Figure 4
Cardiac catheterization revealed a tubular 60 % stenosis mid left anterior descending artery (LAD) and a large filling defect consistent with thrombus with 100 % stenosis of mid RCA with failed thrombectomy with balloon angioplasty
Source publication
Background:
Since the introduction of heparin as part of the management of acute coronary syndrome, the occurrence of pulmonary embolism (PE) as a complication of myocardial infarction (MI) have somewhat been unheard of. Given this rarity, its recognition is now a formidable challenge.
Case description:
We present a case of a previously well 56-...
Context in source publication
Context 1
... echocardiography revealed revealed ejection fraction of 55 to 60%. He was taken to cardiac catheterization which revealed a tubular 60 % stenosis mid left anterior descending artery (LAD) and a large filling defect consistent with thrombus with 100% stenosis of mid right coronary artery (RCA) with failed thrombectomy with balloon angioplasty (Figure 4, Figure 5, Figure 6). His blood pressure dropped after cardiac catheterization, and hence he was started on intravenous fluids and dopamine drip. ...
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Case presentation:
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Citations
... embolismo pulmonar como una complicación del infarto que podría darse en casos extraños como la presentación o terapia de revascularización tardía (7) . En este orden de ideas se ha contemplado que el desarrollo de un trombo en el ventrículo derecho sea debido a un miocardio acinético que produce estasis sanguínea y conduce a la formación del trombo con posterior embolización hacia la vasculatura pulmonar (8) . Este postulado es bastante sugestivo con lo ocurrido en la paciente, quien presentó trombo en ventrículo derecho y embolismo pulmonar masivo post-NSTEMI; además, en el ecocardiograma se logró constatar la hipocinesia septal. ...
Introducción:
un trombo en ventrículo derecho y embolismo pulmonar post infarto agudo de miocardio sin elevación del ST es muy inusual. Es considerado una emergencia médica y es imperativo instaurar una opción terapéutica inmediata.
Presentación del caso:
paciente femenina de 80 años quien consultó en sala de emergencias por síncope, dolor torácico y disnea persistente. Se confirmó síndrome coronario agudo por electrocardiograma y troponina I elevada. En estudios complementarios se encontró hallazgo incidental de trombo en el ventrículo derecho y un angio-TAC confirmó embolismo pulmonar masivo.
Discusión:
el trombo en ventrículo derecho y embolismo pulmonar masivo post infarto es un fenómeno muy raro en el escenario clínico, debido a la instauración temprana de la terapia anti-isquémica. Es necesario mayor investigación para aclarar este fenómeno.
An 86-year-old female on dialysis experienced a decrease in blood pressure and worsening of her respiratory condition during dialysis, for which she visited our emergency unit. She was admitted to our Department of Cardiology with a diagnosis of acute myocardial infarction complicated with heart failure because of anterior wall of left ventricular dysfunction, positive troponin T levels and negative T wave on a precordial lead electrocardiogram. On the same day, she underwent coronary angiography and stenting at left anterior descending artery #7 with 99% stenosis. She also showed an elevated D-dimer level on admission, and contrast-enhanced computed tomography (CT) was performed the day after admission, considering the likelihood of respiratory failure due to pulmonary thromboembolism. However, the findings were negative. On the 4th day of hospitalization, she showed marked hypoxemia. Her D-dimer level was further elevated, and when she underwent enhanced CT again, there was no evidence of deep vein thrombosis, but thrombus in the pulmonary artery and apex of right ventricle was noted. She was therefore diagnosed with acute pulmonary embolism due to thrombosis from the right ventricle rather than from a deep vein. She rapidly received anticoagulant therapy and non-invasive positive pressure ventilation therapy for respiratory failure, but she entered cardiopulmonary arrest and quickly died. She was suspected to have been complicated with a right ventricular infarction and an acute anterior wall myocardial infarction, resulting in a large thrombus along the apex of the right ventricle. This case of both myocardial infarction and pulmonary embolism is very rare, and we report it here with consideration.
