Taquicardia por reentrada ramo ramo / Bundle-branch reentrant tachycardia

A taquicardia por reentrada ramo a ramo, apesar de ter sido descrita há cerca de 30 anos, é entidade por vezes desconhecida de muitos cardiologistas e, por vezes, não identificada por eletrofisiologistas. Provavelmente subdiagnosticada, em especial nos portadores de cardiomiopatia dilatada, essa entidade acomete pacientes com lesão do sistema elétrico infra-hissiano. O reconhecimento dessa arritmia é importante para poder oferecer tratamento curativo, diminuir a necessidade de antiarrítmicos e minimizar terapias apropriadas após um implante de cardiodesfibrilador implantável

Although the bundle-branch reentrant tachycardia was described about 30 years ago, it is unknown to many cardiologists, and at times it is not identified by electrophysiologists. Probably underdiagnosed, especially in patients with dilated cardiomyopathy, this entity affects patients with lesion of the infra-His system. Identifying this arrhythmia is important to enable curative treatment, decrease the need for antiarrhythmics and minimize appropriate therapies after the implant of an implantable cardiac defibrillator

Prognóstico da Cardiomiopatia dilatada com insuficiência cardíaca grave de acordo com escalas de classificação funcional na infância / Prognosis of dilated cardiomyopathy with severe heart failure according to functional classification scales in childhood

Fundamento: A insuficiência cardíaca é principal manifestação da cardiomiopatia dilatada na infância, e a avaliação sistematizada dos sinais e sintomas permite acompanhar o resultado do tratamento. Objetivo: Avaliar o uso de três escalas de classificação funcional da insuficiência cardíaca na evolução de crianças e adolescentes com cardiomiopatia dilatada. Métodos: Estudo longitudinal e observacional incluindo pacientes de zero a 18 anos com cardiomiopatia dilatada e insuficiência cardíaca inicial grave. Todos foram acompanhados por meio das escalas New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) e Ross versão 2012. As análises estatísticas foram feitas com uso do Statistical Package for Social Science , versão 14.0, com teste de Mann-Whitney, teste qui quadrado ou de Fisher, aplicação da Curva Característica de Operação, teste de Wilcoxon e coeficiente de Kappa, para comparação das escalas, e curva Kaplan-Meier, para avaliação da sobrevida. O nível de significância adotado foi de 5%. Resultados: Foram incluídos 57 pacientes, com idade de 1 a 200 meses (média de 48,7 ± 55,9) e seguimento de 6 a 209 meses (média de 63,6 ± 48,4). Houve substancial concordância das escalas Ross 2012 e The NYU PHFI com a NYHA (Kappa = 0,71 e 0,82, respectivamente). A análise pareada pelo teste de Wilcoxon, comparando as escalas antes e após o tratamento, foi significativa (p < 0,0001). A sobrevida maior foi encontrada nos pacientes com classes I/II pela NYHA ou pontuação menor que 11 pontos nas outras. Conclusão: O uso das escalas de avaliação funcional da insuficiência cardíaca se mostrou útil no seguimento e na avaliação da resposta terapêutica. Pacientes que permaneceram em classes funcionais III ou IV de NYHA, ou com pontuação igual ou maior que 11 na Ross 2012 ou na The NYU PHFI tiveram pior prognóstico

DOI: 10.5935/2359-4802.20170085 12 International Journal of Cardiovascular Sciences. 2018;31(1)12-21 ARTIGO ORIGINAL Correspondência: Fátima Derlene da Rocha Araújo Rua Indiana, 789, Ap 301. CEP: 30460350, Jardim América, Belo Horizonte, MG ­ Brasil. E-mail: fatima.derlene@hotmail.com, cleverpsi@hotmail.com Prognóstico da Cardiomiopatia Dilatada com Insuficiência Cardíaca Grave de Acordo com Escalas de Classificação Funcional na Infância Prognosis of Dilated Cardiomyopathy with Severe Heart Failure according to Functional Classification Scales in Childhood Fátima Derlene da Rocha Araújo, Rose Mary Ferreira Lisboa da Silva, Henrique de Assis Fonseca Tonelli, Adriana Furletti M Guimarães, Sandra Regina Tolentino Castilho, Zilda Maria Alves Meira Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG ­ Brasil Artigo recebido em 14/02/2017; revisado em 17/04/2017; aceito em 05/06/2017 Resumo Fundamento: A insuficiência cardíaca é principal manifestação da cardiomiopatia dilatada na infância, e a avaliação sistematizada dos sinais e sintomas permite acompanhar o resultado do tratamento. Objetivo: Avaliar o uso de três escalas de classificação funcional da insuficiência cardíaca na evolução de crianças e adolescentes com cardiomiopatia dilatada. Métodos: Estudo longitudinal e observacional incluindo pacientes de zero a 18 anos com cardiomiopatia dilatada e insuficiência cardíaca inicial grave. Todos foram acompanhados por meio das escalas New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) e Ross versão 2012. As análises estatísticas foram feitas com uso do Statistical Package for Social Science , versão 14.0, com teste de Mann-Whitney, teste qui quadrado ou de Fisher, aplicação da Curva Característica de Operação, teste de Wilcoxon e coeficiente de Kappa, para comparação das escalas, e curva Kaplan-Meier, para avaliação da sobrevida. O nível de significância adotado foi de 5%. Resultados: Foram incluídos 57 pacientes, com idade de 1 a 200 meses (média de 48,7 ± 55,9) e seguimento de 6 a 209 meses (média de 63,6 ± 48,4). Houve substancial concordância das escalas Ross 2012 e The NYU PHFI com a NYHA (Kappa = 0,71 e 0,82, respectivamente). A análise pareada pelo teste de Wilcoxon, comparando as escalas antes e após o tratamento, foi significativa (p < 0,0001). A sobrevida maior foi encontrada nos pacientes com classes I/II pela NYHA ou pontuação menor que 11 pontos nas outras. Conclusão: O uso das escalas de avaliação funcional da insuficiência cardíaca se mostrou útil no seguimento e na avaliação da resposta terapêutica. Pacientes que permaneceram em classes funcionais III ou IV de NYHA, ou com pontuação igual ou maior que 11 na Ross 2012 ou na The NYU PHFI tiveram pior prognóstico. (Int J Cardiovasc Sci. 2018;31(1)12-21) Palavras-chave: Cardiomiopatia Dilatada, Prognóstico, Insuficiência Cardíaca, Escalas, Criança, Adolescentes. Abstract Background: Heart failure is the main manifestation of dilated cardiomyopathy in childhood, and the systematic evaluation of signs and symptoms allows monitoring the treatment outcome. Objective: To evaluate the use of three functional classification scales of heart failure in children and adolescents with dilated cardiomyopathy. Methods: Longitudinal and observational study including patients from zero to 18 years with dilated cardiomyopathy and severe initial heart failure. All of them were followed up using the New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) and Ross version 2012 scales. Statistical analyzes were done using Statistical Package for Social Science, version 14.0, with Mann-Whitney test, Chi-Square test or Fisher's test, application of the Operating Characteristic Curve, Wilcoxon test and Kappa coefficient for comparison of scales and Kaplan-Meier curve for survival evaluation. The level of significance adopted was 5%. Results: A total of 57 patients, aged from 1 to 200 months (mean of 48.7 ± 55.9) and follow-up of 6 to 209 months (mean of 63.6 ± 48.4) were included. There was substantial agreement between the Ross 2012 scales, The NYU PHFI and NYHA (Kappa = 0.71 and 0.82, respectively). Paired analysis by the Wilcoxon test, comparing the scales before and after treatment, was significant (p < 0.0001). The greatest survival was found in patients with class I/II by NYHA or scores lower than 11 points in the others. Conclusion: The use of functional assessment scales of heart failure proved to be useful in the follow-up and evaluation of the therapeutic response and there was no difference between them. Patients who remained in functional classification III or IV NYHA or scores ≥ 11 in Ross 2012 or The NYU PHFI had worse prognosis

Miocardiopatía dilatada reversible asociada a hipotiroidismo severo / Reversible dilated cardiomyopathy in hypothyroidism, case report

Dilated cardiomyopathy is usually not reversible. In a few cases diverse etiologies can be treated and cardiomyopathy may disappear or improve significantly. The case of a young man with hypothyroidism and dilated cardiomyopathy is presented. After thyroid hormone replacement, a severe left ventricular dysfunction became reverted.

RE: Relation of Late Gadolinium Enhancement to Increased Ventricular Wall Stress in Dilated Cardiomyopathy

No abstract available.

Reserva de fluxo coronariano e padrão de disfunção diastólica empacientes com cardiomiopatia dilatada / Coronary Flow Reserve and Diastolic Dysfunction Pattern In Patients with Dilated Cardiomyopathy

Introdução: Na cardiomiopatia dilatada (CMD) de origem não isquêmica uma reserva coronariana diminuída estáassociada a maior risco de morte e um dos possíveis mecanismos é o aumento das pressões de enchimento doventrículo esquerdo. Objetivo: Avaliar a reserva de fluxo coronariano (RFC) pela Ecocardiografia Transtorácica (ETT) e comparar com graus de função diastólica.Métodos: Foram estudados 156 pacientes com CMD não isquêmica (101 homens, média etária 53 ± 12 anos) e disfunção sistólica importante. A função diastólica foi avaliada pelo fluxo transvalvar mitral, fluxo venoso pulmonar e Doppler tecidual, e classificada em: normal (Grau 0); alteração de relaxamento (Grau I); padrão pseudonormal (Grau II); restritivo com reversão à manobra de Valsalva (grau III); e restritivo sem reversão à manobra de Valsalva (Grau IV). A RFC foi determinada pelo fluxo obtido com o Doppler pulsado na artéria descendente anterior e calculada como a relação entre a velocidade diastólica máxima durante a hiperemia (dipiridamol, 0,84 mg/Kg) e no basal.Resultados: Todos os pacientes apresentavam disfunção sistólica importante, fração de ejeção média de 25,3 ± 5,7%; 86 pacientes (55%) apresentavam função diastólica grau 0 ou I, enquanto 70 pacientes (45%) apresentavam disfunção diastólicagraus II, III e IV. A exequibilidade da medida de RFC foi de 90,4%. A RFC foi significativamente maior nos pacientes com função diastólica 0 ou I (2,2 ± 0,5) do que nos pacientes com disfunção diastólica graus II, II e IV (1,9 ± 0,5; p < 0,001). Conclusões: A RFC apresenta-se reduzida em pacientes com CMD de origem não isquêmica e graus avançados de disfunção diastólica.

Introduction: In patients with nonischemic dilated cardiomyopathy (DCM), decreased coronary flow reserve is associated with increased risk of death and one of the possible mechanisms is the increased left ventricular filling pressures. Objective: To evaluate the coronary flow reserve (CFR) by transthoracic echocardiography (TTE) and compare it with degrees of diastolicfunction in patients with DCM. Methods: We studied 156 patients with DCM (101 men, mean age 53±12 years) and severe systolic dysfunction. Diastolic function was assessed by mitral inflow, pulmonary venous flow and tissue Doppler, and classified as normal (grade 0), impaired relaxation pattern (Grade 1), pseudonormal pattern (Grade 2), reversible restrictive pattern during Valsalva maneuver (Grade 3) and irreversible restrictive pattern during Valsalva maneuver (Grade 4). The CFR was determined by pulsed Doppler in left anterior descending coronary artery and calculated as the ratio of the maximumdiastolic velocity during hyperemia (dipyridamole, 0.84 mg/kg) and baseline. Results: All patients had significant systolic dysfunction, with mean left ventricular ejection fraction of 25.3±5.7%. 86 patients (55%) had grade 0 or 1 diastolic function while 70 patients (45%) had grades II, III or IV of diastolic dysfunction. The feasibility of CFR obtained by TTE was 90.4%. The CFR was significantly higher in patients with diastolic dysfunction 0 or 1 (2.2±0.5) than in patients with diastolic dysfunction grades II, II or IV (1.9±0.5, p<0.001). Conclusion: CFR is reduced in patients with nonischemic DCM and advanced degrees of diastolic dysfunction.

Sindrome de inmunodeficiencia adquirida: compromiso del corazón y de los vasos / AIDS: cardiovascular involvement

Las complicaciones cardiovasculares del SIDA, son a menudo asintomáticas, aunque en ocasiones pueden constituir la causa directa de muerte. Puede comprometerse el pericardio, miocardio, endocardio y los vasos, ya sea como manifestación de la enfermedad de base o como resultado de la terapia antirretroviral y su efecto sobre los factores de riesgo, en el contexto de una patología que es actualmente de evolución crónica y con mejores expectativas de sobrevida gracias a las nuevas drogas empleadas para su control y tratamiento. El objetivo de este artículo es presentar una revisión de los aspectos más relevantes del SIDA que comprometen al corazón y los vasos.

The cardiovascular complications of AIDS, are often asymptomatic, although some may be direct cause of death. Pericardium, myocardium, endocardium, and vessels may be involved as a result of illness or the adverse effects of antiretroviral therapy on risk factors, Today has become a chronic condition with improved life expectancy thanks to the development of new drugs for its treatment and control The aim of this article is to present a review of the most relevant aspects of AIDS involving the heart and vessels.

Cardiomyopathy induced by artificial cardiac pacing: myth or reality sustained by evidence? / Miocardiopatia dilatada induzida por estimulação cardíaca artificial: mito ou realidade sustentada pelas evidências?

Implantable cardiac pacing systems are a safe and effective treatment for symptomatic irreversible bradycardia. Under the proper indications, cardiac pacing might bring significant clinical benefit. Evidences from literature state that the action of the artificial pacing system, mainly when the ventricular lead is located at the apex of the right ventricle, produces negative effects to cardiac structure (remodeling, dilatation) and function (dissinchrony). Patients with previously compromised left ventricular function would benefit the least with conventional right ventricle apical pacing, and are exposed to the risk of developing higher incidence of morbidity and mortality for heart failure. However, after almost 6 decades of cardiac pacing, just a reduced portion of patients in general would develop these alterations. In this context, there are not completely clear some issues related to cardiac pacing and the development of this cardiomyopathy. Causality relationships among QRS widening with a left bundle branch block morphology, contractility alterations within the left ventricle, and certain substrates or clinical (previous systolic dysfunction, structural heart disease, time from implant) or electrical conditions (QRS duration, percentage of ventricular stimulation) are still subjecte of debate. This review analyses contemporary data regarding this new entity, and discusses alternatives of how to use cardiac pacing in this context, emphasizing cardiac resynchronization therapy.

A estimulação cardíaca artificial (ECA) é o tratamento mais seguro e eficaz para a bradicardia sintomática irreversível. Nas indicações propícias, pode trazer grande benefício clínico. Contudo, as evidências mostram que a ação da ECA geraria, em alguns casos, efeitos deletérios à estrutura e fisiologia cardíacas. Este potencial efeito negativo da ECA convencional poderia ser mais acentuado principalmente em pacientes com comprometimento prévio da função ventricular esquerda e, sobretudo, quando o eletrodo é colocado em posição apical do ventrículo direito (VD). Intrigante é, contudo, que após quase 6 décadas de ECA do VD, apenas uma reduzida parcela de pacientes apresenta esta condição clinicamente manifesta. Os determinantes do surgimento ou não da cardiopatia por ECA não estão totalmente esclarecidos. Ainda é motivo de debate a existência de uma relação de causalidade entre o padrão de BRE artificial secundário à ativação antifisiológica ventricular, alterações da dinâmica contrátil ventricular, e condições clínicas (disfunção sistólica prévia, cardiopatia estrutural preexistente, tempo desde o implante) ou elétricas (duração do intervalo QRS, dose percentual de estimulação ventricular). Esta revisão aborda dados contemporâneos sobre esta nova entidade e discute alternativas de como utilizar a ECA neste contexto, com ênfase na terapia de ressincronização cardíaca.

Cardiomyopathy induced by incessant fascicular ventricular tachycardia / Miocardiopatía inducida por taquicardia ventricular fascicular incesante

A 12-year-old girl with symptoms of fatigue, decreased exercise tolerance and progressive dyspnea (New York Heart Association functional class III) with a possible diagnosis of dilated cardiomyopathy secondary to viral myocarditis. Because of incessant wide QRS tachycardia refractory to antiarrhythmic drugs, she was referred for electrophysiological study. The diagnosis was idiopathic left ventricular tachycardia involving the posterior fascicle of the left bundle branch. After successful treatment with radiofrequency catheter ablation guided by a Purkinje potential radiological and echocardiographic evaluation showed complete reversal of left ventricular function in the first 3 months and no recurrence of arrhythmia during 2 years of follow up.

Niña de 12 años de edad con síntomas por fatiga, disminución de la tolerancia al ejercicio y disnea progresiva (clase funcional III de la New York Heart Association) con un posible diagnóstico de miocardiopatía dilatada secundaria a miocarditis viral. Debido a taquicardia con QRS ancho de comportamiento incesante refractaria a diversos fármacos antiarrítmicos fue referida para estudio electrofisiológico. El diagnóstico final fue taquicardia ventricular izquierda idiopática con participación del fascículo posterior de la rama izquierda. Después del tratamiento exitoso con ablación transcatéter con radiofrecuencia guiado por un potencial de Purkinje la evaluación radiológica y ecocardiográfica demostró reversión completa de la función ventricular izquierda en los primeros 3 meses y sin recurrencia de la arritmia durante 2 años de seguimiento.

Hypothyroidism: A reversible aetiology of dilated cardiomyopathy.

Hypothyroidism has various cardiovascular manifestations, impairment of LV diastolic function being the commonest. We hereby report a young female who presented to us with features of congestive heart failure and on subsequent work-up she was diagnosed as a case of dilated cardiomyopathy of reversible aetiology, i.e., hypothyroidism.

Miocardiopatía dilatada en paciente con lupus eritematoso sistémico: reporte de un caso / Dilated cardiomyopathy in patient with systemic lupus erythematosus: case report

INTRODUCCIÓN: El Lupus Eritematoso Sistémico (LES) es una enfermedad autoinmune de etiología desconocida, cuyo cuadro clínico incluye diversas manifestaciones cardiovasculares, lasque se pueden presentar entre el 50 y 60 por ciento de los pacientes. La miocarditis es infrecuente (10 por ciento), pudiendo evolucionar tanto a miocardiopatía dilatada como a la mejoría. PRESENTACIÓN DEL CASO: Mujer de 40 años con antecedentes de LES diagnosticado el año 2008 y hospitalización anterior por cuadro de síndrome nefrótico, consulta en la urgencia del Hospital Guillermo Grant Benavente el por cuadro clínico de dos semanas de evolución caracterizado por disnea de mínimo esfuerzo, oliguria y edema continuo de extremidades inferiores. Destacan dentro de sus exámenes de ingreso: creatinina de 1,8 mg/dl, PCR <5 mg/l e índice proteinuria/creatininuria aislada >5; radiografía de tórax muestra cardiomegalia. Se hospitaliza en servicio de medicina interna para manejo. Evoluciona con mayor disnea ydolor torácico, por lo que se realiza ecocardiograma que revela miocardiopatía dilatada y disfunción sistólica severa. Se añade al tratamiento esteroidal previo, furosemida, carvedilol, enalapril y bolos de metilprednisolona y ciclofosfamida. Paciente evoluciona satisfactoriamente, con disminución de la disnea y leve edema de las extremidades inferiores, aunque permanece con valores de creatinina alterados. Luego de un mes es dada de alta. DISCUSIÓN: Señalamos que la miocardiopatía dilatada es una complicación infrecuente del LES, y si bien es cierto es la principal explicación para el cuadro clínico de insuficiencia cardiaca en esta paciente, no explica por si sola la sintomatología, considerando el antecedente de compromiso renal.

INTRODUCTION: Systemic Lupus Erythematosus is an autoimmune disease of unknown etiology, whose clinical picture includes various cardiovascular manifestations, which occur in between the 50 and 60 percent of the patients. Myocarditis is a rare complication (10 percent) and may evolve to dilated cardiomyopathy, or to the improvement. CASE REPORT: Forty year old woman with a history of Systemic Lupus Erythematosus diagnosed in 2008 and previous hospitalization for nephrotic syndrome, consultates in the urgency of Guillermo Grant Benavente Hospital because of a two weeks clinical picture characterized by small effort dyspnea, oliguria and continuous edema of lower extremities.Stands in their entrance examinations: creatinine 1.8 mg / dl, CRP <5 mg/l, proteinuria /creatinine index >5; X-ray shows cardiomegaly. It is decided to hospitalized the patient. Evolves with increasing respiratory distress and chest pain, so it is decided to do echocardiogram, wich revealed dilated cardiomyopathy and severe systolic dysfunction. It´s added to her prevoiuos steroid treatment, furosemide, carvedilol, enalapril, methylprednisolone and cyclophosphamide. The patient has a satisfactory evolution, with decreased dyspnea and mild edema of the lower extremities, although it remains with altered values of creatinine. The patient is sent home and referred to early control. DISCUSSION: We propose that dilated cardiomyopathy is a rare complication of Systemic Lupus Erythematosus, and though we can say that it is the main explanation for the clinical picture of this patient, it does not explain by itself the symptomatology, considering the history of renal involvement.

Alteraciones cardiovasculares en pacientes con infección por VIH / Cardiovascular disorders in patients with HIV infection

El presente trabajo constituye una revisión bibliográfica donde se reflejan los posibles mecanismos de producción de las afecciones cardíacas en pacientes con VIH positivo y con SIDA, donde se concluyó que el VIH podría ser considerado como una infección viral capaz de generar riesgo de afecciones cardíacas, al nivel del endocardio valvular y mural y desencadenar la aparición de endocarditis. El miocardio es una de las estructuras cardíacas más afectadas con la aparición de miocarditis intersticial, miocardiopatía dilatada, neoplasias cardíacas como el sarcoma de Kaposi y el linfoma inmunoblástico de células B. De todas las estructuras cardíacas la más afectada, según estudios de necropsias, es el pericardio con la presencia de pericarditis aguda, derrame pericárdico ligero, moderado y severo, el taponamiento cardíaco y la pericarditis constrictiva. Por último, al nivel del endotelio coronario se ha visto el desarrollo de aterosclerosis coronaria, secundaria a hiperlipidemias, que se atribuyen a la introducción del tratamiento antirretroviral el cual induce la aparición de un síndrome metabólico, el que podría provocar una disfunción del endotelio coronario

This paper is a bibliographic revision of the possible mechanisms of heart disease generation in HIV positive and AIDS patients, which concluded that HIV could be considered as a viral infection capable of generating risk of heart disease at the level of the valvular and mural endocardium and triggering the onset of endocarditis. The myocardium is one of the cardiac structures most frequently affected by the emergence of interstitial myocarditis, dilated cardiomyopathy, cardiac neoplasms such as Kaposi's sarcoma and immunoblastic B-cell lymphoma. Of all cardiac structures, the most frequently affected, according to autopsy studies, is the pericardium, with the presence of acute pericarditis; mild, moderate and severe pericardial effusion; cardiac tamponade and constrictive pericarditis. Finally, the development of coronary atherosclerosis secondary to hyperlipidemia has been observed at the level of the coronary endothelium, which is attributed to the introduction of antiretroviral treatment leading to the emergence of a metabolic syndrome, which could cause coronary endothelial dysfunction

Miocardiopatía por hipocalcemia / Hypocalcemic cardiomyopathy

Se presenta el caso de un varón de 56 años, portador de Miocardiopatía dilatada, considerada, en algún momento, como terminal. Se comprobó que presentaba de base una hipocalcemia crónica secundaria a hipoparatiroidismo. Se discute su notable respuesta a administración de calcio e infusión de levosimendan IV fármaco inotropo positivo que actúa sensibilizando al calcio.

role of dyslipidaemia in pathogenesis of familial dilated cardiomyopathy and nonischemic heart failure

This study had been designed to evaluate the serum lipid profile concentrations in patients with familial dilated cardiomyopathy [FDCM] and nonischemic DCM, and search for a correlation between serum lipid concentrations and the severity of heart failure. This case controlled study was conducted in Department of Cardiology in Ibn Albitar Hospital, Baghdad and in Department of Physiological Chemistry, College of Medicine, University of Baghdad from January 2005 to November 2005. Fifty-one patients DCM were included in this study, 7 patients with FDCM [40-70 years], and the remainder 44 patients with nonischemic DCM [19-72 years old]. Twenty-five healthy subjects [21-60 years] taken as a control group. Investigations included serum estimation of total cholesterol [Tch], triglyceride [TG], low density lipoprotein-cholesterol [LDL-C], high density lipoprotein-cholesterol [HDL-C], HDL-C/LDL-C ratio and Tch/LDL-C ratio in patient and control groups. Some of the echocardiographic parameters were also measured in all patients. The mean [ +/- SD] values of serum concentrations of Tch and LDL-C did not differ significantly between patient groups and controls. Serum TG concentration was significantly increased in patients with FDCM and nonischemic DCM when compared with healthy controls [p<0.018, p<0.011; respectively]. Serum HDL-C concentration was significantly decreased in nonischemic DCM patients compared with controls [p<0.0001]. An important significant correlations were also observed between the serum lipid concentrations and the echocardiographic values in patient groups. Our data revealed that lipid profile abnormalities, in particular high serum TG and low serum HDL-C concentrations, may contribute to the development of FDCM and nonischemic DCM

Sheehan syndrome with reversible dilated cardiomyopathy

Cardiac abnormalities in patients with Sheehan syndrome are uncommon. A case of Sheehan syndrome with dilated cardiomyopathy is presented in whom hormone replacement with levothyroxine and prednisolone resulted in complete recovery of cardiomyopathy. A 25-year-old woman presented with lactation failure, secondary amenorrhea, features of hypothyroidism and a hypocortisol state following severe postpartum hemorrhage after her last child birth. She also had smear positive pulmonary tuberculosis. After starting antitubercular treatment, she developed shock, suggestive of hypocortisol crisis. Hormonal investigations revealed evidence of panhypopitutarism and magnetic resonance imaging revealed partial empty sella. Meanwhile echocardiography revealed evidence of dilated cardiomyopathy [DCM]. The patient was given replacement therapy in the form of glucocorticoids and levothyroxine in addition to antitubercular treatment. She improved and on follow-up over a period of 7 months, the DCM completely reversed. To our knowledge this is the first report of reversible DCM in a patient with Sheehan syndrome

Cardiopatia chagásica crônica na Amazônia: uma etiologia a ser lembrada / Chronic chagasic cardiopathy in Amazon region: an etiology to remember / Cardiopatía chagásica crónica en la Amazonía: una etiología que recordar

Este estudo avaliou a frequência de cardiopatia chagásica crônica (CCC) em 37 pacientes autóctones da Amazônia com disfunção sistólica ventricular esquerda sem etiologia definida. Foram diagnosticados três casos com frequência de 8,1 por cento no grupo estudado.

This study assessed the frequency of chronic chagasic cardiopathy (CCC) in 37 autochthonus patients from Amazon region with left ventricular systolic dysfunction of undefined etiology. Three cases were diagnosed in the studied sample, with an 8.1 percent frequency.

Este estudio evaluó la frecuencia de cardiopatía chagásica crónica (CCC) en 37 pacientes autóctonos de la Amazonía con disfunción sistólica ventricular izquierda sin etiología definida. Se diagnosticaron tres casos con frecuencia del 8,1 por ciento en el grupo estudiado.