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Case 1

A 30-year-old man with a history of deep vein thrombosis and pulmonary embolism came to the hospital with a complaint of left facial numbness for 5 days with associated hearing loss in the left ear and ataxia. Echocardiography was done, and the results are shown in Figure 10.1.1.

Figure 10.1.1

Echocardiography finding: Left ventricular thrombus.

Key Points

  • Thrombus in the left side of the heart is very dangerous because it can lead to stroke and systemic embolism.

  • Low ejection fraction, akinetic cardiac chambers, and hypercoagulable states can all lead to the occurrence of left ventricular (LV) thrombus.

  • Anticoagulation with warfarin is approved for treatment of LV thrombus. Novel oral anticoagulants are not yet approved for treatment of LV thrombus.

Case 2

A 68-year-old woman with medical history of hypertension, diabetes mellitus, and obstructive airway disease came to the hospital with complaints of chest pain. ECG did not reveal ischemic changes. Troponins were negative, and acute coronary syndrome was ruled out. Echocardiography was done, and the results are shown in Figure 10.2.1.

Figure 10.2.1

Echocardiography with contrast finding: Dilated ballooned apex and hyper contractile base—Classical of Takosubo cardiomyopathy.

Key Points

  • Takotsubo cardiomyopathy, also called stress-induced cardiomyopathy, is characterized by regional systolic dysfunction.

  • In the most common form, there is ballooning and dilatation of the apex and hypercontractility of the base.

  • Takotsubo cardiomyopathy is believed to be caused by catecholamine-induced microvascular spasm.

  • It is a close mimicker of acute coronary syndrome.

Case 3

A 38-year-old man with a medical history of end-stage renal disease who is currently on hemodialysis came to the emergency department with complaints of shortness of breath. ECG showed low-voltage complexes. Echocardiography was done, and the results are shown in Figure 10.3.1.

Figure 10.3.1

Echocardiogram finding: Picture showing moderate pericardial effusion, right ventricular diastolic collapse with evidence of cardiac tamponade.

Key Points

  • The Beck clinical triad in cardiac tamponade includes elevated jugular venous pulsation, muffled heart sounds, and low blood pressure.

  • ECG findings include low-voltage QRS complex, electrical alternans, and sinus tachycardia. However, these findings are nonspecific for cardiac tamponade.

  • Echocardiography findings include right atrial systolic collapse, right ventricular diastolic collapse, inferior vena cava plethora, and increased flow variation across mitral and tricuspid valves.

Case 4

A 53-year-old woman with medical history of hypertension, diabetes mellitus, and chronic obstructive pulmonary disease came to the emergency department with severe shortness of breath for 1 day. ECG did not show any ischemic changes. Bedside echocardiography was done, and the results are shown in Figure ...

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