European Heart Journal: Case Reports最新文献

Background: Cardiac magnetic resonance (CMR) is gaining an important role in the setting of acute coronary syndromes: it gives prognostic information based on oedema and late gadolinium enhancement (LGE) extension in acute myocardial infarction, and has a diagnostic value in myocardial infarction with nonobstructive coronary arteries (MINOCA) thanks to its capability to distinguish, based on different LGE patterns, ischaemic and non-ischaemic myocardial injuries.

Case summary: We describe a case of acute myocardial infarction involving a recurrent apical branch showing an atypical intramyocardial LGE pattern in the medium inferior septum.

Discussion: An intramyocardial LGE pattern might be determined by an ischaemic injury involving the interventricular septum. The knowledge of this misleading LGE pattern is important to adequately interpret CMR findings in this clinical setting.

Background: As the number of individuals receiving the coronavirus disease 2019 (COVID-19) vaccine continues to rise, we have observed a concurrent increase in myopericarditis cases within the general population. This case serves as a reminder of the necessity to approach such occurrences with an open mind. Additionally, it underscores the importance of employing multi-modal imaging techniques alongside a collaborative, multi-disciplinary approach when addressing complex medical cases.

Case summary: We present a case of a woman in her 50s attending the emergency department with pyrexia, lethargy, and chest pain following the AstraZeneca COVID-19 vaccine. She had a background of systemic lupus erythematosus that was treated with immunosuppressive medication.Initial assessments revealed abnormal electrocardiogram, elevated troponin, and raised inflammatory markers. A diagnosis of likely vaccine-induced myopericarditis was made. However, blood cultures revealed Listeria monocytogenes, and cardiac imaging confirmed a right atrial (RA) thrombus that was considered to be infected. Subsequently, she was treated for Listeria myopericarditis and infected thrombus with intravenous antibiotics and anticoagulation. The patient did not wish for any invasive investigations given her clinical improvement. This is the first case of Listeria-related myopericarditis with an infected thrombus in the RA. We saw the full resolution of RA mass with medical management.

Discussion: This case highlights the importance of multi-modality imaging techniques to facilitate the diagnosis of Listeria-related myopericarditis accompanied by an infected thrombus. It also emphasizes the importance of conducting interval scanning and follow-up assessments to ensure the resolution of the disease. To improve diagnostic accuracy, an endomyocardial biopsy can also be considered.

Background: There is emerging evidence for the potential utility of left bundle branch area pacing (LBBAP), as an alternative to conventional cardiac resynchronization therapy (CRT). The utility of right ventriculography by way of power injector to facilitate lead placement has not yet been reported in the literature.

Case summary: A 79-year-old female, with a background of poorly rate-controlled atrial fibrillation, presented with worsening dyspnoea. She had recently undergone single-chamber pacemaker insertion prior to an atrioventricular nodal (AVN) ablation, owing to failure in achieving successful CRT coronary sinus lead placement. She had clinical evidence of volume overload, and her electrocardiogram demonstrated right ventricular pacing. Echocardiography demonstrated left ventricular (LV) impairment, with an ejection fraction (EF) of 35%, and severe functional mitral regurgitation (MR). Her diagnosis was overall consistent with pacing-induced cardiomyopathy (PIC). In this patient, the use of right ventriculography, using power-injector-delivered contrast, successfully facilitated placement of an LBBAP lead, with confirmation of good threshold and sensing parameters. Following an upgrade to conduction system pacing, the patient recovered well. On recent follow-up, repeat echocardiography (24 months post initial presentation) demonstrated improved LV function (EF 45% from 35%) and only mild-to-moderate MR.

Discussion: In conclusion, we demonstrate the utility of right ventriculography to facilitate placement of an LBBAP lead, successfully treating a patient who developed PIC from chronic right ventricular pacing following AVN ablation.

[This corrects the article DOI: 10.1093/ehjcr/ytae345.].

Background: This case report details the application of left bundle branch pacing in a patient with congenitally corrected transposition of the great arteries (cc-TGA), a rare congenital heart defect characterized by anatomical complexities that pose unique challenges in the management of device-related complications and heart failure. The patient's history is notable for complex anatomical considerations, cardiovascular implantable electronic device (CIED) infection, and heart failure.

Case summary: The patient underwent a series of interventions, including treatment for pocket-site infections, abandonment of epicardial leads, and an unsuccessful attempt at trans-catheter leadless pacemaker implantation. Given the patient's complex anatomy and prior CIED infection, traditional pacing methods were deemed unsuitable, leading to the selection of left bundle branch pacing. The lead implantation was guided using 3D electro-anatomical mapping to ensure synchronous physiologic pacing in a patient with heart failure.

Discussion: The case underscores the heightened risks faced by cc-TGA patients, with a focus on systemic right ventricular dysfunction and pacing-induced ventricular dysfunction. In these patients, ventricular synchrony is critical and can be achieved with biventricular pacing. Physiologic pacing emerges as a promising alternative to cardiac resynchronization therapy (CRT), especially in cases where endovascular CRT is unfeasible. This case demonstrates the utilization of 3D electro-anatomical mapping for achieving successful physiologic pacing in complex congenital heart lesions. At the 12-month follow-up, the patient presented with stable clinical status and a narrow QRS complex. Echocardiography indicated improvement in the right systemic ventricular function.

Background: Aplastic anaemia (AA) is known to progress to paroxysmal nocturnal haemoglobinuria (PNH) during treatment, and thrombosis is a characteristic symptom of PNH. This case report investigates a case of repeated and rapidly progressive multiple arterial thrombosis due to PNH.

Case summary: This case is a 24-year-old woman undergoing treatment for AA. She presented with chest pain and underwent emergency coronary angiography. Thrombus occlusion was found in the distal portion of the right coronary artery, acute myocardial infarction was diagnosed and percutaneous coronary intervention was performed. Thrombus aspiration and balloon dilation were performed. Anticoagulants were administered, but chest pain flared up again on Day 9; coronary angiography was performed, indicating that the proximal portion of the right coronary artery had caused occlusion. On Days 9 and 24, she experienced back pain and was diagnosed with renal infarction. Considering that AA had evolved into PNH and intravascular haemolysis and thrombosis appeared, the diagnosis of PNH was made via flow cytometry. Multiple arterial thrombosis due to PNH was diagnosed, and ravulizumab treatment was started, resulting in the improvement of thrombus progression, chest pain, and back pain.

Discussion: Thrombosis due to PNH can recur even after the administration of anticoagulants and antiplatelet agents and has been associated with a high fatality rate. The treatment with ravulizumab, a humanized monoclonal antibody against complement C5, helps with the prevention of thrombosis. Furthermore, anti-complement component C5 therapy is very effective in improving rapidly progressive multiple arterial thrombosis resistant to anticoagulants and antiplatelet agents due to PNH.