dal sospetto diagnostico alle complicanze acute - anmco€¦ · dal sospetto diagnostico alle...
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Dal sospetto diagnostico alle complicanze acute
Dott. Cosimo A. GrecoU.O.C. Cardiochirurgia
Ospedale V. Fazzi di Lecce
TIPICALCLINICALSCENARIO
PRESENTAZIONE CLINICA
1. Dolore toracico a riposo, simile a SCA:
nel 33-71% dei casi
2. Dispnea
3. Profonda astenia
4. Sincope
ECG
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)
IMAGING
ECOCARDIOGRAFIA
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
LV segmental systolic dysfunctionaccording to cor art distribution in TT vs 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
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
SAM
OstruzioneEfflussoLVOT
Ostruzione efflusso LVOT
InsufficienzaMitralicada SAM
ESORDIO
LVOT dopoqualche giorno
CORONARYANGIOGRAPHY
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.
Diagnostic workup
Cardiac M. R. I.
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
sistole diastole
Complications
Complications
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%
GRAZIE PER
L’ATTENZIONE
