Images in cardiovascular medicine

A rare complication of myocardial infarction A 75-year-old patient was admitted with lightheadedness and feeling unwell for 5 days. He had no significant past cardiac history, and denied any chest pain or breathlessness. Electrocardiogram showed q waves with residual ST elevation in the inferior leads (Panel A figure 1). On examination, the patient was haemodynamically stable, but profoundly hypoxic with oxygen saturations of 67% on air refractory to oxygen therapy. He had raised jugular venous pressure, clear lung fields and a loud pan-systolic murmur. All the bloods including inflammatory markers were normal, but troponin T was raised. Chest x-ray and CTPA were normal. Echocardiogram revealed dilated and impaired right ventricle (RV) with severe tricuspid regurgitation and mild left ventricular dysfunction (see online supplementary video 1). This raised the possibility of inferior wall myocardial infarction with RVMI and a right-to-left shunt, which was confirmed on bubble contrast study (see online supplementary video 2). There was no target vessel for revascularisation; the patient’s condition deteriorated rapidly and was deemed unsuitable for either surgical or percutaneous closure of shunt, and was treated conservatively.

Figure 1

The development of right-to-left shunt in the context of RVMI is very rare, the incidence of which is not known. Patients can present with hypoxia refractory to oxygen therapy in the absence of any other cause and paradoxical embolisation. Treatment is generally supportive with revascularisation of target artery where possible. There is no general consensus for shunt closure, as normally RV function improves and the shunt closes. Recognition of this condition and early diagnosis is critically important to prevent any life-threatening sequelae.

Usha Rao, Mirela M Marinescu Department of Cardiology, West Suffolk Hospital, Suffolk, UK Correspondence to Dr Usha Rao, SpR, Department of Cardiology, West Suffolk Hospital, Suffolk IP33 2QZ, UK; [email protected] ▸ Additional data are published online only. To view these files please visit the journal online ( Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.

Heart Asia 2012;151. doi:10.1136/heartasia-2012-010183

Panel A: Electrocardiogram showing q waves with residual ST elevation in the inferior leads.

Heart Asia 2012


A rare complication of myocardial infarction.

A rare complication of myocardial infarction. - PDF Download Free
213KB Sizes 0 Downloads 15 Views

Recommend Documents

Letter: Myocardial infarction: a complication of vincristine treatment?
690 choactive polypeptides derived from wheat gluten) may be as easily postulated. We fully endorse the need for further study of the role of wheat gl

Thrombolytic-related complication in a case of misdiagnosed myocardial infarction.
The importance of early thrombolysis in acute myocardial infarction has been highlighted in several large trials. The clinical decision is often taken by physicians who need to take a rapid action with the risk of misdiagnosing non-coronary events th

Segmental Infarction of Testis: A rare complication of acute epididymitis.
Doppler ultrasound of a thirty one year old patient presenting with acute scrotal pain showed features acute epididymitis. Follow up study done on third day showed total ischemia of the testis. Repeat scan on tenth day revealed partially regained flo

Pulmonary alveolar hemorrhage mimicking a pneumopathy: a rare complication of dual antiplatelet therapy for ST elevation myocardial infarction.
Diffuse alveolar hemorrhage after percutaneous coronary intervention (PCI) is a rare complication. The diagnosis is difficult and can mimic by clinical and radiological features other diagnosis as pneumopathy. We herein report the case of a 63-year-o

Intramyocardial dissection with concomitant left ventricular aneurysm as a rare complication of myocardial infarction: a case report.
We describe a rare case of a 60-year-old woman suffering from intramyocardial dissection and left ventricular aneurysm secondary to acute myocardial infarction. A rare form of ventricular septal rupture resulted from intramyocardial dissection deteri