Subject(s)
Cardiac Surgical Procedures , Ebstein Anomaly , Tricuspid Valve Insufficiency , Humans , Ebstein Anomaly/complications , Ebstein Anomaly/diagnosis , Ebstein Anomaly/surgery , Tricuspid Valve/diagnostic imaging , Tricuspid Valve/surgery , Tricuspid Valve/abnormalities , Tricuspid Valve Insufficiency/diagnosis , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/surgeryABSTRACT
Resumen: La miocardiopatía hipertrófica (MCH) es una enfermedad frecuente del miocardio, asociada a muerte súbita cardíaca (MSC). Las principales causas de muerte en MCH son la MSC, la insuficiencia cardíaca y el tromboembolismo. La fibrilación ventricular (FV) es la causa más común de MSC, seguida de asistolia, actividad eléctrica sin pulso y bloqueo auriculoventricular completo. El sustrato de estas arritmias complejas es la hipertrofia asociada a desorganización miofibrilar y fibrosis, que facilitan el desarrollo de arritmias reentrantes y secundarias a actividad desencadenada. Dado que la FV puede ser tratada con el implante de un desfibrilador automático implantable (DAI), la identificación de los pacientes que presentan mayor riesgo se transforma en la principal preocupación del cardiólogo tratante. La indicación de implante de DAI es clara en la prevención secundaria de MSC, pero es compleja en el resto de los pacientes que no han presentado FV o taquicardia ventricular sostenida, lo que configura la prevención primaria de MSC. Debemos estratificar la MCH con el uso de los factores de riesgo derivados de datos clínicos y estudios complementarios. Los principales factores de riesgo relacionados a MSC son: edad temprana al diagnóstico, antecedentes heredofamiliares de MSC, síncope inexplicado, taquicardia ventricular no sostenida, hipotensión arterial inducida durante la prueba de esfuerzo, obstrucción del tracto de salida del ventrículo izquierdo, hipertrofia ventricular izquierda severa, agrandamiento auricular izquierdo y captación de realce tardío en la resonancia magnética. El uso adecuado de los dos principales modelos de estratificación de riesgo actualmente disponibles nos ayuda a estimar el riesgo individual en cada paciente y proceder en consecuencia.
Summary: Hypertrophic cardiomyopathy is one of the most frequent cardiac muscle disorders associated with sudden cardiac death, heart failure and thromboembolism. Ventricular fibrillation is the most common cause of sudden cardiac death in hypertrophic cardiomyopathy, followed by asystole, pulseless electrical activity, and complete atrioventricular block. The substrate behind these complex arrhythmias is the hypertrophy due to myocardial disarray and fibrosis, facilitating the development of reentrant arrhythmias and triggered activity. An implanted cardioverter defibrillator is the treatment of choice, so the identification of high risk patients for ventricular fibrillation is crucial. Implanted cardioverter defibrillator indication is well established in sudden cardiac death secondary prevention, but not in patients without evidence of ventricular fibrillation or sustained ventricular tachycardia, which configures the sudden cardiac death primary prevention group. Identification of sudden cardiac death risk factors is derived from clinical data, complementary studies and validated in risk stratification models. These are: early age at diagnosis, family history of sudden death, unexplained syncope, non-sustained ventricular tachycardia, abnormal blood pressure response with exercise, left ventricular outflow tract obstruction, severe left ventricular hypertrophy, left atrial enlargement and late gadolinium enhancement on cardiac magnetic resonance imaging. The proper use of two available main risk stratification models helps us to estimate the individual patient´s risk and to proceed consequently.
Subject(s)
Female , Humans , Middle Aged , Foreign Bodies/complications , Heart , Pacemaker, Artificial/adverse effects , Electrocardiography , Heart Ventricles , HeartABSTRACT
BACKGROUND: Vasovagal syncope is the most common cause of syncope and is an amount medical, social and economic problem. MATERIAL AND METHODS: We study a population of patients with history of syncope of presumed vasovagal origin submitted to head-up tilt test (TT) with intention to describe and to compare symptoms, signs and trigger situations between positive and negative TT. Twenty four variables were investigated (chosen according to the clinical experience). RESULTS: One hundred thirteen patients were included. The age mean was 33,3 ± 19,4 years and 67.3% corresponded to women. 81 patients (71,7%) experienced syncope during test. The more frequent response was mixed subtype (58 %), followed by vasodepressor response (30,9%) and cardioinhibitory response (11,1%). There were not significant differences between both groups in symptoms, signs and trigger situations. In patients with negative TT was more frequent syncopes triggered by extreme exercise (p = 0,012). CONCLUSION: In patients with vasovagal syncope suspicion, a clinic history does not predict TT results.
Subject(s)
Syncope, Vasovagal/diagnosis , Tilt-Table Test , Adult , Female , Humans , Male , Reproducibility of Results , Syncope, Vasovagal/etiologyABSTRACT
Arrhythmogenic right ventricular dysplasia (ARVD) involves primarily the right ventricle, and should be considered in young patients presenting with syncope, ventricular tachycardia, cardiac arrest or in adults patients with congestive heart failure. Atrial electrical abnormalities due to ARVD have been rarely described. We report a case of ARVD in a 60-year-old man who developed sick sinus syndrome during evolution (sinus node recovery time of 6113 mseg). Atrial arrhythmias may be explained by gradual replacement of right atrium myocytes by adipose tissue.
Subject(s)
Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Sick Sinus Syndrome/diagnosis , Arrhythmogenic Right Ventricular Dysplasia/complications , Arrhythmogenic Right Ventricular Dysplasia/physiopathology , Electrocardiography , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Sick Sinus Syndrome/complications , Sick Sinus Syndrome/physiopathology , Syncope/etiologyABSTRACT
La displasia arritmogénica del ventrículo derecho (DAVD) compromete principalmente al ventrículo derecho y debe ser considereada en pacientes jóvenes que presentan síncope, taquicardia ventricular o paro cardíaco y en adultos con insulficiencia cardíaca congestiva. Las alteraciones eléctricas auriculares debidas a DAVD han sido poco descriptas. Informamos el caso de un varón de 60 años con DAVD que durante la evolución presentó enfermedad del nódulo sinusal (tiempo de recuperación del nódulo sinusal de 6113 mseg). Las arritmias auriculares se podrían explica® por el reemplazo gradual de los miocitos auriculares por tejido adiposo.
Subject(s)
Humans , Male , Middle Aged , Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Sick Sinus Syndrome/diagnosis , Arrhythmogenic Right Ventricular Dysplasia/complications , Electrocardiography , Heart Ventricles , Magnetic Resonance Imaging , Sick Sinus Syndrome/complications , Syncope/etiologyABSTRACT
Arrhythmogenic right ventricular dysplasia (ARVD) involves primarily the right ventricle, and should be considered in young patients presenting with syncope, ventricular tachycardia, cardiac arrest or in adults patients with congestive heart failure. Atrial electrical abnormalities due to ARVD have been rarely described. We report a case of ARVD in a 60-year-old man who developed sick sinus syndrome during evolution (sinus node recovery time of 6113 mseg). Atrial arrhythmias may be explained by gradual replacement of right atrium myocytes by adipose tissue.
ABSTRACT
La displasia arritmogénica del ventrículo derecho (DAVD) compromete principalmente al ventrículo derecho y debe ser considereada en pacientes jóvenes que presentan síncope, taquicardia ventricular o paro cardíaco y en adultos con insulficiencia cardíaca congestiva. Las alteraciones eléctricas auriculares debidas a DAVD han sido poco descriptas. Informamos el caso de un varón de 60 años con DAVD que durante la evolución presentó enfermedad del nódulo sinusal (tiempo de recuperación del nódulo sinusal de 6113 mseg). Las arritmias auriculares se podrían explica½ por el reemplazo gradual de los miocitos auriculares por tejido adiposo. (AU)
Subject(s)
Humans , Male , Middle Aged , Sick Sinus Syndrome/diagnosis , Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Sick Sinus Syndrome/complications , Arrhythmogenic Right Ventricular Dysplasia/complications , Heart Ventricles , Magnetic Resonance Imaging , Syncope/etiology , ElectrocardiographyABSTRACT
Primary sarcomas of the pulmonary artery and right ventricle are rare, and their presentation is unusual in clinical practice; therefore, their diagnosis is often missed or delayed. The progression of the obstruction from the outflow tract of the right ventricle to the pulmonary artery resembles massive pulmonary embolism. We present a case of one of these tumors which mimicked transesophageal echocardiography (TEE), a massive pulmonary embolism. We conclude that TEE represents a noninvasive method of diagnosis and evaluation when the suspicion is massive pulmonary thromboembolism or a heart tumor.
