Left atrial intramural hematoma: The role of echocardiography.

Left atrial intramural hematoma (LAIH) is an uncommon entity for which a timely diagnosis is critical for decision making. Cardiac surgical or catheter-based procedures are potential causing factors. Though cardiac computerized tomography and magnetic resonance are highly accurate diagnostic modalities, their role is limited by the lack of widespread availability. The present clinical case illustrates the diagnostic features of LAIH that can be obtained using echocardiography at the bedside in critically ill patients. We report a case of LAIH, that followed a catheter ablation procedure and was complicated by cardiac and cerebral ischemia. Cardiac surgical management was required.

Giant left atrial myxoma causing acute ischemic stroke.

Atrial myxomas are primary cardiac tumors which may cause ischemic stroke. The authors present a case of a 51-year-old man admitted to the emergency department with right-sided hemiplegia and aphasia caused by ischemic stroke. 2D and 3D transesophageal echocardiography showed an atrial myxoma described as a large mass in the left atrium attached to the interatrial septum. In the end, surgical excision of the myxoma was performed 48 h after diagnosis. Nowadays, specific guidelines concerning the correct time for surgical excision of the myxoma are lacking. The authors highlight the utmost role of echocardiography to promptly characterize a cardiac mass and the importance of discuss about the timing of cardiac surgery.

Atrial myxoma is a rare cardiac tumor that is often located in the left atrium of the heart. Patients with myxoma can have no symptoms, or they can present signs of systemic embolization, where fragments of the tumor have been released into the blood stream and are circulating to different areas of the body. Indeed, if a fragment reaches the brain, it can cause a cerebral acute ischemic stroke, which is a sudden loss of blood circulation to an area of the brain, resulting in a loss of neurologic function. Transesophageal echocardiography, an ultrasound test that produces real-time and detailed images of the heart, is a useful tool that allows physicians to diagnose the presence of an atrial myxoma. In this case report, the authors stress the role of echocardiography in diagnosing patients presenting with sudden neurological symptoms, because it can show a potential mass inside the heart. Once identified, the tumor can be removed surgically as soon as possible to avoid further complications, such as a new stroke.

Acute effects of non-invasive ventilatory support on functional mitral regurgitation in patients with exacerbation of congestive heart failure.

OBJECTIVE: The purpose of this study was to evaluate the acute effects of continuous positive airway pressure (CPAP) and bi-level airway pressure (BiPAP) on functional mitral regurgitation (MR) in patients with acute exacerbation of severe chronic congestive heart failure (CHF). DESIGN: A cross-over study. SETTING: A cardiopulmonary intensive care unit. PATIENTS AND INTERVENTIONS: Ten male patients affected by an acute exacerbation of congestive heart failure and hemodynamically significant MR were submitted to an echocardiograph color Doppler ultrasound evaluation during CPAP and BiPAP non-invasive ventilation. We analyzed left ventricle ejection fraction, area of MR and deceleration time (Dec-t). OUTCOME MEASURES: The primary end point was to evaluate whether CPAP and BiPAP were effective in reducing functional MR. RESULTS: After 30 min, the area of MR decreased from 10.0+/-2.7 to 8.0+/-2.9 cm(2) with CPAP and from 9.9+/-2.6 to 8.6+/-2.6 cm(2) with BiPAP ( p<0.01); Dec-t increased from 120.9+/-12.7 to 136.0+/-8.7 ms after CPAP and from 120.5+/-11.4 to 134.2+/-13.6 ms after BiPAP ( p<0.01). CONCLUSION: In patients with exacerbation of severe CHF and functional MR, both modalities of non-invasive ventilation (CPAP and BiPAP) significantly improved ejection fraction and were equally effective in reducing MR.

Takotsubo syndrome in a newborn.

Takotsubo syndrome is characterized by transient and regional left ventricular dysfunction, which does not correspond anatomically to coronary distribution, without obstructive coronary lesions and frequently follows episodes of emotional or physical stress. The authors present a case of takotsubo syndrome, complicated by acute heart failure and functional severe mitral regurgitation, in a newborn after fetal distress caused by the umbilical cord being twisted around the chest and neck. In newborns after birth asphyxia, left ventricular dysfunction has been reported as global and due to ischemia. In this case, the transient and regional left ventricular dysfunction involving segments of multiple epicardial coronary territories, with associated hyperkinesis of the ventricular septum and basal segments of other walls, could have been caused by delivery stress with catecholamine-mediated cardiac toxicity.

Paradoxical effect of ajmaline in a patient with Brugada syndrome.

AIMS: The typical Brugada ECG pattern consists of a prominent J-wave associated with ST-segment elevation localized in the right precordial leads V1-V3. In many patients, the ECG presents periods of transient normalization and the Brugada-phenotype can be unmasked by the administration of class-I antiarrhythmics. Reports have documented the heterogeneity of the Brugada syndrome ECG-phenotype characterized by unusual localization of the ECG abnormalities in the inferior leads. Case report A 51-year-old man, without detectable structural heart disease, was referred to us because of a history of syncope, dizziness, and palpitations. The ECG showed a J-wave and ST-segment elevation in the right precordial leads, suggesting Brugada syndrome. As other causes of the ECG abnormalities were excluded, the patient underwent an electrophysiological study that documented easy induction of ventricular fibrillation. During infusion of ajmaline, new prominent J-waves and ST-segment elevation appeared in the inferior leads, whereas the basal ECG abnormalities in the right precordial leads normalized. After infusion of isoprenaline, the ECG-pattern resumed the typical Brugada pattern. An implantable cardioverter-defibrillator was recommended. CONCLUSION: In our patient, the double localization of the typical Brugada-pattern and the paradoxical effect of ajmaline on the ECG abnormalities confirmed the possibility of a phenotype heterogeneity in the Brugada syndrome.