Subject(s)
Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/diagnostic imaging , Thrombosis/diagnostic imaging , Thrombosis/etiology , Aged, 80 and over , Atrial Fibrillation/etiology , Coronary Angiography , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Female , Humans , Syncope/etiologySubject(s)
Contrast Media/administration & dosage , Echocardiography , Heart Diseases/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Thrombosis/diagnostic imaging , Aged, 80 and over , Female , Heart Diseases/therapy , Heart Neoplasms/therapy , Humans , Magnetic Resonance Imaging , Male , Microbubbles , Middle Aged , Predictive Value of Tests , Thrombosis/therapy , Treatment OutcomeABSTRACT
An 83-year-old woman with a possible history of myocardial infarction presented with acute chest pain and dyspnoea. The electrocardiogram showed no signs of acute coronary syndrome, but Q waves in the anteroseptal leads. The blood tests showed an important elevation of troponin T level. Emergency coronary angiography revealed normal epicardial arteries, but the left ventriculogram demonstrated anterior akinesis and ballooning with normal apical and basal function. An atypical takotsubo cardiomyopathy was suspected and the patient received beta blocker and ACE inhibitor treatment. Two days later the echocardiogram evolved to a classical pattern of apical ballooning with normalization on the follow-up examination 5 weeks from the acute episode. To our knowledge, this is the first case report describing an evolving pattern of wall motion abnormality from an anterior wall ballooning to an apical form.
Subject(s)
Adrenergic beta-Antagonists/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Heart Ventricles , Takotsubo Cardiomyopathy , Aged, 80 and over , Coronary Angiography/methods , Echocardiography/methods , Electrocardiography/methods , Female , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Takotsubo Cardiomyopathy/blood , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/drug therapy , Takotsubo Cardiomyopathy/physiopathology , Treatment Outcome , Troponin T/bloodABSTRACT
Transoesophageal echocardiography is often recommended in the evaluation of cryptogenic stroke, especially in those patients with no or few risk factors. We report the case of 66-year-old male with a history of multiple ischaemic strokes, admitted to our stroke unit following the discovery of multiple and diffuse new ischaemic lesions on a cerebral magnetic resonance imaging. Transoesophageal echocardiography led to the discovery of a very small mass attached to the tissue fold between the left superior pulmonary vein and the left atrial appendage (often referred to as"coumadin ridge"). The three-dimensional acquisition allowed detailed characterization of this mass. No other source of emboli was detected.The mass was considered to be most likely a tumour and was probably the cause of the multiple strokes. Due to the already advanced neurological disease and the small dimensions of the mass surgery was considered inappropriate. The patient was initiated on oral anticoagulants. This case highlights the importance of three-dimensional ultrasound in the detection and evaluation of intracardiac masses.
