－S 184 －
￭ S-243 ￭
A case of left ventricular pseudoaneurysm associated with myocardial rupture following myocardial infarction
부산백병원 내과1, 심장내과2
*박수영
1, 장재식
2, 박진한
1, 박상율
1, 조영완
2, 진한영
2, 양태현
2, 김대경
2, 김동수
2A 50-year-old man was admitted for large amount of pericardial effusion after ST-segment elevation myocardial infarction (STEMI). 5 days before, he was admitted to another hospital for chest pain and underwent primary percutaneous intervention (PCI) with left circumflex artery (LCX) stent insertion. Initial transthoracic echocardiography (TTE) revealed a large amount of pericardial effusion without hemodynamic significance. Pericardiocentesis was done and 650 mL of hemorrhagic exudates were drained. The patient was discharged on the day 6 without remained pericardial effusion. 3 days after discharge, he readmitted to our emergency department for progressive dyspnea with chest pain. TTE demonstrated a 2.8×2.5cm sized sac, covered by pericardium bulging out along lateral side of left ventricle (Figure). Flow communication between the sac and the left ventricle was confirmed by color doppler examination. Heart surgery was performed with direct suture of left ventricular rupture with teflon belt and reinforcement with bovine pericardial patch. The patient made an uneventful recovery. In contrast to a true ventricular aneurysm, a pseudoaneurysm is composed of thick fibrous tissue and pericardium. Pseudoaneurysm frequently results from rupture of the left ventricle in patients with STEMI. In this case, repeated TTE examination at initial admission period failed to demonstrate pseudoaneurysm of left ventricle. We report an uncommon case of myocardial pseudoaneurysm, initially presented with large hemorrhagic pericardial effusion following primary PCI for STEMI.
￭ S-244 ￭
Acute Myocarditis in a Patient Co-infected with Influenza A Virus and Cosackie Virus
Department of Internal Medicine, KyungHee University School of Medicine, Seoul, Korea
*Jung-Wook Kim, M.D., Woo-Shik Kim, M.D., Ph.D., Sang Jin Ha, M.D., Jin-Bae Kim, M.D., Ph.D., Soo-Joong Kim, M.D., Ph.D., Weon Kim, M.D., Ph.D., Myung-Gon Kim, M.D., Ph.D., Kwon-Sam Kim, M.D., Ph.D.
A 19-year-old male was admitted for symptoms of chest discomfort. He had febrile illness and myalgia for the past 2 days. On admission, blood pressure, heat rate and body temperature were 140/65 mm Hg, 92 beats per minute and 38°C, respectively. Initial electrocardiography (ECG) showed convex-shaped ST elevations in II, III, aVF with no reciprocal change in anterior chest lead. Laboratory test revealed elevated serum C-reactive protein (CRP) and cardiac biomarker (CRP, 1.5 mg/L; CK, 616 IU/L; CK-MB, 53.0 IU/L; Troponin-I, 4.81 ng/mL).
Echocardiogram showed unremarkable findings but automated function imaging assessed by 2-D speckle-tracking imaging showed decreased peak systolic strain of basal inferior and lateral wall. Because influenza A (H1N1) prevailed throughout the country, we prescribed tamiflu for 5 days on suspicion of acute viral myocarditis associated with influenza A (H1N1). Virus test had revealed both common influenza A virus and cosackie virus infection. Gadolinium-enhanced cardiac MRI on the 5th day of admission demonstrated the subepicardial delayed hyper-enhancement at basal inferior, lateral wall and mid lateral wall in short axis 10 minutes delayed enhancement image in accordance with myocarditis. He was restored with ST segment changes improvement and normalization of serum CK level. We present a case of 19-year-old male patient coinfected with influenza A and cosackie virus who showed clinical manifestations mimicking myocardial ischemia. Cardiac MRI as well as 2-D strain helps to make a correct diagnosis and give guidelines to an appropriate treatment in a young patient with presenting with chest pain.
