Cardiovascular magnetic resonance and echocardiographic findings of a large thrombosed intramyocardial dissecting hematoma: a case report and a brief review of literature

Background Intramyocardial dissecting hematoma (IDH) is a rare and potentially life-threatening complication of acute coronary syndrome. So far only isolated case reports and case series have been published. Case summary We report the case of a late presenting myocardial infarction (MI) complicated by IDH of the ventricular septum, following a successful percutaneous coronary intervention (PCI). The clinically inapparent septal mass was discovered during the routine transthoracic echocardiography and the final diagnosis of hematoma was made by magnetic resonance imaging. The patient remained clinically stable, and septal mass on repeated echocardiography showed gradual regression. Discussion This report suggests that IDH can spontaneously resolve without surgical intervention. An urgent echocardiogram should be used to assess the vitality of the myocardial tissue, especially with late presenting MI with deep Q waves on the ECG strip. Conservative treatment in hemodynamically stable patients with IDH following MI and PCI is a feasible solution.

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Conservatively treated intramyocardial dissecting haematoma of the interventricular septum as a rare complication of acute myocardial infarction: a case report

Apostolović

Kostić

Nikola

et al. 2022

European Heart Journal - Case Reports

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Left ventricular dissecting haematoma and aneurysm formation in a patient who uses methamphetamines: a case report

Ruwanpathirana,

Poornima,

Dissanayake

et al. 2024

BMC Cardiovasc Disord

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Introduction Myocardial dissection is a rare complication of ischaemic heart disease. It occurs when a haematoma forms within the cardiac muscle, either due to an endocardial rupture or rupture of an intra-myocardial vessel. Higher ventricular wall tension and reduced myocardial tensile strength increase the risk of dissection. We describe a young male who developed a myocardial dissection following an ST elevation infarction. We explore the possible pathophysiological connection between myocardial dissection and his amphetamine use. Case presentation A 37-year-old Sri Lankan patient presented with progressively worsening heart failure for two weeks. One month before the presentation, he had developed an ischaemic chest pain, for which he had not sought medical advice. He was abusing inhalational heroin, crystal methamphetamines and cigarette smoke daily for five years. On examination, the patient had a blood pressure of 90/60 mmHg and a pulse rate of 110 beats per minute. The cardiac apex was deviated. The jugular venous pressure was elevated, bilateral pitting ankle and pulmonary oedema were present. The ECG had Q-ST elevations in the lateral leads. Serum troponin was elevated. A transthoracic echocardiogram revealed a poorly functioning dilated left ventricle with a mass within the myocardial apex. Cardiac MRI established that the mass was an intra-myocardial haematoma. A coronary angiogram demonstrated a critical plaque stenosis at the mid left-anterior-descending artery with poor distal flow. The patient did not have HIV or infective endocarditis. We treated the patient with diuretics and guideline-directed medical therapy for heart failure with reduced ejection fraction. We did not attempt surgical repair as the dissection was non-expanding, and the patient was at a high risk of operative complications. Conclusions Myocardial dissection with aneurysm formation is a rare complication of ischaemic heart disease. Methamphetamines enhance the risk of myocardial dissection by inducing myocardial inflammation, causing a dilated cardiomyopathy and increasing the left ventricular pressures. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-024-04382-0.

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A Rare Case of Intramyocardial Dissecting Hematoma following Acute Myocardial Infarction

Sarkar¹,

Majumder²,

Ghosh³

et al. 2023

Journal of Cardiovascular Echography

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Intramyocardial dissecting hematoma (IDH) is a rare and very dangerous complication of myocardial infarction (MI) and percutaneous intervention. Hemorrhage inside the spiral fibers of the myocardium causes this type of dreaded complication. We have reported a case of IDH following acute anterior wall MI. The patient’s electrocardiogram showed ST elevation in precordial leads. The serum troponin level was elevated. IDH should be considered a rare complication after acute MI. The patient may present with features of cardiogenic shock. A two-dimensional echocardiography may demonstrate this type of complication.

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Cardiovascular magnetic resonance and echocardiographic findings of a large thrombosed intramyocardial dissecting hematoma: a case report and a brief review of literature

Cited by 3 publications

References 15 publications

Conservatively treated intramyocardial dissecting haematoma of the interventricular septum as a rare complication of acute myocardial infarction: a case report

Conservatively treated intramyocardial dissecting haematoma of the interventricular septum as a rare complication of acute myocardial infarction: a case report

Left ventricular dissecting haematoma and aneurysm formation in a patient who uses methamphetamines: a case report

A Rare Case of Intramyocardial Dissecting Hematoma following Acute Myocardial Infarction

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