title: Rheumatic Heart Disease Predisposing to Embolic Myocardial Infarction: A Multimodality Imaging Approach.
abstract: 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.
authors.affiliation: Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Canali
authors.affiliation: Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cannavale
authors.affiliation: Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Conti
authors.affiliation: Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Mariani
authors.affiliation: Operative Unit of Cardiology and Cardiac Intensive Care Unit, Aurelia Hospital, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Proietti
keywords: cardiac magnetic resonance; embolic myocardial infarction; mitral valve stenosis; rheumatic heart disease; speckle tracking analysis