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PP-048 Unusual Case of Intricate Acute Chest Pain
MARCH 26e29, 2015
- PP-048 Unusual Case of Intricate Acute Chest Pain. Oana Bartos1, Grigore Tinica1, Cristina Grigorescu2. 1 Department of Cardiovascular Surgery, Institute of Cardiovascular Disease “Prof. Dr. George I. M. Georgescu”, Iasi, Romania; 2Department of Thoracic Surgery, Pneumoftisiology Hospital, Iasi, Romania. Objective: The term “acute coronary syndrome” is widely used and some clinicians find it almost synonymous with coronary artery disease. This case presentation highlights the non-cardiac component of intricated acute chest pain. Methods: A young 42 years old male patient presents to the emergency department with acute onset of chest pain, first in his life time, with acute ST elevation in the anterior leads and atrial fibrilation. He was subsequently treated for STEMI. Coronary angiogram however showed normal coronary arteries. Further tests showed a large anterior mediastinal mass invading the anterior pericardium with potential involvement of the myocardium. Results: The patient was taken to theatre where the tumor was resected via left sided video assisted mini-thoracotomy. The tumor was invading the pericardium and had dense adhesions with the epicardial fat but not invading the myocardium. Pathology confirmed thymoma. Conclusion: Acute coronary syndrome can echo an underlying sinister non-cardiac pathology. In rare cases a large anterior mediastinal mass can cause myocardial compression and lead to intricate acute chest pain.
- PP-049 Intrapericardial Coagulum Mass: The Only Manifestation of Subacute Left Ventricular Free Wall Rupture. Nihat Pekel1, Serkan Yakan2, Emre Ozpelit1, Gokhan Albayrak3, Istemihan Tengiz1, Ertugrul Ercan1. 1 Depertment of Cardiology, Izmir University, Izmir, Turkey; 2 Cardiology Clinic, M. Enver Senerdem Torbali Government Hospital, Izmir, Turkey; 3Depertment of Cardiovascular Surgery, Izmir University, Izmir, Turkey. Introduction: Myocardial free wall rupture due to myocardial infarction usually develops suddenly and leads to hemodynamic collapse. Mortality is very high even in patients undergoing emergent cardiac surgery. In very rare circumstances, free wall rupture may limit itself. It is life saving if it could be diagnosed with echocardiography before using reperfusion therapies. Case Presentation: A 56 years old male patient was referred to our clinics with subacute inferior myocardial infarction for primary reperfusion. Serum kreatinine level was 2,1 mg/dl, blood pressure was 90/60 mmHg and heart rate was 110 per minute. Patient had no prior history for renal dysfunction. He was evaluated with echocardiography for myocardial infarction complications. Echocardiography showed little pericardial effusion and hyperechogen mass in pericardial cavity especially located adjacent to apicolateral left ventricle and anterior to right ventricle free wall consistent with coagulum. Possible diagnosis was subacute myocardial free wall rupture confining itself due to myocardial infarction. Anticoagulant and antiaggregan treatments were stopped. Coronary angiography showed occluded Circumflex artery. Patient was operated three days after admission. Rupture at more than one point at posterior wall of the left ventricle over circumflex artery supply area were seen and primaryly sutured with the help of tephlon material. Patient was discharged at 10th postoperative day. Discussion: With the advent and widely usage of reperfusion strategies at acute myocardial infarction, myocardial free wall rupture is seen rarely. Possibility is increased in patients who do not receive
Figure. Echocardiographic and intraoperative images. Figure a-f: Echodens mass in pericardial cavity anterior to right ventricle free wall and adjacent to apicolateral free wall of the left ventricle (red star at figure a and b). Multiple rupture regions at left ventricular posterolateral wall (yellow arrows at figure c). Repair of the rupture regions with tephlon greft material suturing (figure d).Echocardiographic appearance at 30th. day postoperatively. (e and f). Pericardium is normal and left ventricle is dilated due to remodeling (f).
reperfusion treatment due to late presentation. Diagnosis is usually made with echocardiography after sudden cardiopulmonary arrest during myocardial infarction. When the free myocardial wall rupture limits itself, clinical progress is slower but ends up with final rupture and abondanous bleeding leading to death if it is not surgically repaired in a few days. Patients with acute ST elevated myocardial infarction referred for primary percutaneous coronary intervention are usually taken to cath lab without previous echocardiographic evaluation and PCI is performed. With the use of effective anticoagulant and antiaggregant treatments, those patients with subacute free wall rupture are prone to eventual lethal rupture. Echocardiography is the most effective tool to identify myocardial infarction complications especially in patients presenting late with hyperuremia and unstable hemodynamics. A selflimited free wall rupture should be suspected when an echodens mass is seen in pericardial cavity attached to epicardium in a defined region of myocardium.
- PP-050 Dignostic Enigma in a Homocystinuria Patient. Mert Ilker Hayıroglu, Berat Arıkan Aydın, Ahmet Öz, Veysel Ozan Tanık, Muhammed Keskin, Ahmet Okan Uzun, Mehmet Baran Karatas¸. Department of Cardiology, Dr. Siyami Ersek Gögüs Kalp ve Damar Cerrahisi Egitim ve Aras¸tırma Hastanesi, Istanbul, Turkey. Homocystinuria is an autosomal recessively transmitted with a frequency of 1/100000-200000, multisystemic metabolic disease.It occurs in deficiency of enzymes involving in methionine metabolism, enzyme deficiencies result in rise of serum methionine and homocysteine levels.Clinical presentation vary depending on the serum methionine and homocysteine levels. Here we discuss 19* years-old teenager presented to the emergency department with crushing chest pain with blood pressure 160/ 80mmhg.He was tall with long extremities has mental retardation and marfanoid appearance.The patient was already diagnosed as a homocystinuria 8 years ago.In electrocardiogram (ECG) there was ST segment elevation in aVR derivation, ST segment depression in all other derivations.Transthoracic echocardiography(TTE) reveals global hypokinesia.Coronary angiography(CAG) was performed because of
The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster S119
P O S T E R A B S T R A C T S
- PP-048 Unusual Case of Intricate Acute Chest Pain. Oana Bartos1, Grigore Tinica1, Cristina Grigorescu2. 1 Department of Cardiovascular Surgery, Institute of Cardiovascular Disease “Prof. Dr. George I. M. Georgescu”, Iasi, Romania; 2Department of Thoracic Surgery, Pneumoftisiology Hospital, Iasi, Romania. Objective: The term “acute coronary syndrome” is widely used and some clinicians find it almost synonymous with coronary artery disease. This case presentation highlights the non-cardiac component of intricated acute chest pain. Methods: A young 42 years old male patient presents to the emergency department with acute onset of chest pain, first in his life time, with acute ST elevation in the anterior leads and atrial fibrilation. He was subsequently treated for STEMI. Coronary angiogram however showed normal coronary arteries. Further tests showed a large anterior mediastinal mass invading the anterior pericardium with potential involvement of the myocardium. Results: The patient was taken to theatre where the tumor was resected via left sided video assisted mini-thoracotomy. The tumor was invading the pericardium and had dense adhesions with the epicardial fat but not invading the myocardium. Pathology confirmed thymoma. Conclusion: Acute coronary syndrome can echo an underlying sinister non-cardiac pathology. In rare cases a large anterior mediastinal mass can cause myocardial compression and lead to intricate acute chest pain.
- PP-049 Intrapericardial Coagulum Mass: The Only Manifestation of Subacute Left Ventricular Free Wall Rupture. Nihat Pekel1, Serkan Yakan2, Emre Ozpelit1, Gokhan Albayrak3, Istemihan Tengiz1, Ertugrul Ercan1. 1 Depertment of Cardiology, Izmir University, Izmir, Turkey; 2 Cardiology Clinic, M. Enver Senerdem Torbali Government Hospital, Izmir, Turkey; 3Depertment of Cardiovascular Surgery, Izmir University, Izmir, Turkey. Introduction: Myocardial free wall rupture due to myocardial infarction usually develops suddenly and leads to hemodynamic collapse. Mortality is very high even in patients undergoing emergent cardiac surgery. In very rare circumstances, free wall rupture may limit itself. It is life saving if it could be diagnosed with echocardiography before using reperfusion therapies. Case Presentation: A 56 years old male patient was referred to our clinics with subacute inferior myocardial infarction for primary reperfusion. Serum kreatinine level was 2,1 mg/dl, blood pressure was 90/60 mmHg and heart rate was 110 per minute. Patient had no prior history for renal dysfunction. He was evaluated with echocardiography for myocardial infarction complications. Echocardiography showed little pericardial effusion and hyperechogen mass in pericardial cavity especially located adjacent to apicolateral left ventricle and anterior to right ventricle free wall consistent with coagulum. Possible diagnosis was subacute myocardial free wall rupture confining itself due to myocardial infarction. Anticoagulant and antiaggregan treatments were stopped. Coronary angiography showed occluded Circumflex artery. Patient was operated three days after admission. Rupture at more than one point at posterior wall of the left ventricle over circumflex artery supply area were seen and primaryly sutured with the help of tephlon material. Patient was discharged at 10th postoperative day. Discussion: With the advent and widely usage of reperfusion strategies at acute myocardial infarction, myocardial free wall rupture is seen rarely. Possibility is increased in patients who do not receive
Figure. Echocardiographic and intraoperative images. Figure a-f: Echodens mass in pericardial cavity anterior to right ventricle free wall and adjacent to apicolateral free wall of the left ventricle (red star at figure a and b). Multiple rupture regions at left ventricular posterolateral wall (yellow arrows at figure c). Repair of the rupture regions with tephlon greft material suturing (figure d).Echocardiographic appearance at 30th. day postoperatively. (e and f). Pericardium is normal and left ventricle is dilated due to remodeling (f).
reperfusion treatment due to late presentation. Diagnosis is usually made with echocardiography after sudden cardiopulmonary arrest during myocardial infarction. When the free myocardial wall rupture limits itself, clinical progress is slower but ends up with final rupture and abondanous bleeding leading to death if it is not surgically repaired in a few days. Patients with acute ST elevated myocardial infarction referred for primary percutaneous coronary intervention are usually taken to cath lab without previous echocardiographic evaluation and PCI is performed. With the use of effective anticoagulant and antiaggregant treatments, those patients with subacute free wall rupture are prone to eventual lethal rupture. Echocardiography is the most effective tool to identify myocardial infarction complications especially in patients presenting late with hyperuremia and unstable hemodynamics. A selflimited free wall rupture should be suspected when an echodens mass is seen in pericardial cavity attached to epicardium in a defined region of myocardium.
- PP-050 Dignostic Enigma in a Homocystinuria Patient. Mert Ilker Hayıroglu, Berat Arıkan Aydın, Ahmet Öz, Veysel Ozan Tanık, Muhammed Keskin, Ahmet Okan Uzun, Mehmet Baran Karatas¸. Department of Cardiology, Dr. Siyami Ersek Gögüs Kalp ve Damar Cerrahisi Egitim ve Aras¸tırma Hastanesi, Istanbul, Turkey. Homocystinuria is an autosomal recessively transmitted with a frequency of 1/100000-200000, multisystemic metabolic disease.It occurs in deficiency of enzymes involving in methionine metabolism, enzyme deficiencies result in rise of serum methionine and homocysteine levels.Clinical presentation vary depending on the serum methionine and homocysteine levels. Here we discuss 19* years-old teenager presented to the emergency department with crushing chest pain with blood pressure 160/ 80mmhg.He was tall with long extremities has mental retardation and marfanoid appearance.The patient was already diagnosed as a homocystinuria 8 years ago.In electrocardiogram (ECG) there was ST segment elevation in aVR derivation, ST segment depression in all other derivations.Transthoracic echocardiography(TTE) reveals global hypokinesia.Coronary angiography(CAG) was performed because of
The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster S119
P O S T E R A B S T R A C T S