RESUMO
BACKGROUND: The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial showed no difference in outcomes between medical therapy vs coronary revascularization in the management of patients with stable coronary artery disease. We aimed to determine the percentage of patients with at least moderate ischemia that would have been eligible for enrollment and evaluate the outcomes of those who would not. METHODS: Consecutive patients who underwent cardiac single-photon emission computed tomography (SPECT) between April 2016 and September 2019 were identified and all-cause mortality was determined. RESULTS: There were a total of 1508 patients (mean age 67 ± 11.6 years, 69.5% males) with any perfusion defect on SPECT. Patients had a high prevalence of cardiac risk factors (73.4% with hypertension and 54.4% with diabetes mellitus.) Nearly half (709, 47%) had moderate-to-severe ischemia but over two-thirds (479/709, 66.3%) had at least one ISCHEMIA trial exclusion criteria. Patients meeting ISCHEMIA enrollment criteria had a significantly lower all-cause mortality than those who would have been excluded (3.91% vs. 11.3%, respectively, P < .001). CONCLUSION: Our results show that ISCHEMIA selected a relatively small subset of lower risk patients among the larger higher risk group of patients with moderate-to-severe ischemia typical to most cardiology centers.
Assuntos
Doença da Artéria Coronariana , Isquemia Miocárdica , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Feminino , Humanos , Isquemia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
PURPOSE OF REVIEW: Mitral stenosis remains clinically relevant in developing countries where rheumatic heart disease is the predominant culprit. In the western world, mitral annular and valvular calcification is an increasingly recognized cause, particularly in an aging population. Echocardiography plays a primary role in imaging mitral stenosis with a growing role for cardiac computed tomography and magnetic resonance imaging. In this review, we aim to revisit mitral stenosis assessment and quantification using multimodality imaging. RECENT FINDINGS: There is an increasing role for advanced cardiac imaging especially in the era of transcatheter mitral valve intervention. Also, when echocardiography is suboptimal or discordant with symptoms, computed tomography can provide anatomical data, whereas magnetic resonance imaging can provide anatomical along with hemodynamic data. SUMMARY: Diagnosis of mitral stenosis is crucial as it carries an increased morbidity and mortality risk. Echocardiography is the cornerstone imaging modality with alternative, complementary advanced imaging considered when images are suboptimal.
Assuntos
Estenose da Valva Mitral , Cardiopatia Reumática , Idoso , Ecocardiografia , Hemodinâmica , Humanos , Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Cardiopatia Reumática/diagnóstico por imagemRESUMO
PURPOSE OF REVIEW: Viability assessment has a key role in the management of patients with ischemic heart disease. Positron emission tomography (PET) is a unique modality that evaluates myocardial viability via assessing the tissues metabolic and perfusion properties. The mainstay of metabolic imaging relies on glucose metabolism using fluorodeoxyglucose, a radiolabeled glucose analog. Mismatch in perfusion metabolism data denotes hibernating myocardium with a high likelihood of functional recovery following revascularization. Matched absence or reduction in perfusion metabolism data represents scar with a low likelihood of functional recovery following revascularization. This review will focus on PET radiotracers and techniques used to assess myocardial viability. RECENT FINDINGS: Single-center studies have shown that patients with PET mismatch undergoing bypass grafting had improved survival compared with those on medical therapy. In addition to survival benefit, the patients who underwent PET-guided revascularization had significant improvement in angina and heart failure symptomology. Recent technological advancements in the field of PET-magnetic resonance (MR) opens a new frontier in the field of advanced imaging as it combines anatomical, functional, tissue characterization, and metabolic perfusion data obtained in one setting. The incremental value of PET/MRI is best established in diagnosing and monitoring disease activity in patients with cardiac sarcoidosis and occult malignancies, but more studies are needed to assess it value in viability assessment. SUMMARY: In conclusion, imaging myocardial viability by PET provides assessment of both physiological perfusion and myocardial tissue's metabolic activity to differentiate hibernating from scarred myocardium.
Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Sobrevivência de Tecidos , Fluordesoxiglucose F18 , Coração/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Humanos , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Revascularização Miocárdica , Miocárdio/metabolismo , Compostos RadiofarmacêuticosRESUMO
CLINICAL FEATURES: Giant cell myocarditis (GCM) is a rare and a rapidly progressive disorder with fatal outcomes such that patients often require heart transplantation. We present a case of recurrent GCM in a transplanted patient with a history of Crohn disease requiring a novel therapeutic approach. THERAPEUTIC CHALLENGE: After the orthotopic heart transplantation, GCM recurred on aggressive immunosuppression over the months, which included corticosteroids, basiliximab, tacrolimus, antithymocyte globulin, and rituximab. Although combination immunosuppressive therapy containing cyclosporine and 2-4 additional drugs including corticosteroids, azathioprine, mycophenolate mofetil, muromonab, gammaglobulin, or methotrexate have shown to prolong the transplant-free survival by keeping the disease under control, its role in preventing and treating recurrence posttransplantation is unclear. SOLUTION: We added sirolimus, a macrolide antibiotic, with properties of T- and B-lymphocyte proliferation inhibition on the above immunosuppressive treatment postrecurrence of GCM. After sirolimus initiation and continuation, the patient has remained disease free.
Assuntos
Rejeição de Enxerto/tratamento farmacológico , Transplante de Coração/efeitos adversos , Imunossupressores/uso terapêutico , Miocardite/terapia , Sirolimo/uso terapêutico , Aloenxertos/citologia , Aloenxertos/diagnóstico por imagem , Aloenxertos/imunologia , Quimioterapia Combinada/métodos , Ecocardiografia , Células Gigantes/imunologia , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/imunologia , Coração/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico , Miocárdio/citologia , Miocárdio/imunologia , Recidiva , Resultado do TratamentoRESUMO
Echocardiography is the primary imaging modality for diagnosing cardiac conditions. Over the past 2 decades, technological advancements have resulted in the emergence of miniaturized handheld ultrasound equipment that is compact and battery operated, and handheld echocardiography can be readily performed at the point of care with reasonable image quality. The simplicity of use, availability at the patient's bedside, easy transportability, and relatively low cost have encouraged physicians to use these devices for prompt medical decision making. As a consequence, the use of handheld echocardiography is on the rise even among nonechocardiographers (intensivists, emergency care physicians, internists, and medical students). One of the real utilities of ultrasound-augmented clinical diagnosis is in evaluating patients efficiently and selecting patients for appropriate downstream diagnostic testing including comprehensive echocardiography. Although clinical evidence supports the use of handheld devices in various clinical settings and by different users, proficiency in point-of-care ultrasound requires dedicated training in both performance and interpretation. This review summarizes the existing literature on the use of handheld echocardiography in conducting focused cardiac examinations: its training requirements, challenges, opportunities, and future perspectives in the care of the cardiovascular patient.
Assuntos
Ecocardiografia/instrumentação , Cardiopatias/diagnóstico por imagem , Transdutores , Ecocardiografia/métodos , Ecocardiografia Doppler em Cores/instrumentação , Desenho de Equipamento , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Humanos , Valor Preditivo dos Testes , PrognósticoAssuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia/métodos , Eletrocardiografia/métodos , Coração/diagnóstico por imagem , Imagem Multimodal/métodos , Isquemia Miocárdica/diagnóstico por imagem , Adulto , Cálcio/química , Circulação Coronária , Vasos Coronários/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Fatores de RiscoRESUMO
BACKGROUND: Recent studies have broadened the potential use of mineralocorticoid receptor antagonist (MRA) in patients with systolic heart failure after cardiovascular hospitalization. Real-world data on safety and tolerability of MRA initiation during hospitalization for acute decompensated heart failure (ADHF) are lacking. We examined the patterns of utilization of MRAs in patients admitted for ADHF in contemporary clinical practice. METHODS AND RESULTS: We reviewed consecutive hospitalized patients admitted with a primary diagnosis of ADHF from March to June 2011. The treatment patterns of MRA use or discontinuation before, during, and after hospitalization were reviewed and analyzed retrospectively. In the study cohort of 500 patients, 106 patients (21%) were on MRAs before admission. During hospitalization, preadmission and newly started MRAs were discontinued in 64 out of 177 (36%), with worsening renal function being the most common identifiable reason. In a multivariate analysis, high admission creatinine was the only significant predictor of MRA discontinuation during hospitalization (P = .01). Of the 394 patients who did not receive MRA before admission, 81 were eligible for MRAs, but only 17 (21%) were initiated. After a median follow up of 57 days, 21 additional patients discontinued MRAs; of 72 eligible patients for MRA, 55 patients (76%) were still appropriately taking it. CONCLUSIONS: Despite recent data, MRAs are still underutilized in patients admitted with ADHF who are otherwise eligible for it. Elevated serum creatinine and worsening of renal function are the most common cause of in-hospital discontinuation, which highlights the importance of meticulous follow-up after MRA initiation.
Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Hospitalização , Pacientes Internados , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Doença Aguda , Idoso , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico , Resultado do TratamentoRESUMO
The incidence of bioprosthetic valve thrombosis and related embolic complications is extremely rare, obviating the need for long-term anticoagulation. As a result, experience in the diagnosis and treatment of bioprosthetic valve thrombosis is fairly limited. We report the first case of antiphospholipid antibody syndrome presenting as bioprosthetic mitral valve thrombosis, 15 months after valve replacement, and successfully treated with thrombolytic therapy.
Assuntos
Síndrome Antifosfolipídica/complicações , Bioprótese , Próteses Valvulares Cardíacas , Terapia Trombolítica/métodos , Trombose/complicações , Trombose/tratamento farmacológico , Idoso , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Valva Mitral/diagnóstico por imagem , Tenecteplase , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do TratamentoRESUMO
The renin-angiotensin system (RAS) plays a major role in the pathophysiology of cardiovascular disorders. Angiotensin II (Ang-II), the final product of this pathway, is known for its vasoconstrictive and proliferative effects. Angiotensin-converting enzyme 2 (ACE2), a newly discovered homolog of ACE, plays a key role as the central negative regulator of the RAS. It diverts the generation of vasoactive Ang-II into the vasodilatory and growth inhibiting peptide angiotensin(1-7) [Ang(1-7)], thereby providing counter-regulatory responses to neurohormonal activation. There is substantial experimental evidence evaluating the role of ACE2/Ang(1-7) in hypertension, heart failure, and atherosclerosis. In this review, we aim to focus on the conceptual facts of the ACE2-Ang(1-7) axis with regards to clinical implications and therapeutic targets in cardiovascular disorders, with emphasis on the potential therapeutic role in cardiovascular diseases.
Assuntos
Fármacos Cardiovasculares/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Terapia de Alvo Molecular/métodos , Peptidil Dipeptidase A/fisiologia , Angiotensina I/biossíntese , Enzima de Conversão de Angiotensina 2 , Fármacos Cardiovasculares/farmacologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão/fisiopatologia , Fragmentos de Peptídeos/biossíntese , Peptidil Dipeptidase A/efeitos dos fármacos , Sistema Renina-Angiotensina/fisiologia , Remodelação Ventricular/fisiologiaRESUMO
More than 23 million adults worldwide have heart failure (HF). Although survival after heart failure diagnosis has improved over time, mortality from heart failure remains high. At the end of life, the chronic HF patient often becomes increasingly symptomatic, and may have other life-limiting comorbidities as well. Multiple trials have shown a clear mortality benefit with the use of implantable cardioverter defibrillators (ICDs) in patients with cardiomyopathy and ventricular arrhythmia. However, patients who have an ICD may be denied the chance of a sudden cardiac death, and instead are committed to a slower terminal decline, with frequent DC shocks that can be painful and decrease the quality of life, greatly contributing to their distress and that of their families during this period. While patients with ICDs are routinely counseled with regard to the benefits of ICDs, they have a poor understanding of the options for device deactivation and related ethical and legal implications. Deactivating an ICD or not performing a generator change is both legal and ethical, and is supported by guidelines from both sides of the Atlantic. Patient autonomy is paramount, and no patient is committed to any therapy that they no longer wish to receive. Left ventricular assist devices (LVADs) were initially used as bridge in patients awaiting heart transplantation, but they are currently implanted as destination therapy (DT) in patients with end-stage heart failure who have failed to respond to optimal medical therapy and who are ineligible for cardiac transplantation. The decision-making process for initiation and deactivation of LVAD is becoming more and more ethically and clinically challenging, particularly for elderly patients.
Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar/ética , Assistência Terminal/ética , Suspensão de Tratamento/ética , Desfibriladores Implantáveis/ética , Ética Médica , Humanos , Consentimento Livre e Esclarecido , Guias de Prática Clínica como AssuntoAssuntos
Aneurisma Aórtico , Síndrome de Marfan , Seio Aórtico , Adulto , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Feminino , Humanos , Síndrome de Marfan/diagnóstico por imagem , Síndrome de Marfan/patologia , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/patologia , Tomografia Computadorizada por Raios XRESUMO
In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography is the first-line method for noninvasive evaluation of prosthetic valve function. The transthoracic approach is complemented with two-dimensional and three-dimensional transesophageal echocardiography for further refinement of valve morphology and function when needed. More recently, advances in computed tomography and cardiac magnetic resonance have enhanced their roles in evaluating valvular heart disease. This document offers a review of the echocardiographic techniques used and provides recommendations and general guidelines for evaluation of prosthetic valve function on the basis of the scientific literature and consensus of a panel of experts. This guideline discusses the role of advanced imaging with transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance in evaluating prosthetic valve structure, function, and regurgitation. It replaces the 2009 American Society of Echocardiography guideline on prosthetic valves and complements the 2019 guideline on the evaluation of valvular regurgitation after percutaneous valve repair or replacement.
Assuntos
Doenças das Valvas Cardíacas , Coração , Adulto , Humanos , Imageamento por Ressonância Magnética , Ecocardiografia , Próteses e Implantes , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Espectroscopia de Ressonância MagnéticaRESUMO
Pericardial effusions secondary to tumors are commonly metastatic, originating primarily from the lung, breast, and lymphomas. Pericardial tamponade is a rare oncological emergency warranting early identification and treatment. We describe a 66-year-old male found to have a large bloody pericardial effusion causing tamponade physiology, and multimodality imaging was consistent with intrapericardial malignancy with no identifiable primary source. He was subsequently diagnosed with type B3 thymoma after mediastinal resection.
Assuntos
Tamponamento Cardíaco , Derrame Pericárdico , Masculino , Humanos , Idoso , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Coração , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Oncologia , Imagem MultimodalRESUMO
Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a reversible form of cardiomyopathy characterized by reduced ejection fraction with regional wall motion abnormalities, elevated cardiac enzyme levels, and signs of ischemia on electrocardiogram despite the absence of obstructive epicardial coronary artery disease. It is often preceded by intense emotional or physical illness stressors. This case describes a 65-year-old female patient who likely developed takotsubo cardiomyopathy precipitated by the stress of diverticulitis.
Assuntos
Cardiomiopatia de Takotsubo , Feminino , Humanos , Idoso , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Ecocardiografia , Coração , Eletrocardiografia , Resultado do TratamentoRESUMO
BACKGROUND: Left ventricular (LV) diastolic function is primarily assessed by means of echocardiography, which has limited utility in detecting fibrosis. Cardiac magnetic resonance (CMR) readily detects and quantifies fibrosis. OBJECTIVES: In this study, the authors sought to determine the association of LV diastolic function by echocardiography with CMR-determined global fibrosis burden and the incremental value of fibrosis with diastolic function grade in prediction of total mortality and heart failure hospitalizations. METHODS: A total of 549 patients underwent comprehensive echocardiography and CMR within 30 days. Echocardiography was used to assess LV diastolic function, and CMR was used to determine LV volumes, mass, ejection fraction, replacement fibrosis, and percentage extracellular volume fraction (ECV). RESULTS: Normal diastolic function was present in 142 patients; the rest had diastolic dysfunction grades I to III, except for 18 (3.3%) with indeterminate results. The event rate was higher in patients with diastolic dysfunction compared with patients with normal diastolic function (33.4% vs 15.5; P < 0.001). The model including LV diastolic function grades II and III predicted composite outcome (C-statistic: 0.71; 95% CI: 0.67-0.76), which increased by adding global fibrosis burden (C-statistic: 0.74, 95% CI: 0.70-0.78; P = 0.02). For heart failure hospitalizations, the competing risk model with LV diastolic function grades II and III was good (C-statistic: 0.78; 95% CI: 0.74-0.83) and increased significantly with the addition of global fibrosis burden (C-statistic: 0.80; 95% CI: 0.76-0.85; P = 0.03). CONCLUSIONS: Higher grades of diastolic dysfunction are seen in patients with replacement fibrosis and increased ECV. Fibrosis burden as determined with the use of CMR provides incremental prognostic information to echocardiographic evaluation of LV diastolic function.
Assuntos
Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Valor Preditivo dos Testes , Função Ventricular Esquerda , Insuficiência Cardíaca/diagnóstico por imagem , Diástole , Fibrose , Medição de Risco , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/patologia , Volume SistólicoRESUMO
A 55-year-old gentleman presented to the emergency department with shortness of breath for the past 3 days. Cardiac magnetic resonance imaging assessed intracardiac shunting and a mechanism of ventricular septal rupture (VSR), showing significant left-to-right shunting and Qp:Qs of 4:1. There was transmural myocardial infarction as well as an aneurysm at the diaphragmatic inferior wall of the left ventricle.
Assuntos
Infarto do Miocárdio , Ruptura do Septo Ventricular , Masculino , Humanos , Pessoa de Meia-Idade , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Coração , Ventrículos do Coração , Imageamento por Ressonância MagnéticaRESUMO
We describe a 39-year-old man referred for surgical aortic valve replacement for severe symptomatic aortic stenosis. Intraoperative inspection was unexpectedly consistent with marantic endocarditis. Pathology confirmed nonbacterial thrombotic endocarditis. We present high-resolution intraoperative, diagnostic, and pathology images of nonbacterial thrombotic endocarditis in a patient with antiphospholipid syndrome with atypical presentation.
Assuntos
Endocardite não Infecciosa , Endocardite , Próteses Valvulares Cardíacas , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Endocardite/diagnóstico , Endocardite/diagnóstico por imagem , Endocardite não Infecciosa/diagnóstico por imagem , Endocardite não Infecciosa/etiologia , Endocardite não Infecciosa/cirurgia , Humanos , MasculinoRESUMO
BACKGROUND: Middle Eastern (ME) immigrants are one of the fastest-growing groups in the US. Although ME countries have a high burden of atherosclerotic cardiovascular disease (ASCVD), the cardiovascular health status among ME immigrants in the US has not been studied in detail. This study aims to characterize the cardiovascular health status (CVD risk factors and ASCVD burden) among ME immigrants in the US. METHODS: We used 2012-2018 data from the National Health Interview Survey, a US nationally representative survey. ME origin, CVD risk factors, and ASCVD status were self-reported. We compared these to US-born non-Hispanic white (NHW) individuals in the US. RESULTS: Among 139,778 adults included, 886 (representing 1.3 million individuals, mean age 46.8) were of ME origin, and 138,892 were US-born NHWs (representing 150 million US adults, mean age 49.3). ME participants were more likely to have higher education, lower income and be uninsured. The age-adjusted prevalence of hypertension (22.4% vs 27.4%) and obesity (21.4% vs 31.4%) were significantly lower in ME vs NHW participants, respectively. There were no significant differences between the groups in the age-adjusted prevalence of ASCVD, diabetes, hyperlipidemia, and smoking. Only insufficient physical activity was higher among ME individuals. ME immigrants living in the US for 10 years or more reported higher age-adjusted prevalence of hypertension, hyperlipidemia, and ASCVD. CONCLUSIONS: ME immigrants in the US have lower odds of hypertension and obesity, and of having a suboptimal CRF profile compared to US-born NHWs. Further studies are needed to determine whether these findings are related to lower risk, selection of a healthier ME subgroup in NHIS, or possible under-detection of cardiovascular risk factors in ME immigrants living in the US.
RESUMO
Cardiac tumors in adults are exceedingly rare and usually benign. We describe a 29-year-old man with a previous diagnosis of interventricular septal hypertrophy who presented with increasing severity of dyspnea and fatigue. Work-up revealed a 4.9 × 3.7 cm mass at the base of the interventricular septum. Biopsy revealed a benign cardiac hamartoma atypically located in the right ventricle, and the mass was resected via right ventriculotomy.
Assuntos
Hamartoma , Neoplasias Cardíacas , Comunicação Interventricular , Septo Interventricular , Masculino , Adulto , Humanos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Ventrículos do Coração/patologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/cirurgia , Septo Interventricular/patologia , Hamartoma/diagnóstico , Hamartoma/diagnóstico por imagemRESUMO
Intrapericardial organized haematoma secondary to blunt chest trauma is an extremely rare cause of constrictive pericarditis. We report a 30-year-old male who presented with heart failure for 12 months and was found to have an organized intrapericardial haematoma secondary to blunt chest trauma in a road traffic accident 2 years prior. The use of multiple imaging modalities including two-dimensional (transthoracic and transoesophageal) echocardiogram and cardiac magnetic resonance imaging established the diagnosis. Surgical excision of the haematoma and removal of the constricting pericardium relieved his symptoms.