Left ventricular aneurysm and apical thrombus as a late complication of myocardial infarction
Abstract
Ischemic cardiomyopathy is chronic myocardial dysfunction following coronary artery disease, often severe, with clinical manifestations that, at times, cannot be distinguished from those resulting from dilated cardiomyopathy due to other causes. Left ventricular aneurysms, typically subsequent to the almost always acute occlusion of an epicardial coronary vessel, constitute one of its clinical-imaging expressions; they reduce the mechanical function of the affected myocardial segments, produce electrical heterogeneity that can lead to severe arrhythmias, and, due to regional motility abnormalities, can give rise to the formation of intracavitary thrombi and peripheral embolisms. This article describes the case of a patient with chronic myocardial infarction due to occlusion of the left anterior descending artery, resulting in an apical aneurysm of the left ventricle with an associated thrombus.Downloads
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1. Silva Guisasola J, González Santos JM, Ruiz Fernández M, Castaño Ruiz M, López Rodríguez J, Albertos Salvador, et al. Disfunción ventricular isquémica crónica severa. Determinantes del riesgo quirúrgico y del resultado clínico a largo plazo. Rev Esp Cardiol. 1997:50(12):870-81. DOI: https://doi.org/10.1016/S0300-8932(97)74694-3
2. Gorla R, Verna E, Scotti S, Ghiringhelli S, Zoli L, Provasoli S, et al. Clinical role of post-angioplasty hyperemic microvascular resistances in chronic ischemic left ventricular dysfunction. J Cardiovasc Med (Hagerstown). 2017;18(5):332-40. DOI: https://doi.org/10.2459/jcm.0000000000000490
3. Beitzke D, Rasul S, Lassen ML, Pichler V, Senn D, Stelzmüller ME, et al. Assessment of Myocardial Viability in Ischemic Heart Disease by PET/MRI: Comparison of Left Ventricular Perfusion, Hibernation, and Scar Burden. Acad Radiol. 2020;27(2):188-97. DOI: https://doi.org/10.1016/j.acra.2019.03.021
4. Joshi PH, de Lemos JA. Diagnosis and Management of Stable Angina: A Review. JAMA. 2021;325(17):1765-78. DOI: https://doi.org/10.1001/jama.2021.1527
5. Adamson PD, Williams MC, Dweck MR, Mills NL, Boon NA, Daghem M, et al. Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain. J Am Coll Cardiol. 2019;74(16):2058-70. DOI: https://doi.org/10.1016/j.jacc.2019.07.085
6. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77. DOI: https://doi.org/10.1093/eurheartj/ehz425
7. Durko AP, Budde RPJ, Geleijnse ML, Kappetein AP. Recognition, assessment and management of the mechanical complications of acute myocardial infarction. Heart. 2018;104(14):1216-23. DOI: https://doi.org/10.1136/heartjnl-2017-311473
8. Lanz J, Wyss D, Räber L, Stortecky S, Hunziker L, Blöchlinger S, et al. Mechanical complications in patients with ST-segment elevation myocardial infarction: A single centre experience. PLoS One [Internet]. 2019 [citado 8 Ene 2022];14(2):e0209502. Disponible en: https://doi.org/10.1371/journal.pone.0209502
9. Bajaj A, Sethi A, Rathor P, Suppogu N, Sethi A. Acute Complications of Myocardial Infarction in the Current Era: Diagnosis and Management. J Investig Med. 2015;63(7):844-55. DOI: https://doi.org/10.1097/jim.0000000000000232
10. Makaryus AN, Uretsky S. Clinical Applications of Cardiac CT. En: Tilkemeier PL, Hendel RC, Heller GV, Case JA. Quality Evaluation in Non-Invasive Cardiovascular Imaging. Cham (Switzerland): Springer International Publishing; 2016. pp. 51-4. DOI: https://doi.org/10.1007/978-3-319-28011-0_6
11. Shriki JE, Colletti PM, Maximin S. Assessment of Cardiac and Thoracic Masses. En: Budoff M, Shinbane J, eds. Cardiac CT Imaging. Cham (Switzerland): Springer; 2016. pp. 275-93. DOI: https://doi.org/10.1007/978-3-319-28219-0_16
12. McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL, Bhatt DL, McEvoy JW. Left Ventricular Thrombus After Acute Myocardial Infarction: Screening, Prevention, and Treatment. JAMA Cardiol. 2018;3(7):642-9. DOI: https://doi.org/10.1001/jamacardio.2018.1086
13. Nakanishi R, Weigold WG, Budoff MJ. Cardiovascular Computed Tomography: Current and Future Scanning System Design. En: Budoff M, Shinbane J, eds. Cardiac CT Imaging. Cham (Switzerland): Springer; 2016. pp. 25-32. DOI: https://doi.org/10.1007/978-3-319-28219-0_2
14. Delgado Sánchez-Gracián C, Oca Pernas R, Trinidad López C, Santos Armentia E, Vaamonde Liste A, Vázquez Caamaño M, et al. Quantitative myocardial perfusion with stress dual-energy CT: iodine concentration differences between normal and ischemic or necrotic myocardium. Initial experience. Eur Radiol. 2016;26(9):3199-207. DOI: https://doi.org/10.1007/s00330-015-4128-y
15. Sharma RK, Gottlieb I, Lima JAC. Cardiovascular CT for Perfusion and Delayed Contrast Enhancement Imaging. En: Budoff M, Shinbane J, eds. Cardiac CT Imaging. Cham (Switzerland): Springer; 2016. pp. 211-220. DOI: https://doi.org/10.1007/978-3-319-28219-0_12
16. Shaw LJ. Coronary Computed Tomographic Angiography for Detection of Coronary Artery Disease: Analysis of Large-Scale Multicenter Trials and Registries. En: Budoff M, Shinbane J, eds. Cardiac CT Imaging. Cham (Switzerland): Springer; 2016. pp. 281-90. DOI: https://doi.org/10.1007/978-3-319-28219-0_21
17. Vieira Fernandes F, Caldeira Cury R. Evaluación de isquemia miocárdica por tomografía computada con múltiples detectores. Arq Bras Cardiol: Imagem Cardiovasc [Internet]. 2015 [citado 14 Ene 2022];28(1):36-44. Disponible en: https://bit.ly/49nUajP
18. Case JA. Computed Tomography: Quality Control. En: Tilkemeier PL, Hendel RC, Heller GV, Case JA. Quality Evaluation in Non-Invasive Cardiovascular Imaging. Cham (Switzerland): Springer International Publishing; 2016. pp. 71-84. DOI: https://doi.org/10.1007/978-3-319-28011-0_8
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