IJCS | Volume 31, Nº6, November / December 2018

DOI: 10.5935/2359-4802.20180054 662 VIEWPOINT International Journal of Cardiovascular Sciences. 2018;31(6)662-666 Mailing Address: Charles André Rua Visconde de Pirajá, 4114, sala 821. Postal Code: 22410-002, Rio de Janeiro, RJ - Brazil. E-mail: dr.charles.andre@gmail.com Remoras and Spontaneous Echocardiographic Contrast Charles André 1,2 Universidade Federal do Rio de Janeiro, 1 RJ - Brazil Sinapse Neurologia e Reabilitação, 2 RJ - Brazil Manuscript received October 15, 2017, revised manuscript May 27, 2018, accepted June 06, 2018. Cypriniformes (remoras); Atrial Appendage; Embolism and Thrombosis; History, Ancient; Diagnostic Imaging; Ultrasonography/history; Echocardiography/history. Keywords Abstract The term “Remora” (hindrance) – re (again)/mora (delay) -originally designated a family of fishes – the suckerfishes. In ancient Greece and Rome and up to the early 19 th century, these fisheswere believed to slowdown ships by attaching to them. Medicine adopted the term “remora” to describe fluid/blood stasis. Intracardiac blood stasis, or remora, especially in the left atrial appendage, is associated with thrombogenesis and responsible for cardioembolic phenomena. The slow and swirling movement of blood causes the appearance of spontaneous echocardiographic contrast (SEC). I briefly narrate the Naval Battle of Actium, whose result was mythically attributed to the remora fishes, and make a short review of remoras. I also describe Laennec’s discussion about intracardiac blood stasis and give a short account of SEC, its original descriptions and importance. Introduction Atrial fibrillation (AF) is associated with an increased risk of embolism to the brain and other sites. The risk is even greater in the presence of evident decrease in blood flow velocity in the left atrial appendage (LAA), a common feature of many conditions such as AF and mitral stenosis. Echocardiography can show the presence of blood stasis, or “remora”, strongly correlated with an intracavitary smoky appearance, known as spontaneous echocardiographic contrast (SEC) (Figure 1). 1 The term remora designates a family of fishes (shark suckers) known for their ability to adhere to large fishes and mammals using a specialized sucking structure. I describe why these fish were so-called “remora” in the first place, and why Cardiology has borrowed this term to describe the phenomenon of blood stasis. The battle of Actium Actium is a promontory in Acarnania, Greece. It occupies the southern side of a strait connecting the Ionian Sea to the Ambracian gulf. Octavian, later known as Augustus (27 B.C.), defeated Mark Antony and his allied Egyptian forces in a great naval battle there (September 2, 31 B.C.). The battle became the decisive confrontation of the Final War of the Roman Republic. Antony’s infantry was outnumbered (maybe 70,000 vs. 80,000 men) and Octavian had blocked Antony’ s communication with Egypt via the Peloponnese. By following Cleopatra’s advice, Antony moved his larger, heavily armed but less maneuverable fleet (500 vessels including the Egyptian forces). Cleopatra’s fleet followed in the rear, but never entered in the battle. Octavian’s fleet (250-400 warships) was mainly composed of lighter but well-equipped ships. Also, his crews were better trained and in better health, since Antony’s soldiers had been struck by malaria before the confrontation. The battle raged outside the gulf of Actium for many hours. Desertion of Cleopatra’s lighter warships when the winds blew in the right direction decisively influenced the battle’s result. Antony managed to catch up with Cleopatra but left the remaining of his fleet behind, which then surrendered to Octavian and his admiral Agrippa. 2 Antony’s land forces surrendered in the following week. Several battles followed during the following year and led to Octavian’s final victory. Antony and Cleopatra VII committed suicide in 30 B.C. (July 31 and August 12,