ABSTRACT
Abstract Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.
Resumo Fundamento: O aneurisma do ventrículo esquerdo (AVE) é uma importante complicação do infarto agudo do miocárdio (IAM). Objetivo: Investigar o papel da porção N-terminal do pró-hormônio do peptídeo natriurético do tipo B (NT-proBNP) para predizer o desenvolvimento de AVE após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Incluímos prospectivamente 1519 pacientes consecutivos com IAMCST. Os pacientes foram divididos em dois grupos de acordo com o desenvolvimento de AVE nos seis meses após o infarto do miocárdio. Os pacientes com ou sem AVE foram examinados para determinar se existia uma relação significativa entre os valores basais do NT-proBNP e as características clínicas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: O AVE foi detectado em 157 pacientes (10,3%). O nível basal do NT-proBNP foi significativamente maior em pacientes que desenvolveram AVE após IAM (523,5 ± 231,1 pg/mL vs. 192,3 ± 176,6 pg/mL, respectivamente, p < 0,001). Os preditores independentes da formação de AVE após IAM foram idade > 65 anos, tabagismo, classe Killip > 2, cirurgia de revascularização miocárdica anterior, insuficiência cardíaca pós-infarto do miocárdio, fração de ejeção do ventrículo esquerdo < 50%, falha de reperfusão, fenômeno de no-reflow, pico de troponina I e CK-MB e NT-proBNP > 400 pg/mL na internação. Conclusões: Nossos achados indicam que o nível plasmático do fragmento N-terminal do peptídeo natriurético tipo B na admissão, entre outras variáveis, fornece informações preditivas valiosas sobre o desenvolvimento de AVE após o IAMCST agudo.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Peptide Fragments/blood , Ventricular Dysfunction, Left/diagnosis , Natriuretic Peptide, Brain/blood , ST Elevation Myocardial Infarction/complications , Heart Aneurysm/diagnosis , Severity of Illness Index , Biomarkers/blood , Prospective Studies , ROC Curve , Sensitivity and Specificity , Coronary Angiography , Ventricular Dysfunction, Left/etiology , Heart Aneurysm/etiologySubject(s)
Humans , Female , Middle Aged , Spasm/complications , Spasm/diagnosis , Echocardiography, Doppler/methods , Mammary Arteries/physiopathology , Catheterization/methods , Angiography/methods , Myocardial Reperfusion/methods , Aspirin/administration & dosage , Ventricular Function , Treatment Outcome , Coronary Stenosis/diagnosis , Heart Aneurysm/diagnosis , Heart Ventricles , Internal Mammary-Coronary Artery Anastomosis/methodsABSTRACT
Ivemark syndrome (IS) is a rare embryological disorder which results from failure of development of the left-right asymmetry of organs. It is often associated with cardiac and other organ abnormalities, which are the usual causes of death in early neonatal life. We report a 3 months old girl with IS with dextrocardia, transposition of the great vessels, atrio-ventricular connection, total anomalous pulmonary venous drainage, a right atrial and right pulmonary isomerism, a midline liver, a midline gallbladder, asplenia, intestinal malrotation and vena cava anomalies. To our knowledge, complete right heterotaxia syndrome has been rarely described in literature. Lateralization defects such as situs inversus, asplenia or polysplenia due to defective left-right axis development are considered as defects of the primary developmental field. Therefore, additional malformations in IS can be synchronic defects in the primary developmental field rather than causally independent malformations.
El síndrome de Ivermark es un desorden embriológico raro resultante de una falla en el desarrollo de la asimetría izquierda y derecha de los órganos. Usualmente se asocia con anomalías cardíacas y de otros órganos, que son la causa usual de muerte en la vida neonatal. Presentamos una niña de 3 meses con dextrocardia, trasposición de los grandes vasos, comunicación aurículo-ventricular, drenaje anómalo total de la vena pulmonar, isomerismo de la aurícula y pulmón derecho, hígado y vesícula en la línea media, asplenia, malrotación intestinal y anomalías de la vena cava. Una heterotaxia derecha completa ha sido raramente descrita en la literatura. Los defectos de lateralización como situs inverso, asplenia o poli esplenia causados por defectos en el desarrollo izquierda derecha son considerados como defectos del campo de desarrollo primario. Por lo tanto, las manifestaciones adicionales del síndrome de Ivemark pueden ser defectos sincrónicos del campo de desarrollo primario más que malformaciones causalmente independientes.
Subject(s)
Female , Humans , Infant , Abnormalities, Multiple/diagnosis , Heterotaxy Syndrome/diagnosis , Dextrocardia , Heart Aneurysm/diagnosis , Heterotaxy Syndrome/physiopathology , Tomography, X-Ray Computed , Transposition of Great Vessels , Vena Cava, Superior/abnormalitiesABSTRACT
Desde el año 1931 y, especialmente, desde el Código de Núremberg de 1947, un creciente número de declaraciones, regulaciones, normas, guías, leyes, resoluciones y disposiciones pretenden generar condiciones para una mejor protección de los sujetos que participan en estudios de investigación, aunque también algunas implican retrocesos en el respeto a los derechos de poblaciones vulnerables. Sin embargo, todavía no se ha podido evitar la violación de la dignidad de los sujetos de experimentación en ensayos clínicos. Lo que se investiga, cómo se investiga, la calidad y transparencia de los datos obtenidos, el análisis y la publicación de los resultados (tanto de los datos crudos como de los ya elaborados) están sometidos a la lógica del lucro, la cual presenta una tensión permanente con los principios bioéticos y las necesidades de la sociedad. Es necesario el protagonismo activo de los pueblos para que la investigación farmacológica, sus resultados y aplicaciones avancen en un rumbo que subordine el beneficio económico a la protección de los derechos humanos.
Since 1931, and especially since the Nuremberg Code of 1947, an increasing number of declarations, regulations, norms, guidelines, laws, resolutions, and rules intended to create conditions for better protection of subjects participating in research studies have been published, although some have meant setbacks in the human rights of vulnerable populations. As such, violations of the dignity of experimental subjects in clinical trials continue. What researchers investigate and how the research is done, the quality and transparency of the data, and the analysis and the publication of results (of both raw and processed data) respond to the financial interests of the pharmaceutical companies, coming into permanent tension with bioethical principles and the needs of society. The active participation of civil society is necessary to make it so that pharmaceutical research, results and applications subordinate economic benefits to the protection of human rights.
Subject(s)
Adult , Humans , Male , Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Cardiomyopathy, Dilated/diagnosis , Heart Aneurysm/diagnosis , Atrophy/pathology , Edema/pathology , Fibrosis/pathology , Magnetic Resonance Angiography/methods , Myocardium/pathologySubject(s)
Aged , Humans , Male , Hypoxia/etiology , Dyspnea/etiology , Heart Aneurysm/complications , Heart Septal Defects, Atrial/complications , Pulmonary Embolism/complications , Hypoxia/diagnosis , Arterial Pressure/physiology , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Heart Aneurysm/diagnosisSubject(s)
Adolescent , Humans , Male , Atrial Fibrillation/physiopathology , Atrial Septum/physiopathology , Bundle-Branch Block/physiopathology , Heart Aneurysm/physiopathology , Atrial Fibrillation/diagnosis , Atrial Septum , Bundle-Branch Block/diagnosis , Diagnosis, Differential , Echocardiography, Transesophageal , Electrocardiography , Heart Aneurysm/diagnosisABSTRACT
Los aneurismas ventriculares y la ruptura del septum interventricular son complicaciones del infarto agudo del miocardio que pueden acompañarse de alta morbimortalidad. Se reporta el caso de un paciente con formación y ruptura de un aneurisma verdadero de la pared inferior y del septum interventricular inferior después de un infarto agudo de miocardio silente. Se discuten las características clínicas, diagnóstico y manejo de estas complicaciones potencialmente letales.
Ventricular aneurysms and interventricular septal rupture are complications of acute myocardial infarction and thesecomplications may have a high morbidity and mortality. We report the case of a patient with an aneurysm involving theinferior myocardium and the inferior interventricular septum following an acute silent myocardial infarction. The clinicalcharacteristics, diagnosis and management of these potentially lethal complications are discussed.
Subject(s)
Humans , Male , Aged , Heart Aneurysm/diagnosis , Heart Aneurysm/etiology , Costa Rica , Cardiomyopathies/surgery , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Myocardial InfarctionABSTRACT
O aneurisma de apêndice atrial esquerdo é uma entidade extremamente rara e diagnosticada, na maioria das vezes, a partir da segunda década de vida, sendo patologia geralmente oligossintomática e diagnóstico de caráter ocasional. Este caso refere-se a um paciente de 21 anos, com quadro de taquicardia supraventricular sustentada sintomática. O diagnóstico foi feito a partir do ecocardiograma transtorácico, após o achado de aumento de área cardíaca em radiografia do tórax. O tratamento cirúrgico é mandadório e o paciente foi submetido à cirurgia para ressecção do apêndice atrial.
Subject(s)
Humans , Male , Adult , Heart Aneurysm/complications , Heart Aneurysm/diagnosis , Atrial Appendage/surgery , Arrhythmia, Sinus/complications , Arrhythmia, Sinus/diagnosis , Echocardiography/methods , EchocardiographyABSTRACT
Se describe un paciente con ruptura de aneurisma del seno Valsalva derecho, diagnosticado por ecocardiografía transtoracica bidimensional y doppler, con historia previa de insuficiencia cardiaca derecha y soplo continuo en precordio.
Subject(s)
Humans , Male , Middle Aged , Heart Aneurysm/diagnosis , Aneurysm , Echocardiography , Sinus of Valsalva/pathologyABSTRACT
Left ventricular pseudo-aneurysm is a variation of left ventricular free wall rupture, in which collection of blood occurs in pericardial sac, through ventricular wall defect. In pseudo-aneurysm, blood from defect does not fill the entire pericardial sac. Instead, because of adhesions between ventricular wall and the sac, escaping blood is isolated to a localised area between wall and pericardium. Here a case of ventricular pseudo-aneurysm of late onset which behaved as non-resolving pericardial effusion is presented.
Subject(s)
Aneurysm, False/diagnosis , Chronic Disease , Diagnosis, Differential , Echocardiography, Doppler, Color , Electrocardiography , Follow-Up Studies , Heart Aneurysm/diagnosis , Heart Ventricles , Humans , Male , Middle Aged , Pericardial Effusion/complicationsABSTRACT
A 20-year-old intravenous drug abuser man, refered to our hospital with dyspnea and orthopnea. Tranesophageal echocardiography revealed severe aortic regurgitation, healed vegetation of aortic valve and an aneurysm of the anterior leaflet of the mitral valve. The patient was discharged after aortic valve replacement and mitral valve repair
Subject(s)
Humans , Male , Endocarditis, Bacterial/complications , Aortic Valve/diagnostic imaging , Heart Valve Diseases/complications , Heart Valve Diseases/diagnostic imaging , Heart Aneurysm/diagnosisSubject(s)
Adolescent , Adult , Contrast Media , Diagnosis, Differential , Echocardiography , Electrocardiography , Female , Heart Aneurysm/diagnosis , Humans , Male , Mitral Valve , Radiography, Thoracic , Tomography, X-Ray ComputedSubject(s)
Adult , Coronary Angiography , Diagnosis, Differential , Echocardiography , Heart Aneurysm/diagnosis , Humans , Male , Mitral ValveABSTRACT
Para avaliar a prevalência de aneurismas do ventrículo esquerdo, realizou-se um estudo transversal envolvendo uma coorte de 261 pacientes chagásicos crônicos (156 do município de João Costa e 105 de São do João do Piauí; 146 mulheres e 115 homens com idade média de 57,9 ± 14,2 anos). A avaliação cardiológica foi realizada por exame clínico, eletrocardiograma de repouso e ecocardiograma uni e bidimensional. Foram diagnosticados 23 (8,8 por cento) aneurismas do ventrículo esquerdo: 17 (6,5 por cento) no ápice, quatro (1,5 por cento) na parede posterior, um (0,4 por cento) na parede inferior e um (0,4 por cento) no septo interventricular. Cinco (1,9 por cento) pacientes de São João do Piauí apresentaram trombos associados com aneurismas apicais. A prevalência de aneurismas do ventrículo esquerdo foi maior entre os pacientes de São João do Piauí (13,3 por cento) e entre os homens (13,9 por cento), com diferença não significativa em função da faixa etária. Esses resultados revelam baixa prevalência de aneurismas do ventrículo esquerdo entre os pacientes de João Costa e elevada concentração de trombos entre os pacientes de São João do Piauí.
A cross-sectional study involving a cohort of 261 chronic Chagas disease patients (156 from the municipality of João Costa and 105 from São João do Piauí; 146 women and 115 men with mean age of 57.9 ± 14.2 years) was carried out to evaluate the prevalence of left ventricle aneurysms. The cardiological evaluation was performed by means of clinical examination, resting electrocardiograms and one and two-dimensional echocardiograms. A total of 23 cases of left ventricle aneurysms (8.8 percent) were diagnosed: 17 (6.5 percent) in the apical segment, four (1.5 percent) in the posterior wall, one (0.4 percent) in the inferior wall and one (0.4 percent) in the interventricular septum. Five patients (1.9 percent) from São João do Piauí presented thrombi associated with apical aneurysms. The prevalence of left ventricle aneurysms was greater among the patients from São João do Piauí (13.3 percent) and among men (13.9 percent), with no significant difference in relation to age group. These results show that there was low prevalence of left ventricle aneurysms among patients from João Costa and high concentration of thrombi among patients from São João do Piauí.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Chagas Cardiomyopathy/complications , Heart Ventricles , Heart Aneurysm/etiology , Brazil/epidemiology , Chronic Disease , Cohort Studies , Cross-Sectional Studies , Chagas Cardiomyopathy/epidemiology , Echocardiography , Electrocardiography , Heart Aneurysm/diagnosis , Heart Aneurysm/epidemiology , PrevalenceABSTRACT
Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, associated with apical aneurysm formation in some cases. We report a patient presenting with ventricular fibrillation, an ECG with an above normal ST segment, and elevated levels of cardiac enzymes but normal coronary arteries. Left ventriculography revealed a left ventricular obstruction without apical aneurysm. There was a significant pressure gradient between the apical and basal sites of the left ventricle. Cine magnetic resonance imaging (MRI), performed on the 10th hospital day, showed asymmetric septal hypertrophy, mid-ventricular obstruction, and an apical aneurysm with a thrombus. The first evaluation by contrast-enhanced imaging showed a subendocardial perfusion defect and delayed enhancement. It was speculated that the intraventricular pressure gradient, due to mid- ventricular obstruction, triggered myocardial infarction, which subsequently resulted in apical aneurysm formation.
Subject(s)
Humans , Male , Middle Aged , Cardiomyopathy, Hypertrophic/complications , Coronary Angiography , Echocardiography, Doppler , Heart Aneurysm/diagnosis , Hypertrophy, Left Ventricular/complications , Magnetic Resonance Imaging, Cine , Myocardial Ischemia/complicationsABSTRACT
Se presenta el caso de un paciente con cardiopatía isquémica y aneurisma ventricular calcificado con insuficiencia cardíaca, angor de esfuerzo y fenómeno embólico cerebral previo, con el antecedente de trauma cerrado de tórax 24 años antes.