RESUMO
OBJECTIVE: Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) is common, but the causes are to a large extent unknown. Thus, we aimed to study the prevalence of myocarditis and "true" myocardial infarction determined by cardiac magnetic resonance (CMR) imaging in MINOCA patients, and risk markers for these two conditions in this population. METHODS: A search was made in the PubMed and Cochrane databases using the search terms "Myocardial infarction", "Coronary angiography", "Normal coronary arteries" and "MRI". All relevant abstracts were read and seven of the studies fulfilled the inclusion criteria; studies describing case series of patients fulfilling the diagnosis of acute myocardial infarction with normal or non-obstructive coronary arteries on coronary angiography that were investigated with CMR imaging. Data from five of these studies are presented. RESULTS: A total of 556 patients from 5 different sites were included. Fifty-one percent were men with a mean age of 52 ± 16 years. Thirty-three per cent of the patients had myocarditis (n = 183), whereas 21% of the patients had infarction on CMR (n = 115). Young age and a high CRP were associated with myocarditis whereas male sex, treated hyperlipidemia, high troponin ratio and low CRP were associated with "true" myocardial infarction. CONCLUSION AND RELEVANCE: The results of this meta-analysis of individual data showed that myocarditis and "true" myocardial infarction are common in MINOCA when determined by CMR imaging. This information emphasizes the importance of performing CMR imaging in MINOCA patients and can be used clinically to guide diagnostics and treatment of MINOCA patients.
Assuntos
Vasos Coronários , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Miocardite/diagnóstico , Miocárdio/patologia , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , Comorbidade , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , França/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/patologia , Miocardite/epidemiologia , Miocardite/patologia , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Fatores SexuaisRESUMO
Among the wide spectrum of congenital abnormalities of coronary arteries, a left coronary artery connected with the contralateral sinus is considered as an anatomical high-risk while associated with a proximal preaortic course. The ectopic connection may be associated with or without intramural pathway regarding the aortic wall. An intramural pathway is a characteristic to be considered because it is able to be involved in myocardial ischemia-related adverse events of which the sudden death. Therefore, making an identification of an intramural pathway is essential for the ectopic connections of the left coronary artery associated with a preaortic course.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Seio Aórtico/anormalidades , Angiografia Coronária , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Seio Aórtico/diagnóstico por imagem , UltrassonografiaAssuntos
Angioplastia Coronária com Balão/tendências , Doenças do Sistema Nervoso/prevenção & controle , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
With a stable frequency (about 5% of acute coronary syndromes) and a mortality of nearly 45%, cardiogenic shock (CS), especially when it occurs in the immediate waning of myocardial infarction, still represents a therapeutic challenge. In this review, will be detailed the actual epidemiologic data of CS, its physiopathology and the different modalities of treatments available to the interventional cardiologist, especially the coronary revascularisation and the percutaneous left ventricular assistance, whether by intra-aortic balloon counterpulsation or by more complex systems.
Assuntos
Balão Intra-Aórtico , Infarto do Miocárdio/complicações , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/cirurgia , Angioplastia Coronária com Balão/métodos , Medicina Baseada em Evidências , França/epidemiologia , Humanos , Balão Intra-Aórtico/métodos , Infarto do Miocárdio/terapia , Guias de Prática Clínica como Assunto , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Peripartum cardiomyopathy (PPCM) is a rare disorder, with four principal features: 1--development of cardiac heart failure in the last month of pregnancy or within five months after delivery, 2--absence of an identifiable cause for heart failure, 3--absence of underlying heart disease prior to the last month of pregnancy, 4--evidence of left ventricular systolic dysfunction by classic echocardiographic criteria. Reported forms of familial peripartum cardiomyopathy are exceptional. Our observation emphasizes the interest of cardiac magnetic resonance imaging (MRI) in the investigation of an acute heart failure occurring during the peripartum and allows us to evoke a genetic predisposition in some cases of PPCM, to discuss the fact that some forms of familial PPCM could be unknown familial dilated cardiomyopathy unmasked by pregnancy, and to wonder on the familial screening modalities.
Assuntos
Cardiomiopatias/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Adulto , Cardiomiopatias/genética , Cardiomiopatias/terapia , Feminino , Humanos , Linhagem , Gravidez , Complicações Cardiovasculares na Gravidez/genética , Complicações Cardiovasculares na Gravidez/terapia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/genética , Disfunção Ventricular Esquerda/terapiaRESUMO
Pathogenesis of peripartum cardiomyopathy (PPC) is still discussed. We report one case of PPC in which a cardiac magnetic resonance imaging analysis allowed to exclude some "classical" pathogenesis hypotheses. We would like to emphasize the benefits of cardiac MRI in the comprehension of the mechanism(s) involved in the genesis of PPC.
Assuntos
Cardiomiopatia Dilatada/diagnóstico , Imagem Cinética por Ressonância Magnética , Transtornos Puerperais/diagnóstico , Adulto , Cardiomiopatia Dilatada/fisiopatologia , Feminino , Gadolínio , Humanos , Transtornos Puerperais/fisiopatologiaAssuntos
Cardiomiopatias/etiologia , Meios de Contraste , Imagem Cinética por Ressonância Magnética , Isquemia Miocárdica/patologia , Miocárdio/patologia , Idoso , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Ecocardiografia sob Estresse , Humanos , Masculino , Contração Miocárdica , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Índice de Gravidade de Doença , Sobrevivência de Tecidos , Função Ventricular EsquerdaRESUMO
The etiologic diagnosis of chest pain with elevation of specific cardiac enzymes, repolarization abnormalities and a normal angiographic aspect of the coronary arteries is difficult. In this situation, the role of cardiac MRI is growing, frequently allowing to precise the etiology of the chest pain. We present a literature review concerning the semiology of the cardiac MRI in the three main involved etiologies: myocarditis, takotsubo syndrome, and myocardial ischemia with a normal angiographic aspect of the coronary arteries.
Assuntos
Dor no Peito/etiologia , Isquemia Miocárdica/diagnóstico , Miocardite/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Angiografia Coronária , Humanos , Imagem Cinética por Ressonância MagnéticaRESUMO
A 45 year old man, 10 weeks after angioplasty and endoprosthesis insertion for myocardial infarction, developed tamponade in an infectious context. RNA 16S investigation, using the universal amplification method with ribotyping, detected Porphyromonas gingivalis (a strict anaerobic bacillus associated with peridontitis) in the pericardial fluid. This appears to be the first description of such a clinical scenario, and suggests 5 aetio-pathological mechanisms: fissure syndrome, malignant tamponade, post-infarction pericardial syndrome, endoprosthesis infection and infectious tamponade. We also describe the ribotyping method, which by amplifying DNA coding for RNA 16S allows identification of an increasing number of micro-organisms implicated in infectious pathology.
Assuntos
Infecções por Bacteroidaceae/diagnóstico , Tamponamento Cardíaco/microbiologia , Porphyromonas gingivalis/isolamento & purificação , Antibacterianos/uso terapêutico , Infecções por Bacteroidaceae/complicações , Infecções por Bacteroidaceae/tratamento farmacológico , Tamponamento Cardíaco/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Pericardite/tratamento farmacológico , Pericardite/microbiologiaRESUMO
Transoesophageal echocardiography has shown a high incidence on non-obstructive thrombosis after mitral valve replacement with a mechanical prosthesis. The unpredictable outcome and the period during which the complication arises make treatment difficult. The aim of this study was to assess the tolerance and efficacy of the association of long-term heparin and oral anticoagulation, as recommended in this indication. All patients undergoing mitral valve replacement with a mechanical prosthesis between June 1999 and July 2001 were systematically included and studied by transoesophageal echocardiography in the immediate postoperative period. Those with non-obstructive thrombosis at least 5 mm in size were treated by heparin and oral coagulation until the thrombus disappeared on transoesophageal echocardiography. One hundred and fourteen patients undergoing 120 mitral valve replacements (6 reoperations) underwent transoesophageal echocardiography and non-obstructive thrombi measuring at least 5 mm were found on 26 occasions (21.7%). The association of heparin and oral coagulation was maintained for 7 to 115 days (average 20 days). No thromboembolic or haemorrhagic complications and no deaths were observed during this period. Two patients were treated with danaparoid and oral anticoagulation because of heparin-induced thrombocytopenia before the diagnosis. None of the patients died during follow-up (average 49 months); there were 4 recurrent non-obstructive thromboses, three of which were complicated by thromboembolic events with no sequellae in the first 8 months, again treated effectively with the association of heparin and oral anticoagulants; two cerebral embolic events without sequellae were observed without a demonstrable non-obstructive thrombus on transoesophageal echocardiography. The authors conclude that the association of heparin and oral anticoagulants seems well tolerated and effective in this small population and this would justify a large scale clinical trial.