Image in Cardiology
Cardiogenic shock due to sexually transmitted disease – A rare cause of acute myocardial infarction
Choque cardiogénico devido a doença sexualmente transmissível – uma causa rara de enfarte agudo do miocárdio
Marisa Passos Silva
, Marta Ponte, Eulália Pereira, Daniel Caeiro, Lino Santos, Vasco Ribeiro
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Cardiology Department, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
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"nombre" => "Daying" "apellidos" => "Wang" ] 3 => array:2 [ "nombre" => "Zongjun" "apellidos" => "Liu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116303511?idApp=UINPBA00004E" "url" => "/08702551/0000003800000001/v5_201911281009/S0870255116303511/v5_201911281009/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Cardiogenic shock due to sexually transmitted disease – A rare cause of acute myocardial infarction" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "67" "paginaFinal" => "68" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marisa Passos Silva, Marta Ponte, Eulália Pereira, Daniel Caeiro, Lino Santos, Vasco Ribeiro" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Marisa" "apellidos" => "Passos Silva" "email" => array:1 [ 0 => "marisa.passos.silva@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Ponte" ] 2 => array:2 [ "nombre" => "Eulália" "apellidos" => "Pereira" ] 3 => array:2 [ "nombre" => "Daniel" "apellidos" => "Caeiro" ] 4 => array:2 [ "nombre" => "Lino" "apellidos" => "Santos" ] 5 => array:2 [ "nombre" => "Vasco" "apellidos" => "Ribeiro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Department, Vila Nova de Gaia/Espinho Hospital Center, 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" => "Choque cardiogénico devido a doença sexualmente transmissível – uma causa rara de enfarte agudo do miocárdio" ] ] "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" => 3333 "Ancho" => 3333 "Tamanyo" => 688851 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Electrocardiogram on admission; (B) left coronary artery with no atherosclerotic disease; (C) aortography showing mild aortic regurgitation and no signs of ascending aortic dissection; the origin of the left coronary artery can be visualized but the right coronary artery cannot; (D-G) computed tomography angiography showing circumferential wall thickening of the thoracic aorta (arrows), causing occlusion of the right coronary ostium (arrowheads); (H) transesophageal echocardiography (TOE) showing circumferential thickening of the thoracic aorta; (I) TOE showing dilated right ventricle.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0045" class="elsevierStylePara elsevierViewall">A 55-year-old male patient, who was a smoker and chronic alcoholic, was admitted to the emergency department with epigastric pain and vomiting which had lasted 14 hours. He had signs of cardiogenic shock. The electrocardiogram showed atrial fibrillation with slow ventricular response and ST-segment elevation in leads II, III, aVF, V1 and V2 (A). Cardiac angiography was performed immediately showing a normal left coronary artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B and C); the right coronary artery (RCA) could not be catheterized. Computed tomography angiography was performed and showed aortic root (AR) and ascending aorta (AA) dilation with diffuse circumferential wall thickening occluding the ostium of the RCA (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D-F). The wall thickening also extended to the descending aorta (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D and G). On transesophageal echocardiography, the circumferential thickening of the thoracic aorta had a coarse irregular luminal surface (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>H). The right ventricle was dilated and with severely depressed systolic function (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>I).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The patient tested positive for syphilis serology, with elevated titers of <span class="elsevierStyleItalic">Treponema pallidum</span> hemagglutination assay (TPHA) and venereal disease research laboratory (VDRL) testing. The remaining microbiological, serological and immunological tests were negative. A diagnosis of syphilitic aortitis with involvement of the RCA ostium was then made.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Surgical intervention was ruled out and, despite supportive measures, the patient died 72 hours after admission.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Dilatation of the AR and the AA, aortic thickness involving a coronary ostium and elevated VDRL and TPHA titers are highly suggestive of syphilitic aortitis. Syphilis is an etiology that, although rare, should be taken into account in the diagnostic approach of patients with acute myocardial infarction and coronary ostial stenosis.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-21" "fechaAceptado" => "2017-07-09" "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" => 3333 "Ancho" => 3333 "Tamanyo" => 688851 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Electrocardiogram on admission; (B) left coronary artery with no atherosclerotic disease; (C) aortography showing mild aortic regurgitation and no signs of ascending aortic dissection; the origin of the left coronary artery can be visualized but the right coronary artery cannot; (D-G) computed tomography angiography showing circumferential wall thickening of the thoracic aorta (arrows), causing occlusion of the right coronary ostium (arrowheads); (H) transesophageal echocardiography (TOE) showing circumferential thickening of the thoracic aorta; (I) TOE showing dilated right ventricle.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003800000001/v5_201911281009/S0870255117304985/v5_201911281009/en/main.assets" "Apartado" => array:4 [ "identificador" => "75834" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagem em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003800000001/v5_201911281009/S0870255117304985/v5_201911281009/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117304985?idApp=UINPBA00004E" ]
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