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Factor VIII is a clotting factor that plays a crucial role in the coagulation cascade. Above-normal levels are found in 11% of the general adult population. Various studies have established a causal association between elevated factor VIII and venous thrombosis; some studies also suggest a relation with arterial thrombosis, particularly myocardial infarction and stroke. We report the case of a 36-year-old man with obesity, smoking and dyslipidemia as cardiovascular risk factors and a history of acute myocardial infarction at age 26. He was admitted to the coronary care unit with a diagnosis of ST-elevation myocardial infarction. Coronary angiography showed a thrombus in the distal segment of the first obtuse marginal artery, which was causing the obstruction. The thrombus was aspirated but there was no reflow. A coagulation study revealed elevated factor VIII; other parameters were normal. Even though this patient presented several cardiovascular risk factors, we highlight the need for more studies on the effect of elevated factor VIII on thrombus formation leading to acute coronary syndrome. Another important question is the use of oral anticoagulation in these patients as an integral part of the management of acute coronary syndrome.

Myxomas are the most common type of benign cardiac tumor. The most frequent clinical presentations are symptoms resulting from atrioventricular valve obstruction or systemic embolization. Coronary embolization is a rare, although real and potentially fatal, complication of cardiac myxomas. We present a case report and review of the literature on this disease association. A 57-year-old woman was admitted to our coronary care unit with a diagnosis of non-ST elevation acute myocardial infarction. Transthoracic echocardiography showed a large left atrial mass attached to the interatrial septum, coral-like and with a friable appearance, suggestive of myxoma. Coronary angiography revealed no significant lesions and the patient underwent surgical excision of the mass, which histological study showed to be compatible with myxoma. The postoperative period was uneventful and the patient is doing well, with no recurrence of myxoma.

Constrictive pericarditis is a clinical condition characterized by the appearance of signs and symptoms of right heart failure due to loss of pericardial compliance. Cardiac surgery is now one of the most frequent causes in developed countries, while tuberculosis remains the most prevalent cause in developing countries. Malignancy is a rare cause but usually has a poor prognosis. The diagnosis of constrictive pericarditis remains a clinical challenge and requires a combination of noninvasive diagnostic methods (echocardiography, cardiac magnetic resonance and computed tomography); in some cases, cardiac catheterization is needed to confirm the diagnosis. The authors present the case of a 51-year-old man, hospitalized due to cardiac tamponade. Diagnostic investigation was suggestive of tuberculous etiology. Despite directed medical therapy, the patient developed effusive-constrictive physiology. He underwent pericardiectomy and anatomopathologic study suggested a neoplastic etiology. The patient died in the postoperative period from biventricular failure. Pericardite efusiva-constritiva; Insuficiência cardíaca; Ecocardiografia; Pericardite efusiva-constritiva como manifestação de um diagnóstico inesperadoResumo A pericardite constritiva é uma entidade clínica caracterizada pelo aparecimento de sinais e sintomas de insuficiência cardíaca direita, secundários à perda da compliance pericárdica. Atualmente, a cirurgia cardíaca tornou-se numa das etiologias mais frequentes nos países desenvolvidos, mantendo-se a tuberculose como a causa mais prevalente nos países em vias de desenvolvimento. As etiologias neoplásicas são mais raras e habitualmente de pior ଝ Please cite this article as: Marta L, Alves M, Peres M, et al. Pericardite efusiva-constritiva como manifestação de um diagnóstico inesperado. Rev Port Cardiol. 2014. http://dx.69.e2 L. Marta et al. Ressonância magnética cardíaca; Diagnóstico prognóstico. O diagnóstico desta entidade mantém-se um desafio clínico, sendo necessária a integração dos achados dos métodos de diagnóstico não invasivos (ecocardiografia, ressonância magnética e tomografia computorizada) e por vezes o recurso ao cateterismo cardíaco. Os autores apresentam o caso clínico de um homem de 51 anos de idade, internado por tamponamento cardíaco. A investigação etiológica foi sugestiva de etiologia tuberculosa, que apesar da terapêutica médica dirigida, evoluiu para fisiologia efusiva-constritiva. Foi submetido a pericardiectomia e o exame anátomo-patológico sugeriu etiologia neoplásica. O doente veio a falecer no pós-operatório em falência biventricular.

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