Cor et Vasa Case Reports 2/2019

titulka_ico.jpgCor et Vasa Case Reports
Svazek | Volume 2 • Číslo | Number 2
Květen | May 2019

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Případ poinfarktové ruptury volné stěny levé komory srdeční léčené intraperikardiální aplikací trombinu 

B. Fischerová, M. Novák, M. Rezek, J. Seménka

Left ventricular free wall rupture (LVFWR) is a very serious and often fatal complication of acute myocardial infarction. Surgical intervention is the gold standard but can be unacceptably risky in some patients and conservative therapy cannot be sufficient. We are reporting a case of a subacute LVFWR with a slow progression to cardiac tamponade, successfully treated with pericardiocentesis and intra-pericardial thrombin injection. An echo-guided pericardiocentesis was performed from the apical access and a catheter was introduced into the pericardial space. After evacuation of all the blood from a pericardial space there were signs of ongoing bleeding, and so the thrombin glue was injected into the pericardium with immediate bleeding cessation. In conclusion, this is a simple, effective, and less invasive technique for the management of LVFWR and thus can be an alternative to surgical repair for LVFWR after acute myocardial infarction in selected patients.

Léčba arytmické bouře u pacienta se syndromem Brugadových – kazuistika 

M. Holická, T. Novotný

The Brugada syndrome (BrS) is a relatively rare hereditary arrhythmic syndrome. It is characterized by typical electrocardiographic pattern in the right precordial leads and increased risk of malignant ventricular arrhythmias. We are describing a case of an arrhythmic storm in a patient with BrS. The aim of this report is to stress the necessary choice of uncommon pharmacotherapy with isoproterenol. In this rare, nevertheless life threatening situation, such knowledge could be substantial for patient rescue.

Kompletní atrioventrikulární blokáda jako manifestace lymeské karditidy 

J. Málek, J. Večeřa, P. Vojtíšek, J. Matějka

Lyme disease is the most common illness transmitted by tick-borne in Europe, caused by spirochette Borrelia. Lyme carditis is believed to be relatively rare, however, the condition, while reversible, can be severe or fatal. We present a case of 76- year-old male complaining of malaise, vertigo and lower extremities paresthesia with 2-month history of tickbite – repeatedly examined by cardiologist and neurologist – where ELISA test for Borrelia was positive and ECG revealed complete AV block with narrow QRS complex. Intravenous antibiotic therapy (ATB) was initiated. Third degree AV block gradually resolved to normal ECG within 20 days of ATB therapy. Cardiac pacing was not performed. Lyme disease is a rare cause of AV block of variable degree, which is resolved within several days or weeks of ATB therapy and permanent pacemaker implantation is rarely necessary.

Solitární levostranná horní dutá žíla 

M. Mikulcová, Z. Tüdös, M. Troubil

Persistent left superior vena cava (PLSVC) is the most common thoracic vein system anomaly with incidence 0.3–0.5% in the population which constitues almost 10% of all congenital heart defects. So called isolated PLSVC (iPLSVC) is in contrary a very rare anomaly with incidence 0.09–0.13%. The presence of the PLSVC and the iPLSVC can lead to complications during central venous system catheterization. The PLSVC or the iPLSVC could represent a left-to-right shunt if it enters directly into the left atrium. In our case study, we describe case of a female patient with dilated coronary sinus found on echocardiogram leading to suspicion of the PLSVC. Subsequently right-sided catheterization was planned to evaluate severity of mitral regurgitation during a stress test. However, attempt to perform the right-sided catheterization via the right subclavian vein or the right jugular vein failed. Catheterization through left sided central veins was avoided because of suspected PLSVC. CT angiography was performed to confirm the PLSVC, but the iPLSVC was diagnosed instead. The iPLSVC is a rare finding which can lead to different complications during a central cannula insertion, right-sided catheterization, pacemakers or implantable cardioverter-defibrillator implantation or insertion of cardiopulmonary bypass and ECMO.

Těžká hypovolemie jako příčina přechodné masivní „wide open“ mitrální regurgitace a kardiogenního šoku u pacientky s hypertrofickou kardiomypatií 

L. Sabolová, A. Schee, P. Syrovátka, M. Ziaei

We present a case history of the 60-year-old woman, with alcohol abuse, admitted to our department with the suspicion of acute myocardial infarction. On admission the hypertrophic cardiomyopathy with a significant obstruction in LVOT and massive “wide open” mitral regurgitation was determined, concurrently a severe hypovolemia due to dehydratation, which was the most likely the trigger mechanism, was stated. Relatively quick management of the critical state was achieved by massive fluid substitution. After the stabilization of the patient the differential diagnosis of the left ventricle hypertrophy was made. Thesaurismosis was ruled-out by biopsy and as the final resolution the myectomy of septum and the mitral mechanic prosthesis replacement was made.

Léčba inhibitory PCSK9 u pacienta s prokázanou familiární hypercholesterolémií v primární prevenci kardiovaskulárních onemocnění 

B. Nussbaumerová, H. Rosolová

Proprotein convertase subtilisin/kexin type 9 inhibitors are a novel therapy for hypercholesterolemia treatment. A case of one of our first patients with heterozygous familiar hypercholesterolemia with no history of cardiovascular disease is described. Evolocumab added to the intensive lipid-lowering therapy lowered the LDL-cholesterol level by 69% and helped bring the patient closer to target values.

Terapie inhibitory PCSK9 u pacientů se statinovou intolerancí 

M. Šnejdrlová, T. Altschmiedová

Statin intolerance, most often manifested by muscular symptoms (e.g. myalgia, muscle weakness), can be a major complication in the treatment of hypercholesterolemia in the primary and secondary prevention of cardiovascular diseases. The prevalence data of statin intolerance has a very wide range, but absolute statin intolerance is rare. Most patients with statin intolerance suffer from partial intolerance, characterized by statin intolerance at the dose required to reach the LDL-cholesterol target value. A new hope for patients with statin intolerance are the PCSK-9 inhibitors, however the reimbursement conditions of these drugs are mainly linked to patient’s cardiovascular risk, and statin intolerance, which can complicate the treatment, is considered as a secondary factor...

Musejí se infarkty myokardu opakovat? 

J. Václavík

We describe a case report of a patient with severe hypercholesterolemia who has had a total of four myocardial infarctions. Despite treatment with a high dose statin, a stroke event occurred. Even the maximum statin dose in combination with ezetimibe did not lead to the normalization of LDL-cholesterol. Since 2013, therefore, the patient has started evolocumab administration, which has led to a marked lipidogram adjustment and prevented until today the relapse of another cardiovascular event.

Perkutánní koronární intervence chronického uzávěru věnčité tepny vedená intravaskulárním ultrazvukem 

A. Zohoor, R. Ondrejčák, M. Bystroň

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is one of the most challenging procedures and complicated interventions on coronary arteries, needs high consumption of equipment and with high risk of complications. With concurrent strategies and technical equipment, the rate of success on hand of expertise is more than 90%. Successful procedure leads to improvement of symptoms, reduction of a need of coronary artery bypass graft (CABG) surgery, improvement of left ventricular systolic function, improved survival of the patients and more tolerance of new onset ischemia. The use of radial approach in complex lesions can reduce the rate of vascular complications and improve patient comfort. Intravascular ultrasound (IVUS) allows detailed visualization of the coronary artery lumen to further optimize the outcome of complex PCI. In the CTO intervention can be used to detect lesion length, enable appropriate stent sizing, verify guidewire location within an artery discriminating a true lumen from subintimal space and last but not least enable safely puncture the proximal cap of CTO with an ambiguous position.