RESUMO
Myocardial infarction remains a major healthcare problem. Reperfusion therapy has been shown to influence favourably short- and long-term patient survival. The authors reviewed the data of early recognition of STEMI (ST Elevation Myocardial Infarction), the reperfusion modalities including a flowchart management, as proposed by the Belgian working groups (BIWAC and BWGIC), and the lessons learned from European and American registries. Primary PCI often remains the treatment of choice. A national policy is still required to implement the guidelines and improve clinical practice for our STEMI patients.
Assuntos
Infarto do Miocárdio/terapia , Reperfusão Miocárdica , Bélgica , Árvores de Decisões , Serviços Médicos de Emergência , Humanos , Transporte de PacientesRESUMO
Myocardial infarction remains a major healthcare problem. Reperfusion therapy has been shown to influence favourably short- and long-term patient survival. The authors reviewed the data of early recognition of STEMI (ST Elevation Myocardial Infarction), the reperfusion modalities including a flowchart management, as proposed by the Belgian working groups (BIWAC and BWGIC), and the lessons learned from European and American registries. Primary PCI often remains the treatment of choice. A national policy is still required to implement the guidelines and improve clinical practice for our STEMI patients.
Assuntos
Infarto do Miocárdio/terapia , Reperfusão Miocárdica/métodos , Bélgica/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Infarto do Miocárdio/classificação , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/cirurgia , Qualidade de Vida , Sistema de Registros , Reperfusão , Sociedades Médicas , Estados Unidos/epidemiologiaAssuntos
Intervenção Coronária Percutânea , Aorta , Hematoma/diagnóstico , Hematoma/etiologia , HumanosRESUMO
The authors report two cases of benign acute pericarditis after the patients received vaccinations against influenza virus. The diagnoses were confirmed by serologic changes and by the findings of 12-lead electrocardiogram and echocardiography. Symptoms and clinical status improved on aspirin therapy. The authors underline the possible mechanisms of this rare complication of influenza vaccination.
Assuntos
Vacinas contra Influenza/efeitos adversos , Pericardite/etiologia , Doença Aguda , Adulto , Idoso , Ecocardiografia , Eletrocardiografia , Humanos , Vacinas contra Influenza/administração & dosagem , Masculino , Pericardite/diagnóstico por imagemRESUMO
A 71-year-old female with vasovagal near-syncope suffered from paroxysmal second-degree AV block during Holter monitoring. AV block was easily reproduced during head-up tilt test. She was successfully treated with a dual chamber pacemaker. This treatment is unusual and the role of cardiac pacing in patients with vasovagal symptoms is reviewed.
Assuntos
Bradicardia/diagnóstico , Bloqueio Cardíaco/diagnóstico , Teste da Mesa Inclinada , Idoso , Bradicardia/terapia , Diagnóstico Diferencial , Eletrocardiografia Ambulatorial , Feminino , Bloqueio Cardíaco/terapia , Humanos , Marca-Passo Artificial , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/terapiaRESUMO
Electrophysiological testing remains the basic procedure in the assessment of life-threatening sustained ventricular tachycardias (VT). The predictive value of inducible VT depends on the baseline stimulation protocol and probably on some other factors, including automatic balance. We report the cases of four patients, with a history of myocardial infarction, who experienced recurrent episodes of syncope; the clinical aspects of the syncope were suggestive of syncopal VT. With a baseline protocol, electrophysiological testing only allowed the induction of well-tolerated non-sustained VT. Using the same stimulation protocol (rapid ventricular pacing or basal ventricular stimulation with 2 extra-stimuli), monomorphic sustained VT that had the same ECG morphology, as non-sustained VT, could only be induced while low doses of isoproterenol (1-2 micrograms/min) were being administered. In these cases, increased sympathetic tone appears to be prerequisite for a sustained VT reproducing the patients clinical symptoms and discomfort. To conclude, in some patients with recurrent symptoms, including syncope suggestive of ventricular arrhythmia, low-dose infusion of isoproterenol may facilitate the induction of of clinical sustained VT and increase the predictive value of electrophysiological testing. Possible mechanisms of ventricular arrhythmogenesis by isoproterenol are discussed.
Assuntos
Agonistas Adrenérgicos beta , Estimulação Cardíaca Artificial , Isoproterenol , Taquicardia Ventricular/diagnóstico , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Atenolol/uso terapêutico , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Valor Preditivo dos Testes , Sotalol/uso terapêutico , Síncope/etiologia , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/etiologiaRESUMO
Radiofrequency catheter ablation seems to become a first-line therapy for patients with paroxysmal tachycardias using an accessory pathway. We report the case of a 31-year-old woman who suffered from drug-resistant recurrent reciprocating tachycardia, using an uncommon accessory pathway. The 12-lead electrocardiogram in sinus rhythm showed the following characteristics: a positive delta waves in leads I, II, aVL, aVF, QRS axis = 0 degrees, R/S in lead V1 < 1, and a special QRS pattern in the precordial leads (QS or Qr in V1-V3 and QRS transition > V3). A deep septal parahissian accessory pathway has been localized using classic endocardial mapping procedures and has been confirmed during successful radiofrequency catheter ablation. Normal auriculo-ventricular conduction has been totally preserved. No complications or recurrence were observed during the follow-up. We have reviewed the electrophysiologic criteria to confirm this rare accessory pathway location.
Assuntos
Fascículo Atrioventricular/cirurgia , Ablação por Cateter , Taquicardia Paroxística/cirurgia , Adulto , Feminino , HumanosRESUMO
Recent publications have demonstrated that the implantable cardioverter defibrillator (ICD) improves survival in patients with ventricular tachycardia (VT) or fibrillation (VF) by reducing arrhythmic death. We report the case of a patient with a history of an old myocardial infarction and a left ventricular dysfunction, who presented four episodes of syncope associated with a hemodynamically not well tolerated sustained VT, who had easy inductible clinical VT during electrophysiologic study and required an ICD. After a follow-up of 2 months, the patient presents a complete AV block and multiple episodes of torsades de pointes that sometimes degenerate into VF. The ICD delivered 64 adequate and well-tolerated shocks during 10 hours before and during the hospital admission. We programmed a VVI pacing rate at 65 bpm and no more arrhythmia was observed. The left ventricular ejection fraction was not altered afterwards. In conclusion, we experienced the temporary efficacy of the ICD in the treatment of incessant torsades de pointes, without myocardial injury.
Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Parada Cardíaca/terapia , Torsades de Pointes/terapia , Idoso , Eletrocardiografia , Seguimentos , Parada Cardíaca/fisiopatologia , Humanos , Masculino , Recidiva , Torsades de Pointes/fisiopatologia , Resultado do TratamentoRESUMO
The authors report the case of a patient with drug-resistant atrial fibrillation, who developed, for more than 2 hours, a well-tolerated attack of palpitations, after taking 500 mg of flecainide acetate. The Holter monitoring demonstrated atrial flutter with 1:1 AV conduction and a ventricular rate at 220 bpm. This atrial pro-arrhythmic effect is rare and the mechanism is discussed.
Assuntos
Antiarrítmicos/efeitos adversos , Flutter Atrial/induzido quimicamente , Flecainida/efeitos adversos , Idoso , Eletrocardiografia Ambulatorial , Feminino , HumanosRESUMO
Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital abnormality but with a very poor prognosis at birth. Myocardial ischaemia, infarction and sudden death are common. Cases diagnosed in adulthood are exceptionally rare. The authors describe the case of an asymptomatic 52 year old man with this congenital abnormality diagnosed after routine electrocardiography had shown sequellae of anterior myocardial infarction. This case would seem to be one of the rarest cases diagnosed fortuitously at this age. In view of the good clinical tolerance of the disease and the absence of residual ischaemia on effort, the patient was treated medically.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Artéria Pulmonar/diagnóstico por imagemRESUMO
The authors report the case of a patient followed up for 23 years after a double myocardial implantation of the internal mammary arteries (Vineberg technique) for unstable angina. The result of this procedure of surgical revascularisation has been very satisfactory to date. The authors believe this to be the longest follow-up reported in the medical literature.
Assuntos
Angina Instável/cirurgia , Anastomose de Artéria Torácica Interna-Coronária , Revascularização Miocárdica/métodos , Angiografia Coronária , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors report the case of a 32 year old woman who was shot with a shotgun. Acute inferior wall infarction was detected fortuitously on electrocardiography and coronary angiography showed occlusion of the right coronary artery with lead shot. The single coronary lesion, absence, of other cardiac complications (haemopericardium, cardiac perforation, ...) and the favourable outcome with conservative medical treatment has not been previously reported to the authors' knowledge.
Assuntos
Infarto do Miocárdio/etiologia , Traumatismos Torácicos/complicações , Ferimentos por Arma de Fogo/complicações , Adulto , Angiografia Coronária , Trombose Coronária/diagnóstico , Trombose Coronária/etiologia , Vasos Coronários/lesões , Eletrocardiografia , Emergências , Feminino , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Prognóstico , Traumatismos Torácicos/cirurgia , Resultado do Tratamento , Ferimentos por Arma de Fogo/cirurgiaRESUMO
PURPOSE: The purpose of this study was to determine the sensitivity and specificity of arterial Doppler findings of aortic regurgitation to assess if the amplitude of changes of Doppler tracings can accurately quantify the degree of regurgitation. PATIENTS AND METHODS: We analysed and compared the arterial Doppler tracings and echocardiograms of 250 patients. RESULTS: Even if the obvious pitfall of vascular stenoses is avoided, the global sensitivity of arterial Doppler findings for aortic regurgitation remains weak (30%). However, our study demonstrates that it can reach 100% if only significant AR (> or =2/4) is taken into account. Since the clear false-positive cases have been carefully excluded from the very start, the specificity of the classical criteria already proves excellent (above 95%). It will reach perfection if additional simple criteria gathered from the data mentioned in this study are considered. Quantifying precisely the degree of aortic regurgitation on the basis of arterial Doppler tracings is impossible. Nevertheless, we show that it is easy to identify significant AR (> or =2/4) that should be further assessed with echocardiography. CONCLUSION: Arterial Doppler sonography is unable to detect all cases of aortic regurgitation but those that are overlooked are not significant (1/4). If AR signs happen to be detected by arterial Doppler, the amplitude of the leak cannot be accurately determined based on tracing analysis. Yet, simple criteria will indicate whether it is important enough (> or =2/4) to require complementary echocardiogram, with well documented accuracy for morphological and hemodynamic evaluation.
Assuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Ultrassonografia Doppler , Humanos , Sensibilidade e EspecificidadeRESUMO
The Belgium Interdisciplinary Working group on Acute Cardiology, including cardiologists, intensivists and urgentists was formed to provide consensus regarding the management of acute chest pain in the prehospital and the early hospital phase. General recommendations and critical pathways are proposed to improve the treatment of the patients with acute coronary syndromes.
Assuntos
Algoritmos , Angina Instável/diagnóstico , Dor no Peito/etiologia , Infarto do Miocárdio/diagnóstico , Guias de Prática Clínica como Assunto , Doença Aguda , Angina Instável/complicações , Angina Instável/terapia , Diagnóstico Diferencial , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapiaRESUMO
The Belgium Interdisciplinary Working Group on Acute Cardiology (BIWAC), including cardiologists, intensivists and urgentists was formed to give consensus regarding the management of acute chest pain in the prehospital and the early hospital phases. General recommendations and critical pathways are proposed to improve the treatment of the patients with acute coronary syndromes.
Assuntos
Dor no Peito/terapia , Doença Aguda , Dor no Peito/etiologia , HumanosRESUMO
BACKGROUND: Recent trials in acute myocardial infarction indicate that intensive and early statin therapy that lowers low-density lipoprotein cholesterol (LDL-C) to < or = 70 mg dL(-1) is beneficial. The combination of statins with ezetimibe, a newly developed cholesterol-absorption inhibitor, can lead to a further reduction in LDL-C of up to 26%. In this study, we examined the rapidity and intensity of the lipid-lowering effect of ezetimibe co-administered with simvastatin immediately after myocardial infarction. MATERIALS AND METHODS: Sixty patients admitted for acute myocardial infarction were randomized to receive either simvastatin 40 mg (SIMVA), a combination of simvastatin 40 mg and ezetimibe 10 mg (EZE/SIMVA), or no lipid-lowering drugs (NLLD) and had their lipid levels assessed 2, 4 and 7 days later. RESULTS: At baseline, cardiovascular risk factors were similar in all three groups [mean (SD) LDL-C of 141 (36) mg dL(-1)]. At days 2 , 4 and 7 there was no significant change in mean LDL-C levels in the NLLD group (-10%, -6%, and -9%, all P > 0.09), while there were significant reductions with SIMVA (-15%, -27%, and -25%, respectively, all P < 0.001 vs. day 0) and even greater reductions with co-administration of EZE/SIMVA (-27%, -41%, and -51%, respectively, all P < 0.001 vs. day 0). The percentages of patients achieving LDL-C below 70 mg dL(-1) at days 4 and 7 were substantially greater with EZE/SIMVA (45% and 55%, respectively) than with SIMVA (5% and 10%, respectively), while no NLLD patient reached this goal. Triglyceride levels showed a progressive increase in the NLLD group (+45% at day 7, P < 0.05 vs. day 0), no change in the SIMVA group, but a decrease in the EZE/SIMVA group (-17% at day 7, P < 0.05 vs. day 0). No significant difference in HDL-C levels, tolerability, or clinical events was observed between the three groups. CONCLUSIONS: The co-administration of ezetimibe 10 mg with simvastatin 40 mg, by inhibiting cholesterol absorption and production, allowed more patients with acute myocardial infarction to reach LDL-C < or = 70 mg dL(-1) as early as the fourth day of treatment. The effects of such rapid and intense reduction in LDL-C on cardiovascular morbidity and mortality need to be evaluated in future clinical endpoint studies.
Assuntos
Anticolesterolemiantes/uso terapêutico , Azetidinas/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Sinvastatina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , LDL-Colesterol/sangue , Quimioterapia Combinada , Ezetimiba , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangueRESUMO
The authors report a case of Fallot's tetralogy found in an asymptomatic adult patient. Echocardiography and cardiac catheterization confirmed the diagnosis. Life expectancy without surgery is usually short and our patient's survival is therefore uncommon. This case probably represents the oldest patient with uncorrected tetralogy found in the literature.
Assuntos
Tetralogia de Fallot/diagnóstico , Fatores Etários , Cateterismo Cardíaco , Ecocardiografia , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-IdadeRESUMO
A 71-year-old man with a history of myocardial infarction and syncopal ventricular tachycardia received an ICD. Progressively, increased defibrillation charge times of the ICD were observed. During a fast ventricular tachycardia, the patient collapsed. The underlying malfunction could be documented by ICD telemetric interrogation. An excessive charge time was recorded causing subsequent delayed therapy. The ICD was considered potentially ineffective and required a generator exchange. This case report underlines the possible factors affecting the ICD charge times. Excessive charge time must be considered as a rare, or underestimated, cause of ICD malfunction, requiring generator replacement.
Assuntos
Desfibriladores Implantáveis , Eletrocardiografia , Análise de Falha de Equipamento , Infarto do Miocárdio/terapia , Taquicardia Ventricular/terapia , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Síncope/etiologia , Telemetria , Fatores de TempoRESUMO
Twelve-lead electrocardiogram were studied in 40 consecutive patients with angiographic left main coronary artery disease. The ECG were analysed during chest pain. The most frequent pattern was a ST elevation (> 0.1 mV) in lead a VR alone or with ST depression (> 0.2 mV) in the anterior or lateral leads. In coronary artery disease patients, the 12-lead electrocardiogram at rest remains the best test to detect patients at higher risk for massive myocardial infarction or death.
Assuntos
Dor no Peito/diagnóstico , Doença das Coronárias/diagnóstico , Eletrocardiografia , Humanos , Medição de RiscoRESUMO
The authors report the case of a 68-year-old woman who suffered from an acute massive pulmonary embolism. The common electrocardiographic findings were not observed, but rather an extreme QT prolongation. The patient has been successfully treated by thrombolysis. After a few days, the electrocardiogram normalized. These electrocardiographic changes have not yet been described in the medical literature.