Advertisement

Journal of Nuclear Cardiology

, Volume 21, Issue 5, pp 1029–1034 | Cite as

Multimodality cardiac imaging of a patient with syncope

  • Dhaval KolteEmail author
  • Kedar Sankholkar
  • Sahil Khera
  • Amar B. Shah
  • Rocco J. Lafaro
  • Diwakar Jain
Images That Teach
  • 191 Downloads
A 60-year-old man was admitted to the hospital following an episode of syncope lasting for a few minutes while brushing his teeth. He denied chest pain, palpitation, or an aura prior to falling unconscious. He had history of hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, transient ischemic attacks, smoking, and heavy alcohol abuse. He suffered from a myocardial infarction several years ago, which was treated with percutaneous coronary intervention. His electrocardiogram showed precordial Q waves with 1-mm ST-segment elevation (Figure  1A). Chest x-ray revealed a faint curvilinear opacity in the cardiac apical region, suspicious for a calcified apical aneurysm (Figure  1B). Echocardiogram (Figure  2; Video 1) showed left ventricular ejection fraction (LVEF) of 35% and dyskinesia of the distal anteroseptal and apical myocardium. He ruled out for an acute myocardial infarction, but was noticed to have frequent episodes of non-sustained ventricular arrhythmias....

Keywords

Left Ventricular Ejection Fraction Leave Anterior Descend Dacron Patch Aneurysm Resection Obtuse Marginal Branch 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors have indicated that they have no financial conflict of interest.

Supplementary material

Video 1: Echocardiogram in long axis view showing an apical aneurysm and severely impaired global left ventricular ejection fraction. (AVI 542 kb)

12350_2014_9880_MOESM2_ESM.avi (5.6 mb)
Video 2: Raw rotating stress and rest myocardial perfusion images in black and white. (AVI 5696 kb)
12350_2014_9880_MOESM3_ESM.avi (6.2 mb)
Video 3: Raw rotating stress and rest myocardial perfusion images in thermal color scales. (AVI 6368 kb)
12350_2014_9880_MOESM4_ESM.avi (556 kb)
Video 4: Gated myocardial SPECT images in representative short axis and vertical and horizontal long axes, showing an enlarged left ventricle with a dyskinetic left ventricular apex. The global LVEF was severely impaired at 23%. (AVI 556 kb)
12350_2014_9880_MOESM5_ESM.avi (330 kb)
Video 5: Left coronary angiography showing heavily calcified left main and proximal left anterior descending and left circumflex coronary arteries and a completely occluded mid left anterior descending coronary artery and high grade narrowing of the first and second obtuse marginal branches of the left circumflex coronary artery. (AVI 329 kb)
12350_2014_9880_MOESM6_ESM.avi (534 kb)
Video 6: Right coronary angiography with multiple low grade plaques. (AVI 533 kb)
12350_2014_9880_MOESM7_ESM.avi (577 kb)
Video 7: Left ventriculography showing a large calcified apical aneurysm with a large area of dyskinesia involving the apex and apical part of the left ventricle. (AVI 577 kb)

References

  1. 1.
    Napodano M, Tarantini G, Ramondo A, Cacciavillani L, Corbetti F, Marra MP, et al. Myocardial abnormalities underlying persistent ST-segment elevation after anterior myocardial infarction. J Cardiovasc Med (Hagerstown) 2009;10:44-50.CrossRefGoogle Scholar
  2. 2.
    Wang X, Wu H, Sun H. Massive calcified left ventricular aneurysm and ventricular septum: Successful surgical repair and reconstruction. J Thorac Cardiovasc Surg 2012;143:509-11.PubMedCrossRefGoogle Scholar
  3. 3.
    O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:e78-140.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2014

Authors and Affiliations

  • Dhaval Kolte
    • 1
    Email author
  • Kedar Sankholkar
    • 2
  • Sahil Khera
    • 1
  • Amar B. Shah
    • 3
  • Rocco J. Lafaro
    • 4
  • Diwakar Jain
    • 2
  1. 1.Department of MedicineNew York Medical CollegeValhallaUSA
  2. 2.Division of CardiologyNew York Medical CollegeValhallaUSA
  3. 3.Department of RadiologyNew York Medical CollegeValhallaUSA
  4. 4.Department of Cardiothoracic SurgeryNew York Medical CollegeValhallaUSA

Personalised recommendations