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Unexpected coexisting myocardial infarction detected by delayed enhancement MRI.

Gerbaud E, De Clermont-Galleran H, Erickson M, Coste P, Montaudon M - Case Rep Med (2009)

Bottom Line: This second necrotic area was not initially suspected because there were no ECG changes in the anterior leads and the left descending coronary artery did not present any significant stenoses on emergency coronary angiography.Unrecognised myocardial infarction may carry important prognostic implications.CMR is currently the best imaging technique to detect unexpected infarcts.

View Article: PubMed Central - PubMed

Affiliation: Service des Soins Intensifs Cardiologiques, Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac Cedex, France.

ABSTRACT
We report a case of an unexpected coexisting anterior myocardial infarction detected by delayed enhancement MRI in a 41-year-old man following a presentation with a first episode of chest pain during inferior acute myocardial infarction. This second necrotic area was not initially suspected because there were no ECG changes in the anterior leads and the left descending coronary artery did not present any significant stenoses on emergency coronary angiography. Unrecognised myocardial infarction may carry important prognostic implications. CMR is currently the best imaging technique to detect unexpected infarcts.

No MeSH data available.


Related in: MedlinePlus

Initially, the coronary angiography showed an acute thrombotic occlusion on the second segment of the right coronary artery (Panel (a)). The patient underwent angioplasty and stenting with a final good result (Panel (b)). Coronary angiography revealed a severe stenosis on a minor circumflex coronary artery (Panel (c)). There were many diffuse lesions on the left anterior descending coronary artery and his branches without significant stenosis (Panel (d)).
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fig1: Initially, the coronary angiography showed an acute thrombotic occlusion on the second segment of the right coronary artery (Panel (a)). The patient underwent angioplasty and stenting with a final good result (Panel (b)). Coronary angiography revealed a severe stenosis on a minor circumflex coronary artery (Panel (c)). There were many diffuse lesions on the left anterior descending coronary artery and his branches without significant stenosis (Panel (d)).

Mentions: A 41-year-old man was referred to our department with an inferior acute myocardial infarction. He was smoker with hyperlipidaemia (low-density lipoprotein cholesterol was 169 mg/dL). The time symptom onset to admission to the intensive care unit was ten hours. His 12-lead electrocardiogram revealed a normal sinus rhythm at 60 beats/min with persisting ST elevation and Q waves in the inferior leads. Emergency coronary angiography revealed an acute thrombotic occlusion of the second segment of the right coronary artery, a severe stenosis of a non-dominant and small circumflex coronary artery and diffuse plaques in all segments of the left anterior descending coronary artery (Figure 1, Panel (c) and (d)); the patient underwent angioplasty and (bare metal) stenting with a good final result (Figure 1, Panel (a) and (b)). Initial CMR was performed five days after the acute event. Steady-state free precession (SSFP) cine sequences showed normal wall motion in the anterior area and severe myocardial hypokinesia in the inferior wall. Black blood T2 images (T2 weighted short inversion-time, inversion-recovery (STIR) breath hold pulse sequences) suggested myocardial oedema in the inferior wall (Figure 2, Panel (e)). CMR detected transmural delayed enhancement in the inferior wall associated with late microvascular obstruction 10 minutes after gadolinium injection (Figure 2, Panel (f) and (g)). Surprisingly, another area of hyperenhancement which was subendocardial was found in the mid anterior wall of the left ventricle within the distribution of the left anterior descending coronary artery territory.


Unexpected coexisting myocardial infarction detected by delayed enhancement MRI.

Gerbaud E, De Clermont-Galleran H, Erickson M, Coste P, Montaudon M - Case Rep Med (2009)

Initially, the coronary angiography showed an acute thrombotic occlusion on the second segment of the right coronary artery (Panel (a)). The patient underwent angioplasty and stenting with a final good result (Panel (b)). Coronary angiography revealed a severe stenosis on a minor circumflex coronary artery (Panel (c)). There were many diffuse lesions on the left anterior descending coronary artery and his branches without significant stenosis (Panel (d)).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2734919&req=5

fig1: Initially, the coronary angiography showed an acute thrombotic occlusion on the second segment of the right coronary artery (Panel (a)). The patient underwent angioplasty and stenting with a final good result (Panel (b)). Coronary angiography revealed a severe stenosis on a minor circumflex coronary artery (Panel (c)). There were many diffuse lesions on the left anterior descending coronary artery and his branches without significant stenosis (Panel (d)).
Mentions: A 41-year-old man was referred to our department with an inferior acute myocardial infarction. He was smoker with hyperlipidaemia (low-density lipoprotein cholesterol was 169 mg/dL). The time symptom onset to admission to the intensive care unit was ten hours. His 12-lead electrocardiogram revealed a normal sinus rhythm at 60 beats/min with persisting ST elevation and Q waves in the inferior leads. Emergency coronary angiography revealed an acute thrombotic occlusion of the second segment of the right coronary artery, a severe stenosis of a non-dominant and small circumflex coronary artery and diffuse plaques in all segments of the left anterior descending coronary artery (Figure 1, Panel (c) and (d)); the patient underwent angioplasty and (bare metal) stenting with a good final result (Figure 1, Panel (a) and (b)). Initial CMR was performed five days after the acute event. Steady-state free precession (SSFP) cine sequences showed normal wall motion in the anterior area and severe myocardial hypokinesia in the inferior wall. Black blood T2 images (T2 weighted short inversion-time, inversion-recovery (STIR) breath hold pulse sequences) suggested myocardial oedema in the inferior wall (Figure 2, Panel (e)). CMR detected transmural delayed enhancement in the inferior wall associated with late microvascular obstruction 10 minutes after gadolinium injection (Figure 2, Panel (f) and (g)). Surprisingly, another area of hyperenhancement which was subendocardial was found in the mid anterior wall of the left ventricle within the distribution of the left anterior descending coronary artery territory.

Bottom Line: This second necrotic area was not initially suspected because there were no ECG changes in the anterior leads and the left descending coronary artery did not present any significant stenoses on emergency coronary angiography.Unrecognised myocardial infarction may carry important prognostic implications.CMR is currently the best imaging technique to detect unexpected infarcts.

View Article: PubMed Central - PubMed

Affiliation: Service des Soins Intensifs Cardiologiques, Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac Cedex, France.

ABSTRACT
We report a case of an unexpected coexisting anterior myocardial infarction detected by delayed enhancement MRI in a 41-year-old man following a presentation with a first episode of chest pain during inferior acute myocardial infarction. This second necrotic area was not initially suspected because there were no ECG changes in the anterior leads and the left descending coronary artery did not present any significant stenoses on emergency coronary angiography. Unrecognised myocardial infarction may carry important prognostic implications. CMR is currently the best imaging technique to detect unexpected infarcts.

No MeSH data available.


Related in: MedlinePlus