Intramyocardial Dissecting Hematoma Research Articles

Post myocardial infarction left ventricular intramyocardial dissecting hematoma penetrated right ventricular outflow tract: a rare complication report

BackgroundIntramyocardial dissecting hematoma (IDH) is a rare mechanical complication following myocardial infarction (MI), and only a few isolated cases have been reported to date. IDH presents with diverse clinical manifestations, often resulting in missed or misdiagnosed cases due to limited physician understanding. The diagnosis and treatment of IDH is a major challenge.Case presentationsWe report a case of acute extensive anterior MI in a 73-year-old woman, who underwent percutaneous coronary intervention (PCI); the left ventricular intramyocardial dissecting hematoma (LVIDH) penetrated the right ventricular outflow tract (RVOT), resulting in thrombus formation and subsequent RVOT obstruction. Clinically insignificant IDH was detected by transthoracic echocardiography (TTE) at 3 days, 43 days, and 75 days post-PCI, with characteristic changes in the left ventricular wall ultrasound images. This unusual case highlights the important role of continuous transthoracic echocardiography in identifying this rare complication of LVIDH. After a detailed discussion with the patient, the choice between conservative or surgical management of IDH depends on factors such as the size of the hematomae, left ventricular systolic function, and the patient’s clinical and haemodynamic status. In this particular case, conservative management was chosen by the patient who declined surgery but unfortunately succumbed to cardiogenic shock.ConclusionsThis case describes a rare complication of acute myocardial infarction (AMI) and also focuses on the utility of TTE in the diagnosis of this rare complication. Whether LVIDH is treated conservatively or surgically requires careful evaluation to achieve the best prognosis for the patient.

The Left Ventricular Intra-Myocardial Dissecting Hematoma Presented as a Rare Complication of the Neglected Myocardial Infarction

An intramyocardial dissection hematoma is a rare event usually caused by hemorrhagic dissection among the spiral myocardial. Herein, we reported a senile man with Intramyocardial dissection hematoma who presented with neglected myocardial infarction.

AN UNUSUAL LEFT VENTRICULAR APICAL MASS COMPLICATING ACUTE MYOCARDIAL INFARCTION

Abstract An 34–year–old man presented to the emergency department of our hospital with palpitations and presyncope. He was a smoker but had no others known cardiovascular risk factors. At admission, his electrocardiogram (ECG) showed sustained monomorphic ventricular tachycardia (VT) at a rate of 187 beats per minute. The VT was successfully treated with synchronized direct current cardioversion. The ECG in sinus rhythm showed Qs from V1 to V6 with ventricular repolarization anomalies in the same site suspicious for previous anterior necrosis. A transthoracic echocardiogram revealed akinetic apex, akinesia of middle segments of the interventricular septum, anterior and lateral walls, Left Ventricular (LV) ejection fraction of 30% and a large apical mass suspicious for LV thrombus. The patient was admitted to the coronary care unit and taken to the Cath lab that showed total left anterior descending mid–segment occlusion. Due to the chronicity of the condition, the patient was recommended to optimal medical therapy. Suspecting LV thrombus, the patient began treatment with unfractionated heparin i.v. and subsequently imbricate therapy with enoxaparin s.c. and warfarin. Additionally, the patient underwent subcutaneous implantable cardioverter defibrillator (S–ICD) implantation for secondary prevention of sudden cardiac death. At echocardiographic follow–up one week after discharge, the apical mass remained unchanged despite warfarin therapy with INR at target. For this reason, the patient was recommended to perform a Cardiovascular magnetic resonance (CMR). Three months after S–ICD implantation, a CMR was performed which showed transmural areas of late gadolinium enhancement involving all apical segments and middle segments of the interventricular septum which allowed the diagnosis of a large intramyocardial dissecting hematoma (IDH) of left ventricle. IDH is a rare complication of ST–elevation myocardial infarction (STEMI), it is an unusual form of subacute cardiac rupture and could be fatal. It usually consists of a cavity or channels within the myocardium. Its prognosis varies according to its location, but generally apical IDH have more favorable outcome with a higher likelihood of spontaneous retraction. We report this case because the IDH is a diagnostic challenge and it represents an extremely rare and poorly described event in the literature.

Multimodality imaging of acute intramyocardial dissecting haematoma and its dynamic progression.

Multimodality imaging of acute intramyocardial dissecting haematoma and its dynamic progression.

Intramyocardial dissecting hematoma: A systematic review and pooled analysis of available literature.

The current systematic review and pooled analysis were conducted to answer several questions using findings from case reports and case series as follows: (1) Demographic characteristics; (2) clinical findings; (3) management approach; and (4) prognosis of individuals diagnosed with intramyocardial dissecting hematoma. Electronic databases, including PubMed (Medline), Scopus, and Web of Science, were systematically searched from the earliest available date up to February 2023 using selected keywords. All analyses were performed using SPSS software version 27 (IBM Corp, Armonk, NY, USA), and a P-value less than 0.05 was considered statistically significant. A total of 77 patients diagnosed with Intramyocardial dissecting hematoma (IDH) comprised the study population, with a mean (standard deviation) age of 58.72 (13.99) years, of which 22.1% were women. Patients of higher age experienced a higher risk for mortality compared to younger subjects (OR=1.05, 95% CI: 1.01, 1.10; P=0.014). In addition, the implementation of angiography (OR=0.25, 95% CI: 0.08, 0.71; P=0.010) and cardiac magnetic resonance (OR=0.19, 95% CI: 0.06, 0.60; P=0.004) in the context of diagnosis reduced the risk of death compared to those who did not receive these interventions. Similarly, the diagnosis of pericardial effusion significantly increased the risk of mortality compared to those without pericardial effusion (OR=3.92, 95% CI: 1.27, 12.07; P=0.017). The authors found that older patients experience a poor prognosis compared to younger ones. In addition, the utilization of angiography and cardiac magnetic resonance improves the prognosis of individuals. Likewise, the diagnosis of pericardial effusion in patients with IDH increases the odds of mortality.

Ventricular Intramyocardial Dissecting Hematoma: What Is its True Clinical Evolution and the Best Treatment?

Intramyocardial dissecting hematoma (IDH), in the setting of an acute coronary syndrome, is a rare type of cardiac rupture. However, the best treatment for IDH in each clinical scenario is not clearly defined. We present a case in which the best approach for IDH and its final outcome are discussed.

Dissection intramyocardial a rare complication of myocardial infraction: Case report

Intramyocardial dissecting hematoma (IDH) after acute myocardial infarction (MI) is a rare form of subacute cardiac rupture, resulting from hemorrhagic separation of helical fibers within the myocardium, which has been described in most studies as an incomplete cardiac rupture or a specific type of cardiac rupture. The management of myocardial dissection is variable and poorly documented, with clinical outcomes ranging from asymptomatic recovery to fatal cardiac events. We present here a case of myocardial dissection diagnosed by echocardiography.

A case report of intramyocardial dissecting hematoma: a challenging diagnosis.

A case report of intramyocardial dissecting hematoma: a challenging diagnosis.

Abstract 11198: Intra-Myocardial Dissecting Haematoma Presented as a Ventricular Tachycardia in a Patient With Remote Silent Myocardial Infarction

Intramyocardial dissecting haematoma (IMDH), a rare form of myocardial rupture, is recognised as a complication of acute myocardial infarction (MI) but can also occur as a result of a thoracic trauma or spontaneous rupture of intramural coronary vessels. Before the advent of advanced multi-modality cardiac imaging, IMDH was an autopsy diagnosis. In this report, we present a patient with recent onset of palpitation due to non-compromising ventricular tachycardia (VT). Post cardioversion ECG showed anterior-apical deep Q waves in keeping with prior silent MI. Transthoracic echocardiography showed severely reduced left ventricular ejection fraction due to extensive apical aneurysm and raised the possibility of protruding apical thrombus. Subsequent contrast echocardiography showed features compatible with extensive LV apical thrombus and raised the differential diagnosis of contained myocardial rupture and IMDH. During the two years follow-up guideline directed medical therapy for heart failure and antiarrhythmic medication stabilised patient at NYHA class I-II with no recurrence of VT. Multimodality imaging including cardiac CT and MRI confirmed the suspicion of IMDH. With this case we are highlighting the difficulties in the diagnosis and the controversies of the management of IMDH. Figure: A: ECG shows monomorphic VT. B: after chemical cardioversion, ECG shows sinus rhythm with old transmural extensive anterior MI. C: Transthoracic echocardiography, apical 4 chamber view shows aneurysmatic left ventricular apex with echo lucent space with mobile intraventricular membrane separating the true LV lumen and the dissecting hematoma (Asterix). D: Contrast enhanced echocardiography delineating the true LV cavity from the IMDH. E,F: Contrast enhanced CT showing the low attenuation hematoma located in the anterior LV apex. Note the calcification in the LV apical myocardium indication of prior transmural MI.

Intramyocardial dissecting hematoma associated with a coronary sinus diverticulum: a rare cause of chest pain.

Intramyocardial dissecting hematoma associated with a coronary sinus diverticulum: a rare cause of chest pain.

Myocardial Infarction With Ventricular Wall Aneurysm: A Case Report

A ventricular aneurysm can be pseudo or true; it is a rare complication of myocardial infarction induced by an intra-myocardial dissecting hematoma due to fragile myocardium. Ventricular wall rupture takes place two to four days after myocardial infarction when coagulative necrosis and inflammatory infiltrate and lysis of myocardial connective tissue results in weakening of infarcted myocardium. Acute cardiac wall ruptures are mostly fatal; an unwittingly located pericardial adhesion can abort a rupture resulting in a false aneurysm. The wall of a false aneurysm consists of the epicardium in contrast to a true aneurysm, which is composed of the myocardium. True aneurysms are complications seen in transmural infarcts. Thinned-out scar tissue paradoxically bulged during systole, and toughened fibrotic wall rupture doesn't usually occur. Deaths in subjects with true ventricular aneurysms occur due to mural thrombus, arrhythmias, and heart failure. We encountered a case of a true aneurysm, as reported below.

Rare Case of Sars COV2 Virus (COVID 19) Associated Intra Myocardial Hematoma and Role of Diagnostic Imaging

SARS Cov2 infection is a pandemic declared by WHO in early month of 2020 as corona virus disease (COVID 19) which was diagnosed first in Wuhan, China in December 2019. During first wave of COVID 19 we faced with severe acute respiratory insufficiency and respiratory failure with common symptoms of high-grade fever, shortness of breath and loss of sensations but later on we accessed the different symptoms to related with multi systems of human body. Cardiac emergencies or cardiovascular morbidities with mortality were accessed across the globe during COVID 19 pandemic era. Data revealed that SARS Cov2 affected on heart by both direct or indirect pathway which leads to acute myocarditis, myocardial injury/infarct, heart failure, thrombosis and arrhythmias. Here we are presenting a rare case as hematoma in myocardium called as intramyocardial dissecting hematoma. Non-invasive diagnostic tools to prevent mortality in cardiology field and avoid further complication.

C55. Intramyocardial dissecting hematoma, a rare complication after myocardial infarction : a case report

Abstract Background Intramyocardial dissecting hematoma (IDH) is a rare complication of myocardial infarction (MI) that contribute to high morbidity and mortality rate. There is scarce information in literature and hence management uncertainties. Additionally, coronary reperfusion results on the occurrence of IDH is still poorly understood. Case Summary A 49-year-old man with a previous anterior wall MI 3 months before without revascularization, presented with a recent onset of New York Heart Association (NYHA) functional class IV heart failure. Echocardiographic diagnosis of IDH was based on the presence of a neocavity with an endomyocardial border extending from the LV mid inferoseptal wall to the apical segments, corroborated with cardiac magnetic resonance (CMR). Coronary angiography showed severe three-vessel disease. The patient underwent staged complete revascularization and kept on optimal medical management. With non-surgical treatment, the patient remained clinically stable and showed a gradual improvement. Repeated echocardiography up to one year after the initial diagnosis demonstrated regression of the haematoma. Discussion An unusual form of myocardial rupture that can complicate acute myocardial infarction is IDH. The diagnosis can be missed in some cases. Transthoracic echocardiography may allow diagnosing and evaluating IDH at the bedside. Controversy exists regarding whether surgical repair or conservative treatment is the best option for this condition. The appropriate management should be individualized. Conservative treatment in clinically stable patients suffering from IDH following MI and coronary intervention can be a feasible option.

C55. Intramyocardial dissecting hematoma, a rare complication after myocardial infarction : a case report

Abstract Background Intramyocardial dissecting hematoma (IDH) is a rare complication of myocardial infarction (MI) that contribute to high morbidity and mortality rate. There is scarce information in literature and hence management uncertainties. Additionally, coronary reperfusion results on the occurrence of IDH is still poorly understood. Case Summary A 49-year-old man with a previous anterior wall MI 3 months before without revascularization, presented with a recent onset of New York Heart Association (NYHA) functional class IV heart failure. Echocardiographic diagnosis of IDH was based on the presence of a neocavity with an endomyocardial border extending from the LV mid inferoseptal wall to the apical segments, corroborated with cardiac magnetic resonance (CMR). Coronary angiography showed severe three-vessel disease. The patient underwent staged complete revascularization and kept on optimal medical management. With non-surgical treatment, the patient remained clinically stable and showed a gradual improvement. Repeated echocardiography up to one year after the initial diagnosis demonstrated regression of the haematoma. Discussion An unusual form of myocardial rupture that can complicate acute myocardial infarction is IDH. The diagnosis can be missed in some cases. Transthoracic echocardiography may allow diagnosing and evaluating IDH at the bedside. Controversy exists regarding whether surgical repair or conservative treatment is the best option for this condition. The appropriate management should be individualized. Conservative treatment in clinically stable patients suffering from IDH following MI and coronary intervention can be a feasible option.

Postsurgical calcified left ventricular intramyocardial dissecting hematoma

Postsurgical calcified left ventricular intramyocardial dissecting hematoma

An unusual complication due to a standard coronary angioplasty procedure: Intramyocardial dissecting hematoma.

An unusual complication due to a standard coronary angioplasty procedure: Intramyocardial dissecting hematoma.

Multimodality imaging of intramyocardial dissecting haematoma.

Multimodality imaging of intramyocardial dissecting haematoma.

INTRAMYOCARDIAL DISSECTING HEMATOMA SECONDARY TO DELAYED PRESENTATION ANTEROLATERAL STEMI

Background Delayed hospital presentation with STEMI during the SARS-CoV-2 pandemic can lead to increased incidence of typically rare mechanical sequelae Intramyocardial dissecting hematoma (IDH) is one such complication of myocardial infarction Case A 51 year-old male patient with a background of hypertension presented with a 7 hour history of typical chest pain His initial ECG showed anterolateral ST segment elevation with reciprocal ST depression in the inferior leads, consistent with STEMI Urgent angiography revealed a 100% acute occlusion in the mid-LAD TIMI 3 flow was restored using a Xience 3 00 x 18mm stent, with resolution of pain and interval ECG improvement Laboratory investigations revealed new significant anaemia Decision-making Post-procedural transthoracic echocardiography revealed severely impaired systolic function and moderate concentric biventricular hypertrophy, and raised the suspicion of a mechanical complication (see image) This was further supported by his delayed presentation and extensive infarct area His anaemia was suggestive of active haemorrhage Endoscopic investigation failed to show a gastrointestinal source Cardiac MRI (CMR) confirmed the presence of IDH Conclusion This case highlights the need for a heightened index of suspicion for typically rare mechanical complications post-STEMI due to delayed hospital presentation during the current pandemic, as well as the growing utility of multimodality imaging such as CMR [Formula presented]

Progressive intramyocardial dissecting hematoma in the apex of the left ventricle after percutaneous coronary intervention.

Progressive intramyocardial dissecting hematoma in the apex of the left ventricle after percutaneous coronary intervention.

Unusual rupture of left ventricular pseudo-false aneurysm secondary to subacute anterolateral myocardial infarction: a case report

BackgroundLeft ventricular (LV) pseudo-false aneurysm is a rare complication secondary to myocardial infarction and is caused by intramyocardial dissecting hematoma due to fragile myocardium. Very occasionally, intramyocardial dissecting hematoma appears as a neocavitation entirely contained within the myocardial wall (so called “pseudo-false LV”) and is an unusual form of subacute cardiac rupture.Case presentationA 38-year-old male experienced chest discomfort 3 weeks ago, which improved within few days. However, after that episode, he presented at our hospital with rapidly deteriorating severe breathlessness in a preshock state with acute heart failure. Emergency coronary angiography revealed an occluded left anterior descending artery. An intra-aortic balloon catheter was inserted because of unstable hemodynamics. Enhanced computed tomography revealed extensive aneurysm formation in the LV anterior wall and contrast leakage from the inner cavity to the LV myocardium, with a moderately accumulated pericardial effusion. Emergency surgery revealed a large aneurysmal sac on the anterior wall, slightly attached to the pericardium. A 5-mm, slit-like, oozing-type, rupture site was detected in the LV after dissecting the pericardium.ConclusionsTo our knowledge, this is the first report of a pseudo-false aneurysm on the LV anterior wall. Subacute rupture of pseudo-false LV aneurysm is rare.