Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: a report of an unusual case and a brief review of the literature

Abstract

Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene.

Clinical Influencing Factors of Acute Myocardial Infarction Based on Improved Machine Learning

“…Ventricular pseudoaneurysm refers to a tumor-like structure formed by the pericardial tissue surrounding the breach, clogged by thrombus or adhesion after the ventricular wall slowly ruptures. The incidence rate is 0.1%, and the case fatality rate is as high as 48% [ 17 ], which can be confirmed by echocardiography. Once it is found, surgical treatment is required as soon as possible [ 18 ].…”

Symmetrical Peripheral Gangrene Associated with Low Output Cardiac Failure

“…The exact mechanism for SPG is unclear [3]. A hypercoagulable disseminated intravascular coagulation (DIC)-like condition secondary to sepsis has been associated in 85 to 100% of patients with SPG [4,11]. Our patient was not septic on presentation and did not have a clear source of infection that might have led to DIC.…”

“…Low flow state combined with microvascular occlusion from DIC [3,15] leads to ischemic changes that involve distal extremities and advances, proximally [3]. Aggravating factors include cold-induced vasospasm [2,11], the use of vasoconstrictor drugs [2,3], diabetes mellitus, and renal failure [2].…”

“…Various infective and noninfective factors are responsible for the development of SPG [3]. Among them, cardiac conditions myocardial infarction [6,7,8], myocardial infarction with coronary artery bypass graft and, such as ventricular septal defect repair [9], paroxysmal ventricular tachycardia [10], ventricular pseudoaneurysm [11], and severe heart failure [12] have been associated with SPG. We present a case of SPG in the setting of severely depressed cardiac ejection fraction.…”

Symmetrical and Peripheral Gangrene Complicating a Third-Degree Atrioventricular Block: A New Presentation of a Known Disease

“…This condition may result from acute bacteremia or vasopressor drug use, which results in the occlusion of microcirculation of the affected part. Many cardiac conditions were associated with SPG such as myocardial infarction [7][8][9][10], ventricular pseudoaneurysm [11], pulmonary embolism [12], paroxysmal ventricular tachycardia [13], post-cardiac surgery [14][15], severe heart failure [3], and postpartum cardiomyopathy ( Table 1) [16]. It may be also encountered in some chronic conditions such as essential thrombocythemia, polycythemia rubra vera, Raynaud's syndrome, diabetes, small vessel obstruction, and disseminated intravascular coagulation (DIC) [7].…”