Rheumatic Heart Disease Predisposing to Embolic Myocardial Infarction: A Multimodality Imaging Approach

Emanuele Canali; Giuseppe Cannavale; Giulia Conti; Simona Mariani; Fabrizio Proietti

doi:10.1055/s-0033-1349676

International Journal of Angiology, Table of Contents

Int J Angiol 2016; 25(05): e4-e7
DOI: 10.1055/s-0033-1349676

Case Report

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rheumatic Heart Disease Predisposing to Embolic Myocardial Infarction: A Multimodality Imaging Approach

Emanuele Canali

¹Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy

,

Giuseppe Cannavale

²Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

,

Giulia Conti

¹Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy

,

Simona Mariani

¹Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy

,

Fabrizio Proietti

¹Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy

› Author Affiliations

Abstract

We report a clinical case of a 45-year-old male with a diagnosis of inferior myocardial infarction and previous history of rheumatic fever during his childhood. Coronary angiography demonstrated normal coronary arteries. Transthoracic echocardiogram showed hypokinetic left ventricular inferolateral wall and mitral stenosis; furthermore, speckle tracking analysis revealed reduction of global longitudinal strain involving the inferior wall. A three-dimensional transesophaegeal echocardiography, performed to better characterize the anatomy of the valve and to find possible source of embolic infarct in an enlarged left atrium, showed rheumatic valvular involvement. Cardiac magnetic resonance confirmed the ischemic damage and also provided prognostic information. A multimodality imaging approach should be mandatory in patients with acute myocardial infarction and normal coronary angiography, to define possible sources of embolic infarction and to quantify myocardial damage.

Keywords

mitral valve stenosis - rheumatic heart disease - embolic myocardial infarction - speckle tracking analysis - cardiac magnetic resonance

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References

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