The chicken or the egg? Mycoplasma pneumoniae complicated by left ventricle thrombus and anterior myocardial infarction: a case report
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PROVIDER: S-EPMC11375589 | biostudies-literature | 2024 Aug
REPOSITORIES: biostudies-literature
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Project description:We describe a man with cardiac tamponade after anterior myocardial infarction (MI) with a mass on echocardiography, complicated by a S. Milleri purulent pericarditis. This case is an example of how 2 cardiac conditions can interfere with the diagnosis and management of each individual disorder, resulting in an extremely complex disease course. (Level of Difficulty: Beginner.) Central Illustration
| S-EPMC9730162 | biostudies-literature
Project description:AimsThis study aimed to identify echocardiographic determinants of left ventricular thrombus (LVT) formation after acute anterior myocardial infarction (MI).Methods and resultsThis case-control study comprised 55 acute anterior MI patients with LVT as cases and 55 acute anterior MI patients without LVT as controls, who were selected from a cohort of consecutive patients with ischemic heart failure in our hospital. The cases and controls were matched for age, sex, and left ventricular ejection fraction. LVT was detected by routine/contrast echocardiography or cardiac magnetic resonance imaging during the first 3 months following MI. Formation of apical aneurysm after MI was independently associated with LVT formation [72.0% vs. 43.5%, odds ratio (OR) = 5.06, 95% confidence interval (CI) 1.65-15.48, P = 0.005]. Echocardiographic risk factors associated with LVT formation included reduced mitral annular plane systolic excursion (<7 mm, OR = 4.69, 95% CI 1.84-11.95, P = 0.001), moderate-severe diastolic dysfunction (OR = 2.71, 95% CI 1.11-6.57, P = 0.028), and right ventricular (RV) dysfunction [reduced tricuspid annular plane systolic excursion < 17 mm (OR = 5.48, 95% CI 2.12-14.13, P < 0.001), reduced RV fractional area change < 0.35 (OR = 3.32, 95% CI 1.20-9.18, P = 0.021), and enlarged RV mid diameter (per 5 mm increase OR = 1.62, 95% CI 1.12-2.34, P = 0.010)]. Reduced tricuspid annular plane systolic excursion (<17 mm) significantly associated with increased risk of LVT in anterior MI patients (OR = 3.84, 95% CI 1.37-10.75, P = 0.010), especially in those patients without apical aneurysm (OR = 5.12, 95% CI 1.45-18.08, P = 0.011), independent of body mass index, hypertension, anaemia, mitral annular plane systolic excursion, and moderate-severe diastolic dysfunction.ConclusionsRight ventricular dysfunction as determined by reduced TAPSE or RV fractional area change is independently associated with LVT formation in acute anterior MI patients, especially in the setting of MI patients without the formation of an apical aneurysm. This study suggests that besides assessment of left ventricular abnormalities, assessment of concomitant RV dysfunction is of importance on risk stratification of LVT formation in patients with acute anterior MI.
| S-EPMC8712797 | biostudies-literature
Project description:Papillary fibroelastoma is a benign cardiac tumor that most commonly arises from the valvular endocardium and is typically resected because of its predisposition to cause embolic complications. In this clinical vignette, we describe the case of a patient who presented with a round, mobile 1.3 × 1.1-cm sessile mass attached to the left ventricular apex discovered on transthoracic echocardiography at an outside institution. A multidisciplinary team and multimodality imaging approach were taken to treat a diagnostically challenging presentation of a papillary fibroelastoma due to lack of visualization on higher-resolution imaging studies.
| S-EPMC11646900 | biostudies-literature
Project description:Angiographic microvascular resistance (AMR) serves as an effective metric for assessing coronary microvascular status. The aim of this study was to investigate the predictive value of AMR for left ventricular thrombus (LVT) in ST-segment elevation myocardial infarction. This study enrolled 401 consecutive patients with anterior STEMI who underwent primary percutaneous coronary intervention (PPCI) between May 2019 and July 2023. AMR was measured immediately after PPCI via coronary angiography. LVT was identified during hospitalization through cardiac magnetic resonance imaging (CMR) or transthoracic echocardiography (TTE). Major adverse cardiac and cerebrovascular events (MACCEs) were recorded over 36 months follow-up. The predictive value of AMR was evaluated by logistic regression and receiver operating characteristic (ROC) analysis. Kaplan-Meier analysis was performed to estimate event-free rates for MACCEs. LVT was identified in 38 out of 401 anterior STEMI patients (9.5%). After adjusting for confounders through multivariable analysis, AMR was found to be an independent predictor of LVT (odds ratio [OR] 1.240 per 0.1 mmHg·s/cm, 95% confidence interval [CI]: 1.131-1.359, P < 0.001). ROC analysis demonstrated an area under the curve (AUC) of 0.742. For LVT, AMR provided modest incremental predictive value over established risk factors (continuous net reclassification improvement, 0.826 [95% CI: 0.523-1.129]; P < 0.001). Furthermore, Kaplan-Meier analysis revealed MACCEs for anterior STEMI patients with AMR ≥ 2.82 (log-rank P < 0.001). AMR is an independent predictor of LVT in anterior STEMI, providing incremental predictive value beyond traditional risk factors, and may be utilized to identify patients at risk for LVT.
| S-EPMC11880151 | biostudies-literature
Project description: Not available
| S-EPMC7390719 | biostudies-literature
Project description:BackgroundA double-chambered left ventricle (DCLV) is an extremely rare congenital disease that is often asymptomatic and undiagnosed until adulthood. The incidence of a double-chambered right ventricle is estimated to be 1 in 36000 patients, while the incidence of DCLV is certainly even lower. To date, only a handful of cases of DCLV have been reported.Case summaryA 4-year-old boy was admitted to the local hospital in 2019 due to chest discomfort. He had mild tachypnoea and wheezing. Upon physical examination, his heart was found to be enlarged without any obvious cardiac murmur. Cardiac percussion also revealed an enlargement of the heart, and further echocardiography confirmed a diagnosis of a 'dual-chamber left ventricle'. No other cardiac or systemic abnormalities were observed. In January 2022, the patient came to our hospital for further diagnosis and treatment. The laboratory results including coagulation testing showed no obvious abnormality. The 24-hour Holter monitor revealed a sinus rhythm with a left bundle branch block (I°). The bedside chest X-ray indicated an abnormal protrusion of the left margin of the heart. Transthoracic echocardiography showed that the left ventricle was divided into main and accessory chambers by a thick muscle bundle in the middle of the left ventricular cavity. Cardiac magnetic resonance (CMR) imaging confirmed this, and additionally found a giant thrombus in the accessory cavity.DiscussionA DCLV is an extremely rare congenital heart disease that is often asymptomatic and undiagnosed until adulthood. The aetiology of DCLV is still unclear; however, some reports have suggested that it may be related to a hypoplasia of the regional myocardial intra-trabecular sinusoids or an intra-myocardial aneurysm during the embryonic period. Additionally, some cases have indicated that DCLV may be a subtype of genetic cardiomyopathies. A DCLV is characterized by a subdivision of the left ventricle into two chambers by an abnormal septum or by muscle bands. This case report introduces a patient with DCLV and a giant thrombus, in which CMR imaging plays an important role in both diagnosis and differential diagnosis.
| S-EPMC10113928 | biostudies-literature
Project description:BackgroundLeft ventricular (LV) thrombus has a higher incidence among patients with anterior ST-elevation myocardial infarction (STEMI) when compared to other types of acute myocardial infarction and is associated with worse prognosis. The management of LV thrombus diagnosis remains challenging. Contrast echocardiography (transthoracic echocardiography, TTE) has shown potential in improving the accuracy for its diagnosis, thereby influencing treatment strategies concerning antithrombotic/anticoagulation therapy. The aim of this study was to assess the effectiveness of contrast TTE as a routine screening method for detecting LV thrombus in the acute phase of anterior STEMI.MethodsA prospective, single center, randomized controlled trial was conducted among patients with anterior STEMI. The study group underwent contrast TTE, while the control group received a conventional approach. Demographical, clinical, and diagnostic data were collected. Thrombus detection rates were compared between groups.ResultsA total of 68 patients were included (32 in the study group and 36 in the control group). No substantial baseline differences were observed between groups. Thrombus detection rate was 25.0% in the study group and 13.9% in the control group, however these results did not reach statistical significance (P = 0.24). The prevalence of anterior/apical aneurysm was higher in the study group (46.9% vs. 22.2%, P = 0.03).ConclusionsConventional TTE may be adequate for diagnosing LV thrombus in the acute phase of anterior STEMI; however, further larger-scale and multicenter studies are necessary to obtain more robust and conclusive results. Ultrasound contrast may play a significant role in the detection of anterior/apical aneurysms, which are known risk factors for the subsequent development of thrombus.Trial registrationNCT06480929 (ClinicalTrials.gov, Retrospectively registered).
| S-EPMC11299253 | biostudies-literature
Project description: Not available
| S-EPMC11580538 | biostudies-literature
Project description:BackgroundIn-hospital left ventricular (LV) thrombus following acute ST-elevation myocardial infarction (STEMI) has not been evaluated on a national scale and was the focus of this investigation.MethodsWe used the 2003 to 2013 Nationwide Inpatient Sample database to identify adults ≥18 years old with a principal diagnosis code of ST-elevation myocardial infarction. Patients were divided into two groups defined by the presence or absence of LV thrombus. Clinical characteristics and in-hospital outcomes were studied using relevant statistics. Multiple linear and logistic regression models were conducted to identify factors associated with LV thrombus.ResultsOf 1,035,888 STEMI patients hospitalized in the U. S from 2003 to 2013, 1982 (0.2%) developed acute in-hospital LV thrombus. Compared to no LV thrombus, patients with LV thrombus were more likely to have in-hospital complications; acute ischemic and hemorrhagic stroke, acute renal failure, gastrointestinal bleed, cardiogenic shock, in-hospital cardiac arrest and mortality. They also had longer mean length of stay and higher hospital charges. Factors associated with LV thrombus included: anterior/anterolateral STEMI, acute or chronic heart failure with reduced ejection fraction, atrial fibrillation, LV aneurysm, Left heart valvular disease, acute or chronic deep venous thrombosis/pulmonary embolism and alcohol abuse. Patients with LV thrombus were less likely to be female [AOR 0.66, 95% CI (0.51-0.84)].ConclusionThe identification of factors associated with early development of LV thrombus following STEMI, will help direct resources for specific high-risk group and prompt cost-effective therapies. Gender variability in LV thrombus development warrants further investigations.
| S-EPMC6891157 | biostudies-literature
Project description:Left ventricular (LV) thrombus formation is a frequent complication in patients with acute anterior myocardial infarction (MI). Its incidence is lower with inferior wall MI. Risk factors for the development of LV thrombus are consistently irrespective of infarct treatment and include large infarct size, severe apical akinesia or dyskinesia LV aneurysm, and anterior MI.
| S-EPMC5353410 | biostudies-literature