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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 74-year-old woman with type 2 diabetes was admitted with malaise and dyspnea for a week&#46; On initial observation she was cooperative&#59; subcrepitant rales were heard in both lung fields and the electrocardiogram showed Q waves and ST-segment elevation in the precordial leads DII and DIII &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; She was diagnosed with subacute anterior myocardial infarction in Killip class III and coronary angiography was performed&#44; followed by percutaneous coronary intervention of the mid anterior descending artery with stent implantation&#46; An intra-aortic balloon pump was placed to maintain hemodynamic stability and dobutamine infusion &#40;7 &#956;g&#47;kg&#47;min&#41; was begun&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">While in the coronary care unit she continued to experience malaise and faintness and her hypotension and oliguria worsened&#46; On cardiac auscultation a grade III&#47;VI holosystolic murmur was detected at the left sternal border&#44; while the echocardiogram revealed akinesia of the apical segments and compensatory hypercontractility of the basal segments&#44; with preserved global left ventricular &#40;LV&#41; systolic function&#44; and a diagnosis was made of non-restrictive apical interventricular septal rupture &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; Turbulent flow was seen in the LV outflow tract&#44; with a velocity of &#62;4 m&#47;s and systolic anterior motion &#40;SAM&#41; of the anterior leaflet of the mitral valve &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; In view of LV outflow tract obstruction associated with hypotension&#44; it was decided to discontinue dobutamine perfusion and to administer intravenous propranolol&#46; This resulted in symptomatic improvement and increased blood pressure&#44; and the echocardiogram showed less turbulent and slower flow and improvement of SAM &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#46; It was thus possible to stabilize the patient and transfer her to a surgical center&#44; but unfortunately she died of complications in the second week after surgery&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We highlight the importance of thorough assessment of possible complications of myocardial infarction through echocardiography&#44; in order to determine the best therapeutic approach&#44; which in this case was to avoid positive inotropes and to use intravenous beta-blockers to reduce intraventricular obstruction&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Cruz I&#44; Caldeira D&#44; Stuart B&#44; Cotrim C&#44; Jo&#227;o I&#44; Pereira H&#46; Complica&#231;&#245;es de enfarte do mioc&#225;rdio&#58; ecocardiograma para diagn&#243;stico diferencial de sopro card&#237;aco&#46; Rev Port Cardiol&#46; 2015&#59;34&#58;779&#8211;781&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram showing turbulent apical flow &#40;arrow&#41; due to interventricular septal rupture &#40;peak velocities on continuous Doppler &#60;3 m&#47;s&#41;&#46; AD&#58; right atrium&#59; AE&#58; left atrium&#59; VD&#58; right ventricle&#59; VE&#58; left ventricle&#46;</p>"
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