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Clinical image - unknown part I
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Figure 1. A 47-year-old woman presented with a 3-hour history of retrosternal chest pressure. Her past medical history was notable for hypertension, polycystic kidney disease and renal failure for which she underwent living-related renal transplantation 7 years previously. Her medications included clonidine, metolazone, losartan, furosemide, cyclosporine, prednisone, zafirlukast, paroxetine, conjugated estrogens and progesterone. She had no family history of cardiac disease, no history of travel outside the midwest, no history of use of diet medications and no history of rejection of her transplanted kidney. Electrocardiogram showed sinus rhythm with 1 mm of ST segment depression in her lateral leads that was unchanged from an ECG recorded 2 years previously. On laboratory examination, her creatinine was 2.2 mg/dL, WBC 8.9 ⫻ 103, hemoglobin 16.0 mg/dL, CPK 232 IU/L with CK-MB 5.3 IU/L, and troponin-I of 37.1 ng/mL. Cardiac catheterization revealed normal coronary arteries. The left ventriculogram is shown in Figure 1, panel A in diastole and panel B in systole. Overall ejection fraction was 55%. What is the diagnosis? a) LV apical aneurysm with thrombus b) apical hypertrophic cardiomyopathy c) LV angiosarcoma d) endomyocardial fibrosis
ACC CURRENT JOURNAL REVIEW May/Jun 2001 © 2001 by the American College of Cardiology Published by Elsevier Science Inc.
23
1062-1458/01/$20.00 PII S1062-1458(01)00285-9
Figure 1. A 47-year-old woman presented with a 3-hour history of retrosternal chest pressure. Her past medical history was notable for hypertension, polycystic kidney disease and renal failure for which she underwent living-related renal transplantation 7 years previously. Her medications included clonidine, metolazone, losartan, furosemide, cyclosporine, prednisone, zafirlukast, paroxetine, conjugated estrogens and progesterone. She had no family history of cardiac disease, no history of travel outside the midwest, no history of use of diet medications and no history of rejection of her transplanted kidney. Electrocardiogram showed sinus rhythm with 1 mm of ST segment depression in her lateral leads that was unchanged from an ECG recorded 2 years previously. On laboratory examination, her creatinine was 2.2 mg/dL, WBC 8.9 ⫻ 103, hemoglobin 16.0 mg/dL, CPK 232 IU/L with CK-MB 5.3 IU/L, and troponin-I of 37.1 ng/mL. Cardiac catheterization revealed normal coronary arteries. The left ventriculogram is shown in Figure 1, panel A in diastole and panel B in systole. Overall ejection fraction was 55%. What is the diagnosis? a) LV apical aneurysm with thrombus b) apical hypertrophic cardiomyopathy c) LV angiosarcoma d) endomyocardial fibrosis
ACC CURRENT JOURNAL REVIEW May/Jun 2001 © 2001 by the American College of Cardiology Published by Elsevier Science Inc.
23
1062-1458/01/$20.00 PII S1062-1458(01)00285-9