ABSTRACT
INTRODUCTION: Arrhythmogenic right ventricular dysplasia (ARVD), disease of uncertain etiology, is characterized by fibrofatty collections in the right ventricular myocardium, premature ventricular complexes with left bundle branch block (LBBB) morphology, ventricular tachycardia and fibrillation. GOALS: To point out diagnostic methods for this progressive disease and to analyze differential diagnosis and significance of arrhythmogenic right ventricular dysplasia in young, active athletes. RESULTS: Arrhythmogenic right ventricular disease can be asymptomatic or manifested (syncope). It is not uncommon that the first evidence of the disease is ventricular tachycardia/fibrillation or sudden cardiac death. Results of electrocardiography, echocardiography, invasive and other methods can, even after few years, be negative for ARVD. The most significant ECG features are inverese T wave in precordial V1-V3 leads and widened QRS complex (> 120 ms) in V1 lead. Significant echocardiographic features and data obtained by invasive hemodynamic examinations are: dilated right ventricle, left and right ventricular end-diastolic diameter ratio less then 0.5, hypokinetic/akinetic areas involving the wall of the right ventricle, predominantly inferobasal, apical and wall of the left ventricular outflow tract. Findings may also include deep fissures among hypertrophied trabeculae. Biopsy may reveal fibrofatty tissue in hypo/akinetic regions of the right ventricular myocardium. DISCUSSION AND CONCLUSION: Since arrhythmogenic right ventricular dysplasia is diagnosed in predominantly young population, not uncommonly athletes, and since it may be cause of sudden cardiac death, there must be a high degree of suspicion in cases with activity related VT/VF and positive family history (it is proposed that it is a hereditary disease).
Subject(s)
Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Arrhythmogenic Right Ventricular Dysplasia/therapy , Diagnosis, Differential , HumansABSTRACT
INTRODUCTION: The objective of this study was to examine the occurrence of asymptomatic myocardial ischemia prior to and after myocardial revascularization in patients with multivessel occlusive coronary disease. Asymptomatic ischemia can be described as real ischemia without anginal pain or other ischemic symptoms in patients with coronary disease or coronary artery spasm. Our study examined silent ischemia after myocardial revascularization. Early detection of silent ischemia is important for prevention of cardiac incidents. MATERIAL AND METHODS: We have examined patients with multivessel coronary disease with occurrence of continued preoperative silent ischemia. All patients have undergone ECG examination, exercise stress test and Holter-monitoring prior to and after myocardial revascularization. RESULTS: The investigation comprised 27 patients and their average age was 54.5 years. All patients with silent ischemia had a multivessel occlusive coronary disease and have undergone myocardial revascularization managed with triple or quadruple aortocoronary bypass surgery. Exercise stress test was performed postoperatively in elder patients, as well as ECG and Holter-monitoring. Silent ischemia was established in 21.6% of patients, while in 87.5% untreated diabetes mellitus was diagnosed. Silent ischemia most often occurred in the early morning hours and it was frequently associated with heart rhythm disturbances (VES) whereas these rhythm disturbances depended on the length of the ischemic episode. Intermittent 2nd degree atrioventricular block was found in one patient. CONCLUSION: Silent myocardial ischemia occurred in 21% of patients after myocardial revascularization. It is most often detected in the early morning hours and is associated with ventricular rhythm disorders. Silent ischemia is easily detected by simple examination procedures providing adequate therapy and prevention of cardiac incidents.
