[Pulmonary embolism: a clinical case documented, in acute setting, using pulmonary scintigraphic perfusion]. / Embolia pulmonar: um caso clínico documentado, em agudo, por cintigrafia de perfusão pulmonar.

The acute clinical evolution is presented of a patient with previous myocardial infarction who was admitted for dyspnea and chest pain. Acknowledging the possibility of a new ischemic event, confronted with aortic dissection or pulmonary embolism, the clinical investigation is described up to the scintigraphic diagnosis of pulmonary embolism. The clinical presentation, diagnostic investigation and therapeutic decisions are discussed, with emphasis on the usefulness of pulmonary scintigraphy.

[The prognostic significance of late potentials in patients with chronic coronary disease]. / Significado prognóstico dos potenciais tardios em doentes com doença coronária crónica.

OBJECTIVE: The prognostic value of late potentials (LP) in the subacute phase of myocardial infarction (MI) is well known, but its prognostic value in long-standing coronary disease (LSCD) has not yet been established. In a population with LSCD we searched for a relation between the presence of LP in signal-averaged ECG (SAECG) performed before cardiac catheterization, and the incidence of cardiac events. METHODS: Based on our department's casuistics, we selected 50 consecutive patients with coronary disease confirmed by an angiogram and LP, and a control group without LP, in SAECG. We selected 91 men and nine women with an average age of 59 +/- 8 years. None of the patients had had ischemic events or revascularization procedures, in the 3 month period before catheterization. The follow-up was made between the time of the SAECG and the last medical visit. The events recorded were: ventricular arrhythmia, cardiac death, coronary angioplasty, coronary artery by-pass graft, MI or unstable angina. RESULTS: During a follow-up period of 20.1 +/- 8 months, we found no statistically significant difference between the two groups, regarding the incidence of such events. However, there was a higher incidence of ventricular arrhythmic events in the group with LP (four patients with ventricular tachycardia against none in the control group). All patients with ventricular tachycardia had had a previous MI. CONCLUSIONS: In this study, the presence of LP in SAECG did not have the same prognostic value found in the subacute phase of MI, but a higher incidence of arrhythmic events was observed in the group with LP and a previous MI.

[The evolution of the arterial pressure during a stress test in patients with hypertrophic myocardiopathy]. / Evolução da pressão arterial durante a prova de esforço, em doentes com miocardiopatia hipertrófica.

OBJECTIVES: To study the exercise blood pressure response in patients with hypertrophic cardiomyopathy (HC) and its relationship with sudden death. DESIGN: Retrospective study. POPULATION: We studied 51 patients (P) with HC: 18 women and 33 men. Their average age was 45 +/- 14 years, with a mean follow-up of 55 +/- 37 months. METHODS: Every patient had been subjected to a treadmill stress-test, a 24-hour Holter monitoring and an echocardiographic examination. Particular emphasis was given to blood pressure increments (BPI) during stress-test, the existence of premature ventricular contractions with a frequency of 10 or more per hour (PVC > or = 10), the occurrence of couplets (C) and/or non-sustained ventricular tachycardia (NSVT) on a 24-hour Holter. Finally, the finding of systolic anterior motion (SAM) of the mitral valve, in the routine echocardiogram, was valued. RESULTS: Four patterns of BPI were identified: "1": normal evolution (27 P); "2": plateau type increment (16 P); "3": fall in blood pressure during exercise (6 P); "4": abnormal BPI during recovery (2 P). Two groups were considered: group N-normal BPI, group A-patients with abnormal blood pressure responses. There were no significant differences among therapeutic agents, between the two groups, when the stress-test was performed. SAM was found in 21 P. Only 8 P registered ventricular arrhythmias, half of them with NSVT. No statistical relations were found between BPI and P age, the presence of SAM, PVC > or = 10, C, or NSVT. We found 78% of P in group N in NYHA class I. In contrast, in group A only 46% were in class I (p = 0.04). Only one death, of non cardiac cause, occurred (group A). CONCLUSIONS: There is a large number of patients with HC and abnormal BPI. This is, seemingly, not influenced either by a dynamic left ventricular gradient or by ventricular ectopic beat occurrence. However, a relation appears to exist between the abnormal response and functional class, not explained by the usual (noninvasive) clinical tests.

[The ventricular dysrhythmia profile in patients with mitral valve pathology]. / Perfil disrítmico ventricular em doentes com patologia valvular mitral.

OBJECTIVE: To study the relation between ventricular arrhythmias and echocardiographic left ventricular data, in patients with mitral valve pathology. DESIGN: Retrospective study, based on Holter department data on ventricular arrhythmias. POPULATION: We studied 128 patients: 36 were male, 92 were female. Their mean age was 52 +/- 11 years. Three groups were outlined: 54 patients had mitral stenosis (ME), 15 patients had mitral disease (MD) and 59 had associated aortic pathology (MA). METHODS: Patients clinical records were reviewed according to an evaluating protocol. In each Holter recorded the number of premature ventricular contractions per hour (PVC/h), as well as the existence of complex ectopic forms (CF) was considered. Echocardiographic left ventricular data used was: diastolic diameter (DD), systolic diameter (DS) and shortening fraction (SF). Treatment was not significantly different between the three groups, when 24 hour monitoring was performed. RESULTS: We found the average number of PVC/h to be 14 +/- 45 in the ME group, 58 +/- 85 in the MD group and 52 +/- 11 in the MA group. There is significant difference between ME and either DM, or MA. In patients with ME significant relations were found between the occurrence of CF a greater DS (p < 0.01) and a lesser SF (p = 0.02). No significance was found for the occurrence of PVC. In patients diagnosed as DM, the occurrence of PVC/h (> or = 10) was related with greater DD (p = 0.01) or DS (p = 0.04), but there was no relation to SF. Finally in the MA group PVC occurrence was strongly related (p < 0.01) with all the echocardiographic values and thinner relations were found towards SF (p = 0.02 for DD, p = 0.03 for DS and p = 0.05 for SF). CONCLUSIONS: Ventricular arrhythmic occurrence is less frequent in ME. However, in the three groups, there is worsening left ventricular arrhythmic frequency in direct relation to greater ventricular dimensions, or compromised systolic function.