Acute anteroseptal myocardial infarction

Case contributed by Dr David Cuevas

Presentation

Acute chest pain with positive biomarkers for myocardial infarction.

Patient Data

Age: 40 years
Gender: Male
MRI

Function and morphology

Anterior and septal akynesia.

Pericardial effusion.  

MRI

Tissue characterization (no contrast)

T2 weighted images show extensive septal and anterior edema.

Gradient echo image depicts a dark anteroseptal and anterior wall rim consistent with myocardial hemorrhage.

DWI, optional/experimental use in myocardial infraction, shows both findings. 

MRI

Perfusion and viability module (Gadolinium first pass and LGE)

First pass or perfusion images: subendocardial perfusion defect (absence of signal, dark or black) in LAD territory.

Late gadolinium enhancement: depicts transmural infarction (transmural hyperintensity, bright or white), also shows "no reflow" phenomenon (endocardial rim of absence of signal even in LGE images).

Revascularization has a poor outcome in transmural infraction (considered non viable tissue) and the presence of "no reflow" phenomenon has poor prognosis.

DSA (angiography)

There is severe stenosis of the proximal left anterior descending coronary artery (LAD) and total occlusion at the mid LAD. 

Case Discussion

Typical CMR findings in acute myocardial infarction.

Percutaneous coronary intervention was performed first, unable to deploy a stent, CMR is used to assess the extent of the disease and prognosis prior revascularization surgery. Currently, CMR has similar to higher sensitivity compared to SPECT to asses myocardial viability.

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Case information

rID: 68409
Published: 29th May 2019
Last edited: 30th May 2019
System: Cardiac
Tag: pci, cmr
Inclusion in quiz mode: Included
Institution: Instituto Nacional de Cardiología

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