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Case Report
An aneurysmatic surprise: A myocardial infarction unexpected benefit
1 Doctoral Student, Postgraduate Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
2 Intensive Care Unit, Walter Cantídio Federal Hospital, Fortaleza, Ceará, Brazil
3 Undergraduate Medicine Student, Federal University of Ceará, Fortaleza, Ceará, Brazil
4 Cardiac Surgery Department, Hospital São Camilo Cura D'ars, Fortaleza, Ceará, Brazil
5 Postgraduate Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
Address correspondence to:
Diego Bastos Porto
757, Pinto Madeira St. Fortaleza, Ceará,
Brazil
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Article ID: 101299Z01DP2022
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How to cite this article
Porto DB, Beltrão BA, Borges JPS, Simão ADL, de Mesquita Lobo RAC, Boniatti MM. An aneurysmatic surprise: A myocardial infarction unexpected benefit. Int J Case Rep Images 2022;13:101299Z01DP2022.ABSTRACT
Introduction: Atypical presentations of cardiovascular pathologies might delay an accurate diagnosis, contributing to worse prognosis. Myocardial infarctions and aortic aneurysms are examples of such scenarios.
Case Report: A 65-year-old male patient was admitted with retrosternal chest pain and diaphoresis which began 2 hours prior to seeking medical assistance. On evaluation, he had a rise of ultrasensitive T-troponin curve. A cardiac catheterization showed important coronary obstructions which appeared to be related to an extrinsic compression. Transthoracic echocardiography showed an oval-shaped hypoechoic structure which seemed to compress the left atrial appendix. The patient was sent to the operating room in which a large aortic aneurysm was diagnosed. A valve sparing aortic root replacement procedure was made following Tirone David technique. Also, coronary revascularization was performed. Despite a few complications, such as sepsis and pericardial effusion, the patient recovered well, being discharged home.
Conclusion: Our patient developed an unusual presentation of a myocardial infarction, possibly due to a synergic mechanism: atherosclerosis and extrinsic compression of the coronary arteries by an aneurysm which wasn’t initially diagnosed. His coronary disease wasn’t severe, but the extrinsic aneurysm compression, together with arteries distension, may have caused the ischemia and, ultimately, his symptoms. This case emphasizes the importance of an extensive anamnesis (with complementary imaging studies when necessary) in order to elucidate the diagnosis and better care for our patients. Also, it highlights the importance of a due diagnostic and intervention which should be sought by all clinicians in order to avoid potentially harming misdiagnosis and optimize outcomes.
Keywords: Aortic aneurysm, Cardiac catheterization, Cardiac surgical procedures, Myocardial infarction
SUPPORTING INFORMATION
Author Contributions
Diego Bastos Porto - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Beatriz Amorim Beltrão - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Joao Pedro Sobreira Borges - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Antônio Daniel Leite Simão - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Roberto Augusto Carneiro de Mesquita Lobo - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Marcio Manozzo Boniatti - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Diego Bastos Porto et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
