Use of contrast echocardiography in the diagnosis of subacute myocardial rupture after myocardial infarction

Garcı́a-Fernández, Miguel Ángel; Macchioli, Rodolfo Oscar Odreman; Moreno, Pedro Marcos-Alberca; Yangüela, Mar Moreno; Thomas, Javier Bermejo; Sendón, José Luis López; de, Esteban; Abdou, Yasser

doi:10.1067/mje.2001.114135

Cited by 25 publications

(14 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The detection of blood flow at the site of rupture may not be feasible in many cases, as the myocardial tear is most often anfractuous and sometimes covered by thrombi and thus blood flow velocities may be low. Despite the potential ability of contrast echocardiography to decrease the number of false-positive diagnoses [33-35] – by showing leakage of contrast from the left ventricle into the pericardial effusion – it was of no help in our patient.…”

Section: Case Presentationmentioning

confidence: 95%

Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving

Raposo

Andrade

Ferreira

et al. 2006

Cardiovasc Ultrasound

View full text Add to dashboard Cite

Left ventricular free wall rupture (LVFWR) is a fearful complication of acute myocardial infarction in which a swift diagnosis and emergency surgery can be crucial for successful treatment. Because a significant number of cases occur subacutely, clinicians should be aware of the risk factors, clinical features and diagnostic criteria of this complication. We report the case of a 69 year-old man in whom a subacute left ventricular free wall rupture (LVFWR) was diagnosed 7 days after an inferior myocardial infarction with late reperfusion therapy. An asymptomatic 3 to 5 mm saddle-shaped ST-segment elevation in anterior and lateral leads, detected on a routine ECG, led to an urgent bedside echocardiogram which showed basal inferior-wall akinesis, a small echodense pericardial effusion and a canalicular tract from endo to pericardium, along the interface between the necrotic and normal contracting myocardium, trough which power-Doppler examination suggested blood crossing the myocardial wall. A cardiac MRI further reinforced the possibility of contained LVFWR and a surgical procedure was undertaken, confirming the diagnosis and allowing the successful repair of the myocardial tear. This case illustrates that subacute LVFWR provides an opportunity for intervention. Recognition of the diversity of presentation and prompt use of echocardiography may be life-saving.

show abstract

Section: Case Presentationmentioning

confidence: 95%

Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving

Raposo

Andrade

Ferreira

et al. 2006

Cardiovasc Ultrasound

View full text Add to dashboard Cite

show abstract

“…[22][23][24][25] In our patient with acute LVFWR, rapid confirmation of the diagnosis was aided by the use of bedside contrast-enhanced echocardiography, and by our cardiologists' familiarity with this diagnostic method in the care of a critically ill patient. Furthermore, this case highlights the acute nature of mechanical sequelae of MI, particularly because reperfusion therapy was not administered.…”

Section: Discussionmentioning

confidence: 95%

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Okabe¹,

Julien²,

Kaliyadan³

et al. 2015

Texas Heart Institute Journal

View full text Add to dashboard Cite

L eft ventricular free-wall rupture (LVFWR) is a life-threatening sequela of acute myocardial infarction. Contrast-enhanced echocardiography can be used urgently at the bedside to identify LVFWR. Early recognition is paramount, because emergency surgical correction is the only treatment. We describe the use of contrast-enhanced echocardiography in a patient who sustained pulseless electrical activity 5 days after a myocardial infarction (MI). Direct views of a tear in the myocardium enabled rapid confirmation of the diagnosis and expeditious surgical treatment. Case ReportIn January 2013, a 59-year-old woman with hypertension and hypercholesterolemia presented at another hospital with a 2-day history of chest pain. She was treated for non-ST-segment-elevation MI. Her initial serum troponin T level was 0.96 ng/mL (normal, <0.01 ng/mL). An electrocardiogram revealed ST-segment elevation in lead aVL, borderline but nondiagnostic ST-segment elevation in adjacent lead I, rsR′ in lead V 2 , and ST-segment depression in the anterolateral and inferior leads (Fig. 1). The patient was admitted to the intensive care unit and was given aspirin, low-molecularweight heparin, a glycoprotein IIb/IIIa inhibitor, and a nitroglycerin infusion. Her serum troponin T level peaked at 3.79 ng/mL.The patient was transferred to our hospital the next day for elective cardiac catheterization. An electrocardiogram revealed a recent posterolateral infarction (Fig. 2). Coronary angiograms showed an occluded left circumflex coronary artery; faint collateral vessels from a patent, dominant right coronary artery; a 70% stenosis of the first diagonal branch; and a 90% stenosis of the right posterior descending artery (RPDA). Left ventriculograms revealed severe hypokinesis of the inferolateral wall and overall mild left ventricular (LV) dysfunction. No intervention was performed, because the patient was no longer symptomatic and was well beyond 24 hours from symptom onset and presentation.On hospital day 3, the patient sustained a retroperitoneal hemorrhage and was transfused with 2 units of packed red blood cells. On hospital day 5, she became acutely unresponsive and pulseless while conversing with her family. Advanced cardiac life support was initiated immediately. She remained hemodynamically unstable and needed intravenous fluids and vasopressors. A bedside transthoracic echocardio-

show abstract

“…6,7 In the setting of acute cardiac failure, contrast injection can improve the Doppler signal envelope and be helpful for detecting severe aortic valve stenosis in patients with bad quality imaging. It may also be used to facilitate the diagnosis of aortic dissection.…”

Section: Contrast Echocardiographymentioning

confidence: 99%

The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association

Lancellotti

Price

Edvardsen

et al. 2014

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/ critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described.

show abstract

Use of contrast echocardiography in the diagnosis of subacute myocardial rupture after myocardial infarction

Cited by 25 publications

References 6 publications

Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving

Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association

Contact Info

Product

Resources

About