Tx and Followup:
Further investigation of the patientâ€™s cardiac history revealed that he had sustained a left ventricle inferobasilar wall myocardial infarction (MI) four years earlier (occluded left circumflex coronary artery). Prior echocardiography exams noted moderate aortic stenosis as well as a severely hypokinetic inferobasilar LV wall related to the history of MI.
As the patient had also been noticing a recent increase in bilateral leg swelling, an echocardiogram was repeated. The exam demonstrated persisting severe hypokinesis of the inferobasilar wall with mild generalized LV diastolic dysfunction. Moderate aortic stenosis (valve area 0.9cm2) with bicuspid aortic valve and mild LV hypertrophy was unchanged.
Detecting and recognizing calcification related to the heart on nuclear medicine bone scans and other imaging modalities may have important clinical implications. For example, the amount of coronary artery calcification correlates with the severity of coronary artery disease (CAD), and calcification of the aortic or mitral valve may indicate hemodynamically significant valvular stenosis.
This case demonstrates the classic finding of myocardial calcium deposition from prior MI. Approximately 8% of patients who sustain a large myocardial infarction develop myocardial calcification, with anterolateral wall LV infarcts most commonly seen in association with LV aneurysm.
Other causes for calcification within the walls of the heart may include myocarditis and amyloid deposition. Soft tissue calcium deposition can be seen in a wide variety of disease processes (inflammation, infarction and necrosis, metastatic calcification in renal failure, and hypercalcemia of any cause); however, the exact mechanism for cardiac activity as seen on nuclear medicine bone scans is debated, and the degree of cardiac activity on bone scan may differ from visualized calcification on CT imaging.
Localizing calcification to the walls of the heart versus within the pericardium is important as pericardial calcification is strongly associated with constrictive pericarditis.
In summary, correct assessment of cardiac calcification location is important in disease diagnosis and management.
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