Assuntos
Valva Aórtica , Oclusão Coronária/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso de 80 Anos ou mais , Oclusão Coronária/complicações , Feminino , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Fatores de TempoRESUMO
We describe the case of a 48-year-old patient who presented with an out-of-hospital cardiac arrest due to an acute ST-elevation myocardial infarction. Left ventriculography performed during the initial coronary angiography revealed the presence of structural abnormalities in the myocardial wall which subsequently, with the use of contrast echocardiography and cardiac magnetic resonance imaging, were confirmed to represent ventricular clefts. We reviewed the pathophysiological significance of these defects and compared them with similarly looking abnormalities such as aneurysms, pseudoaneurysms, and diverticula. In conclusion, recognition of ventricular clefts is needed to allow clinicians to differentiate them from other myocardial wall defects with different pathological profile and clinical significance.
RESUMO
Percutaneous occlusion techniques of secundum type atrial septal defects have recently become the treatment of choice, delivering excellent results and being associated with a low rate of early and late complications. The investigators report an unusually delayed presentation of acute right heart failure due to Amplatzer septal device embolisation into the main pulmonary artery, 2 years after implantation.
Assuntos
Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Migração de Corpo Estranho/complicações , Insuficiência Cardíaca/etiologia , Comunicação Interatrial/terapia , Artéria Pulmonar , Idoso , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Migração de Corpo Estranho/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Fatores de TempoRESUMO
A 53-year-old man presented with cardiac tamponade due to direct invasion of left atrium by a large cell neuroendocrine metastatic lung adenocarcinoma. Direct invasion of left atrial cavity by this type of lung tumour is rare. When cardiac involvement is suspected, two-dimensional echocardiography is the first-line diagnostic tool. Computerized tomography and magnetic resonance imaging can provide additional anatomical information and, as in this case, further delineation of the relation between intracavity masses and normal structures, including the mural site of attachment and tumour extension.
Assuntos
Tamponamento Cardíaco/etiologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tumores Neuroendócrinos/diagnóstico por imagem , Tamponamento Cardíaco/diagnóstico por imagem , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/secundário , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/secundário , UltrassonografiaRESUMO
BACKGROUND: The appropriate treatment for patients in whom reperfusion fails to occur after thrombolytic therapy for acute myocardial infarction remains unclear. There are few data comparing emergency percutaneous coronary intervention (rescue PCI) with conservative care in such patients, and none comparing rescue PCI with repeated thrombolysis. METHODS: We conducted a multicenter trial in the United Kingdom involving 427 patients with ST-segment elevation myocardial infarction in whom reperfusion failed to occur (less than 50 percent ST-segment resolution) within 90 minutes after thrombolytic treatment. The patients were randomly assigned to repeated thrombolysis (142 patients), conservative treatment (141 patients), or rescue PCI (144 patients). The primary end point was a composite of death, reinfarction, stroke, or severe heart failure within six months. RESULTS: The rate of event-free survival among patients treated with rescue PCI was 84.6 percent, as compared with 70.1 percent among those receiving conservative therapy and 68.7 percent among those undergoing repeated thrombolysis (overall P=0.004). The adjusted hazard ratio for the occurrence of the primary end point for repeated thrombolysis versus conservative therapy was 1.09 (95 percent confidence interval, 0.71 to 1.67; P=0.69), as compared with adjusted hazard ratios of 0.43 (95 percent confidence interval, 0.26 to 0.72; P=0.001) for rescue PCI versus repeated thrombolysis and 0.47 (95 percent confidence interval, 0.28 to 0.79; P=0.004) for rescue PCI versus conservative therapy. There were no significant differences in mortality from all causes. Nonfatal bleeding, mostly at the sheath-insertion site, was more common with rescue PCI. At six months, 86.2 percent of the rescue-PCI group were free from revascularization, as compared with 77.6 percent of the conservative-therapy group and 74.4 percent of the repeated-thrombolysis group (overall P=0.05). CONCLUSIONS: Event-free survival after failed thrombolytic therapy was significantly higher with rescue PCI than with repeated thrombolysis or conservative treatment. Rescue PCI should be considered for patients in whom reperfusion fails to occur after thrombolytic therapy.
Assuntos
Angioplastia Coronária com Balão , Fibrinolíticos/uso terapêutico , Infarto do Miocárdio/terapia , Terapia Trombolítica , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Estudos Cross-Over , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/mortalidade , Proteínas Recombinantes/uso terapêutico , Prevenção Secundária , Análise de Sobrevida , Ativador de Plasminogênio Tecidual/uso terapêutico , Falha de TratamentoRESUMO
We report the case of a 60-year-old female with a history of hypertension who was admitted with an acute inferior myocardial infarction. She received rescue percutaneous transluminal coronary angioplasty/stenting of an occluded right coronary artery for failed thrombolysis with a good initial result. However, this was immediately complicated by cardiogenic shock characterized by left ventricular outflow tract (LVOT) gradient. She was treated with intravenous fluids and adrenaline. Predischarge echocardiography showed no LVOT gradient and features of left ventricular hypertrophy that mainly affected the septum.