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1.
Artigo em Inglês | MEDLINE | ID: mdl-38740184

RESUMO

Vasospastic angina is a clinical condition characterized by coronary artery spasm in angiographically normal coronary arteries. Vasospastic angina can often lead to ventricular arrhythmias, sudden cardiac death, or life-threatening bradyarrhythmias, such as high-degree atrioventricular block or asystole. We present the unusual case of a woman with depressive syndrome who underwent emergency surgery for hemostasis of a neck lesion that caused hemorrhagic shock after a suicide attempt. During surgery, the electrocardiogram revealed inferior and posterior ST-segment elevation, total atrioventricular block and torsades de pointes; the patient also suffered 4 minutes of cardiac arrest. A temporary pacemaker was placed. Coronary angiography showed right coronary artery vasospasm. Following a second similar episode after tracheostomy, a permanent pacemaker was implanted. The indication for definitive electrostimulation in such a context and the stimulation mechanisms of the carotid sinus underlying vasospasm constitute the interesting points of this clinical case. LEARNING OBJECTIVE: The indication for definitive electrostimulation in a context of recurrent episodes of high-degree atrioventricular block during vasospastic angina and the stimulation mechanisms of the carotid sinus underlying vasospasm constitute the interesting points of this clinical case.

2.
J Innov Card Rhythm Manag ; 14(4): 5410-5419, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37143577

RESUMO

Ultrasound-guided axillary vein access is an effective alternative to conventional subclavian and cephalic access for cardiac implantable electronic device implantation. The aim of this study was to compare the safety, efficacy, and radiation exposure data of the ultrasound-guided axillary approach with other conventional access techniques. The study population included 130 consecutive patients, stratified as 65 (64% male; median age, 79 years) in the study group and 65 (66% male; median age, 81 years) in the control group. We performed a retrospective not-randomized analysis by comparing ultrasound-guided axillary vein puncture with subclavian and cephalic approaches in order to test the effect on X-ray exposure, total procedure time, and complications. Significant differences were observed in terms of radiation exposure, including fluoroscopy time (median, 95 s [study group] vs. 193 s [control group]; P < .001), air kerma (median, 29 mGy [study group] vs. 55.7 mGy [control group]; P < .001), and dose-area product (median, 8219 mGy·cm2 [study group] vs. 16736 mGy·cm2 [control group]; P < .001). The median procedure time was 45 min in the study group but 50 min in the control group (P < .05). Complications occurred in 6 control group patients (1 urticaria contrast medium-related, 3 pneumothorax, 2 subclavian artery puncture) and 2 study group patients (2 axillary artery puncture). We conclude that the ultrasound-guided axillary venous approach is a fast, feasible, and safe technique for cardiac lead implantation. It allows a significant reduction in fluoroscopy time without prolonging the procedural time. This approach offers direct visualization of the vessel during the puncture, so it can be useful in patients who cannot receive contrast medium, those who require "difficult" thoracic approaches (emphysema, too much or too little fat tissue), or those on anticoagulant therapy.

3.
Indian Pacing Electrophysiol J ; 22(3): 161-164, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35378279

RESUMO

Subcutaneous hematoma is a complication of cardiac device implantation. In most cases, it is drained or spontaneously reabsorbed. While cases of chylothorax are rare, and cases of pseudochylothorax even rarer, previous cases of accumulation of chyliform material in the subcutaneous pockets of cardiac devices are anecdotal. We present a case of a 60-year-old man with antiphospholipids antibody syndrome and rheumatoid arthritis, who underwent dual-chamber ICD implantation in December 2020; the procedure was complicated by a pocket hematoma, which required surgical drainage. After 7 months, the man returned owing to heart failure, with evidence of the reappearance of a large swelling in the ICD pocket; this was tolerated for months by the patient and was no longer controlled. We drained 100ml of gold-colored, odorless liquid, and found no evidence of blood material in the pocket. The liquid was not pus, as culture testing proved negative for bacterial growth. Chemical-physical examination revealed elevated cholesterol concentration (704 mg/dl) and low levels of triglycerides (80 mg/dl; plasma cholesterol values were 91mg/dl, and triglycerides 48 mg/dl). Microscopic examination revealed isolated leukocytes and rare erythrocytes immersed in mucoid material; cytological analysis showed a carpet of macrophages filled with cholesterol. This evidence supports the diagnosis of pseudochyle fluid, formed by the degradation of a hematoma left intact in a closed cavity for more than 6 months. This is an extremely rare case of chyliform fluid documented in an ICD pocket.

4.
Monaldi Arch Chest Dis ; 92(2)2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34802223

RESUMO

Giant coronary artery aneurysm is an uncommon disease, treated with surgical intervention or percutaneous coil embolization. A thrombosed aneurysm can cause extrinsic compression on the cardiac chambers, with potential hemodynamic effects and may cause problems when we need to implant a cardiac device. We present a case of difficult pacemaker implantation in a patient with 3 syncopes, first-degree AV block and complete left bundle branch block on electrocardiogram. The patient presented a giant aneurysm of the right coronary artery (85 x 90 mm), thrombosed, with right atrial compression. The pacemaker implantation was hampered by the difficulty of passing the lead through the compressed right atrium; indeed, only with simultaneous echocardiographic and fluoroscopic guidance, was it possible to complete the procedure. This case demonstrates the utility of echocardiogram, in particular settings, in cardiac stimulation procedures.


Assuntos
Bloqueio Atrioventricular , Aneurisma Coronário , Marca-Passo Artificial , Bloqueio Atrioventricular/etiologia , Bloqueio de Ramo , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Humanos , Marca-Passo Artificial/efeitos adversos
5.
Monaldi Arch Chest Dis ; 91(3)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33691391

RESUMO

Pheochromocytoma is a rare adrenal tumor characterized by the secretion of catecholamines and vasoactive peptides. It can cause a catecholaminergic storm and lead to acute coronary syndromes. We present the case of a 53-year-old man, without any medical history, who arrived to the hospital following a spinal trauma due a fall. He presents back and retrosternal pain, with a clinical status of acute pulmonary edema, sinus tachycardia with left bundle branch block, left ventricular apical ballooning with depressed systolic function. Blood tests show a very important increase of Troponin and transaminases. A contrast chest-abdomen CT highlighted a right adrenal solid mass, with a diameter of 78mm, partial capsular laceration, compression of the inferior vena cava and the hepatic parenchyma. The clinical condition of the patient rapidly worsens from a respiratory and hemodynamic point of view, with cardiogenic shock, anuria and sepsis, refractory to all the medical treatments, until the patient died. The autopsy confirmed that the abdominal mass was a pheochromocytoma, broken after the trauma suffered. The resulting catecholaminergic storm caused a myocardial ischemia with Takotsubo syndrome, with cardiogenic shock. This unfortunate case confirms the pheochromocytoma as important risk factor for the onset of Takotsubo syndrome, and the how dramatic and severe a catecholaminergic storm can be.


Assuntos
Neoplasias das Glândulas Suprarrenais , Feocromocitoma , Cardiomiopatia de Takotsubo , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Arritmias Cardíacas , Catecolaminas , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/complicações , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico
6.
J Electrocardiol ; 58: 37-42, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31710873

RESUMO

Andersen-Tawil Syndrome (ATS) is a rare periodic paralysis with typical skeletal and neuromuscular features. Cardiac involvement may range from asymptomatic ventricular arrhythmias to sudden death. Its management remains challenging and the choice between antiarrhythmic drug therapy and implantable cardioverter defibrillator (ICD) is not simple. We present a case of ATS patient with episodes of bidirectional ventricular tachycardia, well controlled by flecainide therapy initially, which in particular conditions of fever and hypokaliemia had a cardiac arrest with ventricular fibrillation, with neurological sequelae and need of an ICD implant. A review of the therapeutic management of this disease is presented.


Assuntos
Síndrome de Andersen , Desfibriladores Implantáveis , Taquicardia Ventricular , Síndrome de Andersen/complicações , Síndrome de Andersen/diagnóstico , Síndrome de Andersen/terapia , Antiarrítmicos/uso terapêutico , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Flecainida , Humanos , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/terapia
7.
Echocardiography ; 36(10): 1936-1940, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31573719

RESUMO

Stanford type-A aortic dissection is a clinical emergency; mortality is high, and surgery is urgently required in most cases. Chronic forms of type-A dissection are rare and have a poor prognosis if not treated surgically. We present an unusual case of chronic type-A aortic dissection, with silent onset, in an oncologic patient without risk factors, which was managed conservatively and remained substantially stable during follow-up.


Assuntos
Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/terapia , Dissecção Aórtica/complicações , Dissecção Aórtica/terapia , Tratamento Conservador/métodos , Neoplasias Pancreáticas/complicações , Idoso , Dissecção Aórtica/diagnóstico por imagem , Aorta/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Doença Crônica , Ecocardiografia/métodos , Evolução Fatal , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodos
8.
J Clin Ultrasound ; 46(4): 259-261, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28656711

RESUMO

We report a case of left atrial extrinsic compression caused by an esophageal food bolus in a patient presenting with acute heart failure. Transthoracic echocardiography along with contrast-enhanced CT showed evidence of esophageal dilation producing left atrial compression. Esophageal endoscopy and fragmentation of the bolus, allowing the accumulated food to descend into the stomach, produced a rapid improvement of hemodynamic and clinical status. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:259-261, 2018.


Assuntos
Ecocardiografia , Esôfago/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Tomografia Computadorizada por Raios X , Idoso , Feminino , Alimentos , Corpos Estranhos/complicações , Humanos
9.
Clin Cardiol ; 39(11): 640-645, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27468173

RESUMO

BACKGROUND: Because 20% to 40% of patients undergoing cardiac resynchronization therapy (CRT) do not respond to it, identification of potential factors predicting response is a relevant research topic. HYPOTHESIS: There is a possible association between right ventricular function and response to CRT. METHODS: We analyzed 227 patients from the Cardiac Resynchronization Therapy Modular Registry (CRT-MORE) who received CRT according to current guidelines from March to December 2013. Response to therapy was defined as a decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 6 months. RESULTS: The tricuspid annular plane systolic excursion (TAPSE) value that best predicted improvement in LVESV (sensitivity 68%, specificity 54%) was 17 mm. Stratifying patients according to TAPSE, LVESV decreased ≥15% in 78% of patients with TAPSE >17 mm (vs 59% in patients with TAPSE ≤17 mm; P = 0.006). At multivariate analysis, TAPSE >17 mm was independently associated with LVESV improvement (odds ratio: 1.97, 95% confidence interval: 1.03-3.80, P < 0.05), together with ischemic etiology (odds ratio: 0.39, 95% confidence interval: 0.20-0.75, P < 0.01). These results were confirmed for New York Heart Association class III to IV patients (79% echocardiographic response rate in patients with TAPSE >17 mm vs 55% in patients with TAPSE <17 mm; P = 0.012). CONCLUSIONS: Baseline signs of right ventricular dysfunction suggest possible remodeling after CRT. A TAPSE value of 17 mm was identified as a good cutoff for predicting a better response to CRT in patients with both mildly symptomatic and severe heart failure.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Disfunção Ventricular Esquerda/terapia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Idoso , Idoso de 80 Anos ou mais , Terapia de Ressincronização Cardíaca/efeitos adversos , Distribuição de Qui-Quadrado , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Itália , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Esquerda , Remodelação Ventricular
10.
Echocardiography ; 32(3): 420-7, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25047126

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia, with a high recurrence rate, especially during the first months after cardioversion (CV). Few parameters have been evaluated as predictors for the maintenance of sinus rhythm (SR), with limited results. Recently total atrial conduction time (TACT) has been proposed as independent predictor of AF recurrence. The aim of this study was to investigate the prognostic value of TACT, measured using PA-TDI duration, to predict 1-year maintenance of restored SR after electrical CV. METHODS AND RESULTS: In a population of 104 patients (58 male, aged 70 ± 9) with persistent AF, submitted to external electrical CV, we performed a complete echocardiogram after restoring SR. The TACT was estimated by measuring the time delay between the onset of the P-wave in lead II of the surface electrocardiogram and the peak A'-wave on the tissue Doppler imaging (TDI) tracing of the left atrial lateral wall (so-called PA-TDI duration). After a mean follow-up of 14 ± 2 months, 34 (33%) patients had recurrent AF, whereas 70 (67%) patients maintained SR. At multivariate analysis only PA-TDI was identified as independent predictor of AF recurrence (HR 1.04; 95% CI 1.03-1.06; P < 0.001). Receiver operator characteristics curve analyses demonstrated a high degree of discrimination (area under the curve 0.923); with a cut point of 152 msec, we obtain a good diagnostic accuracy (sensitivity 91%, specificity 87%). CONCLUSION: The TACT using TDI is an independent predictor of AF recurrence and can be used to predict the maintenance of SR after external electrical CV.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/prevenção & controle , Ecocardiografia Doppler/métodos , Técnicas de Imagem por Elasticidade/métodos , Cardioversão Elétrica/métodos , Eletrocardiografia/métodos , Idoso , Fibrilação Atrial/fisiopatologia , Doença Crônica , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Condução Nervosa , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do Tratamento
11.
J Cardiovasc Med (Hagerstown) ; 16(11): 725-35, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25004003

RESUMO

AIMS: In the present study, we compare different echocardiographic cardiac dyssynchrony parameters, both of intraventricular and interventricular dyssynchrony, in order to predict response to cardiac resynchronization therapy (CRT). METHODS AND RESULTS: In a population of 77 heart failure patients scheduled for CRT, we measured the interventricular mechanical delay (IVMD) and we analyzed six different parameters of intraventricular dyssynchony: the tissue Doppler imaging (TDI) septum-lateral wall delay, the systolic dyssynchrony index; the three-dimensional SD of the time to reach minimum systolic volume for 16 left ventricular segments (3D-SDI); the speckle-tracking radial, circumferential and longitudinal dyssynchrony. At 6 months of follow-up, 61 (79%) patients were responders (≤15% in left ventricular end-systolic volume). On baseline analysis, 3D-SDI, radial strain, longitudinal strain and circumferential strain and IVMD were significantly higher in responder group (10.8 ±â€Š3.9 vs. 7.6 ±â€Š1.8% for 3D-SDI; P = 0.003; 212 ±â€Š91 vs. 125 ±â€Š36 ms for radial strain, P = 0.0003; 185 ±â€Š83 vs. 134 ±â€Š53 ms for longitudinal strain, P = 0.02; 190 ±â€Š80 vs. 130 ±â€Š54 ms for circumferential strain, P = 0.006; 45 ±â€Š21 vs. 30 ±â€Š20 ms for IVMD; P = 0.01). On univariate and multivariate analysis, only IVMD was significantly associated with a complete echocardiographic response to CRT. 3D-SDI and radial strain present the better values of sensitivity and specificity, overall if associated to an evaluation of IVMD (sensitivity 76%, specificity 88%, for 3D-SDI + IVMD; sensitivity 80% and specificity 85% for radial strain + IVMD). CONCLUSION: The novel parameters, such as 3D-SDI and speckle-tracking (particularly radial strain), offer better diagnostic accuracy in identifying patients who are responders to CRT. The addition of the contemporary parameter of IVMD improves the diagnostic accuracy.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Doppler/métodos , Ecocardiografia Tridimensional/métodos , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia
12.
Echocardiography ; 31(7): E215-7, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24702723

RESUMO

Isolated supravalvular pulmonary stenosis is a rare finding, usually evidenced in the pediatric age. Here, we report a case of a 76-year-old patient with isolated, severely obstructive, pulmonary supravalvular stenosis. The peculiarity of the present case is the paucity of symptoms and lack of changes in right heart sections, despite of the importance of stenosis. The report confirms the utility of transthoracic two- and three-dimensional echocardiography and transesophageal echocardiography in the detection and quantification of this rare anomaly.


Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Estenose da Valva Pulmonar/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Doenças Raras
13.
G Ital Cardiol (Rome) ; 14(6): 445-55, 2013 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-23748541

RESUMO

Accidental or deliberate ingestion of poisonous herbs has become an increasingly common phenomenon over the last years. From existing literature data and case reports from emergency room visits or poison control centers, an overview is presented of the potential cardiotoxic manifestations following intoxication by wild herbal plants of the territory. The effects of the consumption of cardiac glycoside-containing plants (e.g., digitalis) are discussed along with tachyarrhythmias induced by Aconitum napellus L., Atropa belladonna L., Mandragora officinarum L. or Ephedra distachya L. herbs, and hypertensive crises associated with licorice abuse. For each plant, a brief historical and botanical background is provided, focusing on pathophysiology of intoxication and cardiotoxic effects on the basis of the most recent literature. Finally, medical management of intoxication, from both a general and cardiological viewpoint, is reviewed.


Assuntos
Cardiopatias/induzido quimicamente , Plantas Tóxicas/toxicidade , Cardiopatias/diagnóstico , Humanos
14.
Echocardiography ; 29(6): E141-4, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22329527

RESUMO

Prosthetic valve endocarditis (PVE) due to staphylococcus aureus is associated with high morbidity and mortality. Paravalvular abscess formation is a common complication of PVE at the aortic position, but fistula formation is rarely seen. The transesophageal echocardiography is the "gold-standard" exam to detect PVE. We present a case of a 69-year-old patient with prosthetic aortic valve endocarditis, paravalvular abscess, and fistula in right atrium, where the diagnosis was made with three-dimensional transthoracic echocardiography, without transesophageal evaluation.


Assuntos
Abscesso/diagnóstico por imagem , Aorta/anormalidades , Fístula Artério-Arterial/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Átrios do Coração/anormalidades , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Abscesso/etiologia , Idoso , Aorta/diagnóstico por imagem , Fístula Artério-Arterial/etiologia , Diagnóstico Diferencial , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Infecções Relacionadas à Prótese/etiologia
17.
Eur J Echocardiogr ; 11(1): 57-63, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19910318

RESUMO

AIMS: Transoesophageal echocardiography (TEE) with contrast administration is still considered as the reference method for the detection of patent foramen ovale (PFO) with interatrial shunt, but it is a semi-invasive exam. The aim of the present study is to evaluate a role of two- and three-dimensional transthoracic echocardiography (TTE and R3DTE) as a diagnostic alternative to transcranial Doppler ultrasound (TCD) and TEE for detection of atrial right-to-left shunt. METHODS AND RESULTS: Seventy-five patients with history of cerebrovascular events were subjected to four diagnostic examinations: TCD, TTE, R3DTE, and TEE, with bubble contrast. Bubbles in the left atrium within three cardiac cycles were considered diagnostic for PFO and later as a pulmonary shunt. Greater than 20 bubbles in the left atrium were considered a large shunt and <20 a small shunt. Every exam was read blinded to the results of the others. From the 75 enrolled patients, 62 (82.6%) patients showed right-to-left shunt with TEE; the results were also positive in 53 patients using TCD (70.6%), in 53 using R3DTE (70.6%), and in 55 using TTE (73.3%) (P = NS). There is a statistically significant superiority for TEE in the capacity of detecting shunts compared with TCD (P < 0.024), TTE (P < 0.018), and R3DTE (P < 0.018). The TEE presents a superior ability to recognize mild/moderate interatrial shunts respect to other exams (P = 0.003), without differences for shunts of high degree. In comparison to the TEE, the sensitivity is 89% for TTE, 88% for R3DTE, and 85% for TCD; the specificity is 100% for TTE and R3DTE, and 90% for TCD; the positive predictive value is 100% for TTE and R3DTE, and 98% for TCD; and the negative predictive value is 65% for TTE, 65% for R3DTE, and 53% for TCD. Considering only for mild/moderate shunts, the diagnostic accuracy is clearly inferior (sensitivity 63% for TTE, 58% for R3DTE, and 53% for TCD). CONCLUSION: In this cohort of patients, TEE confirms the role of 'gold standard' exam for the detection of PFO; the non-invasive methods, and the TTE in particular, present a good diagnostic accuracy, but are inferior to the TEE because of the low negative predictive value and the non-optimal detection of small shunts. If the only purpose of TEE is the detection of significative interatrial shunt, TEE can be replaced by TTE. The R3DTE presents a good diagnostic accuracy, provides a better anatomical definition of the interatrial septum, and may have a role in this setting of patients, but does not add a lot to the TTE for the diagnosis.


Assuntos
Ecocardiografia Tridimensional , Ecocardiografia , Forame Oval Patente/diagnóstico por imagem , Adulto , Estudos de Coortes , Ecocardiografia Transesofagiana , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Ultrassonografia Doppler , Ultrassonografia Doppler Transcraniana
18.
J Cardiovasc Med (Hagerstown) ; 10(1): 68-71, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19708131

RESUMO

Familial hypokalemic periodic paralysis is an autosomal dominant muscle disorder characterized by episodic attacks of muscle weakness, accompanied by a decrease in blood potassium levels. It is based on genetic mutations in the genes CACNA1S (most frequent, encoding the skeletal muscle calcium channel) and SCN4A (10% of cases, encoding the sodium channel). Few cases have been reported with cardiac dysrhythmia. We report a rare case of a patient with a novel SCN4A mutation who presented, on ECG, extreme bradycardia and syncopal sinus arrest that required a temporary pacemaker implant


Assuntos
Bradicardia/genética , Frequência Cardíaca/genética , Mutação , Paralisia Periódica Hiperpotassêmica/genética , Parada Sinusal Cardíaca/genética , Canais de Sódio/genética , Adulto , Bradicardia/fisiopatologia , Bradicardia/terapia , Estimulação Cardíaca Artificial , Análise Mutacional de DNA , Eletrocardiografia , Humanos , Masculino , Canal de Sódio Disparado por Voltagem NAV1.4 , Marca-Passo Artificial , Paralisia Periódica Hiperpotassêmica/complicações , Paralisia Periódica Hiperpotassêmica/fisiopatologia , Paralisia Periódica Hiperpotassêmica/terapia , Compostos de Potássio/administração & dosagem , Parada Sinusal Cardíaca/fisiopatologia , Parada Sinusal Cardíaca/terapia , Síncope/genética , Resultado do Tratamento
19.
J Cardiovasc Med (Hagerstown) ; 10(9): 727-32, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19491701

RESUMO

Advanced Digitalis intoxication is a rare event, mainly associated with overdose in patients with Digitalis therapy. We report an unusual case of acute 'familiar' digitalis poisoning in three patients who had eaten potato dumplings flavoured with leaves of Borago officinalis L. unconsciously mixed with leaves of Digitalis purpurea L. A complicated clinical course with marked bradyarrhythmias was presented, with good evolution thanks to the use of digoxin-specific antibody Fab fragments. The theme of the domestic use of plants with medicinal effects has been treated and discussed.


Assuntos
Bradicardia/induzido quimicamente , Glicosídeos Cardíacos/intoxicação , Digitalis , Contaminação de Alimentos , Doença Aguda , Adulto , Antídotos/uso terapêutico , Bradicardia/fisiopatologia , Bradicardia/terapia , Glicosídeos Cardíacos/imunologia , Carvão Vegetal/uso terapêutico , Eletrocardiografia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Folhas de Planta , Intoxicação/etiologia , Intoxicação/terapia
20.
J Cardiovasc Med (Hagerstown) ; 9(11): 1130-3, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18852586

RESUMO

Right cardiac thrombosis is an infrequent complication after pacemaker implant. We report a patient who received a biventricular implantable cardioverter defibrillator, with a large mobile thrombus, adherent to the left ventricular lead. This catheter was partially dislocated, with a large, mobile loop through the right atrium and right ventricle; so the lead thrombus could alternately obstruct the pulmonary valve and the tricuspid valve. We believe that this is the first case of left ventricular lead thrombosis, in which the surgical treatment included thrombectomy with conservation of the catheter that was anchored to the internal right atrial wall in order to limit its great motility, maintaining the contribution to the cardiac resynchronization.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Desfibriladores Implantáveis/efeitos adversos , Trombectomia , Trombose/cirurgia , Idoso , Anticoagulantes/uso terapêutico , Desenho de Equipamento , Humanos , Masculino , Radiografia , Trombose/diagnóstico por imagem , Trombose/etiologia , Resultado do Tratamento , Varfarina/uso terapêutico
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