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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old male with an implanted pacemaker&#44; who had lived in a tropical country for more than 15 years&#44; was admitted because of congestive heart failure&#46; The chest X-ray showed mild cardiomegaly and marked calcification of the left ventricle &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#44; arrow&#41;&#46; The transthoracic echocardiogram revealed left ventricular thickening&#44; calcification of the basal segments &#40;Videos 1&#8211;3&#41;&#44; significant intraventricular gradient &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41; and severe pulmonary hypertension &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46; Cardiac computed tomography &#40;CT&#41; confirmed the presence of endomyocardial calcification of the basal anteroseptal and basal inferior left ventricular walls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#46; Coronary angiography ruled out coronary artery disease and endomyocardial biopsy demonstrated foci of endomyocardial fibrosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E&#41;&#46; Treatment with furosemide and spironolactone was started&#46; After the addition of beta-blockers&#44; a decrease in intraventricular gradient &#40;52 mmHg to 30 mmHg&#41; was seen and a significant improvement in symptoms was observed&#46; After three-month follow-up the patient is stable in NYHA class II&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Endomyocardial fibrosis is an infrequent disease&#44; more prevalent in tropical countries&#44; that causes progressive restrictive cardiomyopathy leading to congestive heart failure&#46; The presence of endomyocardial calcification in this condition is very rare&#46; Although calcified opacities in the left ventricle may be seen on the chest X-ray&#44; other imaging tests are needed to establish the diagnosis&#46; Given the acoustic shadowing caused by the calcium&#44; echocardiography is technically limited as a diagnostic tool&#44; but it may be useful to evaluate the hemodynamic repercussions of the calcification&#46; Calcium strongly attenuates X-rays&#44; appears bright on CT scans and is readily differentiated from surrounding tissue&#46; Cardiac CT is therefore an accurate technique to evaluate the extent and anatomic distribution of endomyocardial calcification&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0015" 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&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0025" 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&#46;</p></span></span><span id="sec0030" 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&#46;</p></span></span>"
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Image in Cardiology
Left ventricular calcification in a patient with endomyocardial fibrosis
Calcificação ventricular esquerda num paciente com endomiocardiofibrose
Alfredo Renillaa,b,
Autor para correspondência
dr.renilla@gmail.com

Corresponding author.
, Irene Álvarez Pichelb, Manuel Barreirob, Iria Silvab
a Cardiology Division, V. Alvarez-Buylla Hospital, Asturias, Spain
b Cardiology Division, Central University Hospital of Asturias, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Panel A&#58; Chest X-ray depicting left ventricular calcification &#40;arrow&#41;&#46; Panels B and C&#58; Continuous-wave Doppler echocardiographic evaluation showing intraventricular gradient and severe pulmonary hypertension respectively&#46; Panel D&#58; Cardiac-CT showing calcification of the basal anteroseptal and basal inferior left ventricular walls&#46; Panel E&#58; Endomyocardial biopsy depicting normal myocardium surrounded by foci of endomyocardial fibrosis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old male with an implanted pacemaker&#44; who had lived in a tropical country for more than 15 years&#44; was admitted because of congestive heart failure&#46; The chest X-ray showed mild cardiomegaly and marked calcification of the left ventricle &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#44; arrow&#41;&#46; The transthoracic echocardiogram revealed left ventricular thickening&#44; calcification of the basal segments &#40;Videos 1&#8211;3&#41;&#44; significant intraventricular gradient &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41; and severe pulmonary hypertension &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46; Cardiac computed tomography &#40;CT&#41; confirmed the presence of endomyocardial calcification of the basal anteroseptal and basal inferior left ventricular walls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#46; Coronary angiography ruled out coronary artery disease and endomyocardial biopsy demonstrated foci of endomyocardial fibrosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E&#41;&#46; Treatment with furosemide and spironolactone was started&#46; After the addition of beta-blockers&#44; a decrease in intraventricular gradient &#40;52 mmHg to 30 mmHg&#41; was seen and a significant improvement in symptoms was observed&#46; After three-month follow-up the patient is stable in NYHA class II&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Endomyocardial fibrosis is an infrequent disease&#44; more prevalent in tropical countries&#44; that causes progressive restrictive cardiomyopathy leading to congestive heart failure&#46; The presence of endomyocardial calcification in this condition is very rare&#46; Although calcified opacities in the left ventricle may be seen on the chest X-ray&#44; other imaging tests are needed to establish the diagnosis&#46; Given the acoustic shadowing caused by the calcium&#44; echocardiography is technically limited as a diagnostic tool&#44; but it may be useful to evaluate the hemodynamic repercussions of the calcification&#46; Calcium strongly attenuates X-rays&#44; appears bright on CT scans and is readily differentiated from surrounding tissue&#46; Cardiac CT is therefore an accurate technique to evaluate the extent and anatomic distribution of endomyocardial calcification&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0015" 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&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0025" 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&#46;</p></span></span><span id="sec0030" 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&#46;</p></span></span>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2015.05.007
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