Metastatic tumors, notably lung cancer, can cause conditions resembling acute myocardial infarctions (AMI), contributing to the minor percentage of AMIs unrelated to coronary atherosclerosis. These instances necessitate specialized diagnostic and therapeutic approaches due to the distinct underlying pathology. We report a case of a 65-year-old male with metastatic lung cancer presenting with prolonged angina pectoris. Elevated troponin and creatine kinase levels led to emergency catheterization, revealing a total occlusion of the distal Left Coronary Artery (LCA) attributed to tumor infiltration. Intervention attempts were unsuccessful, and given the palliative context, other revascularization strategies were not pursued. Two-dimensional Transthoracic Echocardiogram (TTE) depicted tumor invasion at the heart’s apex, confirming the diagnosis. The patient passed away shortly after receiving palliative radiation therapy. This case underscores the challenges in diagnosing and managing myocardial infiltrations from metastatic tumors mimicking AMI. It accentuates the importance of imaging studies for accurate diagnosis and the critical evaluation of intervention strategies, highlighting the need for focused palliative care in such complex scenarios.
转移性肿瘤，尤其是肺癌，可引起类似急性心肌梗死（AMI）的症状，在与冠状动脉粥样硬化无关的急性心肌梗死中所占比例很小。由于这些病例的病理基础不同，因此必须采用专门的诊断和治疗方法。 我们报告了一例 65 岁男性转移性肺癌患者的病例，患者表现为长期心绞痛。肌钙蛋白和肌酸激酶水平升高导致患者接受了急诊导管检查，结果显示远端左冠状动脉（LCA）因肿瘤浸润而完全闭塞。介入治疗尝试未获成功，考虑到是姑息治疗，因此没有采取其他血管再通策略。二维经胸超声心动图（TTE）显示肿瘤侵犯心尖，从而确诊了这一诊断。患者在接受姑息放疗后不久去世。 该病例强调了在诊断和处理模仿 AMI 的转移性肿瘤心肌浸润时所面临的挑战。它强调了影像学研究对准确诊断和干预策略关键评估的重要性，突出了在这种复杂情况下进行重点姑息治疗的必要性。
{"title":"An unusual cause of anterior wall ST-elevation myocardial infarction: A case report","authors":"Z. Dindane, Elena Golgor, Axel Linke, N. Mangner","doi":"10.1093/ehjcr/ytae243","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae243","url":null,"abstract":"\u0000 \u0000 \u0000 Metastatic tumors, notably lung cancer, can cause conditions resembling acute myocardial infarctions (AMI), contributing to the minor percentage of AMIs unrelated to coronary atherosclerosis. These instances necessitate specialized diagnostic and therapeutic approaches due to the distinct underlying pathology.\u0000 \u0000 \u0000 \u0000 We report a case of a 65-year-old male with metastatic lung cancer presenting with prolonged angina pectoris. Elevated troponin and creatine kinase levels led to emergency catheterization, revealing a total occlusion of the distal Left Coronary Artery (LCA) attributed to tumor infiltration. Intervention attempts were unsuccessful, and given the palliative context, other revascularization strategies were not pursued. Two-dimensional Transthoracic Echocardiogram (TTE) depicted tumor invasion at the heart’s apex, confirming the diagnosis. The patient passed away shortly after receiving palliative radiation therapy.\u0000 \u0000 \u0000 \u0000 This case underscores the challenges in diagnosing and managing myocardial infiltrations from metastatic tumors mimicking AMI. It accentuates the importance of imaging studies for accurate diagnosis and the critical evaluation of intervention strategies, highlighting the need for focused palliative care in such complex scenarios.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140981868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Branch retinal artery occlusion with non-obstructive general angioscopy confirmed puff-chandelier rupture releasing cholesterol crystals in the aortic arch: a case report","authors":"Shohei Migita, K. Kojima, Yasuo Okumura","doi":"10.1093/ehjcr/ytae238","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae238","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140991724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farrah Othman, Gerald Yong, Alan Whelan, A. Ihdayhid
{"title":"Aortic Valve Laceration Following Rotational Atherectomy: A Case Report","authors":"Farrah Othman, Gerald Yong, Alan Whelan, A. Ihdayhid","doi":"10.1093/ehjcr/ytae226","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae226","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140993934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The coexistence of Rheumatic Heart Disease (RHD) and Pulmonary Arteriovenous Malformation (PAVM) is a rare clinical scenario that poses diagnostic and therapeutic challenges. This case report explores the clinical presentation, diagnostic journey, and multidisciplinary management of a patient presenting with both conditions. A 47-year-old female with a history of RHD presented with symptoms of dyspnoea on exertion and cyanosis, suggestive of both cardiac and pulmonary involvement. Subsequent investigations involving imaging, echocardiography, and invasive pulmonary angiography, revealed the co-existence of RHD and multiple PAVM in patient’s left lower lobe of lung. The patient underwent a tailored treatment plan, initially involving percutaneous mitral balloon valvuloplasty for RHD, followed by a staged procedure of transcatheter PAVM closure with Amplatzer™ Vascular Plug II performed one month later. Her saturation normalized following intervention. The patient's progress was monitored closely, with adjustments made to the treatment plan based on evolving clinical scenarios. Patient remained well in short term follow up. This case highlights the complexity of managing patients having two diverse conditions RHD and PAVM coexisting together, thus emphasizing the importance of a multidisciplinary approach. The unique intersection of cardiac and pulmonary pathologies necessitates careful consideration of diagnostic nuances and tailored treatment strategies. Lessons learned from this case offer valuable insights for clinicians encountering similar scenarios and underscore the significance of individualized, patient-centred care in optimizing outcomes for those with dual pathologies.
{"title":"“Unveiling the Complexity: Coexistence of Rheumatic Heart Disease and Pulmonary Arteriovenous Malformation - A Unique Case Report”","authors":"R. Charaniya, Jayal Shah, Apoorva M","doi":"10.1093/ehjcr/ytae239","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae239","url":null,"abstract":"\u0000 \u0000 \u0000 The coexistence of Rheumatic Heart Disease (RHD) and Pulmonary Arteriovenous Malformation (PAVM) is a rare clinical scenario that poses diagnostic and therapeutic challenges. This case report explores the clinical presentation, diagnostic journey, and multidisciplinary management of a patient presenting with both conditions.\u0000 \u0000 \u0000 \u0000 A 47-year-old female with a history of RHD presented with symptoms of dyspnoea on exertion and cyanosis, suggestive of both cardiac and pulmonary involvement. Subsequent investigations involving imaging, echocardiography, and invasive pulmonary angiography, revealed the co-existence of RHD and multiple PAVM in patient’s left lower lobe of lung. The patient underwent a tailored treatment plan, initially involving percutaneous mitral balloon valvuloplasty for RHD, followed by a staged procedure of transcatheter PAVM closure with Amplatzer™ Vascular Plug II performed one month later. Her saturation normalized following intervention. The patient's progress was monitored closely, with adjustments made to the treatment plan based on evolving clinical scenarios. Patient remained well in short term follow up.\u0000 \u0000 \u0000 \u0000 This case highlights the complexity of managing patients having two diverse conditions RHD and PAVM coexisting together, thus emphasizing the importance of a multidisciplinary approach. The unique intersection of cardiac and pulmonary pathologies necessitates careful consideration of diagnostic nuances and tailored treatment strategies. Lessons learned from this case offer valuable insights for clinicians encountering similar scenarios and underscore the significance of individualized, patient-centred care in optimizing outcomes for those with dual pathologies.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Ranchordás, A. Vazão, Francisco Soares, Marta Marques
A 53-year-old man with no ischemic cardiac symptoms but dynamic ventricular repolarization changes in Holter monitoring underwent cardiac investigation prior to elective non cardiac surgery. Invasive coronary angiography followed by computed tomography coronary angiography showed left main stem atresia with collaterals from the right coronary artery supplying retrogradely the left coronary circulation. The echocardiogram showed no alterations. Cardiac magnetic resonance myocardial perfusion imaging showed no ischemia. During the 18-month follow-up period, the patient remained asymptomatic for ischemic events and therefore no intervention was deemed necessary.
{"title":"Collateral beauty: Left main stem atresia","authors":"S. Ranchordás, A. Vazão, Francisco Soares, Marta Marques","doi":"10.1093/ehjcr/ytae241","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae241","url":null,"abstract":"\u0000 A 53-year-old man with no ischemic cardiac symptoms but dynamic ventricular repolarization changes in Holter monitoring underwent cardiac investigation prior to elective non cardiac surgery. Invasive coronary angiography followed by computed tomography coronary angiography showed left main stem atresia with collaterals from the right coronary artery supplying retrogradely the left coronary circulation. The echocardiogram showed no alterations. Cardiac magnetic resonance myocardial perfusion imaging showed no ischemia. During the 18-month follow-up period, the patient remained asymptomatic for ischemic events and therefore no intervention was deemed necessary.","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140999916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charlotte Lauwers, T. Rosseel, W. Droogné, L. V. Van Aelst, J. Van Cleemput
Transthyretin (ATTR-) amyloidosis is more prevalent than initially thought. As much as 13% of patients hospitalized with HFpEF may have ATTR-cardiomyopathy (CM). Conversely, heart transplant patients may manifest left ventricular hypertrophy or diastolic dysfunction, especially late after transplantation. We present a case of a 82-year old male heart transplant patient, 31 years following orthotopic heart transplantation. While he was satisfied with his exercise capacity as an octogenarian, several years before he required pacemaker implantation due to 3rd degree AV block, had bilateral carpal tunnel syndrome treated with carpal tunnel release surgery and experienced idiopathic sudden deafness. Based on increasing left ventricular wall thickness during routine follow-up, a diagnosis of ATTR-amyloidosis was suspected. Ultimately, the diagnosis was confirmed non-invasively with a specific scintigraphic exam, while an additional physicochemical stain on an endomyocardial biopsy taken several years before provided pathological proof. We initiated tafamidis, yet stopped this treatment after one month because of gastro-intestinal intolerance. Ultimately, our patient died two years later due to heart failure. Our case shows the long delay between the onset of transthyretin deposition, the presence of clinical signs and the final diagnosis. Echocardiographic findings suggestive for ATTR-CM include left ventricular hypertrophy and diastolic dysfunction, which are both common in heart transplant patients. Yet, ATTR-CM should be considered in the differential diagnosis, especially late after transplantation, in this closely monitored population.
{"title":"A case report of ATTR-amyloidosis following cardiac transplantation: thick ventricles that look alike","authors":"Charlotte Lauwers, T. Rosseel, W. Droogné, L. V. Van Aelst, J. Van Cleemput","doi":"10.1093/ehjcr/ytae242","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae242","url":null,"abstract":"\u0000 \u0000 \u0000 Transthyretin (ATTR-) amyloidosis is more prevalent than initially thought. As much as 13% of patients hospitalized with HFpEF may have ATTR-cardiomyopathy (CM). Conversely, heart transplant patients may manifest left ventricular hypertrophy or diastolic dysfunction, especially late after transplantation.\u0000 \u0000 \u0000 \u0000 We present a case of a 82-year old male heart transplant patient, 31 years following orthotopic heart transplantation. While he was satisfied with his exercise capacity as an octogenarian, several years before he required pacemaker implantation due to 3rd degree AV block, had bilateral carpal tunnel syndrome treated with carpal tunnel release surgery and experienced idiopathic sudden deafness. Based on increasing left ventricular wall thickness during routine follow-up, a diagnosis of ATTR-amyloidosis was suspected. Ultimately, the diagnosis was confirmed non-invasively with a specific scintigraphic exam, while an additional physicochemical stain on an endomyocardial biopsy taken several years before provided pathological proof. We initiated tafamidis, yet stopped this treatment after one month because of gastro-intestinal intolerance. Ultimately, our patient died two years later due to heart failure.\u0000 \u0000 \u0000 \u0000 Our case shows the long delay between the onset of transthyretin deposition, the presence of clinical signs and the final diagnosis. Echocardiographic findings suggestive for ATTR-CM include left ventricular hypertrophy and diastolic dysfunction, which are both common in heart transplant patients. Yet, ATTR-CM should be considered in the differential diagnosis, especially late after transplantation, in this closely monitored population.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Monica Barki, S. Sacchi, Cecilia Marcolin, S. Ajello, A. Scandroglio
The acquired communication between the aorta and the pulmonary artery is a rare and potentially life-threatening condition. Its diagnosis is challenging and may require a multimodality imaging approach. A 67-year-old Caucasian man, admitted for acute respiratory failure unresponsive to medical therapy and non-invasive ventilation, was diagnosed with an aorto-pulmonary fistula (APF) complicating a pseudoaneurysm of the aortic root. This condition developed after Bentall cardiac surgery, which entailed the use of a straight Dacron aortic graft coupled with a mechanical prosthesis. A multimodal imaging approach, combining echocardiography and computed tomography angiography, was diagnostic and supported the development of a surgical treatment strategy. The patient underwent successful surgical closure of the APF and correction of the aortic pseudoaneurysm. Aorto-pulmonary fistula can result in rapid clinical deterioration if left untreated. The combination of echocardiography and computed tomography angiography techniques allowed for the diagnosis and surgical correction of the APF.
{"title":"A Rare Case Report of an Acquired Aorto-Pulmonary Artery Fistula after Bentall Procedure: Multimodality Imaging Approach may be the Key?","authors":"Monica Barki, S. Sacchi, Cecilia Marcolin, S. Ajello, A. Scandroglio","doi":"10.1093/ehjcr/ytae236","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae236","url":null,"abstract":"\u0000 \u0000 \u0000 The acquired communication between the aorta and the pulmonary artery is a rare and potentially life-threatening condition. Its diagnosis is challenging and may require a multimodality imaging approach.\u0000 \u0000 \u0000 \u0000 A 67-year-old Caucasian man, admitted for acute respiratory failure unresponsive to medical therapy and non-invasive ventilation, was diagnosed with an aorto-pulmonary fistula (APF) complicating a pseudoaneurysm of the aortic root. This condition developed after Bentall cardiac surgery, which entailed the use of a straight Dacron aortic graft coupled with a mechanical prosthesis. A multimodal imaging approach, combining echocardiography and computed tomography angiography, was diagnostic and supported the development of a surgical treatment strategy. The patient underwent successful surgical closure of the APF and correction of the aortic pseudoaneurysm.\u0000 \u0000 \u0000 \u0000 Aorto-pulmonary fistula can result in rapid clinical deterioration if left untreated. The combination of echocardiography and computed tomography angiography techniques allowed for the diagnosis and surgical correction of the APF.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Soriano, Andrea R. Munafò, Nurcan Baydaroglun, Stefano Nava, Giuseppe Bruschi, Giuseppe Esposito, J. Oreglia, Claudio Montalto
{"title":"Use of Cangrelor for Complex Percutaneous Coronary Intervention in the Context of Concomitant Severe Aortic Stenosis: a case series","authors":"Francesco Soriano, Andrea R. Munafò, Nurcan Baydaroglun, Stefano Nava, Giuseppe Bruschi, Giuseppe Esposito, J. Oreglia, Claudio Montalto","doi":"10.1093/ehjcr/ytae237","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae237","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141007878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Sakhi, Guillaume Reverdito, G. Soulat, É. Mousseaux
Myocarditis is challenging to diagnose due to its varied presentations. Endomyocardial biopsy is the gold standard for diagnosis, but its invasive nature has led to alternative non-invasive modalities, notably Cardiovascular Magnetic Resonance (CMR). Identifying the precise etiology of myocarditis is crucial for effective treatment, yet extra-cardiac causes are often overlooked. In this paper, we spotlight the underexplored role of CMR in diagnosing extra-cardiac etiologies, utilizing three insightful cases for illustration. The first case is a 31-year-old patient with myocarditis secondary to a pyogenic liver abscess, identified through CMR who improved after abscess drainage. The second case involves a 54-year-old patient with myocarditis attributed to adult T-cell leukemia-lymphoma, with the loco-regional thickening process identified thanks to CMR. This patient had an unfavorable disease progression due to the underlying malignancy. The third case concerns a 23-year-old patient suffering from myocarditis due to pneumonia, again illustrated effectively through CMR imaging and who recovered after antibiotic treatment. These cases underline the overlooked potential of CMR in diagnosing extra-cardiac etiologies of myocarditis, even though such causes are rare. Despite current guidelines recognizing the importance of identifying the etiology of myocarditis, they do not explicitly address the role of CMR in diagnosing extra-cardiac etiologies. Therefore, this article proposes that future guidelines could emphasize the utility of CMR in exploring these causes, potentially leading to more accurate diagnoses and improving patient outcomes. It also advocates for a comprehensive, multidisciplinary approach to myocarditis diagnosis, encouraging vigilance for potential loco-regional causes, and calls for further research in this area.
{"title":"Cardiovascular Magnetic Resonance in the Identification of Extra-Cardiac Causes of Myocarditis: a case series","authors":"H. Sakhi, Guillaume Reverdito, G. Soulat, É. Mousseaux","doi":"10.1093/ehjcr/ytae232","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae232","url":null,"abstract":"\u0000 \u0000 \u0000 Myocarditis is challenging to diagnose due to its varied presentations. Endomyocardial biopsy is the gold standard for diagnosis, but its invasive nature has led to alternative non-invasive modalities, notably Cardiovascular Magnetic Resonance (CMR). Identifying the precise etiology of myocarditis is crucial for effective treatment, yet extra-cardiac causes are often overlooked. In this paper, we spotlight the underexplored role of CMR in diagnosing extra-cardiac etiologies, utilizing three insightful cases for illustration.\u0000 \u0000 \u0000 \u0000 The first case is a 31-year-old patient with myocarditis secondary to a pyogenic liver abscess, identified through CMR who improved after abscess drainage. The second case involves a 54-year-old patient with myocarditis attributed to adult T-cell leukemia-lymphoma, with the loco-regional thickening process identified thanks to CMR. This patient had an unfavorable disease progression due to the underlying malignancy. The third case concerns a 23-year-old patient suffering from myocarditis due to pneumonia, again illustrated effectively through CMR imaging and who recovered after antibiotic treatment.\u0000 \u0000 \u0000 \u0000 These cases underline the overlooked potential of CMR in diagnosing extra-cardiac etiologies of myocarditis, even though such causes are rare. Despite current guidelines recognizing the importance of identifying the etiology of myocarditis, they do not explicitly address the role of CMR in diagnosing extra-cardiac etiologies. Therefore, this article proposes that future guidelines could emphasize the utility of CMR in exploring these causes, potentially leading to more accurate diagnoses and improving patient outcomes. It also advocates for a comprehensive, multidisciplinary approach to myocarditis diagnosis, encouraging vigilance for potential loco-regional causes, and calls for further research in this area.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141011214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Moses Lee, Mariam Thomas, Golsa Joodi, Anthony S. Koppula, Jonathan Soverow
A coronary artery aneurysm is a rare cardiac anomaly that may be incidentally detected on echocardiography. When associated with a coronary cameral fistula, an aneurysm can become symptomatic. We present a unique case of a giant left circumflex coronary aneurysm with a fistula to the left atrium and a large atrial septal defect causing acute heart failure in a young woman during the peripartum period. A 33 year-old woman who presented with hypoxia after the delivery of her fourth child was found to have heart failure with severe mitral regurgitation and multiple abnormal intracardiac shunts. Echocardiography showed a large circular structure with Doppler color flow into the left atrium and between the atria. Cardiac computed tomography showed multiple dilated coronary arteries including a left circumflex coronary artery aneurysm measuring greater than 10 cm in diameter with fistulous communication to the left atrium and a large atrial septal defect. A right heart catheterization was performed and the patient was diagnosed with high-output heart failure. Surgical closure of the coronary cameral fistula was deferred due to risk of worsening pressure in the coronary aneurysm and the patient was referred for cardiac transplantation. This case illustrates severe heart failure as a complication of a giant coronary artery aneurysm with fistulization to the left atrium and subsequent shunting through a large atrial defect. Echocardiography allows for detection of a coronary aneurysm and shunting and cardiac computed tomography provides detailed visualization of a coronary cameral fistula.
{"title":"High-Output Heart Failure due to a Giant Left Circumflex Coronary Aneurysm with a Left Atrial Fistula and Atrial Septal Defect: A Case Report","authors":"Moses Lee, Mariam Thomas, Golsa Joodi, Anthony S. Koppula, Jonathan Soverow","doi":"10.1093/ehjcr/ytae171","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae171","url":null,"abstract":"\u0000 \u0000 \u0000 A coronary artery aneurysm is a rare cardiac anomaly that may be incidentally detected on echocardiography. When associated with a coronary cameral fistula, an aneurysm can become symptomatic. We present a unique case of a giant left circumflex coronary aneurysm with a fistula to the left atrium and a large atrial septal defect causing acute heart failure in a young woman during the peripartum period.\u0000 \u0000 \u0000 \u0000 A 33 year-old woman who presented with hypoxia after the delivery of her fourth child was found to have heart failure with severe mitral regurgitation and multiple abnormal intracardiac shunts. Echocardiography showed a large circular structure with Doppler color flow into the left atrium and between the atria. Cardiac computed tomography showed multiple dilated coronary arteries including a left circumflex coronary artery aneurysm measuring greater than 10 cm in diameter with fistulous communication to the left atrium and a large atrial septal defect. A right heart catheterization was performed and the patient was diagnosed with high-output heart failure. Surgical closure of the coronary cameral fistula was deferred due to risk of worsening pressure in the coronary aneurysm and the patient was referred for cardiac transplantation.\u0000 \u0000 \u0000 \u0000 This case illustrates severe heart failure as a complication of a giant coronary artery aneurysm with fistulization to the left atrium and subsequent shunting through a large atrial defect. Echocardiography allows for detection of a coronary aneurysm and shunting and cardiac computed tomography provides detailed visualization of a coronary cameral fistula.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140656560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：