RESUMO
We present the case of a 60-year-old woman with a non secretor cardiac paraganglioma diagnosed in the setting of an acute coronary syndrome. The tumor was supplied by a huge branch of the circumflex artery and we admit flow steal as the cause of myocardial ischemia. Complete resection was feasible under cardiopulmonary bypass and the patient was discharged on the 9th postoperative day.
Assuntos
Síndrome Coronariana Aguda/etiologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Paraganglioma Extrassuprarrenal/complicações , Paraganglioma Extrassuprarrenal/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND AIM OF THE STUDY: The study aim was to analyze the mid-term prognosis of infective endocarditis (IE) in patients managed with medical therapy during the in-hospital phase and who had a good initial outcome. Comparison was made with the prognosis of patients treated surgically during this period. METHODS: A total of 151 patients diagnosed with IE was studied, and in-hospital outcome, clinical characteristics and mid-term follow up data were analyzed. The main end-point was a composite of death and need for surgical repair. RESULTS: Among 151 patients, 84 (56%) underwent surgery or died during the in-hospital phase, while 67 patients (44%) received medical treatment and were discharged clinically stable with a final diagnosis of healed infective endocarditis. A better baseline profile was seen in the medically treated group, but outcome in this group showed extensive mid-term morbidity/mortality. In total, 52.2% of patients underwent surgery to correct complications and 60% died as a consequence of the disease. The event-free survival rate was 20% at five years. CONCLUSION: Despite a favorable in-hospital clinical course and successful medical treatment, patients with IE are at risk of late complications that result in a need for surgical repair, or in death. A close follow up should be made in order to treat late complications.
Assuntos
Endocardite Bacteriana/tratamento farmacológico , Falso Aneurisma/etiologia , Intervalo Livre de Doença , Ecocardiografia , Endocardite Bacteriana/cirurgia , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Valvas Cardíacas/cirurgia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Prognóstico , Recidiva , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Stress-induced/Takotsubo cardiomyopathy (TC) is an increasingly recognized diagnostic entity. OBJECTIVE: This study was aimed to assess the prevalence and clinical predictors of short and long-term outcome of patients (pts) diagnosed with TC. METHODS: We included all consecutive pts admitted in our department, from November 2006 to August 2011, who met the Mayo Clinic criteria for TC diagnosis. RESULTS: We evaluated 37 pts (35 women) with a mean age of 63 ± 13 years. TC was precipitated by a stressful emotional event in the majority (57%) and chest pain was the most common symptom (89%). Twelve pts (32%) had ST-segment elevation and 15 pts (41%) had T-wave inversion on the electrocardiogram at admission. Severe left ventricular (LV) dysfunction was found in 16 pts (43%) and the mean troponin I level was 2.6 ± 1.8 ng/mL. The in-hospital complication rate was 30%, with cardiogenic shock being the most common situation. Physical stress, severe LV systolic dysfunction and peak brain natriuretic peptide (BNP) were predictors of acute complications. On the other hand, we found no association between peak troponin I and electrocardiographic presentation. Thirty-five pts were followed for a mean time of 482 ± 512 days, without clinic recurrence. CONCLUSION: In our cohort of pts, TC was associated with a high in-hospital complications rate. Physical stress, LV dysfunction and peak BNP could predict acute adverse outcomes.
Assuntos
Estresse Psicológico/fisiopatologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/fisiopatologia , Idoso , Diástole/fisiologia , Eletrocardiografia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico , Sístole/fisiologia , Troponina/sangue , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Fundamento: A cardiomiopatia de estresse/Takotsubo (CT) é uma entidade diagnóstica cada vez mais reconhecida. Objetivo: Este estudo teve como objetivo avaliar a prevalência e os preditores clínicos de complicações de curto e longo prazo de pacientes (pts) com CT. Métodos: Foram incluídos todos os pts consecutivamente admitidos no nosso centro, entre novembro de 2006 e agosto de 2011, que preenchiam os critérios diagnósticos da Clínica Mayo. Resultados: Analisaram-se 37 pts (35 mulheres), com idade média de 63 ± 13 anos. A CT foi precipitada na maioria dos casos por eventos de estresse emocional (57%) e dor torácica foi o sintoma de apresentação mais frequente (89%). O electrocardiograma na admissão mostrou supradesnivelamento do segmento ST em 12 pts (32%) e inversão da onda T em 15 casos (41%). Verificou-se disfunção sistólica ventricular esquerda (VE) grave em 16 pts (45%) e a elevação média de troponina I foi de 2,6 ± 1,8 ng/mL. A taxa de complicações intra-hospitalares foi de 30%, sendo o choque cardiogênico a situação mais comum. O estresse físico, a disfunção sistólica grave do VE e o valor de pico do peptídeo natriurético cerebral (BNP) foram preditores de complicações agudas. Não foi encontrada associação entre o pico de troponina I e a apresentação eletrocardiográfica. Trinta e cinco pacientes foram acompanhados por um tempo médio de 482 ± 512 dias, sem recorrência clínica. Conclusão: Na nossa série de pacientes, a CT foi associada a uma alta taxa de complicações intra-hospitalares. O estresse físico, a disfunção sistólica do VE e o valor de pico do BNP foram preditores de desfechos adversos agudos. .
Background: Stress-induced/Takotsubo cardiomyopathy (TC) is an increasingly recognized diagnostic entity. Objective: This study was aimed to assess the prevalence and clinical predictors of short and long-term outcome of patients (pts) diagnosed with TC. Methods: We included all consecutive pts admitted in our department, from November 2006 to August 2011, who met the Mayo Clinic criteria for TC diagnosis. Results: We evaluated 37 pts (35 women) with a mean age of 63 ±13 years. TC was precipitated by a stressful emotional event in the majority (57%) and chest pain was the most common symptom (89%). Twelve pts (32%) had ST-segment elevation and 15 pts (41%) had T-wave inversion on the electrocardiogram at admission. Severe left ventricular (LV) dysfunction was found in 16 pts (43%) and the mean troponin I level was 2.6±1.8 ng/mL. The in-hospital complication rate was 30%, with cardiogenic shock being the most common situation. Physical stress, severe LV systolic dysfunction and peak brain natriuretic peptide (BNP) were predictors of acute complications. On the other hand, we found no association between peak troponin I and electrocardiographic presentation. Thirty-five pts were followed for a mean time of 482 ± 512 days, without clinic recurrence. Conclusion: In our cohort of pts, TC was associated with a high in-hospital complications rate. Physical stress, LV dysfunction and peak BNP could predict acute adverse outcomes. .
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/fisiopatologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/fisiopatologia , Diástole/fisiologia , Eletrocardiografia , Hospitalização , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico , Sístole/fisiologia , Troponina/sangue , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
OBJECTIVE: Our aim was to provide an initial description of the usefulness of real-time 3-dimensional (3D) echocardiography when evaluating patients with infective endocarditis. METHODS: For this purpose, we describe 3 cases in which the usefulness of real-time 3D echocardiography is shown. RESULTS: Better definition of the morphologic characteristics of the vegetation and valvular apparatus was achieved with real-time 3D echocardiography. Furthermore, the information provided by the real-time 3D echocardiogram to the surgical team was accurate and direct because it was not based on detailed verbal information for performing a 3D mental reconstruction but was a simple image similar to what would be found in the operating room. In all cases, the information provided by the real-time 3D echocardiography was confirmed during surgery. CONCLUSIONS: Real-time 3D echocardiography is an important tool for aiding diagnosis or for fine tuning a suspected diagnosis when traditional echocardiography is not completely clear for both medical and surgical decision making.
Assuntos
Ecocardiografia Tridimensional , Endocardite Bacteriana/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Humanos , Pessoa de Meia-IdadeRESUMO
Real-time 3-dimensional echocardiography allows a comprehensive evaluation of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy. The anterior segment of the anterior mitral leaflet is essential in the development of the LVOT pressure gradient.