UNEXPECTED SUDDEN DEATH IN A YOUNG MAN WITH MYOPERICARDITIS--A CASE REPORT.

A 31 years man was referred by general practitioner (GP) with chest pain preceded by sore throat a week ago. Electrocardiogram was suggestive of pericarditis and Troponin and inflammatory markers were elevated. Echocardiogram showed small pericardial effusion with normal biventricular size and function, and no regional wall motion abnormalities (RWMA). A clinical diagnosis of myopericarditis was made. Patient was in good clinical condition so he self-discharged before cardiac MRI. Two days later he died of cardiac arrest. His post mortem confirmed the diagnosis of myopericarditis. He died despite of absence of known poor prognostic features of Myopericarditis.

[Coronary artery dissection in the postpartum period--a case study]. / Postpartum coronaria dissectio esete.

Spontaneous coronary dissection is a rare condition occurring more often in women, with a higher frequency during the peripartum period. No specific aetiology has been defined to this uncommon, but often fatal disease. We describe the case of a young woman admitted to our intensive care unit with ECG-findings of acute anterior myocardial infarction presented one week after delivery. The acute coronary angiography didn't show significant stenoses or occlusion, therefore angioplasty was not done. Cardiogenic shock developed, which could be reverted by mechanical circulatory support and the condition of our patient stabilized. Later, new-onset cardiac ischemic signs presented warranting a repeated coronary angiography, which detected dissection on the distal part of the left main coronary artery with signs of flow-limiting even in the circumflex artery. Therefore, urgent coronary bypass surgery was performed with good results. Spontaneous coronary dissection must be considered when evaluating a patient in the peripartum period with signs of acute coronary syndrome, given its high overall mortality. The treatment holds specific points of consideration.

[Malignant vasovagal syncope]. / Malignus vasovagalis syncope.

The diagnosis of epilepsy is complicated by various conditions that can mimic an epileptic seizure. Many patients with abnormal seizure activity during loss of consciousness may have cardiovascular syncope with global cerebral hypoxia (convulsive syncope), which may be difficult to differentiate from epilepsy on clinical grounds. The differentiation is, however, important because they need quite different treatment modalities. In addition, long-term anticonvulsant therapy is expensive and can cause serious morbidity. The authors present a case of a patient thought to have treatment-resistant epilepsy for years with recurrent seizure-attacks, who were subsequently found to have a malignant vasovagal reaction of 24s-asystole as a cause for the so called convulsive syncope. A simple, non-invasive evaluation of circulatory responses to acute orthostasis, the head-up tilt table test, can identify cardiovascular reflex abnormalities in patients with recurrent idiopathic seizure-like episodes. The authors could also reproduce the symptoms of the spontaneous attacks in their patient by this way, to confirm an alternative diagnosis of malignant vasovagal reaction and convulsive syncope in this patient with "refractory epilepsy". This rare cardioinhibition can be safely treated by dual-chamber pacemaker implantation, alleviating for the convulsive attacks, this therapeutic option was advised to this patient as well. Orthostatic stress tests should be considered early in the diagnostic workup of patients with convulsive blackouts. Cardiac causes of loss of consciousness should be considered in patients with presumed epilepsy, atypical premonitory symptoms, non-diagnostic electroencephalograms and failure to respond to anticonvulsant therapy.

Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation.

OBJECTIVES: This study evaluated the role of various clinical and echocardiographic parameters, including the left atrial appendage (LAA) anterograde flow velocity, for prediction of the long-term preservation of sinus rhythm (SR) in patients with successful cardioversion (CV) of nonvalvular atrial fibrillation (AF). BACKGROUND: Echocardiographic parameters for assessing long-term SR maintenance after successful CV of nonvalvular AF are not accurately defined. METHODS: Clinical, transthoracic echocardiographic and transesophageal echocardiographic (TEE) data--measured in AF lasting >48 h--of 186 consecutive patients (116 men, mean age: 65 +/- 9 years) with successful CV (electrical or pharmacologic) were analyzed for assessment of one-year maintenance of SR. RESULTS: At one-year follow-up, 91 of 186 (49%) patients who underwent successful CV continued to have SR. Mean LAA peak emptying flow velocity was higher in patients remaining in SR for one year than in those with AF relapse (41.7 +/- 20.2 cm/s vs. 27.7 +/- 17.0 cm/s; p < 0.001). On multivariate logistic regression analysis, only the mean LAA peak emptying velocity >40 cm/s (p = 0.0001; chi(2): 23.9, odds ratio [OR] = 5.2, confidence interval [CI] 95% = 2.7 to 10.1) and the use of preventive antiarrhythmic drug treatment (p = 0.0398; chi(2): 4.2; OR = 2.0, CI 95% = 1.0 to 3.8) predicted the continuous preservation of SR during one year, outperforming other univariate predictors such as absence of left atrial spontaneous echocardiographic contrast during TEE, the left atrial parasternal diameter <44 mm, left ventricular ejection fraction >46% and AF duration <1 week before CV. The negative and positive predictive values of the mean LAA peak emptying velocity >40 cm/s for assessing preservation of SR were 66% (CI 95% = 56.9 to 74.2) and 73% (CI 95% = 62.4 to 83.3), respectively. CONCLUSIONS: In TEE-guided management of nonvalvular AF, high LAA flow velocity identifies patients with greater likelihood to remain in SR for one year after successful CV. Low LAA velocity is of limited value in identifying patients who will relapse into AF.