Case report
Myocardial infarction and thrombophilia: Do not miss the right diagnosis!
Enfarte do miocárdio e trombofilia: não falhe o diagnóstico correto!
Arnaud Huberta,b,c,
, Pierre Guéretd, Guillaume Leurenta,b,c, Raphael P. Martinsa,b,c, Vincent Auffreta,b,c, Marc Bedossaa,b,c
Autor para correspondência
a Centre Hospitalier Universitaire (CHU) de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France
b Université de Rennes 1, Laboratoire Traitement du Signal et de l’Image (LTSI), Rennes, France
c Institut National de la Santé et de la Recherche Médicale (Inserm), Rennes, France
d Centre Hospitalier Universitaire (CHU) de Rennes, Laboratoire d’Hématologie-Hémostase, Rennes, France
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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "91" "paginaFinal" => "92" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Dissecção da aorta iatrogénica – segue a imagem!" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2988 "Ancho" => 3000 "Tamanyo" => 629532 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thin (3 mm) maximal intensity projection reconstructions in coronal (first row) and transverse planes (second and third rows) of the multidetector chest CT scan performed on the first day (Panels A, B, C), on the second day (panels D, E, F) and one week later (Panels G, H, I), showing how the ascending aortic dissection and RCA occlusion and reperfusion evolved.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Catarina Vieira, Nuno Bettencourt, Nuno Ferreira, Mónica Carvalho, Vasco Gama" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Catarina" "apellidos" => "Vieira" ] 1 => array:2 [ "nombre" => "Nuno" "apellidos" => "Bettencourt" ] 2 => array:2 [ "nombre" => "Nuno" "apellidos" => "Ferreira" ] 3 => array:2 [ "nombre" => "Mónica" "apellidos" => "Carvalho" ] 4 => array:2 [ "nombre" => "Vasco" "apellidos" => "Gama" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302876?idApp=UINPBA00004E" "url" => "/08702551/0000003700000001/v1_201802081006/S0870255116302876/v1_201802081006/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255117309149" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.10.015" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "1130" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2018;37:87.e1-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1891 "formatos" => array:3 [ "EPUB" => 152 "HTML" => 1337 "PDF" => 402 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "An unusual cause of ischemia after coronary bypass grafting!!" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "87.e1" "paginaFinal" => "87.e5" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Uma causa rara de isquemia após revascularização cirúrgica!!" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1585 "Ancho" => 2333 "Tamanyo" => 269035 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(a) First we crossed the lesion in a false lumen with a stiff guidewire with retrograde dissection of the aorta, so we withdrew the guidewire; (b) Attempt to cross the lesion with a coronary guidewire (Miracle 6); (c) Predilation of the lesion after the positioning of a TIF Tip™ 0.018 Terumo Hydrophilic Guidewire in subintima; (d) Release of the stent at the stenosis of the subclavian artery with 1 cm into the aorta; (e) Postdilation of the stent; (f) Final result with no residual stenosis and TIMI III flow of left internal mammary artery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rania Hammami, Salma Charfeddine, Nizar Elleuch, Hela Fourati, Leila Abid, Samir Kammoun" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Rania" "apellidos" => "Hammami" ] 1 => array:2 [ "nombre" => "Salma" "apellidos" => "Charfeddine" ] 2 => array:2 [ "nombre" => "Nizar" "apellidos" => "Elleuch" ] 3 => array:2 [ "nombre" => "Hela" "apellidos" => "Fourati" ] 4 => array:2 [ "nombre" => "Leila" "apellidos" => "Abid" ] 5 => array:2 [ "nombre" => "Samir" "apellidos" => "Kammoun" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117309149?idApp=UINPBA00004E" "url" => "/08702551/0000003700000001/v1_201802081006/S0870255117309149/v1_201802081006/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Myocardial infarction and thrombophilia: Do not miss the right diagnosis!" 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Martins, Vincent Auffret, Marc Bedossa" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Arnaud" "apellidos" => "Hubert" "email" => array:1 [ 0 => "arnaud.hubert@chu-rennes.fr" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pierre" "apellidos" => "Guéret" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "Guillaume" "apellidos" => "Leurent" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Raphael P." "apellidos" => "Martins" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Vincent" "apellidos" => "Auffret" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Marc" "apellidos" => "Bedossa" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Centre Hospitalier Universitaire (CHU) de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Université de Rennes 1, Laboratoire Traitement du Signal et de l’Image (LTSI), Rennes, France" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Institut National de la Santé et de la Recherche Médicale (Inserm), Rennes, France" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centre Hospitalier Universitaire (CHU) de Rennes, Laboratoire d’Hématologie-Hémostase, Rennes, France" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Enfarte do miocárdio e trombofilia: não falhe o diagnóstico correto!" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1680 "Ancho" => 2500 "Tamanyo" => 351215 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intravascular ultrasound confirms the diagnosis of plaque rupture with persistence of a lesion of the media of the artery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Combined thrombophilia can be a cause of myocardial infarction, but patients with thrombophilia should be thoroughly investigated for atherosclerosis in the event of coronary thrombosis. Intravascular imaging can help identify atherosclerosis which has remained undetected by angiogram. This has an impact on patient management, as antiplatelet therapy becomes mandatory if atherosclerosis is detected. There are no recommendations at present for the treatment of acute coronary syndrome in patients with thrombophilia and atherosclerosis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 40-year-old Caucasian man with an asymptomatic heterozygous Protein C deficiency and a history of pulmonary embolism in first-degree relatives was admitted with a three-day history of repeated episodes of chest pain at rest lasting 15 to 30 minutes. He had no cardiovascular risk factors (obesity, dyslipidemia, smoking, diabetes, hypertension, familial history).</p><p id="par0015" class="elsevierStylePara elsevierViewall">At admission, the patient was asymptomatic. He was hemodynamically stable with a blood pressure of 125/83 mmHg and a heart rate of 90 bpm. Physical examination was unremarkable. The initial ECG revealed anterior sequelae of ischemia with anterior ST-segment elevation. Initial troponin T concentration was 1538 pg/mL (normal <14 pg/mL) and renal function was normal (creatinine 65 μmol/L, normal 59-104 μmol/L). Further laboratory investigations found that complete blood count, blood chemistry and lipid profile were all within normal ranges. Troponin concentration was in the ascending phase (2156 pg/mL on day 1, 2869 pg/mL on day 2). The screening for antiphospholipid antibodies was negative. Antithrombin was 97% (normal 80-120%). Protein C concentration was abnormal, with a level of 61% (normal 70-120%) checked by chronometric and chromogenic methods. A heterozygous Factor V Leiden mutation was also found in addition to his protein C deficiency. Therefore, this patient had a combined thrombophilia.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Transthoracic echocardiogram showed a depressed left ventricular ejection fraction of 34% with apical akinesia, no valve diseases, and no visible thrombi. Coronary angiography showed proximal and medial left anterior descending occlusions caused by a massive thrombus (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, panel A; moving angiograms in supplementary materials). Circumflex and right coronary arteries were normal. In view of the history of thrombophilia, coronary angioplasty was not initially performed and antithrombotic treatment combining anticoagulation with unfractionated heparin (monitored by anti-Xa activity, targeting 0.3 to 0.7 IU/mL) and dual antiplatelet therapy was initiated. A second coronary angiogram was performed after five days of antithrombotic treatment and showed complete regression of the thrombus with an underlying normal left anterior descending artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, panel B). However, an intravascular ultrasound study (IVUS) revealed an atheromatous plaque (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). Thus, we hypothesized that two mechanisms were in play: the rupture of an atheromatous plaque initiating an anterior myocardial infarction aggravated by his mixed coagulopathy (Protein C deficiency associated with Factor V Leiden mutation).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Protein C is a vitamin K-dependent glycoprotein that plays an important role in the regulation of blood clotting as a natural anticoagulant.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Protein C deficiency is a known risk factor for venous thromboembolic events,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> but also a risk factor for arterial thrombosis, in particular myocardial infarction. Indeed, about twenty case reports and a large study<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> have been published in the past few years regarding patients with heterozygous Protein C deficiency responsible for ischemic cerebral stroke or myocardial infarction. Isolated heterozygous Factor V Leiden mutation usually does not induce myocardial infraction<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> but there have been a few case reports on myocardial infarction provoked by a combined thrombophilia.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This case could be included in a larger entity called “Myocardial infarction with non-obstructive coronary arteries (MINOCA)”. As Pasupathy et al. said in their review paper,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> “this diagnosis is made in a patient presenting with diagnostic features of an acute myocardial infarction, in whom angiography does not show obstructive coronary artery disease, and there is no immediately apparent cause for the presentation.” It could be considered as a “working diagnosis”. In fact, it does not consist of a definitive diagnosis but it does allow us to classify a clinical entity in order to better manage investigation of the “real diagnosis”. A recent meta-analysis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> showed an association between MINOCA and thrombophilia. Indeed, Protein C deficiency has a prevalence of 0.1% to 1% in the general population, reaching 2.6% in patients with MINOCA,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> whereas factor V Leiden mutation has a prevalence of 3% to 7% in Western countries, but affects 12% of MINOCA patients.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Atherosclerosis is the most common cause of myocardial infarction. As recommended in European guidelines, when coronary angiography is normal, intravascular imaging can be used to detect small atherosclerosis plaques (class IIbB recommendation).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> In our patient, to improve diagnostic accuracy, we performed an IVUS which revealed an atherosclerotic plaque in an angiographically normal artery. We then hypothesized, even though a lack of scientific evidence means that this entity remains under debate, that the patient had a STEMI for the following reasons: rupture of an atherosclerotic plaque initiating thrombus genesis, amplified by the thrombophilia.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This case demonstrates: (i) that IVUS is of great value to more accurately rule in/out atherosclerosis when a coronary thrombosis is suspected in patients with clotting disorders; and (ii) the necessity of establishing recommendations to manage this situation and properly assess this rare diagnosis, as there is a lack of consensus in the current literature regarding the management of such patients.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Authorship</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Arnaud Hubert</span>, <span class="elsevierStyleBold">Raphael Martins</span> and <span class="elsevierStyleBold">Vincent Auffret</span>: Writing of the case report, clinical care.</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Guillaume Leurent</span> and <span class="elsevierStyleBold">Marc Bedossa</span>: Performing and interpretation of angiography/intravascular ultrasounds.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Pierre Guéret</span>: Interpretation of coagulation disorders.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres981712" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec949385" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres981713" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec949384" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Authorship" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-07-14" "fechaAceptado" => "2016-12-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec949385" "palabras" => array:6 [ 0 => "Myocardial infarction" 1 => "Coronary thrombosis" 2 => "Thrombophilia" 3 => "Intravascular ultrasound" 4 => "Atherosclerosis" 5 => "Platelet aggregation inhibitors" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec949384" "palabras" => array:6 [ 0 => "Enfarte do miocárdio" 1 => "Trombose coronária" 2 => "Trombofilia" 3 => "Ultrassonografia intravascular" 4 => "Aterosclerose" 5 => "Inibidores de agregação plaquetária" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Protein C deficiency is a coagulation cascade disorder often resulting in venous thromboembolic events but is also a possible contributor to arterial thrombosis. To date, approximately ten cases of myocardial infarction (MI) due to protein C deficiency have been reported in the literature. However, affirming this mechanism requires ruling out the most common causes of MI, i.e. the rupture or erosion of an atherosclerotic plaque. Intravascular imaging of coronary arteries can be of help to identify angiographically undetected atherosclerosis. We report a case of an ST-segment elevation myocardial infarction (STEMI) in a young man with apparent evidence of arterial thrombosis resulting from protein C deficiency and heterozygous factor Leiden mutation which was contradicted by intravascular imaging demonstrating atherosclerosis.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A deficiência de proteína C constitui uma alteração em cascata da coagulação, dá origem muitas vezes aos eventos tromboembólicos venosos e é também um contributo possível de trombose arterial. Aproximadamente dez casos de enfarte do miocárdio (EM) devidos à deficiência da proteína C foram referenciados na literatura. No entanto, a confirmação desse mecanismo requer a exclusão das etiologias mais comuns de EM, <span class="elsevierStyleItalic">i.e.</span> a rotura ou a erosão da placa aterosclerótica. A avaliação imagiológica intravascular das artérias coronárias poderia ser uma ajuda para identificar a aterosclerose não detetada por angiografia. Apresentamos o caso de um enfarte do miocárdio com elevação do segmento-ST (STEMI) que revela evidência aparente de trombose arterial devida à deficiência da proteína C e à mutação do fator heterozigótico Leiden que foi contestada através de avaliação imagiológica intravascular e demonstrou aterosclerose num homem novo.</p></span>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0070" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary material" "identificador" => "sec0035" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 661 "Ancho" => 1500 "Tamanyo" => 132509 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Panel A: Thrombus of the left anterior descending artery; Panel B: Total regression of the thrombus without visible stenosis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1680 "Ancho" => 2500 "Tamanyo" => 351215 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intravascular ultrasound confirms the diagnosis of plaque rupture with persistence of a lesion of the media of the artery.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 1010779 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in understanding pathogenic mechanisms of thrombophilic disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Dahlbäck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2008-01-077909" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2008" "volumen" => "112" "paginaInicial" => "19" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18574041" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protein C deficiency: a database of mutations, 1995 update. On behalf of the Subcommittee on Plasma Coagulation Inhibitors of the Scientific and Standardization Committee of the ISTH" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.H. Reitsma" 1 => "F. Bernardi" 2 => "R.G. Doig" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thromb Haemost" "fecha" => "1995" "volumen" => "73" "paginaInicial" => "876" "paginaFinal" => "889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7482420" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hereditary deficiency of protein C or protein S confers increased risk of arterial thromboembolic events at a young age: results from a large family cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.K. Mahmoodi" 1 => "J.-L.P. Brouwer" 2 => "N.J.G.M. Veeger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.108.780759" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2008" "volumen" => "118" "paginaInicial" => "1659" "paginaFinal" => "1667" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18824642" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seven haemostatic gene polymorphisms in coronary disease: meta-analysis of 66,155 cases and 91,307 controls" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Z. Ye" 1 => "E.H.C. Liu" 2 => "J.P.T. Higgins" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet Lond Engl" "fecha" => "2006" "volumen" => "367" "paginaInicial" => "651" "paginaFinal" => "658" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute myocardial infarction in a young women with normal coronary arteries and a combined thrombophilia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Gotsman" 1 => "M. Mosseri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2003.11.053" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2005" "volumen" => "99" "paginaInicial" => "483" "paginaFinal" => "484" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15771937" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The what, when, who, why, how and where of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Pasupathy" 1 => "R. Tavella" 2 => "J.F. Beltrame" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1253/circj.CJ-15-1096" "Revista" => array:6 [ "tituloSerie" => "Circ J" "fecha" => "2016" "volumen" => "80" "paginaInicial" => "11" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26597354" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Pasupathy" 1 => "T. Air" 2 => "R.P. Dreyer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.114.011201" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2015" "volumen" => "131" "paginaInicial" => "861" "paginaFinal" => "870" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25587100" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Task Force Members" 1 => "G. Montalescot" 2 => "U. Sechtem" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/eht296" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "2949" "paginaFinal" => "3003" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23996286" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003700000001/v1_201802081006/S0870255117309150/v1_201802081006/en/main.assets" "Apartado" => array:4 [ "identificador" => "29263" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Casos Clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003700000001/v1_201802081006/S0870255117309150/v1_201802081006/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117309150?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 7 | 14 |
| 2024 Outubro | 41 | 33 | 74 |
| 2024 Setembro | 39 | 25 | 64 |
| 2024 Agosto | 40 | 37 | 77 |
| 2024 Julho | 44 | 31 | 75 |
| 2024 Junho | 33 | 25 | 58 |
| 2024 Maio | 48 | 21 | 69 |
| 2024 Abril | 52 | 28 | 80 |
| 2024 Maro | 46 | 17 | 63 |
| 2024 Fevereiro | 36 | 25 | 61 |
| 2024 Janeiro | 26 | 23 | 49 |
| 2023 Dezembro | 34 | 21 | 55 |
| 2023 Novembro | 30 | 23 | 53 |
| 2023 Outubro | 23 | 15 | 38 |
| 2023 Setembro | 30 | 33 | 63 |
| 2023 Agosto | 36 | 21 | 57 |
| 2023 Julho | 21 | 12 | 33 |
| 2023 Junho | 27 | 14 | 41 |
| 2023 Maio | 44 | 31 | 75 |
| 2023 Abril | 40 | 3 | 43 |
| 2023 Maro | 72 | 17 | 89 |
| 2023 Fevereiro | 50 | 20 | 70 |
| 2023 Janeiro | 24 | 18 | 42 |
| 2022 Dezembro | 44 | 27 | 71 |
| 2022 Novembro | 47 | 28 | 75 |
| 2022 Outubro | 54 | 29 | 83 |
| 2022 Setembro | 38 | 40 | 78 |
| 2022 Agosto | 35 | 32 | 67 |
| 2022 Julho | 39 | 50 | 89 |
| 2022 Junho | 35 | 30 | 65 |
| 2022 Maio | 37 | 36 | 73 |
| 2022 Abril | 43 | 47 | 90 |
| 2022 Maro | 38 | 59 | 97 |
| 2022 Fevereiro | 26 | 33 | 59 |
| 2022 Janeiro | 41 | 33 | 74 |
| 2021 Dezembro | 29 | 30 | 59 |
| 2021 Novembro | 41 | 40 | 81 |
| 2021 Outubro | 49 | 69 | 118 |
| 2021 Setembro | 29 | 30 | 59 |
| 2021 Agosto | 40 | 33 | 73 |
| 2021 Julho | 39 | 35 | 74 |
| 2021 Junho | 54 | 27 | 81 |
| 2021 Maio | 102 | 39 | 141 |
| 2021 Abril | 178 | 70 | 248 |
| 2021 Maro | 137 | 33 | 170 |
| 2021 Fevereiro | 103 | 21 | 124 |
| 2021 Janeiro | 103 | 15 | 118 |
| 2020 Dezembro | 101 | 22 | 123 |
| 2020 Novembro | 90 | 17 | 107 |
| 2020 Outubro | 71 | 15 | 86 |
| 2020 Setembro | 80 | 12 | 92 |
| 2020 Agosto | 32 | 9 | 41 |
| 2020 Julho | 69 | 23 | 92 |
| 2020 Junho | 67 | 11 | 78 |
| 2020 Maio | 50 | 7 | 57 |
| 2020 Abril | 64 | 14 | 78 |
| 2020 Maro | 51 | 7 | 58 |
| 2020 Fevereiro | 93 | 31 | 124 |
| 2020 Janeiro | 52 | 9 | 61 |
| 2019 Dezembro | 46 | 11 | 57 |
| 2019 Novembro | 63 | 9 | 72 |
| 2019 Outubro | 44 | 10 | 54 |
| 2019 Setembro | 76 | 5 | 81 |
| 2019 Agosto | 46 | 10 | 56 |
| 2019 Julho | 52 | 9 | 61 |
| 2019 Junho | 54 | 5 | 59 |
| 2019 Maio | 46 | 9 | 55 |
| 2019 Abril | 48 | 17 | 65 |
| 2019 Maro | 76 | 14 | 90 |
| 2019 Fevereiro | 68 | 10 | 78 |
| 2019 Janeiro | 46 | 4 | 50 |
| 2018 Dezembro | 60 | 17 | 77 |
| 2018 Novembro | 96 | 20 | 116 |
| 2018 Outubro | 108 | 25 | 133 |
| 2018 Setembro | 40 | 14 | 54 |
| 2018 Agosto | 44 | 11 | 55 |
| 2018 Julho | 22 | 8 | 30 |
| 2018 Junho | 31 | 8 | 39 |
| 2018 Maio | 39 | 20 | 59 |
| 2018 Abril | 43 | 29 | 72 |
| 2018 Maro | 116 | 37 | 153 |
| 2018 Fevereiro | 91 | 69 | 160 |
| 2018 Janeiro | 7 | 22 | 29 |
| 2017 Dezembro | 3 | 24 | 27 |
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