Associação entre prolapso valvar mitral e doença ventricular direita arritmogênica / Association between Mitral Valve Prolapse and Arrhythmogenic Right Ventricular Disease

PURPOSE: To evaluate some features of ventricular arrhythmias in patients with mitral valve prolapse. METHODS: We studied 25 patients (female: 19; mean age: 37 +/- 13 years) with ventricular arrhythmias, mitral valve prolapse and normal ventricular function. All patients underwent a 24h Holter and high resolution ECG (HRECG). The Qtc intervals were measured in lead II (normal < 0.44 s). In order to define the possible origin of the ventricular focus, the morphology of the ectopic beats were analysed in leads I, II, aVF, V1 using the following criteria: 1) LBBB morphology with left axis deviation in the frontal plane (FP): origin at the inflow tract of the right ventricle (RV); 2) LBBB morphology with right axis deviation in the FP: origin at the outflow tract of the RV; 3) RBBB morphology with left axis deviation in the FP: origin at the posterior region of the left ventricle (LV). RBBB morphology with right axis deviation in the FP: origin at the anterior region of the LV. RESULTS: Twenty three (92) patients showed > 720 isolated ventricular ectopic beats/24 h. Paired ventricular response was detected in 18 (72) patients and non-sustained VT in 15 (60). HRECG was positive in six (24) patients and Qtc interval was prolonged in 13 (52). RV was the site of origin of the ventricular ectopic beats in 85 of the patients (outflow: 85; inflow: 15). Only five (20) patients had arrhythmias from the LV. CONCLUSION: There was a high incidence of ventricular arrhythmias with a low incidence of positive HRECG tests, suggesting that the mechanisms of the arrhythmias do not correlate with slow intramyocardial conduction. It was noted a strong association between mitral valve prolapse, arrhythmogenic right ventricular disease and Qtc prolongation. It is possible that in some of this patients the finding could represent a global myocardial disease.

Prolapso valvar mitral e transtorno do pânico / Mitral valve prolapse and panic disorder

Verificar a incidência de prolapso valvar mitral (PVM) em portadores de transtorno do pânico (TP) com e sem agorafobia. Sessenta e cinco pacientes (37 mulheres) com idades entre 19 e 67 (média 39,8) anos. O diagnóstico de PVM baseou-se na presença de estalido mesotelessistólico (EMS) e/ou de sopro mesotelessistólico, com em dados ecocardiográficos: deslocamento mesotelessistólico de uma ou de ambas as cúspides da mitral, 2 mm ou mais, posteriormente à linha de uniäo dos pontos C-D (modo "M") ou movimentaçäo sistólica de pelo menos uma das cúspides da mitral, além do plano do anel valvar, nas incidências apical e para-esternal, eixo transversal (modo bi-dimensional). Sinais clínicos e/ou ecocardiográficos de PVM foram encontrados em 29 (44,6%) pacientes, sendo 12 (42,6%) dos homens e 17 (45,9%) das mulheres. EMS foi auscultado em 19 (29,2%) e sinais ecocardiográficos de PVM foram identificados (39,6%), ambos em 14 (23,6%) pacientes. A incidência de PVM em portadores de TP é maior do que a da populaçäo em geral, de modo mais acentuado no sexo masculino