Defeito do septo átrio ventricular em adulto portador de trissomia do 21 / Case Report defect of the septure ventricular atrial in asult trissomy carrier of 21

Introdução: Dos pacientes com Síndrome de Down que possuem cardiopatias congênitas, metade possuem defeitos no septo atrioventricular, em associação de comunicação interatrial, comunicação interventricular e a persistência do canal arterial. Descrição do caso: M.N.S, 42 anos, portador de trissomia do 21. Encaminhado para a cardiologia,dia 07/09/16, para realização do cateterismo cardíaco após dor torácica recorrente e sopro sistólico. Na admissão, referiu precordialgia, com intensidade forte e duração de um dia, sem irradiações e fatores desencadeantes. Possui histórico de internações recorrentes de dor precordial e história familiar marcante de cardiopatias. Na avaliação clínica, encontrou-se sopro sistólico panfocal acentuado pela manobra de Rivero-Carvallo e diminuído com a manobra de Valsalva, confirmando sobrecarga de câmaras direitas. Realizou-se CATE de câmaras direitas e esquerdas no dia 09/09, onde conclui-se a presença de defeito septo AV de forma intermediária, hipertensão arterial pulmonar,hiperfluxo pulmonar,dilatação moderada da artéria pulmonar, aumento das dimensões do átrio esquerdo e constatou-se que o retorno venoso dáse para átrio esquerdo por uma comunicação interatrial ampla. Foi submetido à correção cirúrgica no dia 19/09/16, onde foi realizado plastia da valva mitral, correção da comunicação interatrial ostium primum com remendo pericárdico bovino e o fechamento do forame oval. Após a cirurgia, foi encaminhado para o CTI, onde permaneceu estável, sendo extubado no dia 21/09. Recebeu alta do CTI no dia 26/09 e encaminhado para a enfermaria para cuidados pós-cirúrgicos. Conclusão: É possível concluir que o despreparo de pequenos centros urbanos faz com que o serviço de saúde se direcione para os grandes centros urbanos e como muitas vezes isso não é possível, o diagnóstico e a terapêutica se dão tardiamente. (AU)

Introduction: Of the patients with Down syndrome who have congenital heart defects, half have defects in the atrioventricular septum, in the association of atrial septal defect, ventricular septal defect and persistence of the ductus arteriosus. Case description: MNS, 42 years old,with trisomy 21. Referred to cardiology, day 07/09/16, to perform cardiac catheterization after recurrent chest pain and systolic murmur. On admission, he reported precordialgia,with strong intensity and duration of one day, without irradiation and triggering factors. He has a history of hospitalizations recurrence of precordial pain and marked family history of cardiopathies.In the clinical evaluation, a panfocal systolic murmur accentuated by the Rivero-Carvallo maneuver and decreased with the Valsalva maneuver,confirming overhead of right chambers.CATE of right chambers and on the 09/09, where the presence of an AV septal defect is found in pulmonary arterial hypertension, pulmonary hyperflow, moderate dilation of the pulmonary artery, enlargement of the left atrium, and venous return to the left atrium by extensive atrial septal defect. It was submitted to surgical correction on day 19 / 09, where mitral valve repair was performed,correction of the ostium primum atrial septal defect with bovine pericardial patch, and closure of the oval foramen. After surgery, the patient was referred to the ICU where he remained stable and was extubated on September 21. He was discharged from the ICU on September 26 and was sent to the ward for post-surgical care. Conclusion: It is possible to conclude that the lack of preparation of small urban centers causes the health service to be directed to large urban centers and how often this not possible, diagnosis and therapy are delayed. (AU)

Hypertrophic obstructive cardiomyopathy in a Yorkshire Terrier / 대한수의학회지

An 11-year-old, castrated male dog presented with a 3-month history of cough and depression. Auscultation revealed systolic murmur and thoracic radiographs showing enlargement of both the atrium and left ventricle. Echocardiography showed thickened mitral valve and moderate-to-severe left atrial enlargement. Additionally, M-mode echocardiography showed symmetric left ventricular wall thickening and systolic anterior motion of the mitral valve, while Doppler imaging revealed high velocity turbulent flow through the left ventricular outflow tract. Based on echocardiography, this case was diagnosed with hypertrophic obstructive cardiomyopathy. After 5 months, the dog was clinically static in radiography and echocardiography.

Pulmonic stenosis with atrial septal defect in a Siamese cat

A 6-month-old mature intact female Siamese cat presented with exertional dyspnea. Diagnostic studies revealed pleural effusion, grade 4/6 left basal systolic murmur, deep S-wave in electrocardiograph leads I, II, and III, cardiomegaly with pleural effusion on radiography, pulmonic systolic (~5.8 m/sec) and tricuspid (3.6 m/sec) regurgitant jets, atrial septal defect, and a hypoplastic right outflow tract. Based on these results, the case was diagnosed as pulmonic stenosis with atrial septal defect. To the best of our knowledge, this is the first case report describing pulmonic stenosis with atrial septal defect in a cat in Korea.

Unusual Disc Dislodgement of a Björk-Shiley Valve after Long-term Implantation

No abstract available.

Musical murmur in a dog with acute chordae tendineae rupture / 대한수의학회지

A 6 year-old, spayed female, Maltese dog was presented with precordial thrill and mild coughing. Thoracic auscultation revealed a grade V/VI systolic murmur with maximal intensity over the left apex characterized by musical murmur. Echocardiography revealed mild myxomatous degeneration of mitral valve and ruptured chordae tendineae. Musical murmur was produced due to the vibration of ruptured piece of chordae tendineae along with regurgitant flow. After treatment with furosemide and ramipril, clinical signs resolved and precordial thrill reduced. This case report describes typical clinical signs and phonocardiogram of musical murmur in a dog with acute chordae tendineae rupture.

Systolic heart murmur as first manifestation of high output heart failure due to the vein of galen malformation / Soplo sistólico como primera manifestación de insuficiencia cardiaca de gasto alto secundaria a malformación de la vena de Galeno

The vein of Galen aneurysmal malformation (VGAM) is an extremely rare arteriovenous malformation. The VGAM clinical manifestations vary depending on the magnitude of vascular compromise and the age at initial presentation. Neonates typically present with severe congestive heart failure. Here we present a case in which a systolic heart murmur was the first manifestation of high output heart failure due to a VGAM.

Las malformaciones de la vena cerebral de Galeno (MVG) son extremadamente raras. Sus manifestaciones clínicas varían dependiendo de la magnitud del compromiso vascular y la edad inicial de presentación. En neonatos, típicamente se presenta con una insuficiencia cardiaca congestiva grave. Se presenta un caso en el cual un soplo sistólico cardiaco fue la primera manifestación de una insuficiencia cardíaca de gasto alto secundaria a una malformación aneurismática de la vena de Galeno.

Iron Deficiency Anemia due to Long-time Bloodletting Using Cupping / 가정의학회지

We report three cases of iron deficiency anemia due to long-time bloodletting using cupping. Case 1 was a 52-year-old man who sought evaluation at the Health Promotion Center in our hospital due to fatigue and dyspnea on exertion (DOE). There were no abnormal findings on his general health examination, except anemia. He has performed self-bloodletting for a long time with cupping on his back and extremities for fatigue, myalgias, or polyarthralgias. Case 2 was a 52-year-old woman with fatigue and DOE. The physical examination revealed a systolic murmur at her left lower anterior chest and pale conjunctiva. The initial hematocrit was 22.4% and the hemoglobin was 6.4 g/dL. She has self-bloodletted using cupping 2 to 3 times a week when she felt tired or had myalgias. Case 3 was a 35-year-old man with sudden onset fatigue and DOE. He had severe DOE during a challenging physical test. He frequently received bloodletting using cuppings on his back and extremities by a doctor of Oriental medicine. There were no abnormal findings on the general health examination, except anemia. All three patients were diagnosed with iron deficiency anemia due to chronic blood loss. We recommended stopping bloodletting using cupping and prescribed oral iron supplements.

[Clinical and hematological findings in affected dairy cows with combined tricuspid and mural endocarditis]

Endocarditis of cattle can develop as valvular, mural or concurrent involvement of the valvular and mural endocardium. Given the importance of endocarditis among the diseases of the cardiovascular system in cattle, 568 dairy cows were studied through complete clinical examination, looking particularly for special signs of heart involvement. The cows suspected of having a heart problem were labeled following the identification. Additional measures including blood sampling, carcass examination, and lesion sampling for histopathology were carried out in the abattoir, and endocarditis was diagnosed in 2.81% of the cases. The mean age of the cows with endocarditis was 5.4 years. The body temperature was higher than 39[degree sign]C in 56.2% of the cases. Almost 70% of the cows had more than 84 heart beats per minute. Acardiac systolic murmur was found in 56.2% of the cows. Fewer than 5,500 white blood cells per microliter and neutrophilia with more than 40% neutrophils was diagnosed in 75% and 50% of the cases, respectively. Given these results, it was concluded that despite the absence of audible systolic murmur using a stethoscope, it is probable to see valvular endocarditis, particularly in industrial mid-aged dairy cows with a focal active infective involvement showing mild fever, persistent high or at least relatively high heart beat rate and intensity, marginal leucopenia, and relatively increased neutrophils and monocytes. Therefore it may be suitable to conduct echocardiography due to its very applicable findings

Mujer de 60 años con disnea progresiva, hipertensión arterial de díficil control y soplo sistólico irradiado a cuello. / 60-year-old woman with progressive dyspnea, difficult arterial hypertension control and systolic breath radiated to the neck.

Una paciente de sexo femenino de 60 años de edad, costurera, natural de Rio de Janeiro, fue valorada por el servicio de clínica cardiológica por queja de falta aire, catalogada como disnea, que inicia con grandes esfuerzos y que evoluciono en corto tiempo a disnea de medianos esfuerzos con aparecimiento de disnea paroxística nocturna. Su cuadro se acompaña de vértigo y cefalea de más de 30 años de evolución, que empeora en los dos últimos años. Adicionlmente refere dolor de espalda de tipo no anginoso de localización interescapular .

A 60-year-old female patient, a seamstress, a native of Rio de Janeiro, was assessed by the cardiology clinic for a complaint of lack of air, cataloged as dyspnea, which begins with great efforts and evolved shortly time to dyspnea of ​​medium efforts with appearance of paroxysmal nocturnal dyspnea. His picture is accompanied by vertigo and headache of more than 30 years of evolution, which worsens in the last two years. Additionally refer back type pain non-anglo of interscapular location.

Aorticopulmonary septal defect in a dog: case report / Defeito do septo aórtico-pulmonar em um cão: relato de caso

A 10-month-old intact female mixed breed dog was referred for evaluation of exercise-induced dyspnea and a low grade II/VI systolic murmur was detected. The communication between ascending aortic and pulmonary trunk was observed by detecting a continuous flow just above the semilunar valves on echoDopplercardiography and attested by surgery. After the surgical procedure, the dog was presented in good clinical conditions without exercise-induced dyspnea, reflecting the importance of an early and accurate diagnostic for the therapeutic success. This is the first Brazilian report of this rare congenital disease and the unique well succeed surgery in the veterinary literature.

Na avaliação da dispneia pós-exercício em uma cadela de 10 meses de idade, não castrada e sem raça definida, foi detectado sopro sistólico leve grau II/VI. A comunicação entre a aorta ascendente e o tronco pulmonar, observada pela presença de fluxo contínuo logo abaixo das valvas semilunares, à eco Dopplercardiografia, foi confirmada pela cirurgia. Após o procedimento cirúrgico, a cadela apresentou boa condição clínica e ausência de dispneia mesmo ao exercício. Ressalta-se a importância do diagnóstico precoce e preciso para o sucesso terapêutico. Este é o primeiro relato brasileiro dessa rara doença e a única cirurgia, bem sucedida, descrita na literatura veterinária consultada.

A Case of Infundibular Pulmonic Stenosis in Adult

A 47-year-old woman was admitted for evaluation of exertional dyspnea (NYHA II-III) that was lasting for 20 years. On physical examination, a grade III systolic murmur in the left second intercostal spaces was detected. The chest Xray showed mild cardiomegaly. ECG showed biatrial and biventricular hypertrophy. Transthoracic echocardiography showed severe infundibular pulmonic stenosis (pressure gradient=174 mmHg), moderate tricuspid regurgitation (jet velocity=6.6 m/sec) with biatrial enlargement and biventricular hypertrophy. Transesophageal echocardiogram showed severe infundibular pulmonic stenosis. Right ventriculography and catheterization revealed a pressure gradient between pulmonary artery and right ventricle (178/6 mmHg). We reported a rare case of infundibular pulmonic stenosis with intact ventricular septum in adult with literatures.

[Prevalence of cardiac murmurs in clinically healthy horses of riding schools [Shiraz, Isfahan and Tehran]]

To determine the prevalence of cardiac murmurs in clinically healthy horses of riding schools [Shiraz, Isfahan and Tehran]. Field Study. Five hundred and twenty six horses [475 sporting and 51 non-sporting horses]. Horses were divided into: sporting horses [jumping, race, endurance, training], non-sporting horses [foals, pleasure] and two different age groups:>2 and 2 years old was significantly greater than horses 2 years old can be related with increase in the prevalence of systolic murmurs on the tricuspid valve. This finding may be due to the effect of training and occurrence of eccentric cardiac hypertrophy

Incidencia de la comunicación interventricular en niños de 0-5 años: manifestaciones clínicas y métodos diagnósticos, hospital pediátrico Roberto Gilbert, 2003 / Incidence of interventricular communication in children 0-5 years: clinic manifestations and diagnostic methods, Dr. Roberto Gilbert hospital 2003

Tipo de estudio: retrospectivo, descriptivo, longitudinal y analítico. Objetivo: Determinar las manifestaciones clínicas y métodos diagnósticos de la CIV, eficaces y económicos en niños atendidos en el hospital “Roberto Gilbert“. Metodología: se incluyeron en este estudio 150 pacientes con CIV como defecto único que acudieron a la consulta externa y con edades comprendidas entre 0 - 5 años. Resultados: el grupo de edad en que se diagnosticó la mayoría de los casos fue 0-1 años, 52,6% hombres y 47,4% mujeres. Las manifestaciones clínicas predominantes fueron: soplo cardiaco 100%, taquipnea 66,6% y disnea 50%. El método diagnóstico mas eficaz y efectivo fue el Eco-Doppler, permitiendo conocer el diámetro del defecto: < 0,5 cm (43,3%), 0,5 -1,5 cm (53,3%) y > 1,5 cm (3,3%); la localización: CIV muscular (35,3%) y CIV perimembranosa (64,6%) y el mecanismo de semicierre: restrictiva (espontáneo) 71,3% y corrección quirúrgica 28,6%. Conclusiones: en este grupo de estudio se encontró como principal manifestación clínica de la CIV, soplo cardiaco localizado en el borde esternal inferior izquierdo de intensidad V/VI, y el diagnóstico de certeza se lo obtuvo mediante la combinación de auscultación, radiografía de tórax, EKG y Eco Doppler.

Type of study: retrospective, descriptive, longitudinal and analytic. Objective: to determine clinic manifestation and diagnostic manifestations of CIV, effective and economic in children of the Dr. “Roberto Gilbert” hospital. Methodology: there were included in this study 150 patients with CIV like unique defect that coming at the external consulting and ages between 0 – 5 years old. Results: the age group which was diagnosed the most of cases was 0 – 1 years, 52,6% men and 47,4% women. The clinic manifestations predominant was: cardiac murmur 100%, taquipnea 66,6% and disnea 50%. The diagnostic method more effective and efficient was the Eco-Doppler, allowing to know the diameter of the defect: < 0,5 cm (43,3%), 0,5-1,5 cm (53,3%) y CIV perimembranosa (64,6%) and the semicloses mechanism: restrictive (spontaneous) 71,3% and surgical correction 28,6%. Conclusions: in this group, it found like principal clinic manifestations of CIV, cardiac murmur located in the right lower costal margin, of intensity V/VI, and the right diagnostic is combination of auscultation, X-ray of thorax, EKG and Eco Doppler

Localized Pulmonary Edema in Patient with Severe Mitral Regurgitation / 결핵및호흡기질환

An 82-year-old female non-smoker with a history of hypertension presented with increasing dyspnea, cough and some purulent sputum without fever. Upon admission, the patient was in a distressed condition. Auscultation revealed diminished breath sounds with no rales over the right lung. An examination of the heart revealed a regular rhythm and a systolic murmur radiating from the apex of the heart. There was no pitting edema in the lower extremities. The blood tests showed mild leukocytosis and an increased C-reactive protein level. The O2 saturation was 98 % whilst breathing room air. The electrocardiogram demonstrated sinus tachycardia. The chest radiograph showed a moderate cardiomegaly, right lobe infiltrates, and blunting of the both costophrenic sulcus suggesting a small pleural effusion. Three days after admission, the symptoms became slightly aggravated despite being treated with empirical antibiotics for presumed community-acquired pneumonia. Transthoracic color Doppler echocardiography indicated an ejection fraction of 48 %, mild left ventricular enlargement, and moderate left atrial enlargement resulting in severe mitral regurgitation. The clinical symptoms and right pulmonary edema resolved quickly with intravenous furosemide treatment.

Diagnosis of Coronary Artery Disease

The routine evaluation of coronary artery disease should include a history that obtains data on the charactor of pain, age, associated symptoms, and past history. The physical examination should include vital signs, a cardiovascular and pulmonary examination. The initial resting ECG plays a central role. Exercise ECG is an appropriate first-line test for patients with an intermediate probability of coronary artery disease. Echocardiogram is as a routine test for diagnosis of the case of acute chest pain especially in patients with a systolic murmur or regional wall motion almormality. Imaging during physical or pharmacological stress is considered to be appropriate in patients for whom exercise ECG is unlikely to be useful because of baseline ECG abnormalities. Pharmacological stress with adenosine or dipyridamole is appropriate for patients who are unable to exercise. Coronary angiography is not considered clearly appropriate as routine test for diagnosis of chronic stable angina in most patients except for those who had survived sudden cardiac death. But it is considered appropriate for diagnosis of angina whose diagonsis is still uncertain after noninsasive testing. Cardiac troponin is as a preferred marker for acute ischemic injury. Biochemical cardiac markers should be performed for all patients with suspected acute myocardial infarction.

Obstruction of Right Ventricular Outflow Tract by Extended Cardiac Metastasis from Esophageal Cancer

We report a case in whom there was right ventricular outflow tract obstruction by extended metastasis from esophageal cancer. A 65-year-old man was admitted to hospital for evaluation of recent onset of weight loss of recent onset and a heart murmur. Physical examination revealed a regular heart rate of 62 beats per minute and a blood pressure of 110/70 mmHg. On cardiac auscultation, a grade 4/6 systolic murmur was heard over the area of pulmonic valve. Electrocardiography showed low voltage. Chest radiography showed a normal cardiac configuration and no pulmonary abnormality was seen. Esophagogram and endoscopy showed a 10cm sized ulcerative and infiltrative esophageal cancer. This esophageal cancer was histologically proven to be a squamous cell carcinoma. To assess the cardiac metastasis, echocardiography, MRI, coronary angiography, and endomyocardial biopsy were performed. The MRI, echocardiography and right ventriculography revealed a 7 cm sized lobulated mass extending to the right ventricular outflow tract, right ventricle, septum, and anterior wall of the left ventricle. Interestingly, the feeding vessels of the tumor were identified by echocardiography and coronary angiography. Histologically, the cardiac tumor was proven to be have the same pathologic findings as the an esophageal cancer, compatible with carcinomatous metastasis.

A Case of Anomalous Origin of Left Coronary Artery from the Pulmonary Artery with Severe Mitral Regurgitation

We report a case of an anomalous origin of left coronary artery from the pulmonary artery with severe mitral regurgitation. A 20-year-old female was admitted to hospital for recurrent syncope and dyspnea on exertion. Cardiac ausculatation revealed systolic murmur radiating to left axilla and blood pressure of 90/70 mmHg. Electrocardiography showed a nonspecific ST-T wave change on V1, V2, V6, I, & aVL leads. Holter monitering showed no significant abnormality except occasional premature ventricular complexes. Chest radiography showed mild cardiomegaly with mitral valvular heart configuration and no pulmonary abnormality. Echocardiography showed normal left ventricular dimension and systolic function with marked dilated left atrium, severe mitral regurgitation, & severe resting pulmonary hypertension. Aortogram didn't show left coronary artery ostium. Right coronary angiogram showed normal right coronary artery which supplied major left epicardial coronary arteries via good collaterals (Rentrop grade III). Pulmonary angiogram showed anomalous origin of left coronary artery from main pulmonary trunk. She underwent mitral valvuloplasty and coronary artery bypass graft.