Hibernated myocardium and heart failure with recovered ejection fraction. Case report
Coronary artery disease will inevitably lead to myocardial dysfunction capable of inducing heart failure (HF). A viable dysfunctional myocardium is defined as one whose contractile function improves after coronary revascularization, either through transluminal coronary angioplasty (TCA), fibrinolysi...
| Autores principales: | , , , , , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2023
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| Materias: | |
| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/42817 |
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I10-R327-article-42817 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
Heart failure coronary disease left ventricular dysfunction Insuficiencia cardíaca enfermedad coronaria disfunción ventricular izquierda . |
| spellingShingle |
Heart failure coronary disease left ventricular dysfunction Insuficiencia cardíaca enfermedad coronaria disfunción ventricular izquierda . Bondone Lopez, A Pereira Priotto , V Sandoval Heredia , AF Quinteros Mancero, V Trecco, PT Rojas, AB Simondi , H Hibernated myocardium and heart failure with recovered ejection fraction. Case report |
| topic_facet |
Heart failure coronary disease left ventricular dysfunction Insuficiencia cardíaca enfermedad coronaria disfunción ventricular izquierda . |
| author |
Bondone Lopez, A Pereira Priotto , V Sandoval Heredia , AF Quinteros Mancero, V Trecco, PT Rojas, AB Simondi , H |
| author_facet |
Bondone Lopez, A Pereira Priotto , V Sandoval Heredia , AF Quinteros Mancero, V Trecco, PT Rojas, AB Simondi , H |
| author_sort |
Bondone Lopez, A |
| title |
Hibernated myocardium and heart failure with recovered ejection fraction. Case report |
| title_short |
Hibernated myocardium and heart failure with recovered ejection fraction. Case report |
| title_full |
Hibernated myocardium and heart failure with recovered ejection fraction. Case report |
| title_fullStr |
Hibernated myocardium and heart failure with recovered ejection fraction. Case report |
| title_full_unstemmed |
Hibernated myocardium and heart failure with recovered ejection fraction. Case report |
| title_sort |
hibernated myocardium and heart failure with recovered ejection fraction. case report |
| description |
Coronary artery disease will inevitably lead to myocardial dysfunction capable of inducing heart failure (HF). A viable dysfunctional myocardium is defined as one whose contractile function improves after coronary revascularization, either through transluminal coronary angioplasty (TCA), fibrinolysis, or myocardial revascularization surgery. Such dysfunction may present as daze or myocardial hibernation. In the first, the dysfunction will be secondary to a transient, acute and short-term interruption of coronary flow. In the hibernating myocardium there will be a chronic decrease in coronary flow with a consequent chronic ventricular dysfunction.
We present the case of a 66-year-old female patient who was admitted with a diagnosis of advanced NSTEMI. Pathological history: Grade II obesity (BMI 36 kg/m2) and COVID 19 pneumonia (2021) and active smoker: 10 cigarettes a day. The electrocardiogram showed sinus rhythm with fibrosis of the anteroseptal face. Troponin T: 0.056 ng/ml and CPK: 61 ng/ml were observed. The Chest X-ray showed grade 3 cardiomegaly and bilateral radiopacities and grade 2 venocapillary hypertension. The transthoracic echocardiogram: Left Ventricular Diameter in Diastole (LVD): 6.5 cm, Left Ventricular Diameter in Systole (LVDs) 5.4 cm, LVEF: 31% with akinesia of the middle and apical segments of the septal, anterior and apex surfaces and lateral hypokinesia. Coronary angiography was performed that revealed severe obstruction of the Left Main Coronary Artery, critical proximal lesion of the Anterior Descending Artery, critical ostial lesion of the Circumflex Artery and moderate to severe lesion of the Right Coronary Artery . Therefore, ATC was carried out: to TCI, ADA and ACX. At 3 months, the transthoracic echocardiogram showed: DVId): 5 cm, DVIs 3.7 cm, LVEF 53%, without segmental contractility disorders at rest. The patient is currently stable, in NYHA functional class I.
Aggressive treatment using TCA associated with complete medical treatment with anti-ischemic drugs in the context of a patient with hibernating myocardium, managed to restore coronary flow, improve myocardial dysfunction, and recover the ejection fraction. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2023 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/42817 |
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I10-R327-article-428172023-10-19T21:19:01Z Hibernated myocardium and heart failure with recovered ejection fraction. Case report Miocardio hibernado e insuficiencia cardíaca con fracción de eyección recuperada. Caso clínico . Bondone Lopez, A Pereira Priotto , V Sandoval Heredia , AF Quinteros Mancero, V Trecco, PT Rojas, AB Simondi , H Heart failure coronary disease left ventricular dysfunction Insuficiencia cardíaca enfermedad coronaria disfunción ventricular izquierda . Coronary artery disease will inevitably lead to myocardial dysfunction capable of inducing heart failure (HF). A viable dysfunctional myocardium is defined as one whose contractile function improves after coronary revascularization, either through transluminal coronary angioplasty (TCA), fibrinolysis, or myocardial revascularization surgery. Such dysfunction may present as daze or myocardial hibernation. In the first, the dysfunction will be secondary to a transient, acute and short-term interruption of coronary flow. In the hibernating myocardium there will be a chronic decrease in coronary flow with a consequent chronic ventricular dysfunction. We present the case of a 66-year-old female patient who was admitted with a diagnosis of advanced NSTEMI. Pathological history: Grade II obesity (BMI 36 kg/m2) and COVID 19 pneumonia (2021) and active smoker: 10 cigarettes a day. The electrocardiogram showed sinus rhythm with fibrosis of the anteroseptal face. Troponin T: 0.056 ng/ml and CPK: 61 ng/ml were observed. The Chest X-ray showed grade 3 cardiomegaly and bilateral radiopacities and grade 2 venocapillary hypertension. The transthoracic echocardiogram: Left Ventricular Diameter in Diastole (LVD): 6.5 cm, Left Ventricular Diameter in Systole (LVDs) 5.4 cm, LVEF: 31% with akinesia of the middle and apical segments of the septal, anterior and apex surfaces and lateral hypokinesia. Coronary angiography was performed that revealed severe obstruction of the Left Main Coronary Artery, critical proximal lesion of the Anterior Descending Artery, critical ostial lesion of the Circumflex Artery and moderate to severe lesion of the Right Coronary Artery . Therefore, ATC was carried out: to TCI, ADA and ACX. At 3 months, the transthoracic echocardiogram showed: DVId): 5 cm, DVIs 3.7 cm, LVEF 53%, without segmental contractility disorders at rest. The patient is currently stable, in NYHA functional class I. Aggressive treatment using TCA associated with complete medical treatment with anti-ischemic drugs in the context of a patient with hibernating myocardium, managed to restore coronary flow, improve myocardial dysfunction, and recover the ejection fraction. La arteriopatía coronaria derivará inevitablemente en disfunción miocárdica capaz de inducir insuficiencia cardíaca (IC). Se define como miocardio disfuncional viable a aquel cuya función contráctil mejora tras la revascularización coronaria ya sea a través de una angioplastia transluminal coronaria (ATC), fibrinólisis o cirugía de revascularización miocárdica. Dicha disfunción puede presentarse como aturdimiento o hibernación miocárdica. En el primero la disfunción será secundaria a una interrupción del flujo coronario transitoria, aguda y de corta duración. En el miocardio hibernado existirá una disminución crónica del flujo coronario con una consecuente disfunción ventricular crónica. Se presenta el caso de una paciente femenina de 66 años que ingreso con diagnóstico de IAMSEST evolucionado. Antecedentes patológicos: Obesidad grado II (IMC 36 kg/m2) y neumonía por COVID 19 (2.021) y tabaquista activa: 10 cigarrillos al día. El Electrocardiograma evidenció ritmo sinusal con fibrosis de cara anteroseptal. Se objetivó una Troponina T: 0.056 ng/ml y CPK: 61 ng/ml. La Radiografía de Tórax presentó cardiomegalia Grado 3 y radiopacidades bilaterales e hipertensión venocapilar grado 2. El ecocardiograma transtorácico: Diámetro del Ventrículo izquierdo en Diástole (DVId): 6.5 cm, Diámetro del ventrículo izquierdo en sístole (DVIs) 5.4 cm, FEVI: 31 % con aquinesia del segmento medio y apical de cara septal, anterior y ápex e hipoquinesia lateral. Se realizó una cinecoronariografía que objetivó obstrucción severa de Tronco Coronario Izquierdo (TCI), lesión crítica proximal de Arteria Descendente Anterior (ADA), lesión crítica ostial de Arteria Circunfleja (ACX) y lesión moderada a severa de la Arteria Coronaria Derecha (ACD). Por lo que se realizó ATC: a TCI, ADA y ACX. A los 3 meses el Ecocardiograma transtorácico mostró: DVId): 5 cm, DVIs 3.7 cm, FEVI 53 %, sin trastornos segmentarios de la contractilidad en reposo. Actualmente la paciente se encuentra estable, en clase funcional NYHA I. El tratamiento agresivo mediante ATC asociado al tratamiento médico completo con drogas antiisquémicas en el contexto de un paciente con miocardio hibernado, logró restaurar el flujo coronario, mejorar la disfunción miocárdica y recuperar la fracción de eyección. . Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2023-10-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/42817 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 80 (2023): Suplemento JIC XXIV Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 80 (2023): Suplemento JIC XXIV Revista da Faculdade de Ciências Médicas de Córdoba; v. 80 (2023): Suplemento JIC XXIV 1853-0605 0014-6722 spa https://revistas.unc.edu.ar/index.php/med/article/view/42817/42838 Derechos de autor 2023 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |