Stiff Left Atrium Syndrome After Atrial Fibrillation Ablation ­ A Diagnosis Not To Forget

Atrial fibrillation is the most prevalent arrhythmia in clinical practice and has different strategies for its control. Of these strategies, the percutaneous ablation of the pulmonary veins stands out, with robust results in relation to drug treatment. It is an invasive procedure and, therefore, not free from complications, which must be properly diagnosed and treated. Among the possible complications, there is stiff atrium syndrome, characterized by reduced atrial compliance caused by post-ablation fibrosis, which, in turn, leads to atrial filling dysfunction and the consequent increase in atrial and venous capillary pulmonary pressures. The case report demonstrates this infrequent but important complication, which presents good results for clinical treatment, in addition to the contribution of cardiac magnetic resonance in its diagnosis and in the assessment of arrhythmia recurrence rates.

Radiofrequency ablation of a middle cardiac vein inserted accessory pathway resulting in posterolateral coronary artery occlusion: A case report.

INTRODUCTION: Posteroseptal accessory pathways account for 34.5% of the total. Of these, 36% are located within the coronary sinus (CS). Its ablation requires technical alternatives to avoid damage to surrounding tissues, especially branches of the right coronary artery. CASE REPORT: A 22-year-old man was referred for re-do ablation of an accessory left septal-septal (PSE) pathway. Inside the CS, a precocity of 25 ms was found in the region of the median cardiac vein (VCM) (Fig. 2, panel A). Radiofrequency (RF) was administered with a non-irrigated bidirectional catheter within this vessel with resolution of the pre-excitation after 5 seconds. Immediately after, the patient presented chest pain and revealed a ST segment elevation of 1 mm in the inferior leads of ECG. Coronary angiography showed occlusion of the middle third of the posterior ventricular branch of the right coronary artery, with no signs of thrombus or dissection. Arterial angioplasty was performed with a bare metal stent, followed by TIMI III distal flow. Retrograde aortic mapping was performed and a precocity of 20 ms was found in the PSE region. The RF was applied followed by loss of pre-excitation after 1.5 seconds of application. CONCLUSION: This case demonstrates the risks involving delivering radiofrequency within the coronary sinus. We discuss some strategy that could help electrophysiologists in similar cases.

Hipertensão arterial secundária a coarctação atípicada aorta abdominal infrarrenal: relato de caso / Secondary arterial hypertension due to atypical coarctation of the aorta below-renal: case report

Relata-se um caso de uma paciente de 50 anos, dislipidêmica, tabagista e hipertensa, que se queixava de claudicação intermitente progressiva há seis anos (durante primeira consulta ao deambular 100 metros). Ao exame clínico inicial, apresentava-se hipertensa (PA: 150 x 70 mmHg) e baixa amplitude de pulso nas artérias femorais, já em uso de quatro classes diferentes de anti-hipertensivos. Durante investigação diagnóstica, detectou-se, na angioressonância, estenose de 75% do lumen da aorta, 5 cm abaixo das artérias renais. Foi submetida à aortoplastia com stent, com satisfatória evolução clínica e normalização dos níveis pressóricos. Dessa forma, com as características clínicas descritas e com o tratamento utilizado para esta paciente, ilustramos um caso de coarctação atípica da aorta abdominal infrarrenal, patologia rara e com mecanismo fisiopatológico pouco compreendido. Destaca-se a importância do diagnóstico precoce e do tratamento adequado dessa síndrome.

We report a case of a 50 years-old patient, with dyslipidemia, that smokes and has hypertension, who complained of progressive intermittent claudication six years ago (during the first visit when walking 100 meters). The initial clinical examination revealed hypertension (BP: 150 x 70 mmHg) and low pulse width in femoral arteries, already in use in four different classes of antihypertensive drugs. During diagnostic investigation was detected in magnetic resonance angiography, 75% stenosis of the aorta lumen 5 cm below the renal arteries. She underwent angioplasty with a stent, a good outcome and normal blood pressure. Thus, with the clinical characteristics and the treatment used for this patient, we illustrate a case of atypical coarctation of the aorta abdominal below-renal, rare disease with poorly understood pathophysiological mechanism. We emphasize the importance of early diagnosis and appropriate treatment of this syndrome.

Prevalência de tabagismo em estudantes de faculdade de medicina / Prevalency of smoking in medicine students

O tabagismo é atualmente a principal causa de enfermidades evitáveis e incapacidades prematuras em âmbito mundial, sendo que a Organização Mundial de Saúde (OMS) estima cerca de 10 milhões de mortes anuais nos próximos 30 a 40 anos em virtude de complicações de saúde decorrentes do tabaco. Apesar de possuir uma função preventiva em programas antitabagistas, estudos recentes revelam que a classe médica possui porcentagem significativa de profissionais fumantes...

This is a epidemiological paper concerning the use of cigarettes by medicine students and also a literature review based on several different articles. According to the World Health Organization (WHO), smoking is the main cause of preventable diseases in the planet and is directly responsable for about 8 millions deaths a year. Such numbers aren't a big surprise for any educated reader, but what is intersting is that despite this, the number of smokers are progressively growing. The medical class, which are the people responsable for informing and warning the population have a great percentage of smokers...