ABSTRACT
Resumen Introducción: un trombo en ventrículo derecho y embolismo pulmonar post infarto agudo de miocardio sin elevación del ST es muy inusual. Es considerado una emergencia médica y es imperativo instaurar una opción terapéutica inmediata. Presentación del caso: paciente femenina de 80 años quien consultó en sala de emergencias por síncope, dolor torácico y disnea persistente. Se confirmó síndrome coronario agudo por electrocardiograma y troponina I elevada. En estudios complementarios se encontró hallazgo incidental de trombo en el ventrículo derecho y un angio-TAC confirmó embolismo pulmonar masivo. Discusión: el trombo en ventrículo derecho y embolismo pulmonar masivo post infarto es un fenómeno muy raro en el escenario clínico, debido a la instauración temprana de la terapia anti-isquémica. Es necesario mayor investigación para aclarar este fenómeno.
Abstract Introduction: right ventricular thrombus and pulmonary embolism after acute myocardial infarction without ST elevation is very unusual. It is considered a medical emergency and it is imperative to establish an immediate therapeutic option. Case presentation: An 80-year-old female patient visited the emergency room for syncope, chest pain, and persistent dyspnea. Acute coronary syndrome was confirmed by electrocardiogram and elevated troponin I. In complementary studies, an incidental finding of a thrombus in the right ventricle was found and a CT angiography confirmed massive pulmonary embolism. Discussion: thrombus in the right ventricle and massive post-infarction pulmonary embolism is a very rare phenomenon in the clinical setting due to the early introduction of anti-ischemic therapy. More research is needed to clarify this phenomenon.
Subject(s)
Humans , Ventricular Remodeling , Heart Ventricles , Primary Health Care , Brazil , Hypertrophy, Left VentricularABSTRACT
Objetivo: Exponer las características histológicas y funcionales que se presentan en el tejido muscular estriado cardíaco especializado en la conducción del estímulo eléctrico y sus implicaciones actuales en las arritmias cardíacas. Materiales y métodos: Se seleccionaron publicaciones en revistas indexadas en las bases PubMed, Wiley, Ovid-Medline y Science Direct. Los descriptores MESH utilizados para la búsqueda fueron cardiac myocytes, myocardium, heart conduction system. Se acoplaron los conceptos histology y arrhythmia. Se revisaron artículos publicados entre 1990 a 2014, originales, reportes de caso y revisiones, relacionados con los conceptos de desarrollo embrionario, diferenciación celular, morfología normal y alteración de los miocardiocitos conducentes ventriculares. Se revisó el resumen de 317 artículos, de los que se clasificaron 75 para lectura completa y de estos, 52 se seleccionaron para la redacción del presente artículo. Conclusión: Los estudios actuales se encaminan hacia las simulaciones del sistema de conducción para establecer otras causas de arritmia y opciones de tratamiento. La terapia con células indiferenciadas y las técnicas moleculares de modificación genética hacen parte de estos estudios, así como la implementación de terapias alternativas no invasivas en el tratamiento de las arritmias cardíacas.
Objective: To expose the histological and functional characteristics that occur in heart striated muscle tissue specialized in the conduction of electrical stimulation and its current implications for cardiac arrhythmias. Materials and methods: Publications in indexed journals in PubMed, Wiley, Ovid-Medline and Science Direct databases were selected. The MESH descriptors used for the search were cardiac myocytes, myocardium and heart conduction system. The concepts of histology and arrhythmia were mated. Articles published from 1990 to 2014 were reviewed as well as the original ones, case reports and reviews related to the concepts of embryonic development, cell differentiation and normal morphology alteration of the leading ventricular cardiomyocytes. The summary of 317 articles were read, from which 75 were classified to complete reading and finally 52 were selected for the drafting of this article. Conclusion: Current studies are directed towards the driving system simulation to establish other causes of arrhythmia and its treatment options. Not only therapies with undifferentiated cells and molecular genetic modification techniques are part of these studies but also the implementation of alternative therapies that are not invasive in the treatment of cardiac arrhythmias.
Subject(s)
Arrhythmias, Cardiac , Myocytes, Cardiac , Heart Ventricles , MyocardiumABSTRACT
Atrioventricular valve complex of 30 Jafarabadi water buffaloes, adult males were studied in this research with no heart diseases. The animals were obtained from a slaughterhouse in Brazilian State of Parana. The hearts were opened at the third portion affording access to the valve complex. The complexes had its area, number and type of tendinous cords submitted to analysis. The results showed that the complex is composed by two cusps and four accessory cusps, two or three papillary muscles in which 10-25 tendinous cords fix on the cusps that face the ventricle wall. The total area of the complex was on average 38.56cm², with a minimum of 24.96cm² and a maximum of 55.54cm². Statistically, no relation between the number of cords and the cusps' area where they are inserted or with the number of papillary muscle where they originated from was observed.
Foram estudados os complexos valvares atrioventricular esquerdo de 30 búfalos da raça Jafarabadi, machos e adultos, sem alterações cardíacas, provenientes de abatedouros do Estado do Paraná. Os corações foram examinados em seu terço médio para acesso ao complexo valvar, que foi submetido a estudos de área, número e tipificação de cordas tendíneas. Os resultados demonstram que este complexo é formado por duas cúspides principais e quatro cúspides acessórias, apresentam em sua formação de 2-3 músculos papilares, nos quais se inserem de 10-25 cordas tendíneas, que se fixam em cúspides voltadas para a parede do ventrículo. A área total deste complexo apresenta uma média de 38,56cm² com um mínimo de 24,96cm² e um máximo de 55,54cm². Estatisticamente não há relação entre número de cordas e a área da cúspide onde estas estão inseridas, nem com o número de músculos papilares dos quais elas provem.