Bloqueio divisional ântero-medial intermitente em paciente com insuficiência coronária / Intermittent antero-medial divisional block in patients with coronary disease

We report the case of a 69 year-old male who developed congestive heart failure functional class IV (NYHA). The admission electrocardiogram (EKG) revealed sinus rhythm, PR interval of 240 ms, QRS interval of 110 ms, the QRS vector of 0 degree, Q waves from V1 to V6, tall R waves from V1 to V4 that decreased to V5 and V6. The vectocardiogram had anteriorization of the electrical forces of QRS, with vector half area in the horizontal plane at +60 degrees. After two years the patient had a myocardial infarction, the EKG at the admission had the same pattern and after two days developed important changes: enlargement of QRS interval with length of 160 ms, QRS vector of +100 degrees, R waves at D2, D3 e AVF that increase from D2 to D3, QS at D1, AVL, AVR and V1, rS at V2 and V3, R wave is notched and thickened+ at V5 and V6, that return to the initial pattern after one day. The patient progressed to death in the eighth day after infarction. This case reported a intermitent pattern of EKG that is an uncontestable proof to the existence of the left middle fascicular block.

Prolapso da valva mitral e elasticidade cuspidiana / Mitral valve prolapse and cusp elasticity

PURPOSE--To verify if systolic bulging of floppy mitral cusps can to elastic behavior of their myxomatous collagen tissue. METHODS--Five hearts with floppy mitral valves obtained from autopsies were distended with air (20 to 250 mmHg) through a catheter connected to the left ventricle. It was observed if some area of the atrial surface of the coapted cusps showed variable bulging according to the variation of air injection pressures. Molding of those surfaces (gypsum) allowed the same kind of analysis by other four researches. It was analyzed the cut surfaces of these radially sectioned molds. Lately, isolated tendinae chords were submitted to repeated tractions and observed if they exhibited elastic behavior. Histological study defined the presence of collagen myxomatous degeneration and quantified the amount of elastic tissue. RESULTS--In no case it was detected elastic bulding of mitral cusps. Cut surfaces of the molds confirmed that no increment of the prominent areas occurred, even in those regions with extensive, histologically confirmed, myxomatous substitution of the native collagen tissue. CONCLUSION--Increment of the degree of mitral bulging occurring during ventricular systole can not be ascertained to cusp elasticity but probably to papilar muscle traction

Dinâmica da contraçäo "post-mortem" do ventrículo esquerdo / Dynamics of the postmortem contraction of the left ventricle

A dinâmica de contraçäo "post-mortem" do ventrículo esquerdo de coraçöes caninos foi analisada por meio de ventriculografia concluindo-se que: 1 - o "rigor mortis" cardíaco provocou uma contraçäo aproximadamente concêntrica do ventrículo esquerdo, muito mais intensa que a contraçäo fisiológica; 2 - a fraçäo de ejeçäo "post-mortem" foi de 79 + ou - 6%; 3 - o resfriamento seletivo de uma regiäo miocárdica (ponta) causou atraso regional no desenvolvimento do "rigor mortis", fazendo surgir, na ventriculografia "post-mortem" uma imagem "aneurismática"; o reaquecimento desta área, por sua vez, permitiu que ocorresse o seu encurtamento, o que resultou, no final, em reduçäo volumétrica e alteraçäo de arquitetura semelhantes àquelas observadas nos coraçöes que desenvolveram "rigor" de modo mais homogêneo

Uma complicação pouco comum das próteses valvares cardíacas. Relato de um caso / An unusual complication of cardiac valve prosthesis. Report of a case

Relata-se um caso de embolia da arteria coronaria esquerda com origem em trombo formado na protese valvar tipo StarrEdwards, colocada em posicao aortica. Esta verificacao se deu durante o exame necroscopico

Taquicardia ventricular pelo uso de amiodarona. Relato de um caso. / Ventricular tachycardia by the use of amiodarone.Report of a case

O autores apresentam o caso de paciente que, durante esforco fisico, desenvolveu taquicardia ventricular, na vigencia de altas doses de amiodarona