RESUMEN
INTRODUCTION: Interatrial block (IAB) is defined as prolonged P-wave duration (≥ 120 ms) due to delayed conduction in the Bachmann bundle. This is readily identifiable using surface electrocardiogram (ECG). Advanced IAB can be classified as typical and atypical. Atypical IAB can be further categorized by (i) duration or (ii) morphology. In this report, we have identified a new pattern of atypical IAB with triphasic morphology of the P-wave in the inferior leads. METHODS: Two clinical cases were evaluated including surface ECGs. P-wave durations and amplitudes were measured with digital calipers using ECG analysis software (MUSE, GE HealthCare). Comparisons were made using prior data to evaluate IAB and P-wave duration and morphology. RESULTS: A new pattern of atypical advanced IAB shows prolonged P-wave duration (P wave >160 ms) and triphasic morphology in all inferior leads with P +/+/- and P +/-/+, respectively. We speculate that triphasic P-waves in the inferior leads represent three moments of atrial depolarization; from right to left. CONCLUSION: This study describes a novel pattern of atypical advanced IAB. Further investigation regarding the increased risk of atrial fibrillation and stroke associated with this new pattern is warranted in the future.
Asunto(s)
Fibrilación Atrial , Accidente Cerebrovascular , Humanos , Bloqueo Interauricular/complicaciones , Electrocardiografía , Accidente Cerebrovascular/etiología , Frecuencia Cardíaca , Atrios CardíacosRESUMEN
Brugada syndrome (BrS) is associated with increased risk of ventricular arrhythmias and sudden death. Some drugs can trigger the electrocardiographic and arrhythmic manifestations of this syndrome. Cold medicines for symptom relief are sold without prescription in Brazil and most contain antihistamines and adrenergic agonists. We report a case of BrS probably triggered by the use of such medication.
Asunto(s)
Bromofeniramina/efectos adversos , Síndrome de Brugada/inducido químicamente , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Descongestionantes Nasales/efectos adversos , Fenilefrina/efectos adversos , Adulto , Humanos , Masculino , Medicamentos Compuestos contra Resfriado, Gripe y Alergia/efectos adversosRESUMEN
Acute Chagas' disease corresponds to the initial period of a Trypanosoma cruzi infection. Levosimendan is a positive inotropic drug with vasodilatory properties that is indicated for acute heart failure. We describe two cases of myocarditis due to acute Chagas' disease, resulting from oral intake of sugar cane juice infected with T. cruzi and resulting complications. Both developed acute decompensated heart failure refractory to Dobutamine. We describe for the first time in the medical literature the use of Levosimendan for myocarditis due to acute Chagas' disease, with excellent clinical and hemodynamic results.