[Acute and chronic sequential atrioventricular pacing in patients with obstructive-type hypertrophic myocardiopathy resistant to medical therapy]. / Electroestimulação aurículo-ventricular sequencial aguda e crónica em doentes portadores de miocardiopatia hipertrófica de tipo obstrutivo resistente à terapêutica médica.

An evaluation was undertaken regarding two female patients suffering from obstructive hypertrophic cardiomyopathy, with high and strongly symptomatic gradients, as well as evidencing a resistance to medication with beta-blockers, verapamil and disopyramide when administered in maximal doses. These patients were provided with the implant of a definitive type DDD pacemaker, with an auricular electrocatheter placed on the right auricular appendix, and with a bipolar ventricular catheter placed on the apex of the right ventricle. The generator was programmed with a short AV so as to ensure that the ventricular stimulation would at any given time be the result of the ventricular contraction would be initiated at the apex portion of the right ventricle. With these therapeutics, we observed not only a reduction or even the gradient, but also the complete elimination of the existing symptoms--angor, dyspnea, dizziness, palpitations and fainting--with the resulting normalcy of the quality of life of the patients. All taken into account we are of the opinion that these therapeutics are, in the case of patients suffering from obstructive hypertrophic cardiomyopathy, a valid alternative for surgical treatment by means of myectomy or myotomy, but without the morbidity and mortality rates presented by such methods.

[Efficacy of the electrocardiographic diagnosis of left ventricular hypertrophy on the basis of gender]. / Eficácia do diagnóstico electrocardiográfico de hipertrofia ventricular esquerda segundo o sexo.

STUDY OBJECTIVE: To determine the efficacy of electrocardiographic criteria of Left Ventricular Hypertrophy (RVL greater than 11 mm, SVE3 + RVL greater than 20 mm in females and greater than 28 mm in males, SV1 + RV6 or SV2 + RV5) in hypertensive patients according to sex. DESIGN: Retrospective study. Gold standard M mode echocardiography. SETTING: Pulido Valente Hospital Department of Cardiology (Lisbon). PATIENTS: 56 hypertensive patients (age 55.1 s.d. 11.6), 27 females and 29 males, with LVH by echocardiographic Left Ventricular Mass Index (LVMI) greater than 110 g/m2 in woman and greater than 134 g/m2 in men, respectively 10 and 19 patients. The LVMI was calculated by the formula of the American Society of Echocardiography modified by Devereux. RESULTS: The LVMI was smaller in females than in males (P = 0.007). The Cornell Criteria had the greatest efficacy in woman and the Sokolow criteria satisfactory efficacy but in man. The electrocardiogram (1 of the 4 criteria positive) had low diagnostic efficacy in woman. CONCLUSIONS: We concluded that echocardiogram is the best non-invasive diagnostic tool of Left Ventricular Hypertrophy in hypertensive females and is necessary to adjust and choose the electrocardiographic Left Ventricular Hypertrophy criteria according to sex.

[Electrocardiographic symptom-signal correspondence in Holter records]. / Correspondência sintoma-sinal electrocardiográfico nos registos de Holter.

STUDY OBJECTIVE: To determine the correspondence symptom-sign in 24-hours ambulatory electrocardiography records. DESIGN: Retrospective study. SETTING: Pulido Valente Hospital (Lisbon). Serviço de Cardiologia. Department of Ambulatory Electrocardiography. PATIENTS: 80 patients, who made 24-hours ambulatory electrocardiography and wrote correctly the diary. Two observators analysed the correspondence symptom-sign of 269 symptomatic moments, 10 minutes before and after the symptom by reviewing the compressed print. RESULTS: We found correspondence symptom-sign in 50% of the symptomatic moments. The correspondence change with the symptom type (increased for palpitations and dyspnea), the presence of Cardiopathy (increased for chest pain and dyspnea in patients with cardiopathy) type of cardiopathy (increased in patients with Mitral Valve Prolapse and Valvular disease) and expression used by the patient.

[Arrhythmia in chronic respiratory insufficiency]. / Disritmias em insuficientes respiratórios crónicos.

Ventricular arrhythmias are frequent in chronic pulmonary disease. Hypoxemia, right ventricular enlargement, associated left ventricular dysfunction and iatrogenic factors are potential determinants of the density and complexity of these arrhythmias. Its prognostic meaning in chronic pulmonary disease and its relationship with the elevated prevalence of sudden cardiac death in these patients, are not well known. Meanwhile, the therapeutic anti-arrhythmic strategy is dominated by the correction of the etiologic factors, namely continuous oxygen therapy which decreases ventricular arrhythmia and prolongs survival. Holter 24 hours monitoring is a useful diagnostic tool in management of these patients.