Mariana Vasconcelos

Short and Long-Term Outcome of Stress-Induced Cardiomyopathy: What Can We Expect?

Background Stress-induced/Takotsubo cardiomyopathy (TC) is an increasingly recognized diagnostic entity. Objective This study was aimed to assess the prevalence and clinical predictors of short and long-term outcome of patients (pts) diagnosed with TC. Methods We included all consecutive pts admitted in our department, from November 2006 to August 2011, who met the Mayo Clinic criteria for TC diagnosis. Results We evaluated 37 pts (35 women) with a mean age of 63 ±13 years. TC was precipitated by a stressful emotional event in the majority (57%) and chest pain was the most common symptom (89%). Twelve pts (32%) had ST-segment elevation and 15 pts (41%) had T-wave inversion on the electrocardiogram at admission. Severe left ventricular (LV) dysfunction was found in 16 pts (43%) and the mean troponin I level was 2.6±1.8 ng/mL. The in-hospital complication rate was 30%, with cardiogenic shock being the most common situation. Physical stress, severe LV systolic dysfunction and peak brain natriuretic peptide (BNP) were predictors of acute complications. On the other hand, we found no association between peak troponin I and electrocardiographic presentation. Thirty-five pts were followed for a mean time of 482 ± 512 days, without clinic recurrence. Conclusion In our cohort of pts, TC was associated with a high in-hospital complications rate. Physical stress, LV dysfunction and peak BNP could predict acute adverse outcomes.

Multicavitated left atrial myxoma with dual coronary supply

Mailing address: Mariana Couto Vasconcelos • Serviço de Cardiologia do Hospital São João Alameda Professor Hernani Monteiro, 4200/319 Porto Portugal E-mail: marvasmed@hotmail.com Manuscript received April 22, 2007; revised manuscript received May 15, 2007; accepted May 15, 2007.

Percutaneous Closure of a Fistulous Giant Coronary Aneurysm

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.

Arrhythmic storm: Short-coupled variant torsade de pointes.

A 49-year-old woman, with no relevant family history, was admitted in 1996 for arrhythmic storm with polymorphic ventricular tachycardia (torsade de pointes) which degenerated into ventricular fibrillation. Iatrogenic causes were excluded, the electrocardiogram (ECG) was normal and there was no structural heart disease. She refused cardioverter-defibrillator implantation. Treatment was begun with amiodarone, which she took irregularly. She remained asymptomatic until 2014 when she was admitted for a new arrhythmic storm with torsade de pointes, refractory to antiarrhythmic therapy and aggravated by ventricular pacing (65 defibrillations). She had frequent ventricular extrasystoles (with short-coupled period <300 ms) preceding the tachycardia. After administration of isoprenaline infusion electric stability was maintained. In this setting and in the absence of structural heart disease or iatrogenic cause, a diagnosis of short-coupled variant torsade de pointes was established. A cardioverter-defibrillator was implanted and she was treated with verapamil, without recurrence of arrhythmias.

Case reportStress-induced cardiomyopathy associated with ipratropium bromide therapy in a patient with chronic obstructive pulmonary diseaseCardiomiopatia associada ao stress após terapêutica com brometo de ipratrópio em doente com doença pulmonar obstrutiva crónica

Stress-induced cardiomyopathy, also known as ‘broken heart syndrome’ or Takotsubo cardiomyopathy, is characterized by transient systolic dysfunction of the apical and/or mid segments of the left ventricle, in the absence of significant coronary artery disease. We report the case of a 56-year-old male patient with chronic obstructive pulmonary disease (COPD), with stress-induced cardiomyopathy associated with the use of ipratropium bromide, administered in the context of an acute exacerbation of COPD.

The lost needle of a seamstress

A 61-year-old seamstress with hypertension, dyslipidemia and diabetes was referred to our hospital for chest pain and a positive exercise test. The ECG and transthoracic echocardiogram were normal. Coronary angiography revealed 60% stenosis in the proximal right coronary artery and 70% stenosis in the posterolateral branch (Figure 1A). A sewing needle was detected in the left hemithorax (Figure 1B and C). Further investigation by thoracic computed tomography (CT) confirmed the location of the needle in the apical segment of the left inferior lobe (Figure 1D and E). When questioned, she mentioned an

A agulha perdida de uma costureira

A 61-year-old seamstress with hypertension, dyslipidemia and diabetes was referred to our hospital for chest pain and a positive exercise test. The ECG and transthoracic echocardiogram were normal. Coronary angiography revealed 60% stenosis in the proximal right coronary artery and 70% stenosis in the posterolateral branch (Figure 1A). A sewing needle was detected in the left hemithorax (Figure 1B and C). Further investigation by thoracic computed tomography (CT) confirmed the location of the needle in the apical segment of the left inferior lobe (Figure 1D and E). When questioned, she mentioned an

Added value of cardiac magnetic resonance in a case of multiple congenital abnormalities

Sub-infundibular stenosis is a rare form of congenital heart disease, difficult to precisely diagnose, especially in adult patients. We report a case of an adult patient, referred to our hospital with long-standing dyspnea on exertion. She was finally diagnosed with sub-infundibular stenosis. During cardiovascular magnetic resonance imaging, right-sided aortic arch and left pulmonary artery agenesis were also identified. <Learning objective: The case described illustrates that cardiovascular magnetic resonance study is a powerful imaging technique in the congenital heart disease population, especially in the setting of multiple congenital abnormalities.>.

Atypical Clinical Presentation of Arrhythmogenic Biventricular Cardiomyopathy

. However, the clinical manifestations and prognosis of biventricular arrhythmogenic cardiomyopathy not yet been established. We present a case of ARVC with left ventricle (LV) involvement, with no typical symptoms and no relevant medical history.

Shock and anterior myocardial infarction: Beyond the initial clinical evidence

Cardiogenic shock is a state of inadequate tissue perfusion due to cardiac dysfunction, most commonly caused by acute myocardial infarction. Mortality rates for patients with cardiogenic shock remain frustratingly high, ranging from 50% to 80%. This high mortality can be counteracted by urgent revascularization and these patients benefit from a prompt invasive procedure. We present an unusual case of a patient admitted for an acute anterior infarction and presumable subsequent cardiogenic shock. The urgent coronary angiography revealed an acute stent thrombosis in the anterior descending coronary artery, but the aortography showed that the original cause of shock was actually an abdominal aneurysm rupture. The stent thrombosis and acute anterior infarction were in fact a complication of a hypoperfusion state due to hypovolemic shock.