Catarina Gomes

Intramyocardial dissecting haematoma: a rare complication of acute myocardial infarction

Intramyocardial dissecting haematoma (IDH) is a rare complication of myocardial infarction, with very scarce reports in medical literature. Before the advent of non-invasive imaging techniques, the diagnosis of IDH was only made by necropsy. It can develop in the left ventricular free wall, the right ventricle, or the interventricular septum. We present a case of a patient with an IDH after acute anterolateral myocardial infarction, focusing on the utility of echocardiography in the diagnosis and follow-up of this unusual complication. By this imaging modality, it was possible to see the various acoustic densities of the progressive clotting of the intramyocardial haematoma, its extension through the haemorrhagic dissection, as well as its independency in relation to ventricular cavities and extracardiac space by confirming intact epicardial and endocardial layers. Based on this report, we believe that serial two-dimensional echocardiography, added, when necessary, by the use of contrast agents is the non-invasive method ideally suited to confirm the diagnosis and monitor its evolution at the patients bedside.

Stunned Myocardium following Ischemic Stroke

Neuromediated stunned myocardium is a well-known complication of subarachnoid hemorrhage but has rarely been reported in association with other central nervous system disorders. The pathophysiology of this entity remains unclear, but a catecholamine-induced neurocardiogenic injury has been proposed as a causal factor. Typically, patients have rapid full cardiovascular recovery within a few days. We report a case of ischemic stroke, coexisting with ischemic electrocardiographic changes, increased cardiac-specific necrosis biomarkers, regional wall motion abnormalities and a cardiac SPECT consistent with inferior myocardial infarction despite normal coronary arteries. Interestingly, left-ventricular dysfunction in this case persisted longer than usually described despite full neurologic recovery. This case also illustrates the diagnostic challenges posed by this entity which frequently mimics acute myocardial infarction and emphasizes the investigation needed in this area.

Hyponatremia – an unusual trigger of Takotsubo cardiomyopathy

Takotsubo cardiomyopathy is an acute cardiac entity with clinical manifestations similar to myocardial infarction, accounting for 1-2% of acute coronary syndrome admissions. Its underlying pathophysiology is not yet well established. It is usually associated with acute physical or emotional stress, but the list of potential triggers has grown as the condition attracts the attention of the medical community. In order to diagnose the condition correctly and to gain new insights into it, we need to know its potential triggers as well as its clinical presentation and diagnostic criteria. We report a case of takotsubo cardiomyopathy triggered by hyponatremia.

Giant Left Ventricular Pseudoaneurysm as a Late Complication of Myocardial Infarction

We present a case of a 63-year-old patient referred to a cardiology consultation due to progressive symptoms of heart failure. He had a history of an inferior ST elevation acute myocardial infarction 6 years ago. Echocardiogram revealed a giant left ventricular aneurysm/pseudoaneurysm involving the inferior and inferolateral left ventricular walls, with a massive mural thrombus. Additional characterization was done by cardiac magnetic resonance, essential in establishing the diagnosis of pseudoaneurysm and to guide subsequent management. In this case, we discuss the differential diagnosis between aneurysm and pseudoaneurysm and highlight the role of non-invasive multimodality imaging.

Partial Papillary Muscle Rupture after Myocardial Infarction and Early Severe Obstructive Bioprosthetic Valve Thrombosis: an Unusual Combination

Mailing Address: Inês Silveira • Largo Prof. Abel Salazar, 4099-001 Porto Portugal E-mail: Ines.c.silveira@gmail.com Manuscript receivde December 02, 2017, revised manuscript April 04, 2018, accepted April 25, 2018

Origem anómala da coronária direita e enfarte agudo do miocárdio: causa ou coincidência?

Congenital coronary artery anomalies are one of the causes of myocardial ischemia and sudden death in the young, mainly during sports. Origin of the right coronary artery from the left anterior descending artery is very rare, with a prevalence of 0.015%, corresponding to 1.2% of all coronary artery anomalies. The authors present the case of a 22-year-old man, with a history of cocaine use, admitted to hospital with a non-ST elevation acute myocardial infarction. Coronary angiography revealed the presence of this rare coronary anomaly and the absence of atherosclerotic luminal stenosis, and so it was assumed to be a type II infarction caused by cocaine-induced vasospasm of the anomalous vessel.

The importance of multimodality cardiac imaging: Echocardiography and cardiovascular magnetic resonance imaging contributions to the diagnosis and management of a right ventricular mass

Cardiac metastases from testicular tumors are rare. We report a case of a 42-year-old man with a cardiac mass incidentally found in a computed tomography-scan included in the workup for lumbago and a suspicious neoformation in the right testicle. Transthoracic echocardiography showed a large multilobular ill-defined mass infiltrating the right ventricle free wall, protruding to, and partially obstructing the right ventricular outflow tract resulting in considerable outflow obstruction. Cardiac magnetic resonance imaging favored a malignant nature, which was confirmed by marked regression of the tumor mass with chemotherapy and anatomopathologic study.