RESUMO
Adipositas cordis is a rare cardiomyopathy characterized by diffuse fatty infiltration of the ventricular myocardium or interventricular septum. This occurs without myocardial cell destruction, unlike arrhythmogenic right ventricular cardiomyopathy. A 40-year-old obese woman was found to have a II/VI systolic murmur that worsened with standing. A transthoracic echocardiogram showed interventricular septal hypertrophy with a preserved left ventricular ejection fraction. Cardiac magnetic resonance imaging revealed a fatty mass in the interventricular septum. An endomyocardial biopsy revealed structurally normal myocytes with diffuse adipose cell infiltration and no evidence of malignant cells. Left and right cardiac catheterizations and stress echocardiography showed no abnormalities. This case shows the importance of considering a broad differential when approaching rare diseases. It also demonstrates the utility of noninvasive imaging and its impact on clinical decision making.
Assuntos
Tecido Adiposo/patologia , Cardiomiopatias/patologia , Septo Interventricular/patologia , Tecido Adiposo/diagnóstico por imagem , Adulto , Biópsia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Diagnóstico Diferencial , Ecocardiografia , Cardioversão Elétrica/instrumentação , Feminino , Humanos , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Prevenção Primária/métodos , Volume Sistólico , Função Ventricular Esquerda , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/fisiopatologiaRESUMO
We report the fatal course of a left atrial myxoma: its systemic embolization to the coronary, cerebral, renal, and peripheral vascular beds in a 39-year-old woman resulted in rapid clinical deterioration, multiorgan failure, and death. Among reported cases of left atrial myxoma, this degree of embolic burden is exceedingly rare. In addition to reporting the patient's case, we discuss the presentation and diagnosis of possible intracardiac sources of systemic emboli.
Assuntos
Oclusão Coronária/etiologia , Neoplasias Cardíacas/patologia , Infarto da Artéria Cerebral Média/etiologia , Mixoma/patologia , Células Neoplásicas Circulantes/patologia , Obstrução da Artéria Renal/etiologia , Adulto , Biópsia , Doença Catastrófica , Angiografia Coronária , Oclusão Coronária/diagnóstico , Evolução Fatal , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/complicações , Humanos , Infarto da Artéria Cerebral Média/diagnóstico , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Mixoma/complicações , Obstrução da Artéria Renal/diagnóstico , Fatores de RiscoAssuntos
Doença da Artéria Coronariana/etiologia , Circulação Coronária , Vasos Coronários/fisiopatologia , Transplante de Coração/efeitos adversos , Infarto do Miocárdio/etiologia , Simulação por Computador , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Humanos , Modelos Cardiovasculares , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Estresse MecânicoRESUMO
Development of left ventricular to coronary sinus fistula is a rare complication of mitral valve surgery. Three of the seven previously reported cases occurred following multiple valve replacement surgeries, all of which were thought to be secondary to a complication of surgery and all were treated with surgical closure of the fistula. We report a case of left ventricular to coronary sinus fistula occurring after two mitral valve replacement surgeries that was treated medically with favorable long-term results.
Assuntos
Seio Coronário , Fístula/etiologia , Cardiopatias/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Mitral/cirurgia , Fístula Vascular/etiologia , Idoso , Angiografia , Feminino , Fístula/diagnóstico por imagem , Fístula/terapia , Ventrículos do Coração , Humanos , Reoperação , Resultado do TratamentoRESUMO
Statins are normally administered for the treatment of dyslipidemia on a daily basis. This standard dosing regimen is well tolerated by most patients. Occasionally, patients discontinue therapy secondary to side effects, most commonly myalgias. We describe 2 patients who were unable to tolerate daily atorvastatin therapy secondary to myalgias and were subsequently treated with rosuvastatin administered on Mondays, Wednesdays, and Fridays, with resolution of adverse effects. Significant reductions in serum low-density lipoprotein cholesterol levels were observed in the 2 patients despite the alternate-day dosing regimen. Rosuvastatin was chosen because of its long half-life (19 hours) and very high potency.
