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Dal sospetto diagnostico alle complicanze acute
Dott. Cosimo A. GrecoU.O.C. Cardiochirurgia
Ospedale V. Fazzi di Lecce
PRESENTAZIONE CLINICA
1. Dolore toracico a riposo, simile a SCA:
nel 33-71% dei casi
2. Dispnea
3. Profonda astenia
4. Sincope
Initial presentation
1. STE in precord fino all’80% se pres precoce
2. Onde T negative profonde: fino al 40%
3. Alteraz. ripolar. non specifiche: 5%
4. Onde Q patologiche: 6-31%
5. ECG normale
ECG: Subacute phase
Initial ST elevation
Days 1-3Deep T wave inversionsProminent QT prolongation> 500 ms
1-2 monthsnormal
BIOMARKERS
1. Peak troponin levels are modest
(60x the ULN as opposed to >400x ULN for STEMI)
2. BNP levels higher in TTC than in STEMI
(BNP/Troponin may diff TTC from STEMI)
ECHOCARDIOGRAPHY
1. Area of dysfunctional myocardium extended beyond the territory
distrib of single coron art: regional abnormalities extending into the
Anterior, inferior and lateral walls
2. RV involvement (14,5%)
3. LVOT obstruction (<20%), MR, LV thrombus, ventricular rupture
4. To confirm recovery of LV function at follow-up
DIAGNOSTIC PATTERN
1. Classic pattern: akinesis of the apical and
mid-ventric segments EXTENDING
BEYOND A SINGLE EPICARDIAL CORON
DISTRIBUTION
2. Mid-ventricular variant: apical preserved
3. Inverted TTC: mid and apical preserved
ECHOCARDIOGRAPHY
1. Area of dysfunctional myocardium extended beyond the territory
distrib of single coron art: regional abnormalities extending into the
Anterior, inferior and lateral walls
2. RV involvement (14,5%)
3. LVOT obstruction (<20%), MR, LV thrombus, ventricular rupture
4. To confirm recovery of LV function at follow-up
RV INVOLVEMENT: biventricularballooning, reverse Mc Connel’s sign
- RV apical akinesis and basalhyperkinesis- TAPSE e TDI anello tricuspidalico non mostrano segni di disfunzione VD
DIAGNOSTIC PATTERN
1. Classic pattern: akinesis of the apical and
mid-ventric segments EXTENDING
BEYOND A SINGLE EPICARDIAL CORON
DISTRIBUTION
2. Mid-ventricular variant: apical preserved
3. Inverted (basal ballooning) TTC: mid and apical
preserved
ECHOCARDIOGRAPHY
1. Area of dysfunctional myocardium extended beyond the territory
distrib of single coron art: regional abnormalities extending into the
Anterior, inferior and lateral walls
2. RV involvement (14,5%)
3. LVOT obstruction (<20%), MR, LV thrombus, ventricular rupture
4. To confirm recovery of LV function at follow-up
CORONARY ANGIOGRAPHY
1. In the acute phase necessary for dif diagnosis
2. Absence of: - stenosi ostruttiva (> 50%)- rottura acuta di placca ATS
3. TIMI frame count e TIMI myocardialperfusion grade prolungati
4.
RISONANZA CARDIACA
1. Non molti studi, assenza di accumulo tardivo
di gadolinio (late enhancement) tipico dell’IMA
2. Assenza di miocardite: edema in acuto e la sua scomparsa tardiva, zone di DE sottoepicard.patchy
3. Molto utile x la diagnosi differenziale
IMPLICATIONS
EARLY IDENTIFICATION OF ANY
POTENTIAL COMPLICATIONS
is CRUCIAL
FOR THE MANAGEMENT,
RISK STRATIFICATION
AND FOLLOW-UP
1 morte x SCC2 riospedalizzazioni:
1 x dolore toracico senza alteraz ECG e labor. 1 x polmonite
92% 69%
Recommended