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Published on: April 25, 2014
Left atrial infarction: a case report and review of the literature
1Medical University of South Carolina, Charleston, NC, USA.
Insights
Left atrial infarction, though rare, can lead to fatal outcomes like transmural rupture. This case highlights a critical, often overlooked, cause of cardiac emergencies in patients with complex cardiac histories.
Area of Science:
- Cardiology
- Pathology
Background:
- Ischemic heart disease is a leading cause of cardiac death, typically involving left ventricular myocardial infarction due to coronary artery atherosclerosis.
- While left ventricular infarction is common, infarction of other cardiac chambers, such as the atria, can occur and may have distinct clinical associations.
Observation:
- A 70-year-old male with a history of rheumatic heart disease, mitral valve stenosis, and severe coronary artery disease experienced left atrial infarction.
- The patient underwent mitral valve replacement and coronary artery bypass grafting, subsequently developing atrial fibrillation, decreased mental status, hematemesis, and ventricular tachycardia.
- Autopsy revealed significant hemopericardium, hemothoraces, and a transmural defect in the left atrium, consistent with acute myocardial infarction at the rupture site.
Findings:
- Microscopic examination confirmed acute myocardial infarction of the left atrium.
- The prosthetic mitral valve and coronary artery bypass graft were intact and patent, ruling them out as the cause of infarction.
- Severe calcific atherosclerosis was noted in the native coronary arteries.
Implications:
- This case underscores the potential for left atrial infarction and rupture, even after cardiac procedures.
- Understanding atrial circulation and the pathology of atrial infarction is crucial for diagnosing and managing such rare but devastating cardiac events.
- Further research into the specific mechanisms and risk factors for atrial infarction is warranted.
Abstract:
The majority of cardiac related deaths are due to ischemic heart disease, with the most common clinical scenario being severe coronary artery atherosclerosis resulting in left ventricular myocardial infarction. However, infarction of other cardiac chambers does occur, and often has specific clinical associations. We report a case of a 70-year-old man who suffered from left atrial infarction that resulted in a transmural rupture of his left atrium. The patient had a history of rheumatic heart disease, mitral valve stenosis, and severe atherosclerotic coronary artery disease. Four days before death, he underwent mitral valve replacement and left circumflex coronary artery bypass. Two days later, he developed atrial fibrillation. On the day of death, he had decreased mental status, questionable seizure activity, hematemesis, ventricular tachycardia, and eventually asystole. At autopsy, he had significant hemopericardium with a fibrinous pericarditis and bilateral hemothoraces (total blood volume: 1250 mL). A 0.1 to 0.2 cm left atrial transmural defect was identified. The prosthetic mitral valve was free of vegetations, and completely intact. Similarly, the left circumflex artery bypass graft was completely patent and unremarkable. Severe calcific atherosclerosis was of his native left circumflex and left main coronary arteries. Microscopic examination revealed acute myocardial infarction of the left atrium at the rupture site. The anatomy of atrial circulation as well as the pathology and consequences of atrial infarction are discussed.
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