Infarto fatal do miocárdio em mulher de 88 anos de idade

Macedo, Ariane Vieira Scarlatelli; Moffa, Paulo Jorge; Grupi, César José; Filho, Eulógio Emílio Martinez; Libby, P; Gutierrez, Paulo Sampaio

doi:10.1590/s0066-782x2005001500014

Cited by 2 publications

(1 citation statement)

References 24 publications

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“…No association has been described between the size of the infarction and the risk of rupture; and it is not unusual for the infarction to be small. Data collected at the Laboratory of Pathology of the Heart Institute (InCor) 20 in cases of necropsy have shown that most ruptures occur at the first infarction (72%), after an average of 5.4 days of evolution 20 . The most commonly affected site is the lateral wall, as shown in the aforementioned series and also others in the lietarture 20,21 .…”

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confidence: 99%

Caso 3: Mulher idosa com infarto agudo do miocárdio apresentou choque súbito durante administração de trombolítico

Bittencourt¹,

Staniak²,

Aiello³

2010

Arq. Bras. Cardiol.

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The laboratory assessment disclosed levels of urea: e68 mg/dl, creatinine: 1.2 mg/dl, glycemia: 189 mg/dl and creatine kinase: 42 U/l. A diagnosis of ongoing myocardial infarction was achieved and TNK-tPA (Tecneplase -a genetically modified form of t-PA, with increased PAI-1 resistance, increased fibrin specificity and longer half-life) ficiwas administered as bolus of 40 mg with non-fractionated heparin as bolus of 6,060 UI/kg, followed by 1,000 UI/h IV. A residual retrosternal pain persisted.One hour after the start of the treatment, the patient presented right hypochondrial pain, followed by cardiogenic shock. Volume replacement and dopamine were administered. The control electrocardiogram (April 7, 2001, 2: 17 PM) showed sinus tachycardia, HR of 110 bpm, QS complexes with ST-segment elevation in uI, III, aVF, and from V 1 to V 6 ( Figure 3). A rescue angioplasty was indicated. However, the patient presented cardiac arrest with pulseless electrical activity, did not respond to the resuscitation maneuvers and died. Clinical aspectsIn a case such as the one described here, of a 72-yearold female patient, with history of coronary artery disease and myocardial revascularization carried out more than 10 years before, who sought emergency medical assistance due to typical precordial pain, the initial evaluation must always include an electrocardiogram (ECG). A normal ECG or an ECG with non-specific alterations or signs of ischemia would lead to an initial approach that would be different from the one described here. The admission ECG of this patient showed ST-segment elevation.Considering that the patient had been submitted to a previous myocardial revascularization (MR), the correlation of the diagnostic findings of the ECG deserves special attention. First, the presence of chronic coronary artery disease, as well as the previous MR without the appropriate description of the grafts used in the surgery makes it difficult to establish the electrocardiographic correlation with the culprit artery, due both to the presence of bypasses and the possible existence of an extensive collateral network. It is also important to remember that, in spite of the native artery lesions, the probability of lesions in bypasses is of 38% 1 . Additionally, the history of chronic coronary disease in elderly diabetic women and the QS in the anterior wall raises the possibility of previous myocardial infarction in the anterior wall, and, as a consequence, the possible correlation of the ST-segment elevation corresponding with the presence of aneurysm in the same wall. Still, the existence of ST-segment elevation in A 72-year-old female patient sought medical assistance due to precordial pain that had lasted for two hours.

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Section: Commentsmentioning

confidence: 99%

Caso 3: Mulher idosa com infarto agudo do miocárdio apresentou choque súbito durante administração de trombolítico

Bittencourt¹,

Staniak²,

Aiello³

2010

Arq. Bras. Cardiol.

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Multiple mechanical complications in ST-segment elevation myocardial infarction with angiographically normal coronary arteries

Monteiro

Galrinho

Branco

et al. 2015

Revista Portuguesa de Cardiologia

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This case report discusses an unusual presentation of ST-segment elevation myocardial infarction (STEMI) with normal coronary arteries and severe mechanical complications successfully treated with surgery. An 82-year-old man presented STEMI with angiographically normal coronary arteries and no major echocardiographic alterations at discharge. At the first month follow-up, he complained of fatigue and dyspnea, and contrast echocardiography complemented by cardiac magnetic resonance imaging revealed a large left ventricular apical aneurysm with a thrombus communicating by two jets of a turbulent flow to an aneurysmatic formation of the right ventricular apex. The patient underwent a Dor procedure, which was successful.Ventricular septal defects and ventricular aneurysms are rare but devastating complications of STEMI, with almost all patients presenting multivessel coronary artery disease. Interestingly in this case, the angiographic pattern was normal. © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved. Document downloaded from http://www.elsevier.pt, day 27/03/2015. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. PALAVRAS-CHAVE 209.e2A. Viveiros Monteiro et al. Artérias coronárias normaisum EAMCST com artérias coronárias angiograficamente normais e sem alterações ecocardiográficas de relevo aquando da alta. Na consulta do primeiro mês pós enfarte, por queixas de cansaço e dispneia, realizou um ecocardiograma complementado por uma ressonância magnética cardíaca que revelaram um grande aneurisma apical do ventrículo esquerdo, com trombo, comunicando através de dois jatos de fluxo turbulento com uma formação aneurismática do ápice do ventrículo direito. O paciente foi submetido a um procedimento de Dor com sucesso.A rutura do septo interventricular e os aneurismas ventriculares permanecem eventos raros mas devastadores com a quase maioria dos pacientes apresentado doença coronária multivaso. Curiosamente neste caso, o padrão angiográfico era normal.

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Infarto fatal do miocárdio em mulher de 88 anos de idade

Cited by 2 publications

References 24 publications

Caso 3: Mulher idosa com infarto agudo do miocárdio apresentou choque súbito durante administração de trombolítico

Caso 3: Mulher idosa com infarto agudo do miocárdio apresentou choque súbito durante administração de trombolítico

Multiple mechanical complications in ST-segment elevation myocardial infarction with angiographically normal coronary arteries

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