scholarly journals Midventricular Hypertrophic Cardiomyopathy with Apical Aneurysm: Potential for Underdiagnosis and Value of Multimodality Imaging

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Archana Sivanandam ◽  
Karthik Ananthasubramaniam
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
African American Woman ◽  
Multimodality Imaging ◽  
American Woman ◽  
Implantable Defibrillator ◽  
Left Ventricular ◽  
Apical Region ◽  
St Segment Elevation ◽  
St Segment ◽  
Apical Aneurysm

We illustrate a case of midventricle obstructive HCM and apical aneurysm diagnosed with appropriate use of multimodality imaging. A 75-year-old African American woman presented with a 3-day history of chest pain and dyspnea with elevated troponins. Her electrocardiogram showed sinus rhythm, left atrial enlargement, left ventricular hypertrophy, prolonged QT, and occasional ectopy. After medical therapy optimization, she underwent coronary angiography for an initial diagnosis of non-ST segment elevation myocardial infarction. Her coronaries were unremarkable for significant disease but her left ventriculogram showed hyperdynamic contractility of the midportion of the ventricle along with a large dyskinetic aneurysmal apical sac. A subsequent transthoracic echocardiogram provided poor visualization of the apical region of the ventricle but contrast enhancement identified an aneurysmal pouch distal to the midventricular obstruction. To further clarify the diagnosis, cardiac magnetic resonance imaging with contrast was performed confirming the diagnosis of midventricular hypertrophic cardiomyopathy with apical aneurysm and fibrosis consistent with apical scar on delayed enhancement. The patient was medically treated and subsequently underwent elective implantable defibrillator placement in the ensuing months for recurrent nonsustained ventricular tachycardia and was initiated on prophylactic oral anticoagulation with warfarin for thromboembolic risk reduction.

Abstract 3268: Ethnic Differences in the 12 Lead -EKG - Relevance to the Cardiovascular Evaluation for Hypertrophic Cardiomyopathy in Athletes

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
John Rawlins ◽  
Michael Papadakis ◽  
Carey Edwards ◽  
Sandeep Basavarajaiah ◽  
Sanjay Sharma
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Black Athletes ◽  
St Segment Elevation ◽  
T Wave ◽  
St Segment ◽  
Phenotypic Features ◽  
Cardiovascular Evaluation

Introduction Cardiac adaptation to intense physical exercise is associated with physiological increases in cardiac dimensions that are reflected on the EKG. The EKG changes in Caucasian athletes (WA) are established, however, there is a paucity of data in black athletes (BA) who constitute an increasing proportion of elite athletes in Western countries. We sought to identify differences (if any) in EKG characteristics between BA and WA participating in similar sporting disciplines. Methods Between 2007– 8, 222 nationally ranked male BA aged 14 –35 and 496 WA of similar age, size and range of sporting disciplines underwent a EKG and standard 2-D echocardiography. All athletes with a left ventricular wall thickness > 12mm and deep T wave inversion (> −0.2 mV) underwent Holter monitor, exercise stress test, and cardiac MRI to exclude phenotypic features of hypertrophic cardiomyopathy (HCM). Results Black athletes had a greater prevalence of voltage criteria for left ventricular hypertrophy (LVH) (57% vs 42%; p < 0.005), ST segment elevation (76% vs 33%; p < 0.001) and T wave inversions (25% vs 4%; p < 0.001) compared with WA. ST segment elevation in all athletes was confined to the anterior precordial leads but 50% BA exhibited a unique convex ST segment elevation pattern that was absent in WA. There was no correlation between T wave inversions and LVH at echocardiography or cardiac MRI. Indeed none of the BA with T wave inversions displayed any phenotypic features of HCM. Conclusion Black athletes exhibit different adaptive responses to exercise than WA. Deep T wave inversions and convex ST segment elevation are common in BA, with or without LVH and may overlap with HCM. These results have significant implications during pre-participation screening. There is the potential risk of generating a false positive diagnosis of HCM and lead to unnecessary exclusion from competitive sport, if data derived from WA, used to identify an abnormal EKG, is incorrectly extrapolated to BA.

scholarly journals P1259 When it rains, it pours: Late presentation STEMI in a patient with intricate symptomatology due to concomitant acute pancreatitis and pneumonia

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Nicolae ◽  
R Aflorii ◽  
A C Popescu
Keyword(s):  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Left Ventricular Systolic Dysfunction ◽  
Multimodality Imaging ◽  
Late Presentation ◽  
Left Ventricular ◽  
Left Main ◽  
St Segment Elevation ◽  
St Segment ◽  
The Right

Abstract Background ST segment elevation acute myocardial infarction and acute pancreatitis are diagnostic and therapeutic emergencies. The concomitance of these two pathologies produces intricate and confusing symptoms leading to late presentation. Clinical Case Description- We present the case of a 62-year-old male patient, non-smoker, admitted in the emergency department for intense, continuous epigastric pain with posterior radiation and dyspnea, started four days before. On admission we found hemodynamic stability, lung crackles in the ½ inferior of the right lung, SaO2= 94% under 3l/min O2, normal cardiac sounds, HR 102/min, mitral systolic murmur, BP 145/80mmHg, abdominal pain on palpation. Lab tests revealed elevated cardiac troponin values and detection of a fall of cTn values in dynamics (hs-cTnI 30372ng/l, TnI 73ng/ml), but also high serum transaminases, amylase and lipase (1278 U/l), with high inflammatory markers, leukocytosis and neutrophilia. ECG showed sinus rhythm, QRS axis 0 degrees, ST segment elevation in V1-V4, ST segment depression DI, aVL, negative and biphasic T waves in V5-V6, DI, DII, aVL, Q wave in DIII, aVF and poor R wave progression V1-V4. Admission echocardiography revealed dilated left cavities with severe left ventricular systolic dysfunction (EF 20%), akinesia of the anterior and inferolateral walls, moderate mitral and tricuspid regurgitation, grade III diastolic dysfunction and possible pulmonary arterial hypertension. Coronary angiography revealed distal stenosis of the left main, involving the bifurcation, 80% ostial LAD stenosis, proximal LAD occlusion, 30% ostial LCX. PCI with DES of the proximal LAD, and left main–LDA junction with overlapping was performed successfully. Abdominal echography showed increased volume of the pancreas and significant decrease in echogenicity. Abdominal CT scan assessed inflammatory changes in pancreas and peripancreatic fat (grade C Balthazar score), superior mesenteric artery partial thrombosis and alveolar consolidation in the right lung. Echocardiography reassessment four days later revealed a fresh apical thrombus of the left ventricle. He received treatment with low molecular weight heparin, dual antiplatelet therapy statin, loop diuretic, aldosterone antagonist, digoxin, antibiotics and food restriction with gradual oral realimentation. He needed positive inotropic support for the first 4 days from a total of 28 days of hospitalization. Conclusions ECG changes and prothrombotic status can occur in patients with acute pancreatitis. The diagnosis and management of STEMI concomitant with acute pancreatitis can be challenging. The multimodality imaging and interdisciplinary approach individualized to the patient’s clinical situation is important, especially when having safety concerns about the revascularization therapy, antiplatelet and anticoagulant therapy. Abstract P1259 Figure.

scholarly journals Rapid Fire Abstract session: multimodality imaging of ischaemic heart disease928Regional left ventricular longitudinal function and myocardial blood flow929The influence of plaque burden, morphology and inflammatory markers on coronary microvascular function in patients with chest pain and unobstructed coronary arteries930Predictors of coronary microcirculatory function after primary percutaneous coronary intervention in STEMI patients932Prediction of adverse events after ST segment-elevation myocardial infarction by imaging techniques933Echocardiography, contractile reserve and magnetic resonance to predict left ventricular remodelling934Relationship between the morphology of myocardial infarction scar border assessed by cardiac magnetic resonance and the inducibility of ventricular tachycardia935Comprehensive echocardiographic long-term risk stratification for the prediction of heart failure hospitalization and cardiovascular death following ST-segment elevation myocardial infarction

2015 ◽  
Vol 16 (suppl 2) ◽  
pp. S139-S141
Author(s):  
L Faber ◽  
K T Nel ◽  
D Trifunovic ◽  
S Rodero ◽  
S Rodero ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Magnetic Resonance ◽  
Multimodality Imaging ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Plaque Burden ◽  
Contractile Reserve ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

El-Sherif sign and lateral ST segment elevation in hypertrophic cardiomyopathy associated with apical aneurysm

2016 ◽  
Vol 207 ◽  
pp. 80-83
Author(s):  
Dursun Aras ◽  
Ozcan Ozeke ◽  
Serkan Cay ◽  
Firat Ozcan ◽  
Hasan Can Konte ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
St Segment Elevation ◽  
St Segment ◽  
Apical Aneurysm

Left Ventricular Apical Aneurysm in a Patient with Hypertrophic Cardiomyopathy Diagnostic and Management Dilemmas

2019 ◽  
Vol 03 (03) ◽  
Author(s):  
Parthena Theodoridou ◽  
Despoina Masmanidou ◽  
Panagiotis Kousidis ◽  
Panagiotis Roumelis ◽  
Anastasios Tsarouchas ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular ◽  
Apical Aneurysm

scholarly journals Cardiac Rupture—The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review

2021 ◽  
Vol 10 (5) ◽  
pp. 1066
Author(s):  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
Sławomir Dobrzycki
Keyword(s):  
Female Gender ◽  
Left Ventricular ◽  
Cardiac Rupture ◽  
Control Group ◽  
Mechanical Complication ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Risk Of Death ◽  
St Segment

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

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