Key result
A multimodality imaging approach identified rheumatic valvular involvement as the source of embolic myocardial infarction in a patient with normal coronary arteries.
Case Report (n=1)
A multimodality imaging approach is essential for identifying embolic sources and quantifying myocardial damage in patients presenting with acute myocardial infarction and normal coronary arteries.
Multimodality imaging may identify embolic sources in MI with normal coronaries; case report leaves open need for prospective validation.
We report a clinical case of a 45-year-old male with a diagnosis of inferior myocardial infarction and previous history of rheumatic fever during his childhood. Coronary angiography demonstrated normal coronary arteries. Transthoracic echocardiogram showed hypokinetic left ventricular inferolateral wall and mitral stenosis; furthermore, speckle tracking analysis revealed reduction of global longitudinal strain involving the inferior wall. A three-dimensional transesophaegeal echocardiography, performed to better characterize the anatomy of the valve and to find possible source of embolic infarct in an enlarged left atrium, showed rheumatic valvular involvement. Cardiac magnetic resonance confirmed the ischemic damage and also provided prognostic information. A multimodality imaging approach should be mandatory in patients with acute myocardial infarction and normal coronary angiography, to define possible sources of embolic infarction and to quantify myocardial damage.
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Canali et al. (2013) conducted a case report in Inferior myocardial infarction and rheumatic fever (n=1). Multimodality imaging approach was evaluated. A multimodality imaging approach identified rheumatic valvular involvement as the source of embolic myocardial infarction in a patient with normal coronary arteries.
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