[Acute pulmonary edema as an early manifestation of systemic lupus erythematosus]. / Edema agudo de pulmão como manifestação precoce de lupus eritematoso sistêmico.

A 36 year-old male patient developed acute pulmonary edema due acute mitral insufficiency as early manifestation of systemic lupus erythematosus. The patient was treated with supportive measures, oxygen, furosemide, and isosorbide dinitrate. He was started on prednisone 60 mg daily 14 days later, after the diagnosis of lupus was established. The patients is asymptomatic with mitral systolic murmur 5 months after hospital discharge.

[Coronary-cavitary fistula after resection of vascularized left atrial myxoma]. / Fístula coronário-cavitária após ressecção de mixoma atrial esquerdo vascularizado.

A 52-year-old man with left atrial myxoma, in whom postoperative angiographic control revealed a coronary-cavitary fistula originated from a previous atrial branch from the circumflex coronary artery. These fistulas should be considered in cases of revascularized atrial myxoma.

[Acute atrial fibrillation in the emergency room. Which is the best drug for a rapid sinus rhythm conversion?]. / Fibrilação atrial aguda na unidade de emergência. Qual a droga ideal para rápida reversão ao ritmo sinusal?

PURPOSE: To evaluate differences between amiodarone, procainamide and quinidine in the time delay necessary to convert acute atrial fibrillation (AF) to sinus rhythm. METHODS: Sixty patients with acute AF were randomized in three groups (G) and treated with: quinidine (QG)-(21 patients) i.v. digital + quinidine up to 600 mg; procainamide (PG)-(23 patients) i.v. digital + i.v. procainamide, 10 mg/kg; amiodarone (AG)-(16 patients) i.v. amiodarone, 5 mg/kg. To evaluate time delay to conversion, all patients have their rhythm recorded by Holter system during four hours. Statistics were done with x2, considering significant a p < 0.05. RESULTS: There were no differences between groups regarding to age, gender and delay from symptoms initiation and medical assistance. Conversion to sinus rhythm occurred, in QG-71.4% cases; PG-47.8% and AG-50% (p > 0.05). Time delay in minutes to conversion were, respectively (media +/- SD): QG-112 +/- 43; PG-44.1 +/- 28; AG-20 +/- 13, significantly lower in PG and AG related to QG (p = 0.001). Although not significant, side effects were observed mostly in PG. CONCLUSION: Amiodarone is a good choice to convert, very quickly, acute AF. Otherwise, quinidine has the best rate of conversion but with a longer time delay.