Úvod: Koronárna embolizácia je raritnou príčinou akútneho infarktu myokardu. V práci popisujeme prípad koronárnej embolizácie, ktorá spôsobila extenzívny anterolaterálny infarkt myokardu s eleváciami segmentu ST (STEMI) u pacienta podstupujúceho elektívnu výmenu elektródy srdcovej resynchronizačnej liečby/defibrilátora (CRT-D). Popis prípadu: 72-ročný pacient s fibriláciou predsiení bol prijatý za účelom realizácie elektívnej repozície/výmeny elektródy CRT-D. Pred výkonom bola pozastavená antikoagulačná liečba. Po výkone u pacienta vznikla náhla bolesť na hrudníku, dýchavica a zhoršenie vitálnych funkcií. Tieto príznaky sprevádzal nález rozsiahlych ischemických zmien na EKG v anterolaterálnej oblasti a korešpondujúcich lokálnych porúch kinetiky. Urgentná koronarografia odhalila embolický uzáver distálnej časti ramus interventricularis anterior ľavej koronárnej artérie. Záver: Prezentujeme prípad raritnej, dobre dokumentovanej koronárnej embolizácie komplikujúcej výmenu elektródy CRT-D.

Introduction: Coronary artery embolism is a rare cause of acute myocardial infarction. We present a case of coronary embolism causing extensive anterolateral ST elevation myocardial infarction (STEMI) after an elective replacement of a cardiac resynchronization therapy/defibrillator (CRT-D) electrode. Case presentation: A 72-year-old male with atrial fibrillation was admitted for an elective reposition/replacement of CRT-D electrode. Anticoagulation was stopped before the procedure. After the procedure the patient developed sudden chest pain, dyspnea, and worsening of vital signs. These were accompanied by extensive ischemic anterolateral ECG changes and corresponding regional wall motion abnormalities. The urgent coronary angiography showed embolic distal occlusion of left anterior descending coronary artery. Conclusion: We present a rare, well-documented case report of coronary embolism complicating CRT-D electrode replacement.

• Keywords
• CRT-D, koronární embolizace, výměna elektrody,
• MeSH
• Chest Pain etiology   MeSH
• Dyspnea etiology   MeSH
• Electrocardiography MeSH
• Embolism diagnostic imaging   MeSH
• Atrial Flutter MeSH
• Hypotension etiology   MeSH
• Electrodes, Implanted * adverse effects   MeSH
• ST Elevation Myocardial Infarction * diagnostic imaging   etiology   MeSH
• Ischemia etiology   MeSH
• Coronary Angiography MeSH
• Coronary Vessels diagnostic imaging   pathology   MeSH
• Humans MeSH
• Treatment Failure MeSH
• Oxygen Saturation MeSH
• Aged MeSH
• Cardiac Resynchronization Therapy adverse effects   MeSH
• Vascular Grafting MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

Akutní končetinová ischemie na podkladě paradoxní embolie je považována za vzácnou příhodu, ke které dochází při embolizaci žilního trombu do tepenného řečiště při pravolevém srdečním zkratu (perzistující foramen ovale / defekt septa síní). V představené kazuistice demonstrujeme případ 28leté ženy hospitalizované pro dušnost a bolesti obou dolních končetin s následným průkazem masivní plicní embolizace a mnohočetných okluzí v tepenném řečišti obou dolních končetin. V našem případě byla pacientka úspěšně léčena podáním systémové trombolýzy s následnou chirurgickou trombembolektomií, která vedla ke kompletní obnově perfuze postižených končetin. Dále je diskutován výběr léčebné strategie ve srovnání s dalšími dostupnými možnostmi terapeutických intervencí akutní končetinové ischemie a prevence recidivy embolizační příhody.

Acute limb ischemia due to paradoxical embolization is considered a rare event. It occurs under specific circumstances when a patient with persistent foramen ovale / atrial septal defect suffers from arterial embolism by vein thrombosis. In this report we demonstrate a case of a 28-year-old woman hospitalized for dyspnea and severe pain in both lower limbs. She was diagnosed with massive pulmonary embolism and multiple occlusions in the arterial bed of both lower limbs. The patient was successfully treated with systemic thrombolysis followed by surgical thromboembolectomy which led to a complete recovery of the affected limbs. Furthermore, other feasible treatment strategies and therapeutic interventions of acute limb ischemia, as well as the long-term preventive measures of recurrent embolization events in this context, are discussed.

• Keywords
• altepláza,
• MeSH
• Pulmonary Artery diagnostic imaging   pathology   MeSH
• Arteries surgery   diagnostic imaging   pathology   MeSH
• Pain etiology   MeSH
• Pulmonary Heart Disease diagnostic imaging   pathology   MeSH
• Computed Tomography Angiography MeSH
• Cysts diagnosis   pathology   MeSH
• Lower Extremity surgery   diagnostic imaging   pathology   MeSH
• Adult MeSH
• Dyspnea etiology   MeSH
• Echocardiography, Transesophageal MeSH
• Echocardiography MeSH
• Embolectomy MeSH
• Embolism * surgery   diagnostic imaging   etiology   pathology   MeSH
• Fibrinolytic Agents pharmacokinetics   MeSH
• Foramen Ovale, Patent surgery   diagnostic imaging   complications   MeSH
• Heparin, Low-Molecular-Weight therapeutic use   MeSH
• Clinical Decision-Making MeSH
• Comorbidity MeSH
• Humans MeSH
• Peripheral Arterial Disease * surgery   diagnosis   complications   physiopathology   pathology   therapy   MeSH
• Pulmonary Embolism diagnostic imaging   etiology   pathology   MeSH
• Risk MeSH
• Vascular Grafting classification   MeSH
• Thrombectomy methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

The development of left ventricular thrombus (LVT) is a well-known and serious complication of acute myocardial infarction (AMI) due to the risk of systemic arterial embolism (SE), which is variable in its clinical picture and has potentially serious consequences depending on the extent of target organ damage. SE results in an increase in mortality and morbidity in these patients. LVT is one of the main causes of the development of ischaemic cardio-embolic cardiovascular events (CVE) after MI and the determination of the source of cardiac embolus is crucial for the initiation of adequate anticoagulant therapy in secondary prevention. Echocardiography holds an irreplaceable place in the diagnosis of LVT, contrast enhancement provides higher sensitivity. The gold standard for LVT diagnosis is cardiac magnetic resonance imaging, but it is not suitable as a basic screening test. In patients with already diagnosed LVT, it is necessary to adjust antithrombotic therapy by starting warfarin anticoagulation for at least 6 months with the need for echocardiographic follow-up to detect thrombotic residues. The effect of prophylactic administration of warfarin in high-risk patients after anterior AMI does not outweigh the risk of severe bleeding complications and does not result in a decrease in mortality and morbidity. At the present time, there is not enough evidence to use direct oral anticoagulants in this indication.

• MeSH
• Embolism diagnostic imaging   therapy   MeSH
• Myocardial Infarction complications   diagnostic imaging   therapy   MeSH
• Percutaneous Coronary Intervention MeSH
• Coronary Thrombosis complications   diagnostic imaging   therapy   MeSH
• Humans MeSH
• Heart Ventricles MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Atherosclerosis is the most common cause of both carotid and coronary steno-occlusive disease. Rupture of an atherosclerotic plaque may lead to the formation of an overlying thrombosis resulting in complete arterial occlusion or downstream embolism. Clinically, this may manifest as a stroke or acute myocardial infarction, the overall leading causes of mortality and disability in developed countries. In this article, we summarize current concepts of the development of vulnerable plaque and provide an overview of commonly used imaging methods that may suggest/indicate atherosclerotic plaque vulnerability.

• MeSH
• Carotid Arteries diagnostic imaging   pathology   MeSH
• Plaque, Atherosclerotic diagnostic imaging   physiopathology   MeSH
• Atherosclerosis diagnostic imaging   physiopathology   MeSH
• Stroke physiopathology   MeSH
• Embolism diagnostic imaging   MeSH
• Myocardial Infarction physiopathology   MeSH
• Coronary Angiography MeSH
• Humans MeSH
• Disease Progression MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Transkraniální dopplerometrie (TCD) je metodou volby pro detekci embolizace do mozkového řečiště. Toto vyšetření je indikováno u pacientů s rizikem embolizace k identifikaci a lokalizaci zdroje embolizace, k selekci pacientů s vyšším rizikem embolické, resp. trombembolické ischemické cévní mozkové příhody, event. úpravě nebo monitorování efektivity antitrombotické léčby, u pacientů v průběhu intervenčních výkonů s vyšším rizikem embolizace, či identifikaci potápěčů s vyšším rizikem dekompresní nemoci. Vzhledem k rozdílným parametrům nastavení TCD přístroje a různým charakteristikám používaným k detekci embolů byl přijat v roce 1998 mezinárodní konsenzus pro detekci mikrombolizace pomocí TCD, který definuje charakteristiky mikroembolického signálu a také parametry nastavení TCD přístroje.

Transcranial Doppler (TCD) is a method of choice for detecting embolism into the cerebral vascular bed. This test is indicatedin patients with a risk of embolism in order to identify and locate the source of embolism; to select patients with a higher riskof embolic and/or thromboembolic ischaemic stroke; to adjust or monitor the efficacy of antithrombotic treatment; in patientsundergoing interventional procedures with an increased risk of embolism; or to identify divers with a higher risk of decompressionsickness. Given the different parameters for adjusting the TCD device and various characteristics used to detect emboli, aninternational consensus for detecting microembolism by using TCD was adopted in 1998 that defines the characteristics of themicroembolic signal as well as the parameters for adjusting the TCD device.

• Keywords
• mikroembolizace,
• MeSH
• Stroke prevention & control   MeSH
• Decompression Sickness prevention & control   MeSH
• Embolism * diagnostic imaging   etiology   physiopathology   pathology   MeSH
• Foramen Ovale, Patent diagnosis   MeSH
• Humans MeSH
• Cerebral Arterial Diseases diagnostic imaging   MeSH
• Embolism, Paradoxical MeSH
• Carotid Stenosis prevention & control   MeSH
• Thrombosis * diagnostic imaging   physiopathology   pathology   MeSH
• Ultrasonography, Doppler, Transcranial * methods   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a method used for the treatment most severe cases of decompensated heart failure. The purpose of this study was to evaluate the risk of the formation of microembolisms during VA-ECMO-based therapy. Heart failure was induced with simultaneous detection of microembolisms and the measurement of blood flow rate in the common carotid artery (CCA) without VA-ECMO (0 l/min) and at the VA-ECMO blood flow rate of 1, 2, 3 and 4 l/min. If embolisms for VA-ECMO 0 l/min and the individual regimes for VA-ECMO 1, 2, 3, 4 l/min are compared, a higher VA-ECMO flow rate is accompanied by a higher number of microembolisms. The final microembolism value at 16 min was for the VA-ECMO flow rate of 0 l/min 0.0 (0, 1), VA-ECMO l/min 7.5 (4, 19), VA-ECMO 2 l/min 12.5 (4, 26), VA-ECMO 3 l/min, 21.0 (18, 57) and VA-ECMO 4 l/min, 27.5 (21, 64). Such a comparison is statistically significant if VA-ECMO 0 vs. 4 l/min p<0.0001, 0 vs. 3 l/min p<0.01 and 1 vs. 4 l/min p<0.01 are compared. The results confirm that high VA-ECMO flow rates pose a risk with regards to the formation of a significantly higher number of microemboli in the blood circulation and that an increase in blood flow rates in the CCA corresponds to changes in the VA-ECMO flow rates.

• MeSH
• Acute Disease MeSH
• Carotid Artery, Common diagnostic imaging   physiopathology   MeSH
• Embolism diagnostic imaging   physiopathology   MeSH
• Microcirculation physiology   MeSH
• Extracorporeal Membrane Oxygenation adverse effects   trends   MeSH
• Disease Models, Animal * MeSH
• Swine MeSH
• Blood Flow Velocity physiology   MeSH
• Heart Failure diagnostic imaging   physiopathology   therapy   MeSH
• Ultrasonography, Doppler methods   trends   MeSH
• Animals MeSH
• Check Tag
• Female MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH