Cor et Vasa Case Reports 2/2020

titul-1.jpgCor et Vasa Case Reports
Svazek | Volume 3 • Číslo | Number 2
Srpen | August 2020

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Mnohočetný papilární fibroelastom jako zdroj kardioembolizační cévní mozkové příhody – kazuistika a přehled literatury 

T. Urbanec, Š. Havránek, T. Grus, et al.

Despite recent advances in primary and secondary prevention, ischemic stroke remains one of the leading causes of morbidity and mortality in western countries. The etiology of ischemic stroke is heterogenous. Unravelling the causality of ischemic stroke enables subsequent targeted therapy as part of secondary prevention. However, in 30% of all cases, the etiology of ischemic stroke remains unclear. Embolic stroke of undetermined source (ESUS) has been recently proposed as a new entity, for which the optimal diagnostic and therapeutic algorithm needs to be defined. Papillary fibroelastoma is an uncommon heart tumor and a rare cause of embolic stroke. Here we present a case of papillary fibroelastoma complicated by ischemic stroke.

Význam stanovení sérové koncentrace kalcia u pacienta s kardiovaskulárním onemocněním 

B. Siláková, A. Dufka, A. Hondlová

Hypercalcaemia is defined as a serum calcium level greater than twice the standard deviation of a physiological serum calcium level in a given laboratory.The most common cause of hypercalcaemia in our population is primary hyperparathyroidism or cancer.The clinical signs of hypercalcaemia on the cardiovascular system may be tachyarrhythmias, bradyarrhythmias or conduction blocking disorders. On ECG hypercalcaemia causes a shortening of the QT interval. We present a case report of a patient with atrial flutter capture. Hypercalcaemia was suspected by analysis of the resting ECG of the patient after electrical cardioversion. Primary hyperparathyroidism was confirmed by paraclinic examinations. After successful surgical treatment ECG changes have regressed and the patient continues in clinical follow-up without atrial flutter recurrence.

Eosinophilic myocarditis as a manifestation of eosinophilic granulomatosis with polyangiitis 

H. Hnátová, L. Hornofová, T. Adla, J. Veselka

We present a case– clinical presentation, diagnosis, management and follow up of a 36-year-old woman with acute myocarditis as a manifestation of eosinophilic granulomatosis with polyangiitis (EGPA). The patient with a history of asthma and allergies presented with clinical signs of acute myocarditis and with peripheral eosinophilia in blood, an endomyocardial biopsy was then performed with histological proof of necrotizing eosinophilic myocarditis...

Specifika pravostranné implantace implantabilních kardioverter-defibrilátorů 

P. Keprt, M. Paďour, K. Sedláček

A usual approach to transvenous implantation of cardiac implantable electronic devices is via left subclavian vein with placement of the device in a subcutaneous pocket in left subclavian area. There are, however, situations which make implantation of the system this wayimpossible. We present a case reportof a patient indicated for implantation of a one-chamber implantable cardioverter-defibrillator within primary prevention of sudden cardiac death in whom an anomaly of a central venous system was found during the procedure, and attempts to implant the electrode this way failed. The cause of impossibility of left-side implantation lied in necessity of using a rigid defibrillation electrode, and in unfavorable geometry of the coronary sinus ostium.Anatomy verification of patient’s central venous system through computer tomography established presence of a minority variant of a rare congenital defect in a form of a persistent left superior vena cava, and without mutual communication with a patent right vena cava through left brachiocephalic vein. The solution wastransvenous implantation of the device via right subclavian vein. This provides an adequate alternative with the same therapeutic effectivity, however, with a significantly higher defibrillation threshold.

Infarkt myokardu jako vyvolávající příčina stresové kardiomyopatie? 

V. Gloger, Z. Coufal

Takotsubo syndromebelongs tounclassifiedcardiomyopathies. An exclusion of acute coronary syndrome is needed, beforethe diagnosis is established.Typical for takotsubo syndrome isapicalballooning ofthe left ventricle.We present twocases of myocardial infarction withcoronary artery occlusionanddevelopment of scar,both documented by coronary angiography and magnetic resonance.However, the extentofthe left ventricular wall hypokinesis did not correspond withoccluded coronary arteryand wasmore typical fortakotsubo syndrome, whichmay be coincidental, but also subsequent tomyocardial infarction.

„Upside-down stomach“ jako netradiční příčina paroxysmální fibrilace síní a akutního infarktu myokardu 

M. Tropp, V. Kaučák, M. Heczko

The case report aims to point out the relationship between recurrent paroxysmal atrialfibrillation and largehiatal hernia, when urgent operation of hiatal hernia led to the disappearance of paroxysms of atrial fibrillation, maintenance of sinus rhythm and withdrawal of antiarrhythmic drugs. It also points to a wide differential diagnosis of chest pain and possible non-coronary causes of acute myocardial infarction. By our patient, sudden chest pain and an electrocardiogram of ST segment elevation, leads to emergent coronary angiography, without finding significant stenosis. The case report emphasizes caution in differential diagnosis of chest pain, the importance of verifying patienthistory and performing acute bedside echocardiography, and also points to caution in the indication of dual antiplatelet therapy and unfractionated heparin in unclear etiology.

Časná recidiva plicní embolie po trombolytické léčbě – když se dvakrát vstoupí do téže řeky 

J. Karlíček, M. Gřiva, J. Šťastný, P. Kopřiva, Z. Coufal

Acute pulmonary embolism associated with obstructive shock is a serious condition with high mortality. In this case, the treatment of choice is systemic thrombolysis, followed by anticoagulant treatment. This procedure will allow rapid management of hemodynamic instability while preventing early recurrence of pulmonary embolism. In our case report, we describe an 80-year-old patient suffering from early recurrence of severe acute pulmonary embolism, presenting shortly after successful systemic thrombolysis. The case is interesting thanks to the fact that the presence of mobile thrombi in the right heart compartments was documented by echocardiography.