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PP-019: IDIOPATHIC ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN A PATIENT WITH ISOLATED LEFT VENTRICULAR NONCOMPACTION
S108
Poster Discussions / International Journal of Cardiology 147S2 (2011) S103–S130
typical angina for two months. He had medically controlled hyperlipidemia. His physical examination was unremarkable. Resting ECG showed normal sinus rhythm with no ischemic changes. He underwent treadmill exercise test which showed 2 mm ST segment depression in leads V4–6 and DII-DIII-aVF and also ST segment elevation in leads aVR and V1. So, coronary angiography was planned. Results: Coronary angiography showed LAD occlusion after first diagonal branch and non-critical plaques in other vessels. Ventriculography was normal. Coronary by-pass surgery was planned for the patient. He underwent CABG (LAD-LIMA graft) with no complication. He was discharged uneventfully from the hospital. Conclusions: Exercise-induced ST-segment elevation in lead aVR accompanied by ST-segment elevation in lead V1 might be sensitive and specific finding of LAD stenosis in patients.
Methods: A 44-year-old male patient presented with a complaint of finger amputation after getting into a fight and assaulted by his relatives. He had chest pain only during fight and on admission it had been resolved. He has hypertension and smoking history. Because of finger amputation during fight, reconstruction was attempted. During preoperative evaluation, electrocardiogram revealed 6–7 mm ST segment elevation in precordial derivations which was consistent with anterior AMI. Unfractioned heparin, aspirin, clopidogrel and statin were initiated at emergency room. Although the patient was asymptomatic, due to increased risk of bleeding from amputed finger, he was taken into the primary PCI. Results: Coronary angiogram revealed total occlusion at proximal LAD which was revascularized with predilatation and stent implantation. Also after coronary angiogram, his finger was reconstructed by plastic surgery and reconstruction physicians under UFH infusion. There were no perioperative complication. Anterior ST segment elevation on electrocardiogram was resolved and his remaining hospital stay was uneventful. Conclusions: Acute extraordinary stress may be responsible for the development of AMI during periods of struggles. Electrocardiogram may be important and diagnostic particularly in asymptomatic patients after acute stress and struggle. PP-019 IDIOPATHIC ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN A PATIENT WITH ISOLATED LEFT VENTRICULAR NONCOMPACTION B. Erer, S. Altay, T.S. Guvenc, N. Sayar, A.L. Orhan, M. Eren. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
Figure 1. (A) Electrocardiogram was showing ST-segment depression in leads V4–6 and DII-DIII-aVF, also ST-segment elevation in leads aVR and V1 (B) Coronary angiogram showed LAD total occlusion after first diagonal branch and retrograde filling of the LAD distal segments by RCA (C).
PP-018 ASYMPTOMATIC ANTERIOR MYOCARDIAL INFARCTION IN A PATIENT WITH FINGER AMPUTATION TRIGGERED BY ACUTE INTENSE STRUGGLE U. Canpolat, A.H. Ates, H. Yorgun, E.B. Kaya, K. Aytemir, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Psychosocial stresses are associated with an increased risk of acute myocardial infarction (AMI). Acute extraordinary stress may trigger AMI and stressful life events such as fights, earthquakes, war, threat of attack, and fear of death may precipitate AMI. Increased risk for AMI associated with high levels of stress is still significant after adjustment of other cardiovascular risk factors. We hereby report a male patient with finger amputation who developed anterior AMI after sustaining acute physical and psychological trauma on the basis of struggle.
Left ventricular noncompaction is a rare hereditary cardiomyopathy which is characterized by prominent intraventricular trabeculations separated with deep intratrabecular recesses. Cardinal features of this disorder are heart failure, a variety of supraventricular and ventricular arrythmias, and to a lesser extent, systemic arterial thromboembolism. While asymptomatic cardiac ischemia due to microvascular dysfunction is common in these patients; ST-segment elevation myocardial infarction, which is caused by complete occlusion of an epicardial coronary artery, is due to coincidental coronary artery disease rather than direct consequence of cardiomyopathy. We report a 20-year old male patient admitted to our emergency department with a complaint of squeezing chest pain. A diagnosis of ST-segment elevation myocardial infarction was made depending on ECG finding, but emergent coronary angiogram demonstrated normal coronary arteries. Echocardiography revealed isolated left ventricular noncompaction, and the diagnosis is confirmed with MRI. Repeat coronary catheterization with acetylcholine infusion and coronary flow reserve measurement failed to demonstrate vasospasm and microvascular dysfunction. As no apparent cause was found, the case was designated “idiopathic” myocardial infarction. Coronary thromboembolism due to stagnation of blood in LV cavity remained as the most probable mechanism underlying myocardial infarction. PP-020 DO NOT IGNORE EVEN MILD CHEST PAIN DURING PERCUTANEOUS CORONARY INTERVENTION: IT MAY BE A SIGNAL OF STENT EDGE DISSECTION OCCURRING WITHIN A SHORT PERIOD OF TIME E. Kardesoglu, Z. Isilak, O. Yiginer, O. Uz, B.S. Cebeci. Gata Haydarpasa Egitim Hastanesi, Istanbul, Turkey During PCI, chest pain is expected during balloon inflation. In primary PCI, a temporary exacerbation of chest pain may occur just after flow restoration due to vasoactive substances such as adenosine. Slow/no reflow, distal embolism and side branch occlusion may explain the chest pain. Therefore, the operator should carefully explore the reason of chest pain, and always
Poster Discussions / International Journal of Cardiology 147S2 (2011) S103–S130
typical angina for two months. He had medically controlled hyperlipidemia. His physical examination was unremarkable. Resting ECG showed normal sinus rhythm with no ischemic changes. He underwent treadmill exercise test which showed 2 mm ST segment depression in leads V4–6 and DII-DIII-aVF and also ST segment elevation in leads aVR and V1. So, coronary angiography was planned. Results: Coronary angiography showed LAD occlusion after first diagonal branch and non-critical plaques in other vessels. Ventriculography was normal. Coronary by-pass surgery was planned for the patient. He underwent CABG (LAD-LIMA graft) with no complication. He was discharged uneventfully from the hospital. Conclusions: Exercise-induced ST-segment elevation in lead aVR accompanied by ST-segment elevation in lead V1 might be sensitive and specific finding of LAD stenosis in patients.
Methods: A 44-year-old male patient presented with a complaint of finger amputation after getting into a fight and assaulted by his relatives. He had chest pain only during fight and on admission it had been resolved. He has hypertension and smoking history. Because of finger amputation during fight, reconstruction was attempted. During preoperative evaluation, electrocardiogram revealed 6–7 mm ST segment elevation in precordial derivations which was consistent with anterior AMI. Unfractioned heparin, aspirin, clopidogrel and statin were initiated at emergency room. Although the patient was asymptomatic, due to increased risk of bleeding from amputed finger, he was taken into the primary PCI. Results: Coronary angiogram revealed total occlusion at proximal LAD which was revascularized with predilatation and stent implantation. Also after coronary angiogram, his finger was reconstructed by plastic surgery and reconstruction physicians under UFH infusion. There were no perioperative complication. Anterior ST segment elevation on electrocardiogram was resolved and his remaining hospital stay was uneventful. Conclusions: Acute extraordinary stress may be responsible for the development of AMI during periods of struggles. Electrocardiogram may be important and diagnostic particularly in asymptomatic patients after acute stress and struggle. PP-019 IDIOPATHIC ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN A PATIENT WITH ISOLATED LEFT VENTRICULAR NONCOMPACTION B. Erer, S. Altay, T.S. Guvenc, N. Sayar, A.L. Orhan, M. Eren. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
Figure 1. (A) Electrocardiogram was showing ST-segment depression in leads V4–6 and DII-DIII-aVF, also ST-segment elevation in leads aVR and V1 (B) Coronary angiogram showed LAD total occlusion after first diagonal branch and retrograde filling of the LAD distal segments by RCA (C).
PP-018 ASYMPTOMATIC ANTERIOR MYOCARDIAL INFARCTION IN A PATIENT WITH FINGER AMPUTATION TRIGGERED BY ACUTE INTENSE STRUGGLE U. Canpolat, A.H. Ates, H. Yorgun, E.B. Kaya, K. Aytemir, A. Oto. Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Psychosocial stresses are associated with an increased risk of acute myocardial infarction (AMI). Acute extraordinary stress may trigger AMI and stressful life events such as fights, earthquakes, war, threat of attack, and fear of death may precipitate AMI. Increased risk for AMI associated with high levels of stress is still significant after adjustment of other cardiovascular risk factors. We hereby report a male patient with finger amputation who developed anterior AMI after sustaining acute physical and psychological trauma on the basis of struggle.
Left ventricular noncompaction is a rare hereditary cardiomyopathy which is characterized by prominent intraventricular trabeculations separated with deep intratrabecular recesses. Cardinal features of this disorder are heart failure, a variety of supraventricular and ventricular arrythmias, and to a lesser extent, systemic arterial thromboembolism. While asymptomatic cardiac ischemia due to microvascular dysfunction is common in these patients; ST-segment elevation myocardial infarction, which is caused by complete occlusion of an epicardial coronary artery, is due to coincidental coronary artery disease rather than direct consequence of cardiomyopathy. We report a 20-year old male patient admitted to our emergency department with a complaint of squeezing chest pain. A diagnosis of ST-segment elevation myocardial infarction was made depending on ECG finding, but emergent coronary angiogram demonstrated normal coronary arteries. Echocardiography revealed isolated left ventricular noncompaction, and the diagnosis is confirmed with MRI. Repeat coronary catheterization with acetylcholine infusion and coronary flow reserve measurement failed to demonstrate vasospasm and microvascular dysfunction. As no apparent cause was found, the case was designated “idiopathic” myocardial infarction. Coronary thromboembolism due to stagnation of blood in LV cavity remained as the most probable mechanism underlying myocardial infarction. PP-020 DO NOT IGNORE EVEN MILD CHEST PAIN DURING PERCUTANEOUS CORONARY INTERVENTION: IT MAY BE A SIGNAL OF STENT EDGE DISSECTION OCCURRING WITHIN A SHORT PERIOD OF TIME E. Kardesoglu, Z. Isilak, O. Yiginer, O. Uz, B.S. Cebeci. Gata Haydarpasa Egitim Hastanesi, Istanbul, Turkey During PCI, chest pain is expected during balloon inflation. In primary PCI, a temporary exacerbation of chest pain may occur just after flow restoration due to vasoactive substances such as adenosine. Slow/no reflow, distal embolism and side branch occlusion may explain the chest pain. Therefore, the operator should carefully explore the reason of chest pain, and always