[Pregnancy and acute pulmonary embolism: a case report]. / Tromboembolismo pulmonar agudo na gravidez. A propósito de um caso clínico.

We describe the case of a 37-year-old pregnant woman who presented at 29 weeks of gestation with syncope and shortness of breath caused by pulmonary embolism. Due to persistent hypotension thrombolytic therapy with tenecteplase was administered and the clinical and hemodynamic response was excellent, with no maternal or fetal hemorrhagic complications. The clinical presentation of pulmonary embolism is sometimes camouflaged by the physiological changes that occur in pregnancy and diagnosis is often delayed by reluctance to expose the fetus to ionizing radiation. Systemic thrombolysis is considered a high-risk treatment in pregnancy and very few women have received it. However the complication rates of thrombolytic therapy are acceptable in the light of the underlying disease.

Noncompaction of the ventricular myocardium: characterization and follow-up of an affected population.

Noncompaction of the ventricular myocardium (NVM) is a rare congenital disease caused by an arrest in normal myocardial embryogenesis, leading to persistence of numerous prominent trabeculations which communicate with the left ventricle. It was first described as a congenital condition affecting children, but several cases have been reported of late presentation, and recent studies suggest it may be underdiagnosed. The main clinical manifestations are congestive heart failure, arrhythmias (supraventricular or ventricular) and systemic embolism. We describe a series of twenty patients, focusing on clinical history, echocardiography and follow-up.

A portuguese family with Brugada syndrome.

The authors present a family with Brugada syndrome, the largest ever described in Portugal. From a fortuitous electrocardiographic finding in a previously symptomatic young man with a family history of sudden death, 126 possibly affected family members were studied. This article describes the diagnostic approach, risk stratification for sudden death and therapeutic interventions offered to this family, and presents a brief review of Brugada syndrome.

Left ventricular noncompaction: diagnosis by three-dimensional echocardiography.

Left ventricular noncompaction (LVNC) is a rare congenital disease caused by an arrest in normal myocardial embryogenesis, leading to persistence of numerous prominent trabeculations that communicate with the left ventricle. It was first described as a congenital condition affecting children, but several cases have been reported of late presentation. The main clinical manifestations are congestive heart failure, arrhythmias (supraventricular or ventricular) and systemic embolism. We present the case of a 51-year-old patient brought to our emergency department after an episode of symptomatic ventricular flutter requiring electrical cardioversion. Two-dimensional echocardiography with color Doppler suggested the diagnosis and the three-dimensional echocardiogram revealed the deep trabeculations typical of LVNC.

Cardiac sarcoidosis: a case report.

Cardiac involvement is found in approximately 5% of patients with sarcoidosis. The course of the disease is variable, ranging from benign arrhythmias to high-degree heart block or sudden death, and diagnosis is difficult. Endomyocardial biopsy can confirm the diagnosis but the diagnostic yield of the procedure is low because of the uneven distribution of the granulomatous process. Cardiac sarcoidosis should be presumed in patients with known sarcoidosis who develop arrhythmias, conduction disease, heart failure or ECG abnormalities. The authors present a case report and brief review of cardiac sarcoidosis.

Acute myocardial infarction with angiographically normal coronary arteries.

The authors present the case of a 51-year-old woman, with no known cardiovascular risk factors, admitted with anterior acute myocardial infarction complicated by primary ventricular fibrillation, who underwent reperfusion therapy with tenecteplase. Left heart catheterization on the sixth day showed left ventricular anteroapical akinesia and normal coronary arteries. The causes of acute myocardial infarction with normal coronary arteries and its differential diagnosis are discussed.