Image in Cardiology
Looking into and beyond the heart
A olhar para e para além do coração
Ana Isabel Azevedo
, Ricardo Fontes-Carvalho, Adelaide Dias, Vasco Gama Ribeiro
Autor para correspondência
Cardiology Departement, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
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4886
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1689
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"identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Fontes-Carvalho" ] 2 => array:2 [ "nombre" => "Adelaide" "apellidos" => "Dias" ] 3 => array:2 [ "nombre" => "Vasco" "apellidos" => "Gama Ribeiro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Departement, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A olhar para e para além do coração" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 638 "Ancho" => 1301 "Tamanyo" => 94457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Air-fluid level at the level of the cardiac silhouette (A) and behind the heart (B). Also seen are dual-chamber pacemaker generator and leads (B, arrows) and 26<span class="elsevierStyleHsp" style=""></span>mm Edwards<span class="elsevierStyleSup">®</span> biological aortic valve (B, arrowhead).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 89-year-old man presented with intermittent chest and epigastric pain, nausea and vomiting of one day's duration. His previous medical history included coronary artery disease and severe aortic valve stenosis, treated by transcatheter aortic valve implantation (26 mm Edwards<span class="elsevierStyleSup">®</span>) 14 months before. After the procedure, he suffered complete atrioventricular block, and a dual chamber pacemaker was implanted. Physical examination revealed low-grade fever (37.6<span class="elsevierStyleHsp" style=""></span>°C) and an aortic systolic murmur; no pain was elicited on thoracic or abdominal examination. Laboratory findings included high-sensitivity cardiac troponin 0.073 ng/ml (normal 0.003–0.014), myoglobin 153 ng/ml (normal 28–72) and C-reactive protein 4.5 mg/dl (normal <0.5). The electrocardiogram showed ventricular pacing and transthoracic echocardiography revealed no significant abnormal findings. The chest X-ray (posteroanterior view) showed widening of the mediastinum, with air-fluid level at the level of the cardiac silhouette (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). In lateral view (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B), the air-fluid level was located behind the heart. Both pacemaker generator and leads (arrows) and biological aortic valve (arrowhead) are seen in this view. Upper gastrointestinal endoscopy confirmed a type III paraesophageal hiatus hernia, with signs of mucosal ischemia. Urgent surgical correction (Dor fundoplication) was performed. The postoperative period was complicated by respiratory and surgical wound infections. The patient was discharged to a rehabilitation unit 65 days after admission.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a man who presented with a life-threatening condition, diagnosed with a chest X-ray. In this era of ultra-high technology, sometimes clinical history, physical examination and simple and inexpensive exams provide the diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-02-09" "fechaAceptado" => "2015-04-11" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 638 "Ancho" => 1301 "Tamanyo" => 94457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Air-fluid level at the level of the cardiac silhouette (A) and behind the heart (B). Also seen are dual-chamber pacemaker generator and leads (B, arrows) and 26<span class="elsevierStyleHsp" style=""></span>mm Edwards<span class="elsevierStyleSup">®</span> biological aortic valve (B, arrowhead).</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003400000010/v1_201510211302/S0870255115002164/v1_201510211302/en/main.assets" "Apartado" => array:4 [ "identificador" => "29264" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagens em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003400000010/v1_201510211302/S0870255115002164/v1_201510211302/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115002164?idApp=UINPBA00004E" ]
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