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Transient ischemic attack due to an atrial septal defect
International Journal of Cardiology 173 (2014) e5–e6
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Transient ischemic attack due to an atrial septal defect S. Crosca a,⁎, G. Torrisi b, G.M. Calvagna b, S. Patanè b a b
Internal Medicine Unit, Hospital of Lipari, ASP 5 Messina, Italy Cardiology Unit, Hospital “San Vincenzo” Taormina, ASP Messina, Italy
a r t i c l e
i n f o
Article history: Received 20 January 2014 Accepted 9 March 2014 Available online 17 March 2014 Keywords: Congenital heart disease Atrial septal defect Cardioembolic Stroke
Certain congenital cardiac defects may go undetected for several years due to lack of symptoms and signs [1–5]. Both cryptogenic stroke and transient ischemic attack have been reported to be associated with cardiac defects and other cardiac conditions in literature as well as other cardioembolic diseases [6–26]. We present a case of a transient ischemic attack due to an important atrial septal defect in a 39-year-old Italian woman. A 39-year-old Italian woman reported a recent transient ischemic attack and a history of dyspnea, palpitations and of high blood pressure in newly diagnosed [27–33]. Echocardiographic evaluation revealed a mild aortic insufficiency (Fig. 1 Panel A), a right atrial dilatation and an important atrial septal defect (Fig. 1 Panels B, C, and D) as the most probable cause for the paradoxical cardioembolic event. Also this case focuses its attention on the occurrence of the transient ischemic attack due to a cardioembolic source.
Acknowledgements The authors of this manuscript have certified that they adhere to the statement of ethical publishing as appears in International Journal of Cardiology. Author contributions: Sergio Crosca conducted the clinical diagnosis, Giuseppe Torrisi prepared the references, Giuseppe Mario Calvagna prepared the figure and the figure legend, and Salvatore Patanè wrote the manuscript. ⁎ Corresponding author at: Unità Complessa di Medicina Interna, Ospedale di Lipari, Via Sant'Anna n.1, 98055 Messina, Italy. Tel.: +39 3356168172. E-mail address: [email protected] (S. Crosca).
http://dx.doi.org/10.1016/j.ijcard.2014.03.062 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
References [1] Tulino V, Cacace C, Tulino E, Imbalzano E, Dattilo G. Clinical variants in Ebstein's anomaly. Int J Cardiol Oct 12 2013;168(5):4969–70. [2] Gupta-Malhotra M, Dave A, Sturhan BC, McNiece K, Syamasundar Rao P, Portman R. Prevalence of undiagnosed congenital cardiac defects in older children. Cardiol Young Aug 2008;18(4):392–6. [3] Dattilo G, Lamari A, Tulino V, et al. Congenital valvular heart disease with high familial penetrance. Recenti Prog Med Dec 2012;103(12):581–3. [4] Dattilo G, Tulino V, Tulino D, Lamari A, Marte F, Patanè S. Interatrial defect, ventricular septal defect and patent ductus arteriosus in a 2-day-old newborn infant. Int J Cardiol May 15 2009;134(2):e82–3. [5] Patanè S, Marte F, Dattilo G, Tulino V, Pagano GT, Sturiale M. The chance finding of a ventricular septal defect in a 2-day-old newborn infant. Int J Cardiol Nov 3 2011;152(3):e45–6. [6] Kwong JS, Lam YY, Yu CM. Percutaneous closure of patent foramen ovale for cryptogenic stroke: a meta-analysis of randomized controlled trials. Int J Cardiol Oct 9 2013;168(4):4132–8. [7] Faggiano P, Frattini S, Piovesana P, et al. Low cerebrovascular event rate in subjects with patent foramen ovale and different clinical presentations: results from a prospective non randomized study on a population including patients with and without patent foramen ovale closure. Int J Cardiol Apr 5 2012;156(1):47–52. [8] Ker J. Congenital left atrial bands and cardioembolic events. Int J Cardiol Jan 1 2014;170(3):e72–3. [9] Zhang B, Zhou J, Li H, Zhou M, Chen A, Zhao Q. Transcatheter closure of patent foramen ovale does not reduce the risk of recurrent ischemic stroke versus medical therapy alone: a meta-analysis of randomized controlled trials. Int J Cardiol Nov 30 2013;169(6):e106–8. [10] Leong MC, Uebing A, Gatzoulis MA. Percutaneous patent foramen ovale occlusion: current evidence and evolving clinical practice. Int J Cardiol Nov 15 2013;169(4):238–43. [11] Kuwata S, Yoneyama K, Izumo M, et al. A rare adult case of corrected transposition of the great vessels with situs inversus with a single coronary artery and an atrial septal defect. Int J Cardiol Oct 3 2013;168(3):e91–3. [12] Imbalzano E, Saitta A, Lamari A, et al. Echo-doppler evaluation of recent onset chronic venous insufficiency in elderly patients: does the heart have a role? Recenti Prog Med Nov 2013;104(11):569–73. [13] Siniorakis E, Arvanitakis S, Pantelis N, et al. Left atrium in cor triatriatum: arrhythmogenesis and thrombogenesis leading to stroke. Int J Cardiol Oct 9 2013;168(4):4503–4. [14] Evola S, Kauroo BA, Trovato RL, et al. The percutaneous closure of patent foramen ovale (PFO): impact on the quality of life. Int J Cardiol Sep 30 2013;168(2):1622–3. [15] Ellison S, Lamb J, Haines A, et al. A guide for identification and continuing care of adult congenital heart disease patients in primary care. Int J Cardiol Mar 10 2013;163(3):260–5. [16] Park Y, Choi H, Kim SH, et al. Multisite paradoxical embolisms in a patient with patent foramen ovale and pulmonary thromboembolism. Int J Cardiol Aug 23 2012;159(2):e29–31. [17] Ghent F, Bassin L, Keller M, Cranney G, McKenzie D, Grant P. Impending paradoxical embolism: have we lost the clot? Clin Respir J Dec 13 2013. [18] Ntaios G, Papavasileiou V, Makaritsis K, Michel P. PFO closure vs. medical therapy in cryptogenic stroke or transient ischemic attack: a systematic review and metaanalysis. Int J Cardiol Oct 30 2013;169(2):101–5. [19] Peña JM, Kizer JR. Management of the stroke patient with patent foramen ovale: new insights and persistent questions in the wake of recent randomized trials. Curr Atheroscler Rep Jul 2013;15(7):338 [Review].
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S. Crosca et al. / International Journal of Cardiology 173 (2014) e5–e6
Fig. 1. Panel A: Echocardiographic evaluation revealed a mild aortic insufficiency. Panels B, C, and D: Echocardiographic evaluation revealed an important atrial septal defect and a right atrial dilatation.
[20] Amin H, Nowak RJ, Schindler JL. Cardioembolic stroke: practical considerations for patient risk management and secondary prevention. Postgrad Med Jan 2014;126(1):55–65. [21] Dattilo G, Lamari A, Di Bella G, et al. Treatment failure of low molecular weight heparin bridging therapy. Int J Cardiol Aug 20 2013;167(4):e106–7. [22] Patanè S, Marte F, Risica G, et al. Treatment failure of low molecular weight heparin bridging therapy before a cardiac surgery intervention in a patient with atrial fibrillation. Int J Cardiol Nov 12 2009;137(3):e59–60. [23] Dattilo G, Tulino D, Lamari A, Tulino V, Marte F, Patanè S. Treatment failure of low molecular weight heparin in a patient with an aortic mechanical prosthesis. Int J Cardiol Jan 21 2011;146(2):e30–2. [24] La Rocca R, Materia V, Pasquini A, La Rosa FC, Marte F, Patanè S. T-wave inversion after a severe head injury without ischemic heart disease. Int J Cardiol Sep 1 2011;151(2):e43–4. [25] Patanè S, Marte F, Lentini C, Buonamonte S. ST-elevation myocardial infarction associated with acute ischemic stroke. Int J Cardiol Dec 3 2010;145(3):e116–8. [26] Patanè S, Marte F, Lentini C, Buonamonte S. Coexistence of ST-elevation myocardial infarction and acute ischemic stroke. Int J Cardiol Jan 21 2011;146(2):233. [27] Tulino D, Imbalzano E, Casale M, et al. Treatment failure of low molecular weight heparin in diabetic patient. Int J Cardiol Sep 30 2013;168(2):e63–4.
[28] Imbalzano E, Trapani G, Creazzo M, Lizio G, Saitta A. Coronary artery disease in radiotherapy. Int J Cardiol Oct 9 2013;168(4):e125–6. [29] Sardo MA, Mandraffino G, Riggio S, et al. Effects of the angiotensin II receptor blocker losartan on the monocyte expression of biglycan in hypertensive patients. Clin Exp Pharmacol Physiol Sep 2010;37(9):933–8. [30] Sardo MA, Mandraffino G, Campo S, et al. Biglycan expression in hypertensive subjects with normal or increased carotid intima-media wall thickness. Clin Chim Acta Aug 2009;406(1–2):89–93. [31] Dattilo G, Lamari A, Crosca S, et al. Correlation between insulin resistance and endothelial dysfunction assessed by flow-mediated dilation. Recenti Prog Med Sep 2012;103(9):328–32. [32] Imbalzano E, Ceravolo R, Di Stefano R, Vatrano M, Saitta A. Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome. Int J Cardiol Dec 4 2013 [pii: S0167-5273(13)02122-0]. [33] Imbalzano E, Dattilo G, Scarpelli M, Lo Gullo A, Saitta A. Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis. Intern Emerg Med Dec 2013;8(8):765–6.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Transient ischemic attack due to an atrial septal defect S. Crosca a,⁎, G. Torrisi b, G.M. Calvagna b, S. Patanè b a b
Internal Medicine Unit, Hospital of Lipari, ASP 5 Messina, Italy Cardiology Unit, Hospital “San Vincenzo” Taormina, ASP Messina, Italy
a r t i c l e
i n f o
Article history: Received 20 January 2014 Accepted 9 March 2014 Available online 17 March 2014 Keywords: Congenital heart disease Atrial septal defect Cardioembolic Stroke
Certain congenital cardiac defects may go undetected for several years due to lack of symptoms and signs [1–5]. Both cryptogenic stroke and transient ischemic attack have been reported to be associated with cardiac defects and other cardiac conditions in literature as well as other cardioembolic diseases [6–26]. We present a case of a transient ischemic attack due to an important atrial septal defect in a 39-year-old Italian woman. A 39-year-old Italian woman reported a recent transient ischemic attack and a history of dyspnea, palpitations and of high blood pressure in newly diagnosed [27–33]. Echocardiographic evaluation revealed a mild aortic insufficiency (Fig. 1 Panel A), a right atrial dilatation and an important atrial septal defect (Fig. 1 Panels B, C, and D) as the most probable cause for the paradoxical cardioembolic event. Also this case focuses its attention on the occurrence of the transient ischemic attack due to a cardioembolic source.
Acknowledgements The authors of this manuscript have certified that they adhere to the statement of ethical publishing as appears in International Journal of Cardiology. Author contributions: Sergio Crosca conducted the clinical diagnosis, Giuseppe Torrisi prepared the references, Giuseppe Mario Calvagna prepared the figure and the figure legend, and Salvatore Patanè wrote the manuscript. ⁎ Corresponding author at: Unità Complessa di Medicina Interna, Ospedale di Lipari, Via Sant'Anna n.1, 98055 Messina, Italy. Tel.: +39 3356168172. E-mail address: [email protected] (S. Crosca).
http://dx.doi.org/10.1016/j.ijcard.2014.03.062 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
References [1] Tulino V, Cacace C, Tulino E, Imbalzano E, Dattilo G. Clinical variants in Ebstein's anomaly. Int J Cardiol Oct 12 2013;168(5):4969–70. [2] Gupta-Malhotra M, Dave A, Sturhan BC, McNiece K, Syamasundar Rao P, Portman R. Prevalence of undiagnosed congenital cardiac defects in older children. Cardiol Young Aug 2008;18(4):392–6. [3] Dattilo G, Lamari A, Tulino V, et al. Congenital valvular heart disease with high familial penetrance. Recenti Prog Med Dec 2012;103(12):581–3. [4] Dattilo G, Tulino V, Tulino D, Lamari A, Marte F, Patanè S. Interatrial defect, ventricular septal defect and patent ductus arteriosus in a 2-day-old newborn infant. Int J Cardiol May 15 2009;134(2):e82–3. [5] Patanè S, Marte F, Dattilo G, Tulino V, Pagano GT, Sturiale M. The chance finding of a ventricular septal defect in a 2-day-old newborn infant. Int J Cardiol Nov 3 2011;152(3):e45–6. [6] Kwong JS, Lam YY, Yu CM. Percutaneous closure of patent foramen ovale for cryptogenic stroke: a meta-analysis of randomized controlled trials. Int J Cardiol Oct 9 2013;168(4):4132–8. [7] Faggiano P, Frattini S, Piovesana P, et al. Low cerebrovascular event rate in subjects with patent foramen ovale and different clinical presentations: results from a prospective non randomized study on a population including patients with and without patent foramen ovale closure. Int J Cardiol Apr 5 2012;156(1):47–52. [8] Ker J. Congenital left atrial bands and cardioembolic events. Int J Cardiol Jan 1 2014;170(3):e72–3. [9] Zhang B, Zhou J, Li H, Zhou M, Chen A, Zhao Q. Transcatheter closure of patent foramen ovale does not reduce the risk of recurrent ischemic stroke versus medical therapy alone: a meta-analysis of randomized controlled trials. Int J Cardiol Nov 30 2013;169(6):e106–8. [10] Leong MC, Uebing A, Gatzoulis MA. Percutaneous patent foramen ovale occlusion: current evidence and evolving clinical practice. Int J Cardiol Nov 15 2013;169(4):238–43. [11] Kuwata S, Yoneyama K, Izumo M, et al. A rare adult case of corrected transposition of the great vessels with situs inversus with a single coronary artery and an atrial septal defect. Int J Cardiol Oct 3 2013;168(3):e91–3. [12] Imbalzano E, Saitta A, Lamari A, et al. Echo-doppler evaluation of recent onset chronic venous insufficiency in elderly patients: does the heart have a role? Recenti Prog Med Nov 2013;104(11):569–73. [13] Siniorakis E, Arvanitakis S, Pantelis N, et al. Left atrium in cor triatriatum: arrhythmogenesis and thrombogenesis leading to stroke. Int J Cardiol Oct 9 2013;168(4):4503–4. [14] Evola S, Kauroo BA, Trovato RL, et al. The percutaneous closure of patent foramen ovale (PFO): impact on the quality of life. Int J Cardiol Sep 30 2013;168(2):1622–3. [15] Ellison S, Lamb J, Haines A, et al. A guide for identification and continuing care of adult congenital heart disease patients in primary care. Int J Cardiol Mar 10 2013;163(3):260–5. [16] Park Y, Choi H, Kim SH, et al. Multisite paradoxical embolisms in a patient with patent foramen ovale and pulmonary thromboembolism. Int J Cardiol Aug 23 2012;159(2):e29–31. [17] Ghent F, Bassin L, Keller M, Cranney G, McKenzie D, Grant P. Impending paradoxical embolism: have we lost the clot? Clin Respir J Dec 13 2013. [18] Ntaios G, Papavasileiou V, Makaritsis K, Michel P. PFO closure vs. medical therapy in cryptogenic stroke or transient ischemic attack: a systematic review and metaanalysis. Int J Cardiol Oct 30 2013;169(2):101–5. [19] Peña JM, Kizer JR. Management of the stroke patient with patent foramen ovale: new insights and persistent questions in the wake of recent randomized trials. Curr Atheroscler Rep Jul 2013;15(7):338 [Review].
e6
S. Crosca et al. / International Journal of Cardiology 173 (2014) e5–e6
Fig. 1. Panel A: Echocardiographic evaluation revealed a mild aortic insufficiency. Panels B, C, and D: Echocardiographic evaluation revealed an important atrial septal defect and a right atrial dilatation.
[20] Amin H, Nowak RJ, Schindler JL. Cardioembolic stroke: practical considerations for patient risk management and secondary prevention. Postgrad Med Jan 2014;126(1):55–65. [21] Dattilo G, Lamari A, Di Bella G, et al. Treatment failure of low molecular weight heparin bridging therapy. Int J Cardiol Aug 20 2013;167(4):e106–7. [22] Patanè S, Marte F, Risica G, et al. Treatment failure of low molecular weight heparin bridging therapy before a cardiac surgery intervention in a patient with atrial fibrillation. Int J Cardiol Nov 12 2009;137(3):e59–60. [23] Dattilo G, Tulino D, Lamari A, Tulino V, Marte F, Patanè S. Treatment failure of low molecular weight heparin in a patient with an aortic mechanical prosthesis. Int J Cardiol Jan 21 2011;146(2):e30–2. [24] La Rocca R, Materia V, Pasquini A, La Rosa FC, Marte F, Patanè S. T-wave inversion after a severe head injury without ischemic heart disease. Int J Cardiol Sep 1 2011;151(2):e43–4. [25] Patanè S, Marte F, Lentini C, Buonamonte S. ST-elevation myocardial infarction associated with acute ischemic stroke. Int J Cardiol Dec 3 2010;145(3):e116–8. [26] Patanè S, Marte F, Lentini C, Buonamonte S. Coexistence of ST-elevation myocardial infarction and acute ischemic stroke. Int J Cardiol Jan 21 2011;146(2):233. [27] Tulino D, Imbalzano E, Casale M, et al. Treatment failure of low molecular weight heparin in diabetic patient. Int J Cardiol Sep 30 2013;168(2):e63–4.
[28] Imbalzano E, Trapani G, Creazzo M, Lizio G, Saitta A. Coronary artery disease in radiotherapy. Int J Cardiol Oct 9 2013;168(4):e125–6. [29] Sardo MA, Mandraffino G, Riggio S, et al. Effects of the angiotensin II receptor blocker losartan on the monocyte expression of biglycan in hypertensive patients. Clin Exp Pharmacol Physiol Sep 2010;37(9):933–8. [30] Sardo MA, Mandraffino G, Campo S, et al. Biglycan expression in hypertensive subjects with normal or increased carotid intima-media wall thickness. Clin Chim Acta Aug 2009;406(1–2):89–93. [31] Dattilo G, Lamari A, Crosca S, et al. Correlation between insulin resistance and endothelial dysfunction assessed by flow-mediated dilation. Recenti Prog Med Sep 2012;103(9):328–32. [32] Imbalzano E, Ceravolo R, Di Stefano R, Vatrano M, Saitta A. Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome. Int J Cardiol Dec 4 2013 [pii: S0167-5273(13)02122-0]. [33] Imbalzano E, Dattilo G, Scarpelli M, Lo Gullo A, Saitta A. Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis. Intern Emerg Med Dec 2013;8(8):765–6.