and therefore, no recommendations have been made for their use. A 67-year-old male physician with no significant medical history presented to the cardiology clinic complaining of shortness of breath that had been gradually worsening over a 2-week period and was found to have an anterior wall myocardial infarction with apical left ventricular thrombus that was treated with apixaban. We present a case of rapid resolution of left ventricular thrombus with the use of apixaban for anticoagulation. Although there are no guideline recommendations for this use, there have been case series and case reports that have shown safety and efficacy. Apixaban can be used for rapid resolution of left ventricular thrombus treatment.

Intra-Cardiac Thrombus in COVID-19 pandemic – Case Series and Review

2020 ◽  
Author(s):  
Kartik Pandurang Jadhav ◽  
Pankaj Jariwala
Keyword(s):  
Myocardial Infarction ◽  
Thrombus Formation ◽  
Case Series ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Systemic Thrombolysis ◽  
Cardiac Thrombus ◽  
Exact Etiology ◽  
St Elevation

ABSTRACT Various publications have increasingly reported the development of the prothrombotic state and its consequences associated with coronavirus disease 2019 (COVID-19). Although the exact etiology is uncertain, various factors collectively increase the risk of thrombus formation in COVID-19 patients. We present a case series of four patients with left ventricular (LV) thrombus formation along with simultaneous COVID-19 infection. All these patients had acute myocardial infarction with left ventricular ejection fraction (LVEF) between 35-45%. Among the series, two patients had favourable outcomes with complete resolution of LV thrombus, whereas the other two suffered cerebral embolization followed by mortality. This study looks in depth at all cases of intracardiac thrombi formation in patients with COVID-19 published worldwide. n addition to the increased predisposition for venous/ arterial thrombosis, even a few cases of intra- cardiac thrombus have been reported. Systemic thrombolysis is an initial treatment of choice for the management of right cardiac thrombi with pulmonary thromboembolism (PTE) and ST-elevation myocardial infarction (STEMI) in COVID-19. Right cardiac thrombi have better outcomes when compared to left cardiac thrombi.

scholarly journals Who ′Nose′, is it the ARNi?: A Case Series of Persistent Nasal Pruritus in Heart Failure Patients receiving Sacubitril/Valsartan

2021 ◽  
Author(s):  
Jaclyn Gan ◽  
Haunnah Rheault ◽  
Yee Weng Wong
Keyword(s):  
Heart Failure ◽  
Adverse Effect ◽  
Product Information ◽  
Case Series ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Mortality And Morbidity ◽  
Case Summary

Abstract Background Sacubitril/valsartan is approved for the treatment of chronic heart failure with reduced left ventricular ejection fraction (HFrEF) of less than or equal to 40% to decrease mortality and morbidity. Nasal pruritus is not a recognised adverse effect in the product information. In this case series, we encountered three patients presented with nasal pruritus that improved after discontinuation of sacubitril/valsartan. Case Summary Three patients aged 58-73 years-old presented with pruritus at the nasal septum post-initiation of sacubitril/valsartan. The pruritus did not subside despite the use of anti-histamines. Within 3-6 months, all individuals discontinued sacubitril/valsartan with complete resolution of their nasal pruritus. Discussion Many physicians may not aware of this unusual but reversible adverse effect of sacubitril/valsartan. Despite the positive prognostic value of sacubitril/valsartan, the constant nasal pruritus had impacted the quality of life of our patients, leading them to discontinue sacubitril/valsartan permanently.

scholarly journals Unmasking of Neurosarcoidosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A618-A618
Author(s):  
Sharini Venugopal ◽  
Binita Neupane ◽  
Mahesh Nepal ◽  
Luis F Chavez
Keyword(s):  
Diabetes Insipidus ◽  
Medical History ◽  
Case Reports ◽  
Rare Complication ◽  
Case Series ◽  
Primary Hypothyroidism ◽  
Past Medical History ◽  
Water Excretion ◽  
History Of ◽  
Glucocorticoid Deficiency

Abstract Introduction: Central diabetes insipidus is a rare complication of neurosarcoidosis. In patients with concomitant adrenal insufficiency (AI), the symptoms of Diabetes Insipidus (DI) can be masked. Case: A 55-year-old female with past medical history of sarcoidosis presented to the hospital with hematemesis, nausea and dizziness. She has a past medical history of cardiac sarcoidosis that was revealed on a PET scan done before 10 years for which she was being treated with methotrexate and prednisone. She was off prednisone for a year prior to hospitalization. She underwent an upper endoscopy that showed diffusely erythematous gastric mucosa in the antrum. She was also hypotensive on admission, and she received packed red blood transfusions after which her sodium increased from 145mmol/L to 165mmol/L (Normal: 135-145mmol/L) in 48 hours. Further workup revealed persistent hypernatremia and urine osmolality was 75mOsm/kg H2O. (Normal: 50-1200mOsm/kg H2O). She was also hypoglycemic and hypotensive requiring multiple fluid boluses throughout her hospitalization. This prompted us to perform a random cortisol that came back at 2.1ug/dl (Normal: 3-23ug/dl) and 1.8ug/dl on two occasions. Cortisol Stimulation test was subsequently ordered, but was done only at 30 minutes, and Cortisol increased from 1.8ug/dl to 6.3ug/dl. Free thyroxine was 0.5 ng/dl (Normal: 0.9-1.8 ng/dl) and her TSH was 7.58uIU/ml (Normal: 0.55-4.78uIU/ml). MRI of the brain revealed extensive areas of extra-axial supra-sellar/infundibular nodular homogeneous intense enhancement that is most consistent with neuro-sarcoid. She was started on prednisone 40 mg daily, Desmopressin 0.05 mg twice daily, and levothyroxine as well. Her sodium level normalized and was 137mmol/L at discharge. She followed up later with outpatient Endocrinology and reported around 90lbs weight gain and no more episodes of nausea or vomiting or epistaxis or lightheadedness. Conclusion: The involvement of the hypothalamic-pituitary axis in sarcoidosis is extremely rare and attributes to < 1% of patients with a sellar mass. Small case series have shown that hypogonadism is the most common endocrine abnormality followed by DI. Our patient had a long-standing history of sarcoidosis with her pituitary dysfunction unmasked only on admission for other causes. She did not manifest any symptoms of DI or AI. There have been case reports where the symptoms of DI are masked due to underlying glucocorticoid deficiency. There have been theories that glucocorticoid deficiency impairs renal water excretion by both ADH (Anti-diuretic hormone) dependent and ADH independent pathways. Another notable feature in our case is that our patient presented with primary hypothyroidism. In fact, sarcoidosis has been commonly implicated in auto-immune polyglandular syndromes type 3, which can present with auto-immune thyroiditis more so in females.

scholarly journals Maternal Collapse during Caesarean Section: Two Case Reports

2016 ◽  
Vol 11 (1) ◽  
pp. 65-67
Author(s):  
Ritu Pradhan ◽  
Tara Gurung ◽  
Sangeeta Shrestha ◽  
Ujjwol Basnet ◽  
Kiran R Sharma ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Caesarean Section ◽  
Blood Transfusion ◽  
Case Reports ◽  
Rare Complication ◽  
Case Series ◽  
Massive Blood Transfusion ◽  
Obstetric Haemorrhage ◽  
The World

Obstetric haemorrhage is the leading cause of maternal collapse in our part of the world. That can result in cardiac arrest. Cardiac arrest during caesarean section is a rare complication which is challenging to both the anaesthesiologists and the obstetricians. Here we are reporting two case series of cardiac arrest during caesarean section following delivery of baby due to haemorrhage. Both the cases revived after prompt and active resuscitation followed by massive blood transfusion.

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