Document Detail

Rapid retraction of a post-infarction intramyocardial dissecting hematoma.
MedLine Citation:
PMID:  24899483     Owner:  NLM     Status:  Publisher    
A 60-year-old male with a recent anterior myocardial infarction (MI) was referred to our hospital for implantable cardioverter defibrillator (ICD) implantation. He was on the 42nd day of MI and clinically stable on admission. Electrocardiography showed right bundle branch block with QS pattern on anterior leads. Transthoracic echocardiographic examination revealed an ejection fraction of 25% with akinesis of the apex and mid-apical segments of anterior and septal walls. In the apical-septal region, a pulsatile cavity with systolic expansion surrounded by a thin endomyocardial border was visualized. Color-Doppler interrogation did not demonstrate any flow within that structure. These findings suggested an intramyocardial dissecting hemorrhage formed after MI. Cardiac magnetic resonance imaging also confirmed an intramyocardial hematoma in the mid-apical anteroseptal region. A conservative approach was assumed as the patient was hemodynamically stable. The planned ICD implantation was postponed due to the high risk of perforation. Subsequently, oral anticoagulant therapy with warfarin was initiated against risk of intracardiac thrombus formation. The existing dual antiplatelet therapy was also continued. One week after hospital discharge, he was rehospitalized due to a very high INR of 6.3. The repeated transthoracic echocardiography revealed an almost complete resolution of the intramyocardial dissecting hematoma and adhesion of the surrounding myocardial layers. Oral anticoagulant therapy was discontinued. Echocardiographic examinations showed no change compared to the last examination during hospitalization. This case illustrates a conservatively managed intramyocardial dissecting hematoma case, in which anticoagulant and antiaggregant therapy yielded a rapid retraction without any complication.
Ebru Ozpelit; Ozer Badak; Mehmet Emre Ozpelit; Omer Kozan
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Publication Detail:
Journal Detail:
Title:  Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir     Volume:  42     ISSN:  1016-5169     ISO Abbreviation:  Turk Kardiyol Dern Ars     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9426239     Medline TA:  Turk Kardiyol Dern Ars     Country:  -    
Other Details:
Languages:  ENG     Pagination:  380-383     Citation Subset:  -    
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