[Takotsubo cardiomyopathy in a young woman after a traffic accident with blunt chest trauma]. / Kardiomiopatia takotsubo u mlodej kobiety po wypadku komunikacyjnym z tepym urazem klatki piersiowej.

Takotsubo cardiomyopathy (TC) is characterized as an acute, reversible left ventricular dysfunction which may be triggered by mental or physical stress. In the case of a 32-year-old woman severe heart failure was observed after a traffic accident with blunt chest trauma. ECG showed ST changes mimicking acute myocardial infarction; although, echocardiography revealed a profile of left ventricular contractile disturbances typical of TC, with ejection fraction reduced to 20%. Additionally, repeated echocardiography showed transient left ventricular wall thickness, suggestive of myocardial edema. Recovery to normal heart function and morphology was confirmed in cardiovascular magnetic resonance. Coronary arteries potency was verified in multi-slice computed tomography. Summing up, it seems that TC should be included in differential diagnosis of heart failure in posttraumatic patients; however, it is impossible to say conclusively which factor was dominant in TC pathogenesis in the case presented: emotional stress or chest trauma.

[Recurrent right atrial thrombus in a patient with atrial fibrillation and heart failure]. / Nawrotowa skrzeplina w prawym przedsionku u chorego z migotaniem przedsionków i niewydolnoscia serca.

Atrial fibrillation and heart failure are factors predisposing to locally formed intracardiac thrombosis, which is usually localized in left-sided chambers. A case report. The authors present a case of a 50-year-old male with permanent atrial fibrillation and dilated cardiomyopathy in whom recurrent right atrial thrombus was observed. Initially, the lesion was detected in echocardiography while he was hospitalized due to extensive right-sided pneumonia. The thrombus was successfully treated with heparin, followed by warfarin. Even though the patient continued warfarin use properly, there was recurrence of the thrombus two years later during a new episode of heart failure exacerbation. Because the thrombus was resistant to intensified anticoagulation, cardiac surgery was needed. A large (30 x 25 mm) pedunculated thrombus, as well as two smaller ones (each of 10 x 10 mm) attached closely to the atrial wall and previously not detected either by echocardiography or by magnetic resonance imaging, were excited. A partially organized pattern of the thrombi in histological examination can explain lack of anticoagulation effectiveness.