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Ventricular Septal Rupture in a Case Suspected as Stress Induced Cardiomyopathy.

Rhyou HI, Park TH, Han JE, Kim MH, Kim YD - J Cardiovasc Ultrasound (2015)

Bottom Line: However, coronary angiography showed normal coronary artery.On the fourth day after admission, the patient died.We suspect that VSR was developed by stress induced cardiomyopathy, not by AMI.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Dong-A University Hospital, Busan, Korea.

ABSTRACT
An 87-year-old woman with continuous chest discomfort was referred to our hospital. ST-segment elevation in lead V1-4 was detected on electrocardiography and ventricular septal rupture (VSR) was observed on echocardiography. Post-acute myocardial infarction (AMI) VSR was suspected and she underwent emergency cardiac catheterization. However, coronary angiography showed normal coronary artery. On the fourth day after admission, the patient died. We suspect that VSR was developed by stress induced cardiomyopathy, not by AMI.

No MeSH data available.


Related in: MedlinePlus

Coronary angiography demonstrates no stenotic lesion in left (A) and right coronary artery (B).
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Figure 3: Coronary angiography demonstrates no stenotic lesion in left (A) and right coronary artery (B).

Mentions: Chest radiography showed no signs of cardiomegaly, nor signs of pulmonary congestion. Laboratory data on admission showed increased levels of cardiac biomarkers (troponin-I 8.2 ng/nL and CK-MB 50 U/L). Echocardiography showed akinesis in apical segments of LV and right ventricular (RV), and hyperkinesis in the basal segments of LV (Fig. 2A and B). Filling defect (0.8 cm in size) and left to right shunt flow were shown on apical segment of interventricular septum (Fig. 2C and D). Post-AMI VSR was suspected and she underwent emergency cardiac catheterization. However, coronary angiography revealed normal coronary artery with thrombolysis in myocardial infarction grade 3 (Fig. 3). Angiographic findings showed no spontaneous coronary spasm, nor thrombus. However, we could not perform coronary spasm provocation test. Since the patient and her family did not want to get a cardiac operation, only medical therapy including intravenous inotropics was continued. Her peak troponin-I level gradually decreased during follow-up examinations. On the third day after admission, ECG showed persistent ST-segment elevation in V2-5, and Q-wave in lead aVR, III, and V1-4 (Fig. 1B). On the fourth day after admission, polymorphic ventricular tachycardia developed (Fig. 1C), and the patient died even after cardiopulmonary resuscitation was performed (Fig. 1D).


Ventricular Septal Rupture in a Case Suspected as Stress Induced Cardiomyopathy.

Rhyou HI, Park TH, Han JE, Kim MH, Kim YD - J Cardiovasc Ultrasound (2015)

Coronary angiography demonstrates no stenotic lesion in left (A) and right coronary artery (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595704&req=5

Figure 3: Coronary angiography demonstrates no stenotic lesion in left (A) and right coronary artery (B).
Mentions: Chest radiography showed no signs of cardiomegaly, nor signs of pulmonary congestion. Laboratory data on admission showed increased levels of cardiac biomarkers (troponin-I 8.2 ng/nL and CK-MB 50 U/L). Echocardiography showed akinesis in apical segments of LV and right ventricular (RV), and hyperkinesis in the basal segments of LV (Fig. 2A and B). Filling defect (0.8 cm in size) and left to right shunt flow were shown on apical segment of interventricular septum (Fig. 2C and D). Post-AMI VSR was suspected and she underwent emergency cardiac catheterization. However, coronary angiography revealed normal coronary artery with thrombolysis in myocardial infarction grade 3 (Fig. 3). Angiographic findings showed no spontaneous coronary spasm, nor thrombus. However, we could not perform coronary spasm provocation test. Since the patient and her family did not want to get a cardiac operation, only medical therapy including intravenous inotropics was continued. Her peak troponin-I level gradually decreased during follow-up examinations. On the third day after admission, ECG showed persistent ST-segment elevation in V2-5, and Q-wave in lead aVR, III, and V1-4 (Fig. 1B). On the fourth day after admission, polymorphic ventricular tachycardia developed (Fig. 1C), and the patient died even after cardiopulmonary resuscitation was performed (Fig. 1D).

Bottom Line: However, coronary angiography showed normal coronary artery.On the fourth day after admission, the patient died.We suspect that VSR was developed by stress induced cardiomyopathy, not by AMI.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Dong-A University Hospital, Busan, Korea.

ABSTRACT
An 87-year-old woman with continuous chest discomfort was referred to our hospital. ST-segment elevation in lead V1-4 was detected on electrocardiography and ventricular septal rupture (VSR) was observed on echocardiography. Post-acute myocardial infarction (AMI) VSR was suspected and she underwent emergency cardiac catheterization. However, coronary angiography showed normal coronary artery. On the fourth day after admission, the patient died. We suspect that VSR was developed by stress induced cardiomyopathy, not by AMI.

No MeSH data available.


Related in: MedlinePlus