ABSTRACT
Adipositas cordis is a rare cardiomyopathy characterized by diffuse fatty infiltration of the ventricular myocardium or interventricular septum. This occurs without myocardial cell destruction, unlike arrhythmogenic right ventricular cardiomyopathy. A 40-year-old obese woman was found to have a II/VI systolic murmur that worsened with standing. A transthoracic echocardiogram showed interventricular septal hypertrophy with a preserved left ventricular ejection fraction. Cardiac magnetic resonance imaging revealed a fatty mass in the interventricular septum. An endomyocardial biopsy revealed structurally normal myocytes with diffuse adipose cell infiltration and no evidence of malignant cells. Left and right cardiac catheterizations and stress echocardiography showed no abnormalities. This case shows the importance of considering a broad differential when approaching rare diseases. It also demonstrates the utility of noninvasive imaging and its impact on clinical decision making.
Subject(s)
Adipose Tissue/pathology , Cardiomyopathies/pathology , Ventricular Septum/pathology , Adipose Tissue/diagnostic imaging , Adult , Biopsy , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/physiopathology , Cardiomyopathies/therapy , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable , Diagnosis, Differential , Echocardiography , Electric Countershock/instrumentation , Female , Humans , Magnetic Resonance Imaging , Predictive Value of Tests , Primary Prevention/methods , Stroke Volume , Ventricular Function, Left , Ventricular Septum/diagnostic imaging , Ventricular Septum/physiopathologyABSTRACT
We report the fatal course of a left atrial myxoma: its systemic embolization to the coronary, cerebral, renal, and peripheral vascular beds in a 39-year-old woman resulted in rapid clinical deterioration, multiorgan failure, and death. Among reported cases of left atrial myxoma, this degree of embolic burden is exceedingly rare. In addition to reporting the patient's case, we discuss the presentation and diagnosis of possible intracardiac sources of systemic emboli.
Subject(s)
Coronary Occlusion/etiology , Heart Neoplasms/pathology , Infarction, Middle Cerebral Artery/etiology , Myxoma/pathology , Neoplastic Cells, Circulating/pathology , Renal Artery Obstruction/etiology , Adult , Biopsy , Catastrophic Illness , Coronary Angiography , Coronary Occlusion/diagnosis , Fatal Outcome , Female , Heart Atria/pathology , Heart Neoplasms/complications , Humans , Infarction, Middle Cerebral Artery/diagnosis , Multiple Organ Failure/diagnosis , Multiple Organ Failure/etiology , Myxoma/complications , Renal Artery Obstruction/diagnosis , Risk FactorsSubject(s)
Coronary Artery Disease/etiology , Coronary Circulation , Coronary Vessels/physiopathology , Heart Transplantation/adverse effects , Myocardial Infarction/etiology , Computer Simulation , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Coronary Vessels/diagnostic imaging , Humans , Models, Cardiovascular , Myocardial Infarction/diagnosis , Myocardial Infarction/physiopathology , Predictive Value of Tests , Risk Factors , Stress, MechanicalABSTRACT
Development of left ventricular to coronary sinus fistula is a rare complication of mitral valve surgery. Three of the seven previously reported cases occurred following multiple valve replacement surgeries, all of which were thought to be secondary to a complication of surgery and all were treated with surgical closure of the fistula. We report a case of left ventricular to coronary sinus fistula occurring after two mitral valve replacement surgeries that was treated medically with favorable long-term results.
Subject(s)
Coronary Sinus , Fistula/etiology , Heart Diseases/etiology , Heart Valve Prosthesis Implantation/adverse effects , Mitral Valve/surgery , Vascular Fistula/etiology , Aged , Angiography , Female , Fistula/diagnostic imaging , Fistula/therapy , Heart Ventricles , Humans , Reoperation , Treatment OutcomeABSTRACT
Statins are normally administered for the treatment of dyslipidemia on a daily basis. This standard dosing regimen is well tolerated by most patients. Occasionally, patients discontinue therapy secondary to side effects, most commonly myalgias. We describe 2 patients who were unable to tolerate daily atorvastatin therapy secondary to myalgias and were subsequently treated with rosuvastatin administered on Mondays, Wednesdays, and Fridays, with resolution of adverse effects. Significant reductions in serum low-density lipoprotein cholesterol levels were observed in the 2 patients despite the alternate-day dosing regimen. Rosuvastatin was chosen because of its long half-life (19 hours) and very high potency.