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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
1   Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy
,
Giuseppe Cannavale
2   Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
,
Giulia Conti
1   Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy
,
Simona Mariani
1   Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy
,
Fabrizio Proietti
1   Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy
› Author Affiliations
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Publication History

Publication Date:
23 July 2013 (online)

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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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