Arritmia ventricular maligna asociada a un gossypiboma: reporte de un caso / Malignant ventricular arrhythmia associated to gossypiboma: clinical case report / Arritmia ventricular maligna vinculada a gossypiboma: reporte de um caso clínico

Un gossypiboma, oblitoma o textiloma se define como todo cuerpo extraño olvidado en el interior de un paciente durante una intervención quirúrgica. Representa una complicación posquirúrgica poco frecuente pero de consecuencias potencialmente graves. En general, se manifiesta con cuadros clínicos variables: una masa o pseudotumor, sangrados, fiebre, dolor, varios meses o años después de la cirugía original. También puede ser un hallazgo accidental. Describimos el caso clínico de una paciente con un gossypiboma vinculado a una cirugía cardíaca que se realizó 40 años antes al cuadro clínico actual, que se presenta con arritmia ventricular maligna.

A gossypiboma, oblitoma or textiloma is defined as a surgical object left in the interior of the body after surgery. It represents an uncommon but potentially life threatening post-surgery complication. Clinical manifestations are variable and depend on location, relations and size, from pseudo-tumoral masses, bleeding, fever, pain and other nonspecific presentations. The onset of symptoms is unpredictable, occurring from months or years after surgery. Patients may course asymptomatically and be diagnosed incidentally as an imaging finding. We describe a case of a patient with gossypiboma diagnosed 40 years after undergoing cardiac surgery, who presented with a malignant ventricular arrhythmia.

Um gossypiboma, oblitoma ou textiloma está definido como todo corpo estranho esquecido no interior de um paciente durante um procedimento cirúrgico, representando uma complicação pos cirúrgica pouco frequente, mas com consequências potencialmente graves. Geralmente, se manifesta com quadros clínicos variáveis: uma massa ou pseudotumor, sangramentos, febre, dor, varios meses ou anos após a cirurgia original ou ser um hachado acidental. Descrevemos o caso clínico de uma paciente com um gossypiboma vinculado a uma cirurgia cardíaca realizada 40 anos antes do quadro clínico atual, que se apresenta com arritmia ventricular maligna.

Arritmias y muerte súbita en la falla cardíaca: estratificación eléctrica de grupos de riesgo / Arrhythmias and sudden death in heart failure: electrical stratification of risk groups

RESUMEN Se presenta una panorámica de la falla cardíaca ligada a las arritmias y a la muerte súbita, que pueden coexistir, agravarse, o ser causa o consecuencia una de otra. Se discuten los signos eléctricos premonitorios que permiten estratificar riesgo en pacientes con eventos previos, con posible acercamiento a la realidad, y en quienes no los han presentado (la mayoría, los no protegidos), y resulta muy difícil o imposible establecer un pronóstico. Estos signos son numerosos, esquivos, de baja especificidad y sensibilidad, ninguno es absoluto ni despreciable, para interpretarlos se requiere una visión integral. Se discuten las extrasístoles ventriculares como predictoras y desencadenantes de arritmias, de muerte súbita y de miocardiopatía, y la utilidad de los procedimientos ablativos frente a los medicamentosos. Los signos eléctricos son buenos para identificar grandes grupos de riesgo pero no lo son tanto para, dentro del gran grupo de bajo riesgo (la mayoría), identificar los individuos de alto riesgo.

ABSTRACT In this research is presented an overview of heart failure related to arrhythmias and sudden death, which can coexist, worsen, or be cause or consequence of one another. Here are discussed the premonitory electrical signs that allow to stratify risk in patients with previous events, with a possible approach to reality, and in those who have not presented them (most of them, the unprotected ones) and where a prognosis is very difficult, or impossible, to be established. These signs are numerous, elusive, with low specificity and sensitivity, none is absolute or negligible, in order to interpret them, a comprehensive vision is required. Premature ventricular contractions are discussed as predictors and triggers of arrhythmias, sudden death and cardiomyopathy, as well as the usefulness of ablative procedures versus medications. Electrical signs are good for identifying large risk groups but not for identifying high risk individuals inside the large low risk group (the majority).

The Influence of High-Dose Atorvastatin in Heart Rate Variability and Malignant Ventricular Arrhythmia in Patients Underwent Emergency PCI / 天津医药

Objective To study the influence of high dose atorvastatin (80 mg/d) in early heart rate variability and malignant ventricular arrhythmia in patients underwent emergency coronary intervention (PCI). Methods A total of 350 pa-tients underwent emergency PCI were randomly divided into two groups:high dose atorvastatin group and regular dose atorv-astatin group. And 85 cases of control were enrolled randomly. The patients using high dose atorvastatin group received atorv-astatin 80 mg orally STAT upon hospitalization and 40 mg once a day from the second day. The patients using regular dose atorvastatin group received atorvastatin 40 mg orally STAT after hospitalization and 20 mg once a day from the second day. Patients were monitored by continuous dynamic electrocardiogram for 24 hours after PCI. According to the results of dynamic electrocardiogram, the early heart rate variability (HRV) and rate of malignant ventricular arrhythmia (MVA) were measured and compared between three groups. Results The values of standard deviation of all normal sinus RR intervals over 24 h (SDNN) were(108.3 ± 21.5)ms and(70.6 ± 17.6)ms for high dose atorvastatin group and regular dose atorvastatin group re-spectively. The values of SDNN measured every 5 minutes during 24 hours (SDANN) were (111.7 ± 19.2)ms and (65.9 ± 18.5)ms respectively, and values of root-mean-square of successive normal sinus RR interval difference (RMSSD) were (25.6±8.3)ms and(18.7±10.2)ms respectively, and the percentage of adjacent RR intervals that differed by more than 50 ms (PNN50) were(14.7±5.9)%and(6.9±3.4)%for high dose atorvastatin group and regular dose atorvastatin group respec-tively. The above data were significantly lower than those in control group [ (122.5±23.8) ms and (119.6±15.2) ms, (29.2±9.3) ms and (17.7±6.5)%, P＜0.05]. There were significantly higher values in high dose atorvastatin group than those in regular dose atorvastatin group (P＜0.05). The incidence rate of MVA was much higher in high dose atorvastatin group and regular dose atorvastatin group than that in normal control group (12.00%vs 21.14%vs 2.35%). The incidence rate of MVA was sig-nificantly lower in high dose atorvastatin group than that in regular dose atorvastatin group (χ2=5.29, P＜0.05). Conclu-sion The HRV was significantly reduced and the incidence rate of MVA was much higher in patients with early AMI. High-dose atorvastatin can increase the HRV and decrease the incidence rate of MVA in patients underwent emergency PCI.

Dispersive level of QT and its significance in dilated cardiomyopathy / 中国综合临床

Objective To evaluate the clinical significance of QT dispersion (QTd),QTcd in dilated cardiomyopathy(DCM).Methods QTd and QTcd on simultaneous recording 12 lead ECG in 60 DCM cases were measured and compared with 60 healthy subjects.Results QTd and QTcd in DCM group were remarkably higher than those in control group (P

Tp-e/QT ratio as a predictive index of sudden cardiac death in patients with ST-segment elevation myocardial infarction / 西安交通大学学报(医学版)

Objective To detect Tp-e/QT ratio in patients with acute ST-segment elevation myocardial infarction (STEMI) and explore its clinical significance. Methods Healthy individuals and patients with acute STEMI were recruited in this study. Their first QTc,QTd and Tp-e were measured within 24 h after admission to hospital,and Tp-e/QT ratio was calculated so as to analyze the relation between Tp-Te/QT ratio and malignant ventricular arrhythmia. Results Compared with those of the healthy individuals,the intervals of QTd,Tp-e and QTc were significantly lengthened \[(33.66?16.76)ms vs. (55.29?31.12)ms,(89.55?12.61)ms vs. (142.65?39.33)ms,and (426.57?65.03)ms vs. (482.26?48.03)ms,P