[Spontaneous multivessel coronary dissection as a cause of acute myocardial infarct--case report]]. / Dissecção coronária multivasos espontânea como causa de enfarte agudo do miocárdio--a propósito de um caso.

The authors describe a case reported in a young female with antecedents of aortic pathology and renovascular hypertension submitted to renal artery surgery admitted to emergency with an extensive acute myocardial infarction, treated with thrombolysis. After coronariography we identify, as etiological factor, a spontaneous coronary dissection involving the descending anterior coronary artery and circumflex coronary artery with no affect on the left main coronary artery. About this case, the authors make a brief review of the literature emphasizing the therapeutic options.

[Severe digoxin poisoning. The successful use of the classic treatment]. / Intoxicación grave por digoxina. Utilización exitosa del tratamiento clásico.

In our environment, the use of Fab antibodies for digoxin intoxication is often difficult due to the low availability of this drug in most centers. We present a case of massive digoxin intoxication that was successfully managed with the classic treatment. Later, we discuss the need to individualize the management of this kind of intoxications in order to reduce, when possible, sanitary costs.

[Vector electrocardiographic findings in chronic Chagas cardiomyopathy]. / Hallazgos electrovectocardiográficos en la miocardiopatía chagásica crónica.

Dilated Cardiomyopathy (DCM) is associated with many diseases. By means of epidemiologic, clinical and invasive diagnostic techniques, the etiology of DCM is identified almost in 50% of the cases. Chronic infection with Trypanosoma cruzi is recognized as a cause of DCM in Latin America. A blind study of 40 cases of DCM explores the electrovectorcardiographic data obtained in chronic chagasic cardiomyopathy (CCC). Twenty one of 40 patients fulfilled epidemiologic and seroimmunologic criteria for CCC, 19 had DCM. There were not differences between these groups in regard to sex or age. Patients suffering DCM had in addition diabetes mellitus, systemic hypertension or ischemic heart disease. Those with CCC had not comorbid diseases in 50% of the cases. Arrhythmias and conduction blocks were equally recognized in both groups, as well as ECG evidence of injury or necrosis (p > 0.05). However, ECG signs of subepicardial ischemia were a dominant feature in patients with CCC and normal epicardial coronary arteries (p < 0.05). Probably this finding is due to a small vessels damage, a pathogenic mechanism proposed in CCC.

[Primary angioplasty: comparison of working hours and night]. / Angioplastía primaria: comparación entre los horarios matutino y nocturno.

A prospective, observational, comparative study of 100 patients with acute myocardial infarction and primary angioplasty was performed to establish if there was statistically difference between the lag of time when symptoms begin and the time of the emergency admission to the time of arrival at the catheterization suite during working hours vs the "on call" hours. Patients were allocated in two groups accordingly to morning hours or on call hours. Time of onset of symptoms to the catheterization suite arrival between the two groups was no significantly different. Time from emergency room arrival to catheterization suite arrival was significant different < 0.05, however success rate between groups 86% vs 80% and complications rate were statistically non significant between both groups. We conclude that primary angioplasty is a highly effective method of reperfusion. Even though the time from the emergency room arrival to the catheterization suite arrival was significantly less during day than the on call hours, there is no difference between the success rate and complications incidence in both groups.