Medicine in images
A case of cardiogenic shock with preserved ejection function
Un caso de shock cardiogénico con función de eyección conservada
S. Lázaro Mendes
, F. Gonçalves, D. Ramos, M. Pego
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Coimbra University Hospital and Medical School – Cardiology Department, Coimbra, Portugal
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Rivero-Sanz, J.L. Camacho-Velasquez, B. Gracia-Tello, C. Tejero-Juste" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Rivero-Sanz" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Camacho-Velasquez" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Gracia-Tello" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Tejero-Juste" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515001794?idApp=WRCEE" "url" => "/00142565/0000021600000003/v1_201604010057/S0014256515001794/v1_201604010057/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Medicine in images</span>" "titulo" => "A case of cardiogenic shock with preserved ejection function" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "168" "paginaFinal" => "169" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Lázaro Mendes, F. Gonçalves, D. Ramos, M. Pego" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Lázaro Mendes" "email" => array:1 [ 0 => "sofialazaromendes@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Gonçalves" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Ramos" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Pego" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Coimbra University Hospital and Medical School – Cardiology Department, Coimbra, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un caso de shock cardiogénico con función de eyección conservada" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1456 "Ancho" => 1667 "Tamanyo" => 341801 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 69-year-old woman with several risk factors for cardiovascular disease presented to the emergency department with cardiogenic shock. She had suffered from progressive fatigue, dyspnea on exertion and weight loss in the last 3 months.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Her temperature was 36.8<span class="elsevierStyleHsp" style=""></span>°C, heart rate 60<span class="elsevierStyleHsp" style=""></span>beats/min and blood pressure 85/50<span class="elsevierStyleHsp" style=""></span>mmHg; a large tongue and jugular venous distention were evident; vesicular murmur was abolished at both lung bases; and palpable cervical lymphadenopathy was present. The electrocardiogram showed a first degree atrioventricular block, left bundle branch block morphology and low QRS voltage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A coronary angiography was immediately performed and coronary disease was excluded.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was admitted to the intensive care unit. The echocardiogram revealed an increased wall thickness, a preserved systolic function and a ground-glass appearance of ventricular myocardium (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The Doppler evaluation of transmitral blood flow velocity showed a restrictive filling pattern with striking E dominance and a short deceleration time with early to late ventricular filling velocities (E/A) ratio of 2.6. The serum and urine immunofixation identified a monoclonal paraprotein. Due to suspicion of light-chain amyloidosis, a cardiovascular magnetic resonance was performed and the patient underwent a fine-needle aspiration biopsy of a submandibular lymph node. The magnetic resonance revealed global subendocardial late gadolinium enhancement (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and increased interatrial septum thickness. Lastly the diagnosis of cardiac amyloidosis was confirmed by demonstrating amyloid deposits on histologic examination of the biopsy from submandibular ganglion consistent with immunoglobulin light-chain amyloidosis diagnosis. She was discharged after a few weeks but she was admitted to another hospital one month later and died of heart failure.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-06" "fechaAceptado" => "2015-08-10" "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1456 "Ancho" => 1667 "Tamanyo" => 341801 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 689 "Ancho" => 1000 "Tamanyo" => 67400 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 813 "Ancho" => 1000 "Tamanyo" => 95517 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00142565/0000021600000003/v1_201604010057/S0014256515002246/v1_201604010057/en/main.assets" "Apartado" => array:4 [ "identificador" => "1065" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Medicina en imágenes" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00142565/0000021600000003/v1_201604010057/S0014256515002246/v1_201604010057/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515002246?idApp=WRCEE" ]
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