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1.
Rev. urug. cardiol ; 36(2): e402, ago. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1289998

ABSTRACT

El tromboembolismo pulmonar tiene una presentación clínica variada. Es fundamental tener un alto índice de sospecha para arribar al diagnóstico oportuno. El síncope se asocia a casos graves y tiene importancia pronóstica. El tratamiento trombolítico es la piedra angular en el subgrupo de pacientes de alto riesgo. Se presentan tres casos clínicos de tromboembolia pulmonar de alto riesgo con el fin de discutir el escenario clínico de presentación y el tratamiento instaurado.


Pulmonary thromboembolism has a varied clinical presentation. It is essential to have a high index of suspicion to arrive at a timely diagnosis. Syncope is associated with severe cases and is of prognostic significance. Thrombolytic treatment is the cornerstone in the subgroup of high-risk patients. Three clinical cases of high-risk pulmonary thromboembolism are presented in order to discuss the clinical presentation scenario and the established treatment.


O tromboembolismo pulmonar tem a presentação clínica variada. É essencial ter um alto índice de suspeita para chegar a um diagnóstico oportuno. A síncope está associada a casos graves e tem significado prognóstico. O tratamento trombolítico é a pedra angular no subgrupo de pacientes de alto risco. São apresentados três casos clínicos de tromboembolismo pulmonar de alto risco para discutir o quadro clínico e o tratamento instituído.


Subject(s)
Humans , Male , Female , Aged , Pulmonary Embolism/diagnosis , Syncope/complications , Heart Arrest/complications , Pulmonary Embolism/etiology , Pulmonary Embolism/drug therapy , Radiography, Thoracic , Catastrophic Illness , Electrocardiography
2.
Univ. salud ; 23(2): 92-99, mayo-ago. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1252312

ABSTRACT

Resumen Introducción: El síncope vasovagal tiene una incidencia entre 10% y 19% en la población general, el primer episodio suele aparecer en la juventud. Objetivo: Estimar la prevalencia de síncope vasovagal en una población universitaria del sur de Colombia, utilizando una adaptación de la Escala de Calgary como cuestionario diagnóstico. Materiales y métodos: Después de la firma voluntaria del consentimiento informado, los estudiantes fueron entrevistados y se les aplicó la Escala de Calgary. Posteriormente, se realizó un cuestionario de seguimiento a los participantes positivos. Resultados: Participaron 280 estudiantes, el 17% obtuvo un puntaje positivo para síncope vasovagal. La edad media fue 21,45±5,18; con mayor positividad para el género femenino. En el seguimiento, el 10% de los positivos, consultó a urgencias por pérdida de conciencia, 4% fue ingresado a hospitalización y 10% presentó lesiones secundarias. Conclusiones: Un número representativo de participantes fue positivo en la Escala de Calgary, ninguno de ellos había recibido diagnóstico de síncope neuralmente mediado, pese a haber consultado a urgencias y/o presentar lesiones secundarias por pérdida de conciencia. Incluir la Escala de Calgary en la evaluación inicial del paciente consultante por pérdida de conciencia, podría ayudar al diagnóstico temprano de síncope vasovagal.


Abstract Introduction: Vasovagal syncope has an incidence between 10% and 19% in the general population, whose first episodes appear in youth. Objective: To estimate the prevalence of vasovagal syncope in a university student population from the southern Colombia, using a diagnostic questionnaire adapted from the Calgary Scale. Materials and methods: After voluntary signing of the informed consent form, students were surveyed through the Calgary Scale, and a subsequent follow-up questionnaire was conducted on positive participants. Results: 280 students participated in the study and 17% of them obtained a positive score for vasovagal syncope, being positive female participants the largest group. The mean age of participants was 21.45±5.18 years. At the follow-up, 10% of the positive cases had sought out treatment in emergency rooms because of consciousness loss, 4% were hospitalized, and 10% had secondary injuries. Conclusions: Even though an important number of patients was positive on the Calgary Scale, none of them had been diagnosed with neutrally mediated syncope, despite being treated in emergency rooms and/or presenting secondary lesions due to consciousness loss. The use of the Calgary Scale during the assessment of patients being treated for consciousness loss could help to early diagnose vasovagal syncope.


Subject(s)
Syncope, Vasovagal , Syncope , Surveys and Questionnaires , Health Surveys
3.
Acta méd. colomb ; 46(1): 1-6, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1278148

ABSTRACT

Resumen Introducción: el síncope es una entidad clínica frecuente en urgencias con un pronóstico variable que depende de su etiología. El estudio STePS identificó cuatro variables que se asociaron independientemente con desenlaces graves a 10 días. El objetivo del estudio fue evaluar su rendimiento en una población de pacientes que acuden al servicio de urgencias por síncope. Metodología: estudio prospectivo observacional de pacientes que consultaron a urgencias del Hospital Universitario Clínica San Rafael con diagnóstico de síncope. Se realizó un análisis descriptivo de las variables demográficas y clínicas de la población, y un análisis comparativo según el ingreso o no a UCI. Se analizaron las variables cualitativas y cuantitativas por medio de prueba de chi cuadrado y t student respectivamente. Las características operativas de la regla STePS fueron evaluadas en una gráfica considerándose como aceptable un área bajo la curva (AUC) mayor a 0.8 y como óptima un AUC mayor a 0.9. Resultados: se incluyeron 98 pacientes. El rendimiento de la regla de predicción STePS fue AUC-ROC 0.64 (IC95%; 0.53-0.75). Sólo el electrocardiograma anormal (OR 13.98, IC 95% 1.29151.9) y trauma concomitante (OR 5.22, IC 95% 1.20-22.67) demostraron ser factores de riesgo para desenlaces graves a 10 días. Se identificaron factores prevalentes en la población con ingreso a UCI: edad >65 años (p=0.02), antecedente de falla cardiaca (p=0.047), enfermedad renal crónica (p=0.002) y cardiopatía (p=0.01). Conclusión: la regla de predicción STePS no tuvo un rendimiento favorable para predicción de desenlaces graves a 10 días del evento sincopal en esta población estudiada.


Abstract Introduction: syncope is a common clinical condition in the emergency room with a variable prognosis depending on its etiology. The STePS study identified four variables which were independently related to serious outcomes within 10 days. The objective of the study was to evaluate its performance in a population of patients seen in the emergency room for syncope. Methods: a prospective observational study of patients seen in the emergency room of the Hospital Universitario Clínica San Rafael with a diagnosis of syncope. A descriptive analysis of the population's demographic and clinical variables was conducted, along with a comparative analysis according to admission or non-admission to the ICU. Qualitative and quantitative variables were analyzed using Chi-square or Student's t test, respectively. The operative characteristics of the STePS rule were evaluated in a graph, with an area under the curve (AUC) greater than 0.8 considered to be acceptable, and greater than 0.9 considered to be optimal. Results: Ninety-eight patients were included. The performance of the STePS prediction rule was AUC-ROC 0.64 (95% CI; 0.53-0.75). Only an abnormal electrocardiogram (OR 13.98, 95% CI 1.29-151.9) and concomitant trauma (OR 5.22, 95% CI 1.20-22.67) proved to be risk factors for serious outcomes within 10 days. Prevalent factors in the population admitted to the ICU were: age >65 years (p=0.02), a history of heart failure (p=0.047), chronic kidney disease (p=0.002) and heart disease (p=0.01). Conclusion: the STePS prediction rule did not perform favorably for predicting serious outcomes within 10 days of the syncopal event in this study population.


Subject(s)
Humans , Male , Female , Aged , Syncope , Wounds and Injuries , Risk Factors , Threshold Limit Values , Emergencies , Forecasting , Heart Diseases
4.
Iatreia ; 34(1): 64-70, ene.-mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1154359

ABSTRACT

RESUMEN La amiloidosis AL (antes denominada amiloidosis primaria) es una entidad sistémica poco frecuente, con incidencia desconocida en el mundo, que puede llegar a presentar compromiso cardíaco en casi la mitad de los pacientes, llevando a una cardiomiopatía restrictiva por depósito de tejido amiloide. A continuación, presentamos 3 casos de pacientes que consultaron por falla cardíaca aguda y síncope, en quienes finalmente se confirmó el diagnóstico de amiloidosis AL. Al final, se realiza una breve revisión de la literatura, enfatizando en los elementos clínicos para un diagnóstico temprano.


SUMMARY AL amyloidosis (formerly called primary amyloidosis) is a rare systemic entity, with an unknown incidence in the world, which can develop heart involvement in almost half of patients, leading to restrictive cardiomyopathy by amyloid tissue deposit. We present 3 cases of patients who consulted for acute heart failure and syncope, in which the diagnosis of AL amyloidosis was finally confirmed. We conclude with a brief review of the literature, emphasizing clinical elements for an early diagnosis.


Subject(s)
Humans , Aged , Syncope , Heart Failure , Amyloid , Cardiomyopathy, Restrictive , Heart
5.
Rev. bras. cir. cardiovasc ; 36(1): 18-24, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155788

ABSTRACT

Abstract Introduction: It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. Methods: Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann-Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher's exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P<0.05. Results: The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope (P<0.01). Conclusion: While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.


Subject(s)
Humans , Pacemaker, Artificial , Syncope, Vasovagal/diagnosis , Syncope, Vasovagal/etiology , Syncope, Vasovagal/therapy , Atrioventricular Block , Syncope/diagnosis , Syncope/etiology , Tilt-Table Test
6.
Rev. colomb. cardiol ; 28(1): 80-85, ene.-feb. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1341264

ABSTRACT

Resumen El síndrome de QT largo representa un grupo de desórdenes electrofisiológicos cardiacos, caracterizados por la prolongación del intervalo QT, que se asocian a muerte súbita, taquicardias ventriculares y síncope. Se presenta el caso de dos familias con la descripción clínica de los afectados, el estudio genético y el respectivo manejo, y se hace una breve actualización de la literatura sobre el síndrome de QT largo.


Abstract Long QT syndrome represents a group of electrophysiologic disorders characterized by a prolongation in the QT interval that are associated with sudden death, ventricular tachycardia and syncope. We present 2 families describing the clinical presentation, the genetic study and their respective treatment also there is a brief review about long QT syndrome.


Subject(s)
Humans , Female , Adolescent , Adult , Romano-Ward Syndrome , Syncope , Tachycardia, Ventricular , Death, Sudden
7.
Rev. colomb. cardiol ; 27(6): 597-601, nov.-dic. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289277

ABSTRACT

Resumen La taquicardia ventricular polimórfica catecolaminérgica es una enfermedad caracterizada por arritmias ventriculares desencadenadas por estrés o actividad física. Existen casos descritos de taquicardia ventricular polimórfica catecolaminérgica asociada a ventrículo izquierdo no compactado, en relación con mutaciones del gen RYR2 localizadas en el exón 3. Se expone el caso clínico de una paciente joven que debutó con clínica de síncopes recurrentes asociados a estrés físico o emocional. En el estudio posterior se descubrió taquicardia ventricular polimórfica catecolaminérgica, con áreas de miocardio no compactado y una nueva variante genética posiblemente asociada a la enfermedad.


Abstract Catecholaminergic polymorphic ventricular tachycardia is disease characterised by ventricular arrhythmias triggered by stress or physical activity. There are some cases of catecholaminergic polymorphic ventricular tachycardia described that are associated with non-compacted left ventricle in relation to mutations of the RYR2 gene located in exon 3. A case is presented of a young patient in whom the clinical signs started with recurrent syncope associated with physical or emotional stress. In the subsequent study, catecholaminergic polymorphic ventricular tachycardia was discovered, with areas of non-compacted myocardium and new genetic variant possibly associated with the disease.


Subject(s)
Humans , Female , Adult , Tachycardia, Ventricular , Syncope , Heart Ventricles , Cardiomyopathies
8.
Rev. colomb. cardiol ; 27(6): 517-525, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289267

ABSTRACT

Resumen Introducción: El síncope es un síntoma complejo de evaluar, que además representa un reto diagnóstico; la estratificación inadecuada del riesgo de los pacientes puede conllevar mal uso de los recursos en salud y aumentar así el costo derivado de la atención. Objetivo: Comparar la incidencia de desenlaces a un año en pacientes con síncope de alto y bajo riesgo en cuatro hospitales de Bogotá. Metodología: Estudio de cohorte retrospectiva, en el que se incluyeron pacientes mayores de 18 años que consultaron a urgencias por síncope, y que fueron seguidos desde febrero de 2013 hasta julio de 2015. Fueron clasificados en bajo y alto riesgo según la escala de Martin et al. Se hizo seguimiento telefónico para evaluar los desenlaces a un año. Resultados: Los pacientes de alto riesgo tienen mayor frecuencia de mortalidad, recurrencia del síncope, requerimiento de hospitalización, eventos neurológicos y necesidad de intervención cardiovascular. La mortalidad global está alrededor del 6% y en el subgrupo de pacientes de mayor puntaje (4 puntos) asciende al 16,6%. La mayoría de eventos se presentaron en los primeros 6 meses de seguimiento. La mortalidad y la necesidad de intervención cardiovascular tuvieron un incremento de su frecuencia a medida que aumentó el puntaje de la escala. Conclusión: Los pacientes clasificados en alto riesgo según la escala de Martin et al. tienen mayor frecuencia de desenlaces adversos a un año de seguimiento, y por tanto podrían beneficiarse de un estudio más amplio y expedito de la causa del síncope.


Abstract Introduction: Syncope is a complex symptom to assess, and is a diagnostic challenge. The inadequate risk stratification can lead to the inappropriate use of health resources and to an increase in the costs arising from the care. Objective: To compare the outcomes at one year in patients with high and low risk syncope in four Bogota hospitals. Material and method: A retrospective cohort study was conducted that included patients over 18 years-old that were seen in the Emergency Department due to a syncope. They were followed-up from February 2013 until July 2015. They were classified into low and high risk according to the score on the scale of Martin et al. At one year, a telephone call follow-up was made to assess the outcomes. Results: The high risk patients had higher rates of mortality and recurrence of syncope, required more hospital admissions, had more neurological events, and a greater need for cardiac intervention. The overall mortality was 6%, and in sub-group of patients with a higher score (4 points) it increased to 16.6%. The majority of events occurred in the first 6 months of follow-up. The mortality and the need for cardiovascular intervention were associated with the increase in the score on the scale. Conclusion: Patients classified as high risk according to the scale of Martin et al. are more likely to have adverse outcomes at one year of follow-up, and thus could benefit from a larger study and directed at the cause of the syncope.


Subject(s)
Humans , Male , Female , Middle Aged , Syncope , Recurrence , Risk , Mortality , Emergencies
9.
Arq. bras. cardiol ; 115(5 supl.1): 9-9, nov. 2020.
Article in Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1128779

ABSTRACT

INTRODUÇÃO: As ectopias atriais podem manifestar-se de diversas formas desde a ausência de sintomas até síncope. Descrevemos um caso de bigeminismo atrial bloqueado com prolongamento do intervalo QT e consequente Torsades de Pointes. Relato de caso: Paciente do sexo feminino, 75 anos, foi admitida no serviço de pronto atendimento devido a queixa de episódios recorrentes de síncope em posição sentada após sensação inespecífica de mal-estar, dispneia e turvação visual associado a liberação esfincteriana. ECG na admissão revelou ritmo sinusal e ectopias supraventriculares frequentes, motivo pelo qual iniciou-se terapia com amiodarona. Holter de 24h demonstrou bigeminismo atrial bloqueado e prolongamento do intervalo QT seguido por episódios de Torsade de Pointes e fibrilação ventricular. Realizado implante de marcapasso provisório seguido por ablação do foco arritmogênico em região de anel triscuspídeo. A paciente evoluiu com melhora da sintomatologia e Holter de controle demonstrou ausência de arritmias.


Subject(s)
Arrhythmias, Cardiac , Torsades de Pointes , Syncope
10.
Rev. colomb. psiquiatr ; 49(3): 216-219, jul.-set. 2020.
Article in Spanish | LILACS, COLNAL | ID: biblio-1149831

ABSTRACT

RESUMEN Don Quijote de la Mancha, el pintoresco personaje creado por Miguel de Cervantes Saavedra en su obra inmortal El Ingenioso Hidalgo Don Quijote de la Mancha, presenta varias condiciones neuropsiquiátricas que incluyen tremor, trastornos del sueño, síntomas neuropsiquiátricos, síncope, trastornos de la percepción y traumatismo craneoencefálico. A lo largo de la obra, se presentan episodios en los que se hacen evidentes los diferentes trastornos mencionados. El artículo hace un recuento de ellos a través de la novela y un análisis a la luz de los conocimientos actuales sobre dichas condiciones.


ABSTRACT Don Quixote of La Mancha, the picturesque character created by Miguel de Cervantes Saavedra in his immortal book The Ingenious Nobleman Sir Quixote of La Mancha, presents several neuropsychiatric conditions, including tremor, sleep disturbances, neuropsychiatric symptoms, syncope, perception disorders and traumatic brain injury. Throughout the masterpiece, there are episodes where the aforementioned disorders are evident. This paper makes a list of them and analyses them in the light of the current knowledge of those conditions.


Subject(s)
Humans , Perceptual Disorders , Neuropsychiatry , Sleep , Sleep Wake Disorders , Syncope , Discrimination, Psychological
11.
CorSalud ; 12(3): 338-342, jul.-set. 2020. graf
Article in Spanish | LILACS | ID: biblio-1154040

ABSTRACT

RESUMEN La fibrilación auricular por vía accesoria es una peligrosa enfermedad que puede provocar muerte súbita; es poco frecuente y necesita una conducta exacta, mucho más si aparece un patrón de preexcitación ventricular. Se presenta el caso de un adolescente masculino de 17 años de edad y piel blanca, con antecedentes de palpitaciones cortas a esfuerzos moderados y pérdida ocasional del conocimiento de breve duración, sin otra sintomatología asociada. Al momento del ingreso presenta un cuadro de palpitaciones, fatiga, palidez e hipotensión arterial, y en el electrocardiograma se observa una taquicardia con QRS ancho, irregular, con onda delta y frecuencia ventricular rápida, que fue interpretada como fibrilación auricular preexcitada. Se realizó cardioversión eléctrica sincronizada al QRS con 100 julios y se logró restaurar el ritmo sinusal con patrón electrocardiográfico de preexitación ventricular (síndrome de Wolff-Parkinson-White).


ABSTRACT Atrial fibrillation by accessory pathway is a dangerous disease that can cause sudden death, it is rare and it needs a careful management, even more, if a pattern of ventricular pre-excitation appears. The case of a white skin 17-year-old teenager with a history of short palpitations at moderate effort, and occasional loss of consciousness of short duration, without other associated symptoms, is presented. At the moment of admission, he presents palpitations, fatigue, pallor and low blood pressure; in the electrocardiogram a tachycardia with wide, irregular QRS, with delta wave and rapid ventricular rate is observed, which was interpreted as pre-excited atrial fibrillation. Synchronized electrical cardioversion to QRS with 100 joules was performed, and sinus rhythm was restored with electrocardiographic pattern of ventricular pre-excitation (Wolff-Parkinson-White syndrome).


Subject(s)
Atrial Fibrillation , Syncope , Pre-Excitation Syndromes , Tachycardia
14.
Arq. bras. cardiol ; 114(2): 245-253, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088859

ABSTRACT

Abstract Background: Cardioinhibitory carotid sinus hypersensitivity (CICSH) is defined as ventricular asystole ≥ 3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). There is a common concern that a prolonged asystole episode could lead to death directly from bradycardia or as a consequence of serious trauma, brain injury or pause-dependent ventricular arrhythmias. Objective: To describe total mortality, cardiovascular mortality and trauma-related mortality of a cohort of CICSH patients, and to compare those mortalities with those found in a non-CICSH patient cohort. Methods: In 2006, 502 patients ≥ 50 years of age were submitted to CSM. Fifty-two patients (10,4%) were identified with CICSH. Survival of this cohort was compared with that of another cohort of 408 non-CICSH patients using Kaplan-Meier curves. Cox regression was used to examine the relation between CICSH and mortality. The level of statistical significance was set at 0.05. Results: After a maximum follow-up of 11.6 years, 29 of the 52 CICSH patients (55.8%) were dead. Cardiovascular mortality, trauma-related mortality and the total mortality rate of this population were not statistically different from that found in 408 patients without CICSH. (Total mortality of CICSH patients 55.8% vs. 49,3% of non-CICSH patients; p: 0.38). Conclusion: At the end of follow-up, the 52 CICSH patient cohort had total mortality, cardiovascular mortality and trauma-related mortality similar to that found in 408 patients without CICSH.


Resumo Fundamento: A resposta cardioinibitória (RCI) à massagem do seio carotídeo (MSC) caracteriza-se por assistolia ≥ 3 segundos provocada por 5 a 10 segundos de MSC. Existe uma preocupação de que pacientes com RCI e episódios prolongados de assistolia possam falecer em consequência direta de bradiarritmia, ou em decorrência de lesão cerebral, trauma grave ou arritmia ventricular pausa dependente. Objetivos: Determinar a mortalidade total, a mortalidade cardiovascular e a mortalidade relacionada ao trauma de uma coorte de pacientes com RCI à MSC e comparar essas mortalidades com as de uma coorte de pacientes sem RCI à MSC. Métodos: Em 2006, 502 pacientes com idade igual ou superior a 50 anos foram submetidos à MSC. Destes, 52 pacientes (10,4%) foram identificados com RCI. A sobrevida desta coorte foi comparada àquela observada em uma coorte de 408 pacientes sem RCI por meio de curvas de Kaplan-Meier. A regressão de Cox foi utilizada para avaliação da relação entre a RCI à MSC e a mortalidade. Variáveis com p < 0,05 foram consideradas estatisticamente significativas. Resultados: Após seguimento máximo de 11,6 anos, 29 dos 52 portadores de RCI (55,8%) faleceram. A mortalidade total, a mortalidade cardiovascular e a mortalidade relacionada ao trauma desta coorte de pacientes não foram significativamente diferentes daquelas encontradas nos 408 pacientes sem RCI (mortalidade total com RCI: 55,8% versus 49,3% sem RCI; p: 0,38). Conclusões: No fim do seguimento, a mortalidade dos 52 portadores de RCI foi semelhante à observada em uma coorte de pacientes sem RCI. A mortalidade cardiovascular e a relacionada ao trauma também foi semelhante nas duas coortes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Carotid Artery Diseases/physiopathology , Carotid Artery Diseases/mortality , Carotid Sinus/physiopathology , Heart Arrest/physiopathology , Heart Arrest/mortality , Syncope/physiopathology , Syncope/mortality , Proportional Hazards Models , Risk Factors , Follow-Up Studies , Longitudinal Studies , Statistics, Nonparametric , Electrocardiography , Kaplan-Meier Estimate , Heart Injuries/physiopathology , Heart Injuries/mortality
18.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 391-395, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1012351

ABSTRACT

Prior statements have recommended restriction from competitive sports participation for all athletes with ICDs. Recent data, however, suggests that many athletes can participate in sports without adverse events. In the ICD Sports Registry, 440 athletes, aged 8-60 years, 77 of which were high-level interscholastic athletes, who had continued to practice sports, were prospectively followed for 4 years, with no deaths or failures to defibrillate during practice, and no injuries related to arrhythmia or shock during sports. Shocks did occur, for ventricular and supraventricular arrhythmias. While more athletes received shocks during physical activity than at rest, there were no differences between competition or practice, versus other physical activity. Programming with higher rate cut-offs and longer durations was associated with fewer inappropriate shocks, with no increase in syncope. Based on this study, current recommendations now state that returning to competition may be considered for an athlete with an ICD. In considering this decision, the underlying disease and type of sport should be discussed, and shared decision-making between doctor, patient, and often family, is critical


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Sports , Defibrillators, Implantable , Athletes , Quality of Life , Sports , Syncope , Cardiovascular Diseases/mortality , Exercise , Death, Sudden, Cardiac/prevention & control , Electrocardiography/methods
19.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3 Supl): 320-323, jul.-set. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1023248

ABSTRACT

A cardiomiopatia periparto é uma causa rara de insuficiência cardíaca no período entre o último mês de gestação e os cinco meses após o parto. A síndrome do QT longo caracteriza-se pelo atraso da repolarização ventricular e pode se manifestar com síncope e morte súbita devido a um tipo de taquicardia ventricular polimórfica conhecida como torsades de pointes. Descrição do caso: J.S., 26 anos, sexo feminino, natural e procedente de São Paulo. Paciente puérpera - 40º dia (G3P3A0), procurou o pronto-socorro com queixa de síncope durante amamentação e dispneia em moderados esforços. Durante a avaliação no PS, evoluiu para desconforto torácico e agitação psicomotora, sendo notada taquicardia ventricular não sustentada no monitor cardíaco ( torsades de pointes), que foi controlada com cardioversão elétrica e sulfato de magnésio intravenoso. O eletrocardiograma mostrou ritmo sinusal, alteração difusa da repolarização ventricular e intervalo QTc de 580 ms. O ecocardiograma mostrou disfunção sistólica moderada, com fração de ejeção do ventrículo esquerdo de 43% à custa de hipocinesia difusa. Após avaliação da equipe de arritmologia chegou-se ao diagnóstico de cardiomiopatia periparto associado à síndrome do QT longo. Foi iniciado tratamento otimizado para insuficiência cardíaca e implantado cardiodesfibrilador por causa de episódios recorrentes de arritmia durante a internação. Discussão: A cardiomiopatia periparto é uma doença rara, porém, tem taxa de mortalidade elevada, entre 18% e 56%. A paciente descrita satisfez os quatro critérios para o diagnóstico: sintomas de insuficiência cardíaca nos primeiros 5 meses depois do parto, ausência de cardiomiopatia prévia, etiologia desconhecida e disfunção sistólica com FEVE < 45%. A síndrome do QT longo é uma doença genética de apresentações variáveis. Os fatores que desencadeiam as taquiarritmias são situações de instabilidade elétrica por hiperatividade do sistema simpático e também situações raras, como a cardiomiopatia periparto. Em casos de arritmias ventriculares graves, o tratamento é o implante de cardiodesfibrilador. Conclusão: A associação da cardiomiopatia periparto com a síndrome do QT longo é rara. A gravidade associada a essas condições torna importante o diagnóstico precoce e tratamento imediato pelo potencial risco de morte associado a ambas as condições clínicas


Peripartum cardiomyopathy is a rare cause of heart failure during the period between the last month of pregnancy and five months after delivery. Long QT syndrome is characterized by a delay in ventricular repolarization and may manifest with syncope and sudden death due to a type of polymorphic ventricular tachycardia known as torsades de pointes. Case description: J.S., 26-years-old, female, born and residing in São Paulo, Puerperal - 40th day (G3C3A0), went to the emergency room complaining of syncope during breastfeeding and dyspnea on moderate exertion. During evaluation in the ER, the patient developed thoracic discomfort and psychomotor agitation, with non-sustained ventricular tachycardia on the cardiac monitor (torsades de pointes), which was controlled with electrical cardioversion and intravenous magnesium sulfate. The electrocardiogram showed sinus rhythm, diffuse alteration of ventricular repolarization and QTc interval of 580 ms. The echocardiogram showed moderate systolic dysfunction, with a left ventricular ejection fraction of 43% influenced by diffuse hypokinesia. After evaluation by the arrhythmology team, the diagnosis of peripartum cardiomyopathy associated with long QT syndrome was made. Optimized treatment for heart failure was initiated and a cardioverter-defibrillator was implanted due to recurrent episodes of arrhythmia during hospitalization. Discussion: Peripartum cardiomyopathy is a rare disease, but it has a high mortality rate, between 18% and 56%. The patient described met the 4 diagnostic criteria: symptoms of heart failure in the first 5 months after delivery, absence of prior cardiomyopathy, unknown etiology, and systolic dysfunction with LVEF<45%. Long QT syndrome is a genetic disease of varying presentations. The factors that trigger the tachyarrhythmias are situations of electrical instability due to sympathetic system hyperactivity and rare situations, such as peripartum cardiomyopathy. In cases of severe ventricular arrhythmias, the treatment is a cardioverter-defibrillator implant. Conclusion: The association of peripartum cardiomyopathy with long QT syndrome is rare. The severity associated with these conditions points out early diagnosis and immediate treatment important because of the potential risk of death associated with both clinical conditions


Subject(s)
Humans , Female , Adult , Long QT Syndrome , Tachycardia, Ventricular , Peripartum Period , Cardiomyopathies/diagnosis , Syncope , Risk Factors , Torsades de Pointes , Electrocardiography/methods , Heart Rate
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