RESUMO
Wolff-Parkinson-White syndrome is a common condition in the emergency department. A case is presented of a 76-year-old patient with acute chest pain and broad complex tachycardia. Despite the fact that previous and post cardioversion ECG tracings in sinus rhythm showed no signs of pre-excitation, the characteristic pattern of pre-excited atrial fibrillation (AF) is recognized and after successful DC cardioversion the patient is referred for catheter ablation of the accessory pathway. This case illustrates a non-typical presentation of the WPW syndrome, with an older patient than usual with slight signs of pre-excitation. We highlight the need for high grades of suspicion for the early recognition of pre-excited AF when attending patients with tachycardia and the obligation to know the distinctive aspects of its management for this potentially life-threatening arrhythmia.
Assuntos
Acidentes de Trânsito , Contusões/diagnóstico , Oclusão Coronária/diagnóstico , Vasos Coronários/lesões , Traumatismos Cardíacos/diagnóstico , Infarto do Miocárdio/diagnóstico , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Idoso , Angioplastia Coronária com Balão/instrumentação , Contusões/etiologia , Angiografia Coronária , Oclusão Coronária/etiologia , Oclusão Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Feminino , Traumatismos Cardíacos/etiologia , Humanos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Stents , Tomografia Computadorizada por Raios XRESUMO
Familial restrictive cardiomyopathy is an autosomal dominant cardiomyopathy histologically characterized by myocyte hypertrophy and interstitial fibrosis. The case of a 54-year-old man diagnosed with restrictive cardiomyopathy is reported. The patient had been implanted with a two-chambered pacemaker for a complete atrioventricular block 12 years before. The family history was positive with several affected members, none of whom had findings of skeletal myopathy. Genetic analysis of the index patient revealed no troponin I mutations.
RESUMO
Prospectively, clinical and biochemical data of 83 patients with a diagnosis of pericardial effusion were studied. The etiologies were as follows: Idiopathic: 42 cases (50%); Tuberculous: 18 cases (22%); Neoplastic: 14 cases (17%); Other: 9 cases (11%) with a miscellaneous etiology. Sedimentation rate resulted significantly higher in Tuberculous group (67-102), p<0.05. The highest values of adenosine deaminase in pericardial fluid were observed in Tuberculous group (110 U/l), p<0.001. Diagnosis of tuberculosis was established by culture of the bacillus in sputum in 8 cases and by pericardial biopsy in 11 patients. Analysis of the pericardial fluid leads to diagnosis in 25 cases (30%). The pericardial biopsy resulted as the most reliable method for the diagnosis of tuberculous pericarditis.
