RESUMO
Catheter-induced mechanical trauma to accessory pathways is an infrequent, usually transitory phenomenon related to manipulation of the ablation catheter. We describe a patient with Wolff-Parkinson-White syndrome due to a midseptal accessory pathway with recurrent episodes of paroxysmal tachycardias under antiarrhythmic treatment. During the diagnostic electrophysiological study coinciding with manipulation of the His catheter (5 French), mechanical trauma to the accessory pathways occurred, with preexcitation not being recovered in the midterm follow up (28 months). This is a exceptional case demonstrating the complexity of the decision making (expectant or rescue ablation) following accidental catheter-induced mechanical trauma.
Assuntos
Cateterismo Cardíaco/efeitos adversos , Síndrome de Wolff-Parkinson-White/terapia , Adulto , Eletrodos , Humanos , Masculino , Indução de RemissãoAssuntos
Anti-Hipertensivos/uso terapêutico , Farmacoeconomia , Insuficiência Cardíaca/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Espironolactona/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/economia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/economia , Método Duplo-Cego , Custos de Medicamentos , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/mortalidade , Humanos , Antagonistas de Receptores de Mineralocorticoides/administração & dosagem , Antagonistas de Receptores de Mineralocorticoides/economia , Placebos , Prognóstico , Ramipril/administração & dosagem , Ramipril/economia , Ramipril/uso terapêutico , Espironolactona/administração & dosagem , Espironolactona/economia , Fatores de TempoRESUMO
We report a case of spontaneous dissection of right coronary artery diagnosed in a 31-year-old woman in the postpartum period, presenting with prolonged angina and ST segment elevation in the ECG, a rare manifestation of this extremely uncommon anatomico-clinic entity. We described the clinical presentation, the findings derived from transthoracic echocardiography and coronary arteriography, and the clinical course with medical therapy.
Assuntos
Dissecção Aórtica/diagnóstico , Aneurisma Coronário/diagnóstico , Transtornos Puerperais/diagnóstico , Adulto , Cateterismo Cardíaco , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , HumanosRESUMO
In the last few years the has been an enormous development in noninvasive testing in the field of clinical cardiology. In fact, excellent monographs on each one of these techniques have been published elsewhere, but fewer publications exist that treat the topic of their indications and use in an integrated way, except for in the most common clinical situations. In this paper, the treatment of patients who present chest pain, stable and unstable angina is discussed, including the study of postinfarction patients. Furthermore, the role of noninvasive tests in the detection of coronary heart disease in women and in patients with left bundle branch block is thoroughly analyzed; as well as their usefulness after surgical or percutaneous coronary revascularization and in patients with peripheral vascular disease.
Assuntos
Doença das Coronárias/diagnóstico , Angina Pectoris/diagnóstico , Angina Instável/diagnóstico , Angioplastia Coronária com Balão , Dor no Peito/diagnóstico , Doença das Coronárias/diagnóstico por imagem , Diagnóstico Diferencial , Ecocardiografia , Teste de Esforço , Feminino , Bloqueio Cardíaco/diagnóstico , Humanos , Masculino , Revascularização Miocárdica , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
INTRODUCTION AND OBJECTIVES: It has been shown that the delta P/delta t index, derived from the continuous Doppler mitral regurgitation signal correlates strongly with dP/dt. This study evaluates the feasibility, reproducibility and correlation of the index with ejection fraction and other conventional echocardiographic parameters. MATERIAL AND METHODS: One hundred and ten patients with mitral regurgitation demonstrated by colour Doppler were studied. delta P/delta t were calculated by the ratio between the interval of pression between two points of the Doppler signal (-1 and -3 m/s; 32 mmHg, applying the modified Bernouilli equation) and the interval of time (s) which separates both. Ejection fraction was measured in 70 patients by non-echocardiographic methods (isotopic ventriculography, n = 52, and angiography, n = 18). RESULTS: The index was feasible in 91 cases, the variability of intra and interobserver was 5% and 7% respectively. The correlation between delta P/delta t and ejection fraction was significant although weak (r = 0.59; p < 0.001; n = 70). It was better in the group of dilated idiopathic myocardiopathy (r = 0.72; p < 0.001; n = 18) than in the group of myocardial infarction (r = 0.54; p < 0.01; n = 25). No significant correlation was founded in the cases with mitral rheumatic valvulopathy. Regarding to the echocardiographic parameters, the best correlation was obtained with end systolic diameter (r = -0.64; p < 0.001; n = 49). Finally, a value of delta P/delta t < 1,000 mmHg/s predicted the existence of left ventricular systolic dysfunction with high accuracy (84%), sensitivity (80%) and specificity (92%). CONCLUSIONS: High feasibility when mitral regurgitation exists, adequate reproducibility and heightened precision in diagnosing left ventricular systolic dysfunction, are characteristics which make delta P/delta t useful in the echocardiographic routine practice.
Assuntos
Ecocardiografia Doppler em Cores , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/fisiopatologia , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Contração Miocárdica , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Variações Dependentes do Observador , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Two patients admitted to hospital because syncope and chest pain are presented. In both patients, hyperventilation test caused severe myocardial ischaemia (ST segment elevation) and sudden development of presyncopal sustained ventricular tachycardia which immediately responded to intravenous nitroglycerin. The relationship between coronary vasospasm and sudden death secondary to polymorphic ventricular tachycardia is discussed. Also, the usefulness of the hyperventilation test to detect this problem and to monitor its therapeutic response is addressed.
Assuntos
Dor no Peito/complicações , Vasoespasmo Coronário/diagnóstico , Hiperventilação , Síncope/etiologia , Angiografia Coronária , Eletrocardiografia , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Nitroglicerina/administração & dosagem , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/etiologia , Vasodilatadores/administração & dosagemRESUMO
Angina pectoris is one of the most important manifestation of coronary artery disease. In this review, the Ischemic Cardiopathy and Coronary Units Group defines the Spanish Society of Cardiology policy concerning angina pectoris definition and classification.