RESUMEN
INTRODUCTION: Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death. OBJECTIVE: To assess whether OSA increases the risk of sudden death in the non-cardiac population. METHODS: This is a systematic review of the literature. The descriptors "sudden death" and "sleep apnea" and "tachyarrhythmias" and "sleep apnea" were searched in the PubMed/Medline and SciELO databases. RESULTS: Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death. CONCLUSION: There was a cause-effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population.
Asunto(s)
Muerte Súbita , Apnea Obstructiva del Sueño , Humanos , Arritmias Cardíacas/etiología , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/epidemiología , Muerte Súbita/etiología , Muerte Súbita/epidemiología , Factores de Riesgo , Síndromes de la Apnea del Sueño/complicaciones , Apnea Obstructiva del Sueño/complicacionesRESUMEN
BACKGROUND: Investigation of syncope involves the use of electrophysiological study, particularly in patients with cardiac conduction disorder. There is conflicting evidence about the role of electrophysiological study in patients with Chagas disease. OBJECTIVE: The objective of this study was to evaluate the electrophysiological study findings in patients with Chagas disease and bundle branch block and/or divisional block presenting with syncope. METHODS: This is a retrospective study of patients with Chagas disease and cardiac conduction disorder who underwent electrophysiological study from 2017 to 2021 for the investigation of syncope in a tertiary hospital in São Paulo, Brazil. Those with non-interpretable ECG, known coronary artery disease, and/or other cardiomyopathies were excluded. HV interval and electrophysiological study-induced malignant ventricular arrhythmias data were analyzed. RESULTS: A total of 45 patients (60.2±11.29 years, 57.8% males) were included. The mean HV interval was 58.37 ms±10.68; 22.2% of the studied population presented an HV interval of ≥70 ms; and malignant ventricular arrhythmias were induced in 57.8% patients. The use of beta-blockers and amiodarone (p=0.002 and 0.036, respectively), NYHA functional class≥II (p=0.013), wide QRS (p=0.047), increased HV interval (p=0.02), Rassi score >6.5 (p=0.003), and reduced left ventricular ejection fraction (p=0.031) were associated with increased risk of inducible malignant ventricular arrhythmias. CONCLUSION: More than half of the patients with Chagas disease, syncope, and cardiac conduction disorder have inducible malignant ventricular arrhythmias. Prolonged HV interval was observed in only 20% of population. Wide QRS, prolonged HV, reduced ejection fraction, and higher Rassi score were associated with increased risk of malignant ventricular arrhythmias.
Asunto(s)
Enfermedad de Chagas , Función Ventricular Izquierda , Masculino , Humanos , Femenino , Estudios Retrospectivos , Volumen Sistólico , Brasil/epidemiología , Arritmias Cardíacas/complicaciones , Bloqueo de Rama/complicaciones , Síncope/etiología , Enfermedad de Chagas/complicaciones , Electrocardiografía/efectos adversosRESUMEN
Background: The Tpe interval (Tp-e) in the surface electrocardiogram represents ventricular repolarization, a key phase in the pathogenesis of severe ventricular arrhythmias. However, there are few studies evaluating changes in this electrocardiographic interval as a risk factor for serious arrhythmias in patients with dilated cardiomyopathy. Objective: To determine whether the Tp-e interval prolongation predicts the presence of life-threatening arrhythmias in patients with dilated cardiomyopathy (DCM) with implantable cardioverter-defibrillator (ICD). Material and methods: Analytical, cross-sectional study in patients with DCM with ICDs. The Tp-e interval was measured in the V2 electrocardiographic lead and correlated with the incidence of life-threatening arrhythmias identified by the ICD. Results: 53 patients were recruited, 10 (18.8%) presented life-threatening arrhythmias. Prolongation of Tp-e interval was related to an increase in the incidence of ventricular tachycardia/fibrillation tachycardia (VT/FT) with a mean of 93 ± 20.5 ms (p = 0.003), using ROC curves to determine the thereshold of 90 ms for increased risk of VT/VF with sensitivity of 70% and specificity of 84%, with an area under the curve of 0.798. Conclusion: The prolongation of the ITp-e interval greater than 90 ms in a population with dilated cardiomyopathy predicts the presence of arrhythmic episodes, such as VT and/or VT/FT.
Introducción: el intervalo Tpe (ITp-e) en el electrocardiograma de superficie representa la repolarización ventricular, fase clave en la patogénesis de arritmias ventriculares graves. Sin embargo, existen pocos estudios que evalúen la alteración de este intervalo electrocardiográfico como factor de riesgo de arritmias graves en pacientes con miocardiopatía dilatada. Objetivo: determinar si la prolongación del ITp-e predice la presencia de arritmias potencialmente mortales en pacientes con miocardiopatía dilatada (MCD) portadores de desfibrilador automático implantable (DAI). Material y métodos: estudio, transversal analítico en pacientes con MCD portadores de DAI. Se midió el ITp-e en la derivación electrocardiográfica V2 y se correlacionó con la incidencia de arritmias potencialmente letales identificadas por el DAI. Resultados: se incluyeron 53 pacientes, 10 (18.8%) presentaron arritmias potencialmente mortales. La prolongación del ITp-e se relacionó con aumento de incidencia de taquicardia ventricular/fibrilación ventricular (TV/FV) con media de 93 ± 20.5 ms (p = 0.003), por lo que se determinó mediante curvas ROC el punto de corte de 90 ms para el aumento de riesgo de TV/FV con sensibilidad de 70% y especificidad de 84%, con área bajo la curva de 0.798. Conclusión: la prolongación del intervalo ITp-e > 90 ms en población con miocardiopatía dilatada predice la presencia de episodios arrítmicos como TV o FV.
Asunto(s)
Cardiomiopatía Dilatada , Taquicardia Ventricular , Humanos , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/diagnóstico , Estudios Transversales , Arritmias Cardíacas/etiología , Arritmias Cardíacas/complicaciones , Fibrilación Ventricular/etiología , Taquicardia Ventricular/etiología , Taquicardia Ventricular/complicaciones , Electrocardiografía/efectos adversos , Factores de RiesgoRESUMEN
BACKGROUND: The high incidence of atrial arrhythmias in pulmonary hypertension (PH) might be associated with poor prognosis, and the left atrium (LA) may play a role in this. An important finding in PH studies is that LA remodeling is underestimated. OBJECTIVE: This study investigated LA morphology and mechanical function, as well as the susceptibility to develop arrhythmias in a monocrotaline-induced PH (MCT-PH) model. METHODS: Wistar rats aged 4 weeks received 50 mg/kg of MCT. Electrocardiography and histology analysis were performed to evaluate the establishment of the MCT-PH model. The tissue was mounted in an isolated organ bath to characterize the LA mechanical function. RESULTS: Compared with the control group (CTRL), the MCT-PH model presented LA hypertrophy and changes in cardiac electrical activity, as evidenced by increased P wave duration, PR and QT interval in MCT-PH rats. In LA isolated from MCT-PH rats, no alteration in inotropism was observed; however, the time to peak contraction was delayed in the experimental MCT-PH group. Finally, there was no difference in arrhythmia susceptibility of LA from MCT-PH animals after the burst pacing protocol. CONCLUSION: The morphofunctional remodeling of the LA did not lead to increased susceptibility to ex vivo arrhythmia after application of the burst pacing protocol.
FUNDAMENTO: A alta incidência de arritmias atriais na hipertensão pulmonar (HP) pode estar associada a um prognóstico ruim, e o átrio esquerdo (AE) pode desempenhar um papel neste quadro. Um achado importante nos estudos de HP é que a remodelação do AE é subestimada. OBJETIVO: Este estudo investigou a morfologia e a função mecânica do AE, bem como a suscetibilidade ao desenvolvimento de arritmias em um modelo de HP induzida por monocrotalina (HP-MCT). MÉTODOS: Ratos Wistar com 4 semanas de idade receberam 50 mg/kg de MCT. Foram realizadas análises eletrocardiográficas e histológicas para avaliar o estabelecimento do modelo de HP-MCT. O tecido foi montado em banho de órgão isolado para caracterizar a função mecânica do AE. RESULTADOS: Em comparação com o grupo controle, o modelo de HP-MCT apresentou hipertrofia do AE e alterações da atividade elétrica cardíaca, conforme evidenciadas pelo aumento da duração da onda P, PR e intervalo QT. Não foi observada alteração no inotropismo do AE isolado de ratos com HP-MCT; no entanto, o tempo para atingir a contração máxima foi atrasado. Finalmente, não observamos diferença na suscetibilidade à arritmia no AE dos ratos com HP-MCT após o protocolo de estimulação intermitente. CONCLUSÃO: A remodelação morfofuncional do AE não levou ao aumento da suscetibilidade à arritmia ex vivo após a aplicação do protocolo de estimulação intermitente.
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Hipertensión Pulmonar , Ratas , Animales , Hipertensión Pulmonar/inducido químicamente , Ratas Sprague-Dawley , Ratas Wistar , Atrios Cardíacos , Arritmias Cardíacas/inducido químicamente , Arritmias Cardíacas/complicaciones , Monocrotalina/efectos adversos , Arteria PulmonarRESUMEN
BACKGROUND: Cardiac magnetic resonance (CMR) has an increasing diagnostic relevance in survivors of sudden cardiac death (SCD) or unstable ventricular arrhythmia (UVA) in developed countries. OBJECTIVE: To evaluate retrospectively the additional role of CMR in a developing country where few resources are available, and should be used more effectively. METHODS: The study included SCD or UVA survivors admitted between 2009 and 2019 at a tertiary academic institution referred to CMR. Demographic, clinical, and laboratory data were collected from the medical records. CMR images and reports were reviewed and their impact on the final etiological diagnosis was determined. A descriptive analysis was performed and p<0.05 established as significant. RESULTS: Sixty-four patients, 54.9±15.4 years old, and 42 (71.9%) males. Most events (81.3%) were out of the hospital and ventricular tachycardia was the most common rhythm. Cardiovascular medications were previously used by 55 patients, and beta-blockers were the most used medications (37.5%). Electrocardiogram had electrical inactive areas in 21.9% and all of them had fibrosis at CMR. Mean left ventricular ejection fraction (LVEF) was 44±14%, with 60.9% ≤50% and only 29.7% ≤35%. Late gadolinium enhancement was identified in 71.9%, with a transmural pattern in 43.8%. Chagas cardiomyopathy was the most common etiology (28.1%), followed by ischemic cardiomyopathy (17.2%). Among 26 without a previously identified etiology, CMR could define it (15 patients - 57%). CONCLUSION: In accordance with previous studies in developed countries, CMR was capable of increasing etiological diagnosis and identifying the arrhythmogenic substrate, allowing better care in half of the underdiagnosed patients.
FUNDAMENTO: A ressonância magnética cardíaca (RMC) tem relevância diagnóstica crescente em sobreviventes de morte súbita cardíaca (MSC) ou arritmia ventricular instável (AVI) em países desenvolvidos. OBJETIVO: Procuramos avaliar retrospectivamente o papel adicional da RMC em um país em desenvolvimento com poucos recursos disponíveis e que pode direcionar um uso mais eficaz desses recursos. MÉTODOS: Foram incluídos sobreviventes de MSC ou AVI admitidos entre 2009 e 2019 em uma instituição acadêmica terciária após a realização de RMC. Dados demográficos, clínicos e laboratoriais foram coletados dos prontuários. Imagens e laudos de RMC foram analisados e o impacto disso no diagnóstico etiológico final foi afirmado. Realizou-se análise descritiva e definiu-se p<0,05 como significativo. RESULTADOS: Sessenta e quatro pacientes, 54,9±15,4 anos, sendo 42 (71,9%) do sexo masculino. A maioria dos eventos (81,3%) foi extra-hospitalar e a taquicardia ventricular foi o ritmo mais comum. Medicamentos cardiovasculares foram utilizados anteriormente por 55 pacientes, sendo os betabloqueadores os medicamentos mais utilizados (37,5%). O eletrocardiograma apresentava áreas elétricas inativas em 21,9% e todos apresentavam fibrose na RMC. A média da fração de ejeção do ventrículo esquerdo (FEVE) foi de 44±14%, com 60,9% ≤50% e apenas 29,7% ≤35%. Identificou-se realce tardio com gadolínio em 71,9%, com padrão transmural em 43,8%. A miocardiopatia chagásica foi a etiologia mais comum (28,1%), seguida da miocardiopatia isquêmica (17,2%). Entre 26 sem etiologia previamente identificada, foi possível definir com RMC (15 pacientes - 57%). CONCLUSÃO: De acordo com estudos anteriores em países desenvolvidos, a RMC foi capaz de aumentar o diagnóstico etiológico e identificar o substrato arritmogênico, permitindo melhor atendimento em metade dos pacientes subdiagnosticados.
Asunto(s)
Medios de Contraste , Función Ventricular Izquierda , Masculino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Femenino , Volumen Sistólico , Estudios Retrospectivos , Gadolinio , Arritmias Cardíacas/diagnóstico por imagen , Arritmias Cardíacas/complicaciones , Muerte Súbita Cardíaca/etiología , Espectroscopía de Resonancia Magnética/efectos adversos , Imagen por Resonancia CinemagnéticaRESUMEN
Presentamos el caso de un paciente quien presentó un evento presincopal en el que destacan 3 patologías asociadas a muerte súbita de forma independiente: miocardiopatía hipertrófica, origen anómalo coronario y enfermedad arterial coronaria epicárdica; diagnósticos coexistentes. Se describe las patologías, diagnóstico, manejo médico y terapéutico y se revisa la literatura.
A patient presented with a presyncopal event. Three conditions independently associated with sudden death, hypertrophic cardiomyopathy, anomalous origin of coronary arteries and epicardial coronary artery disease were found. Diagnosis, and medical management are described, followed by a review of the literature.
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Humanos , Masculino , Anciano , Arritmias Cardíacas/complicaciones , Cardiomiopatía Hipertrófica/complicaciones , Aterosclerosis/complicaciones , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Imagen por Resonancia Magnética , Ecocardiografía , Anomalías de los Vasos Coronarios , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Aterosclerosis/diagnóstico por imagenRESUMEN
PURPOSE OF REVIEW: Among the most common causes of cardiac syncope are arrhythmias and ischemic heart disease, both of which can coexist. The purpose of this review is to discuss the main causes of cardiac and vascular syncope related to atherosclerosis, its epidemiological and clinical aspects, warning signs, and initial approach. RECENT FINDINGS: Cardiac syncope may have a frequency of up to 34% in elderly people. Atherosclerosis-related causes of cardiac and vascular syncope may be due to cardiac arrhythmia and/or structural impairment of the heart or arteries. Late ventricular tachycardia and late-onset high-grade atrioventricular block associated with myocardial ischemia may occur with syncope, which is related to higher mortality. Besides ventricular dysfunction, concentric remodeling is also a prognostic factor. In calcific degenerative aortic stenosis, syncope carries a worse prognosis than the other cardinal signs. Cardiac syncope has a high recurrence and mortality rate. There are red flag alerts that must be considered in risk stratification.
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Aterosclerosis , Isquemia Miocárdica , Taquicardia Ventricular , Anciano , Válvula Aórtica/patología , Estenosis de la Válvula Aórtica , Arritmias Cardíacas/complicaciones , Aterosclerosis/complicaciones , Calcinosis , Corazón , Humanos , Isquemia Miocárdica/complicaciones , Síncope/diagnóstico , Síncope/etiologíaRESUMEN
BACKGROUND: The FLNC gene has recently garnered attention as a likely cause of arrhythmogenic cardiomyopathy, which is considered an actionable genetic condition. However, the association with disease in an unselected clinical population is unknown. We hypothesized that individuals with loss-of-function variants in FLNC (FLNCLOF) would have increased odds for arrhythmogenic cardiomyopathy-associated phenotypes versus variant-negative controls in the Geisinger MyCode cohort. METHODS: We identified rare, putative FLNCLOF among 171 948 individuals with exome sequencing linked to health records. Associations with arrhythmogenic cardiomyopathy phenotypes from available diagnoses and cardiac evaluations were investigated. RESULTS: Sixty individuals (0.03%; median age 58 years [47-70 interquartile range], 43% male) harbored 27 unique FLNCLOF. These individuals had significantly increased odds ratios for dilated cardiomyopathy (odds ratio, 4.9 [95% CI, 2.6-7.6]; P<0.001), supraventricular tachycardia (odds ratio, 3.2 [95% CI, 1.1-5.6]; P=0.048), and left-dominant arrhythmogenic cardiomyopathy (odds ratio, 4.2 [95% CI, 1.4-7.9]; P=0.03). Echocardiography revealed reduced left ventricular ejection fraction (52±13% versus 57±9%; P=0.001) associated with FLNCLOF. Overall, at least 9% of FLNCLOF patients demonstrated evidence of penetrant disease. CONCLUSIONS: FLNCLOF variants are associated with increased odds of ventricular arrhythmia and dysfunction in an unselected clinical population. These findings support genomic screening of FLNC for actionable secondary findings.
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Cardiomiopatía Dilatada , Filaminas , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/genética , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/genética , Exoma , Femenino , Filaminas/genética , Humanos , Masculino , Fenotipo , Volumen Sistólico , Función Ventricular Izquierda , Secuenciación del ExomaRESUMEN
Abstract An acute respiratory syndrome caused by SARS-CoV2 was declared a pandemic by the World Health Organization. Current data in the world and in Brazil show that approximately 40% of patients who died have some type of cardiac comorbidity. There are also robust reports showing an increase in IL-6 / IL-1B / TNF-alpha and the presence of lymphopenia in patients with COVID-19. Our team and others have shown that increased cytokines are the link between arrhythmias/Left ventricular dysfunction and the immune system in different diseases. In addition, it has been well demonstrated that lymphopenia can not only be a good marker, but also a factor that causes heart failure. Thus, the present review focused on the role of the immune system upon the cardiac alterations observed in the SARS-CoV2 infection. Additionally, it was well described that SARS-CoV-2 is able to infect cardiac cells. Therefore, here it will be reviewed in deep.
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Arritmias Cardíacas/complicaciones , SARS-CoV-2/patogenicidad , COVID-19/complicaciones , Insuficiencia Cardíaca/etiología , Miocardio/inmunología , Arritmias Cardíacas/fisiopatología , Citocinas , Citocinas/inmunología , Coronavirus/patogenicidad , Disfunción Ventricular Izquierda/fisiopatología , Miocitos Cardíacos/patología , Síndrome Respiratorio Agudo Grave , Insuficiencia Cardíaca/complicaciones , Linfopenia/complicacionesRESUMEN
Electrocardiographic (ECG) abnormalities are frequently identified in Chronic Chagas cardiomyopathy (CCC) patients and advanced abnormalities are related to a worse prognosis. Cardiac Magnetic Resonance (CMR) can precisely assess ventricular systolic dysfunction and quantify myocardial fibrosis (MF), both identified as prognostic factors. We sought to investigate if ECG abnormalities in CCC patients were associated with more severe myocardial involvement as evaluated by CMR. METHODS: CCC patients with 12lead ECG and CMR closely obtained were included. ECG analysis evaluated rhythm, presence, and type of intraventricular conduction disturbances (IVCD) and, ventricular premature beats (VPB). CMR short-axis cine and late gadolinium enhancement images were evaluated to obtain left and right ventricular ejection fractions and MF mass, respectively. Statistical significance was set in 5%. RESULTS: 194 CCC patients (98 women, 56 ± 14 years) were evaluated, and no IVCD was detected in 71. The most common IVCD was the association of right bundle branch block and left anterior fascicular block (RBBB+LAFB) in 58 patients, followed by isolated RBBB in 34, isolated LAFB in 17, and left bundle branch block (LBBB) in 14 patients. Of patients with no IVCD, 63% had MF and the burden of fibrosis (no IVCD - 7.4 ± 8.6%; RBBB - 6.6 ± 6.5%; p = 1.00), as well as left ventricular ejection fraction (LVEF) (no IVCD - 52 ± 14%; RBBB - 55 ± 10%; p = 1.00) were similar to patients with isolated RBBB. Left conduction system impairment was associated with lower LVEF (LAFB - 39 ± 15%; RBBB+LAFB- 41 ± 15%; and LBBB - 35 ± 15%; p < 0.001) and more MF (RBBB+LAFB - 12.2 ± 10.4%; LBBB - 10.6 ± 7.5%; and LAFB - 12.0 ± 7.0%; p < 0.001). The univariable model showed that the presence of MF was related to RBBB+LAFB (OR 5.0; p = 0.001) and VPB (OR 6.3; p = 0.014). After adjustment for age, gender, and different risk factors in a multivariable model, the same findings were still significantly related to CMR myocardial fibrosis (RBBB+LAFB OR 5.0; p = 0.002 / VPB OR 6.9; p = 0.015). CONCLUSIONS: ECG without IVCD does not exclude serious cardiac abnormalities in CCC, and isolated RBBB seems to have a benign course. The presence of VPB and left branch conduction impairment, especially LAFB associated with RBBB, indicate a more severe cardiac involvement.
Asunto(s)
Cardiomiopatías , Cardiomiopatía Chagásica , Enfermedad de Chagas , Disfunción Ventricular Izquierda , Arritmias Cardíacas/complicaciones , Bloqueo de Rama , Cardiomiopatías/complicaciones , Cardiomiopatía Chagásica/complicaciones , Cardiomiopatía Chagásica/diagnóstico por imagen , Enfermedad de Chagas/complicaciones , Cicatriz/complicaciones , Medios de Contraste , Electrocardiografía , Femenino , Gadolinio , Humanos , Imagen por Resonancia Magnética , Volumen Sistólico , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/etiología , Función Ventricular IzquierdaRESUMEN
Abstract Background In Brazil the factors involved in the risk of death in patients with COVID-19 have not been well established. Objective To analyze whether elevations of high-sensitivity troponin I (hTnI) levels influence the mortality of patients with COVID-19. Methods Clinical and laboratory characteristics of hospitalized patients with COVID-19 were collected upon hospital admission. Univariate and binary logistic regression analyzes were performed to assess the factors that influence mortality. P-value<0.05 was considered significant. Results This study analyzed192 patients who received hospital admission between March 16 and June 2, 2020 and who were discharged or died by July 2, 2020. The mean age was 70±15 years, 80 (41.7%) of whom were women. In comparison to those who were discharged, the 54 (28.1%) who died were older (79±12 vs 66±15years; P=0.004), and with a higher Charlson´s index (5±2 vs 3±2; P=0.027). More patients, aged≥60years (P <0.0001), Charlson´s index>1 (P=0.004), lung injury>50% in chest computed tomography (P=0.011), with previous coronary artery disease (P=0.037), hypertension (P=0.033), stroke (P=0.008), heart failure (P=0.002), lymphocytopenia (P=0.024), high D-dimer (P=0.024), high INR (P=0.003), hTnI (P<0.0001), high creatinine (P<0.0001), invasive mechanical ventilation (P<0.0001), renal replacement therapy (P<0.0001), vasoactive amine (P<0.0001), and transfer to the ICU (P=0.001), died when compared to those who were discharged. In logistic regression analysis, elevated hTnI levels (OR=9.504; 95% CI=1.281-70.528; P=0.028) upon admission, and the need for mechanical ventilation during hospitalization (OR=46.691; 95% CI=2.360-923.706; P=0.012) increased the chance of in-hospital mortality. Conclusion This study suggests that in COVID-19 disease, myocardial injury upon hospital admission is a harbinger of poor prognosis.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Troponina I/sangre , COVID-19/mortalidad , Miocarditis/complicaciones , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/etiología , Estudios Retrospectivos , Estudios de Cohortes , COVID-19/complicacionesRESUMEN
A disjunção do anel mitral (DAM) é uma inserção anormal da linha de flexão do anel mitral na parede atrial. O anel mostra uma separação (disjunção) entre a junção folheto posterior-parede atrial e a crista miocárdica ventricular esquerda.1 A DAM foi descrita pela primeira vez há mais de 30 anos em estudo de autópsia, estando relacionada com prolapso da valva mitral (PVM) em 92% dos casos.2 Desde então, foram realizados diversos estudos, sendo a prevalência de DAM em pacientes com PVM reportada de forma variável, podendo ou não estar associada à insuficiência mitral. O ecocardiograma transtorácico (ETT) faz parte da avaliação inicial do prolapso valvar mitral, permitindo o diagnóstico e a avaliação de complicações relacionadas. Com a evolução de novos métodos diagnósticos, a ressonância magnética cardíaca (RMC) e o ecocardiograma transesofágico (ETE) passaram a aprimorar a avaliação dessa patologia, bem como de sua extensão e localização. Contudo, as características fenotípicas do PVM que estão mais associadas a DAM permanecem incertas, sobretudo devido ao número limitado de pacientes, nos estudos clássicos sobre o tema. Portadores de DAM podem desenvolver sintomas relacionados a arritmias ventriculares, configurando a síndrome arrítmica da DAM (SDAM), podendo evoluir para morte súbita. Na literatura, os dados prognósticos ainda são conflitantes entre os diversos estudos acerca do tema, indo desde critérios claros de diagnóstico, o melhor método de imagem a ser aplicado, o tratamento e o prognóstico. Esta revisão descreve as características da DAM associada ou não ao prolapso valvar, auxiliando no diagnóstico e na conduta dessa importante patologia. (AU)
Mitral annulus disjunction (MAD) is an abnormal insertion of the flexion line of the mitral annulus into the atrial wall. The annulus presents a separation (disjunction) between the posterior leafletatrial wall junction and the left ventricular myocardial crest.1 MAD was first described more than 30 years ago in an autopsy study and is reportedly related to mitral valve prolapse (MVP) in 92% of cases.2 Since then, several studies have been conducted, and reports on the prevalence of MAD in patients with MVP have varied. Ultimately, it may or may not be associated with mitral regurgitation. Transthoracic echocardiography is part of initial MVP assessment, allowing its diagnosis and the assessment of related complications. As new diagnostic methods emerged, cardiac magnetic resonance imaging and transesophageal echocardiography improved the assessment of this pathology in terms of its diagnosis, extension, and location. However, the phenotypic characteristics of MVP that are more closely associated with MAD remain uncertain mainly due to the limited number of patients in classic studies on the subject. Patients with MAD may develop symptoms related to ventricular arrhythmias, configuring the MAD arrhythmic syndrome, which may progress to sudden death. The literature presents conflicting prognostic data among several studies on the subject from clear diagnostic criteria and best imaging method to be used to treatment and prognosis. This review describes MAD characteristics associated (or not) with valve prolapse to improve the diagnosis and management of this important pathology. (AU)
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Humanos , Masculino , Femenino , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico , Arritmias Cardíacas/complicaciones , Pronóstico , Ecocardiografía/métodos , Espectroscopía de Resonancia Magnética/métodos , Muerte Súbita Cardíaca , Ecocardiografía Transesofágica/métodos , Atrios Cardíacos/patología , Ventrículos Cardíacos/anomalíasAsunto(s)
Humanos , Masculino , Femenino , Embarazo , Niño , Adulto , Arritmias Cardíacas/complicaciones , Insuficiencia Cardíaca/complicaciones , Cardiomiopatías/congénito , Cardiomiopatías/diagnóstico , Cardiomiopatías/tratamiento farmacológico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Ecocardiografía/métodos , Desfibriladores Implantables , Diuréticos/uso terapéutico , Electrocardiografía/métodos , Anticoagulantes/uso terapéuticoRESUMEN
A doença de Chagas representa um importante problema de saúde pública, sobretudo nos países endêmicos da América Latina. Dentre suas apresentações clínicas, a cardiomiopatia crônica é a mais frequente. De patogênese multifatorial, o acometimento miocárdico pode levar à insuficiência cardíaca, a eventos tromboembólicos, a arritmias e à morte súbita. Nesse contexto, a ressonância magnética cardiovascular é um excelente método não invasivo para a investigação do dano miocárdico e a compreensão dos mecanismos e consequências relacionados às essas lesões. Com elevada resolução espacial e capacidade de caracterização tecidual, a ressonância magnética cardiovascular proporciona análise morfofuncional altamente confiável e possibilita a identificação de marcadores de risco de eventos adversos em pacientes com doença de Chagas, sendo de grande utilidade para o diagnóstico e o acompanhamento desses indivíduos na rotina clínica. (AU)
Chagas disease represents an important public health problem, especially in endemic countries in Latin America. Chronic cardiomyopathy is its most frequent clinical presentation. Myocardial involvement has a multifactorial pathogenesis and can lead to heart failure, thromboembolic events, arrhythmias, and sudden death. In this context, cardiovascular magnetic resonance imaging (CMR) is an excellent noninvasive method for investigating myocardial damage and understanding the mechanisms and consequences of these injuries. CMR has high spatial resolution and tissue characterization capacity, enabling a highly reliable morphofunctional analysis and the identification of risk markers for adverse events in patients with Chagas disease. This exam is very useful for the diagnosis and follow-up of these patients in the routine clinical setting. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Diagnóstico por Imagen/métodos , Cardiomiopatía Chagásica/diagnóstico , Enfermedad de Chagas/etiología , Disfunción Ventricular/patología , Ventrículos Cardíacos/anomalías , Arritmias Cardíacas/complicaciones , Tromboembolia/complicaciones , Imagen por Resonancia Magnética/métodos , Muerte Súbita , Insuficiencia Cardíaca/complicaciones , América Latina/epidemiologíaRESUMEN
Introducción: Los aneurismas aórticos abdominales constituyen un problema de salud por la alta mortalidad que provocan. Su seguimiento y tratamiento son fundamentales para evitar las complicaciones posquirúrgicas. Objetivo: Caracterizar las principales complicaciones posquirúrgicas de los pacientes con aneurisma de la aorta abdominal operados electivamente. Métodos: Se realizó un estudio observacional y descriptivo en 94 pacientes operados de forma electiva en el Instituto Nacional de Angiología y Cirugía Vascular por presentar un diagnóstico de aneurisma de la aorta abdominal. Las variables de estudio fueron: edad, sexo, color de la piel, enfermedades asociadas, diámetro del aneurisma, profilaxis antibiótica, tiempo quirúrgico, tipo de prótesis vascular, tipo de complicación posoperatoria, tiempo de aparición de las complicaciones, estadía hospitalaria posoperatoria y estado al egreso. Se determinaron las frecuencias absolutas y relativas. Resultados: El 56,4 por ciento de los pacientes operados presentó algún tipo de complicación, las cuales fueron más frecuentes en el sexo masculino por encima de los 60 años. Las más predominantes resultaron la bronconeumonía (24,5 por ciento) y las arritmias cardíacas (20,8 por ciento). La proporción de complicaciones se mostró mayor en los pacientes con injertos bifurcados, así como en aquellos sin profilaxis y con un tiempo quirúrgico prolongado. Hubo mayor frecuencia de enfermedades cardiovasculares entre los fallecidos. Conclusiones: En los pacientes operados de forma electiva de aneurisma de la aorta abdominal predominaron las complicaciones respiratorias y cardiovasculares, estas últimas provocaron un aumento en la mortalidad(AU)
Introduction: Abdominal aortic aneurysms are a health problem because of the high mortality they cause. Their follow-up and treatment are essential to avoid post-surgical complications. Objective: Characterize the main post-surgical complications of patients with electively operated abdominal aortic aneurysm. Methods: An observational and descriptive study was conducted in 94 electively operated patients at the National Institute of Angiology and Vascular Surgery after having a diagnosis of abdominal aortic aneurysm. The study variables were: age, sex, skin color, associated diseases, aneurysm diameter, antibiotic prophylaxis, surgical time, type of vascular prosthesis, type of postoperative complication, time of onset of complications, postoperative hospital stay, and state at discharge moment. Absolute and relative frequencies were determined. Results: 56.4 percent of operated patients had some form of complication, which were more common in the males over 60 years. The most predominant complications were bronchopneumonie (24.5 percent) and cardiac arrhythmias (20.8 percent). The proportion of complications was shown to be higher in patients with forked grafts, as well as in those without prophylaxis and with prolonged surgical time. There was a higher frequency of cardiovascular diseases among the deceased patients. Conclusions: In patients electively operated of abdominal aortic aneurysm, there was a predominance of respiratory and cardiovascular complications, and the latter caused an increase in mortality(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Arritmias Cardíacas/complicaciones , Complicaciones Posoperatorias , Enfermedades Cardiovasculares/mortalidad , Aneurisma de la Aorta Abdominal/diagnóstico , Epidemiología Descriptiva , Estudio ObservacionalRESUMEN
Objetivo: Elaborar um perfil clínico e epidemiológico de pacientes com insuficiência cardíaca descompensada, de acordo com a etiologia da descompensação, e analisar o desfecho clínico dentre os diferentes grupos etiológicos encontrados. Métodos: Estudo retrospectivo e observacional. Os pacientes foram reunidos em seis grupos, conforme etiologia de descompensação, e comparados de acordo com dados coletados. Realizaram-se verificação por meio da análise de variância e teste exato de Fisher. Obteve-se significância estatística por meio do valor de p <0,10. Resultados: Foram analisados 123 prontuários de pacientes admitidos entre 2016 e 2018. A maior causa de descompensação da doença foi a má aderência ao tratamento (32,5%). Além disso, a doença foi responsável por maior tempo de internação (13,5 dias) e número de óbitos (seis). Conclusão: Otimizando-se os cuidados e o acompanhamento desses pacientes, pode haver um importante impacto sobre a incidência, as complicações e a frequência de descompensações. (AU)
Objective: To develop a clinical and epidemiological profile of patients with decompensated heart failure according to the etiology of decompensation and to analyze the clinical outcome among the different etiological groups found. Methods: This is a retrospective, observational study. Patients were divided in six groups according to etiology of decompensation and were compared according to data collected. Variance analysis and Fisher's exact test were performed. Statistical significance was obtained by means of p-value <0.10. Results: We analyzed 123 medical records of patients admitted between 2016 and 2018. The greatest cause of decompensation was the poor adherence to treatment (32.5%). In addition, the disease was responsible for longer hospitalization time (13.5 days) and number of deaths (six). Conclusion: Optimizing care and follow-up of these patients can have an important impact on the incidence, complications, and frequency of decompensation. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Perfil de Salud , Insuficiencia Cardíaca/epidemiología , Hospitales de Enseñanza/estadística & datos numéricos , Arritmias Cardíacas/complicaciones , Brasil/epidemiología , Epidemiología Descriptiva , Estudios Retrospectivos , Distribución por Sexo , Distribución por Edad , Síndrome Coronario Agudo/complicaciones , Cumplimiento de la Medicación/estadística & datos numéricos , Registros Electrónicos de Salud , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/sangre , Hospitalización , Hipertensión/complicaciones , Infecciones/complicacionesRESUMEN
INTRODUCTION: Epileptic seizures can be associated with peri-ictal heart rhythm disorders and even sudden death (SUDEP). Few paediatric studies have been conducted on the subject. AIM: To determine heart rhythm disorders in paediatric patients with epilepsy who were studied with video-electroencephalogram (video-EEG). METHODS: Prospective, observational study in patients under 18 years of age admitted for video-EEG at the Hospital Clinico Red de Salud UC-Christus, Santiago, Chile. A neurological and cardiological evaluation and electrocardiogram (ECG) were performed, in addition to a Holter ECG simultaneously with the video-EEG. RESULTS: Twenty-five patients were studied, 12 with refractory epilepsies, 23/25 focal and 20 on polytherapy. Altogether 768 hours of video-EEG were recorded, including 281 seizures in 15 patients: 157 clinical and 103 generalised. There were no serious arrhythmias, only non-specific or probably benign disorders, mainly incomplete right bundle branch block in 11 patients, which were more frequent in refractory epilepsies (p<0.036). Heart rate variation occurred mainly in seizures >30 seconds. No patient presented SUDEP. CONCLUSIONS: This is the first prospective study, with a new technique, using video-EEG and Holter ECG simultaneously in paediatrics. Despite the high number of seizures and refractory patients, we found no serious heart rhythm disorders, consistent with the clinical evaluation. Right bundle branch block is considered a non-pathological cardiological finding, but was highly prevalent in our sample compared to the normal population, especially in refractory epilepsy. Given that this is a serious event in epilepsy, it is important to further investigate such studies to assess preventive measures.
TITLE: Alteraciones electrocardiográficas periictales en pacientes pediátricos con epilepsia. Un estudio prospectivo.Introducción. Las crisis epilépticas pueden asociarse a alteraciones del ritmo cardíaco periictales e incluso a muerte súbita (SUDEP). Existen escasos estudios pediátricos al respecto. Objetivo. Determinar las alteraciones del ritmo cardíaco en pacientes pediátricos con epilepsia estudiados con videoelectroencefalograma (video-EEG). Métodos. Estudio prospectivo, observacional, en pacientes menores de 18 años ingresados para video-EEG en el Hospital Clínico Red de Salud UC-Christus, Santiago, Chile. Se realizó una evaluación neurológica y cardiológica, electrocardiograma (ECG) y Holter ECG simultáneo al video-EEG. Resultados. Se estudió a 25 pacientes, 12 con epilepsias refractarias, 23/25 focales y 20 en tratamiento con politerapia. Se registraron 768 horas de video-EEG, incluyendo 281 crisis epilépticas en 15 pacientes: 157 clínicas y 103 generalizadas. No hubo arritmias graves; sólo alteraciones inespecíficas o probablemente benignas, principalmente bloqueo incompleto de la rama derecha en 11 pacientes, más frecuente en las epilepsias refractarias (p menor de 0,036). La variación de la frecuencia cardíaca ocurrió principalmente en crisis > 30 segundos. Ningún paciente ha presentado SUDEP. Conclusiones. Éste es el primer estudio prospectivo, con una nueva técnica, usando simultáneamente video-EEG y Holter ECG en pediatría. Pese al alto número de crisis y pacientes refractarios, no encontramos alteraciones graves del ritmo cardíaco, en concordancia con la evaluación clínica. El bloqueo de la rama derecha se considera un hallazgo cardiológico no patológico, pero tuvo una alta prevalencia en nuestra muestra, comparada con la población normal, especialmente en la epilepsia refractaria. Dado que la SUDEP es un evento grave en la epilepsia, es importante ahondar más en este tipo de estudios para evaluar medidas preventivas.
Asunto(s)
Arritmias Cardíacas/fisiopatología , Electroencefalografía , Epilepsia/fisiopatología , Arritmias Cardíacas/complicaciones , Niño , Preescolar , Electroencefalografía/métodos , Epilepsia/complicaciones , Femenino , Humanos , Masculino , Estudios Prospectivos , Grabación en VideoRESUMEN
Sudden cardiac arrest (SCA) and sudden death (SD) continue to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCA victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Autopsy, histological, and toxicological studies are necessary in all victims of SCA and SD to determine the precise cause of death; when these studies are carried out, causes of non-cardiac origin have been found in up to 40% of victims. The type of arrhythmia responsible for an episode of SCA and SD has changed over the years, now asystole and pulseless electrical activity are detected more frequently than ventricular fibrillation or pulseless ventricular tachycardia. These and other aspects that we consider important in the current behavior of SCA and SD are analyzed in this article.
El paro cardíaco súbito (PCS) y la muerte súbita (MS) continúan siendo un problema de salud pública mundial; aunque su verdadera incidencia se desconoce, se calcula que producen el 30% de la mortalidad de origen cardíaco y pueden representar el 20% de la mortalidad total en los adultos. Desafortunadamente, la mayor parte de los casos se presenta en la población general, de forma extrahospitalaria, en los hogares y en personas que no se conocían portadoras de cardiopatía. Aunque se considera que la mayoría de las víctimas de PCS es de origen cardíaco, y que es más frecuente el isquémico, no es posible descartar otras causas sólo con el diagnóstico clínico. Son necesarios la necropsia y los estudios histológicos y toxicológicos en todas las víctimas de PCS y MS para determinar la causa precisa de la muerte; cuando estos estudios se efectúan se han encontrado causas de origen no cardíaco hasta en 40% de las personas. El tipo de arritmia causante de un episodio de PCS y MS ha cambiado a través de los años; ahora se detectan con mayor frecuencia asistolia y actividad eléctrica sin pulso (AESP) que la fibrilación ventricular (FV) o la taquicardia ventricular sin pulso (TVSP). Estos y otros aspectos de importancia en el comportamiento actual del PCS y la MS se analizan en este artículo.
Asunto(s)
Arritmias Cardíacas/complicaciones , Muerte Súbita Cardíaca/epidemiología , Salud Global , Adulto , Arritmias Cardíacas/epidemiología , Autopsia , Causas de Muerte , Muerte Súbita Cardíaca/etiología , Humanos , Incidencia , Salud PúblicaRESUMEN
Abstract Sudden cardiac arrest (SCA) and sudden death (SD) continue to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCA victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Autopsy, histological, and toxicological studies are necessary in all victims of SCA and SD to determine the precise cause of death; when these studies are carried out, causes of non-cardiac origin have been found in up to 40% of victims. The type of arrhythmia responsible for an episode of SCA and SD has changed over the years, now asystole and pulseless electrical activity are detected more frequently than ventricular fibrillation or pulseless ventricular tachycardia. These and other aspects that we consider important in the current behavior of SCA and SD are analyzed in this article.
Resumen El paro cardíaco súbito (PCS) y la muerte súbita (MS) continúan siendo un problema de salud pública mundial; aunque su verdadera incidencia se desconoce, se calcula que producen el 30% de la mortalidad de origen cardíaco y pueden representar el 20% de la mortalidad total en los adultos. Desafortunadamente, la mayor parte de los casos se presenta en la población general, de forma extrahospitalaria, en los hogares y en personas que no se conocían portadoras de cardiopatía. Aunque se considera que la mayoría de las víctimas de PCS es de origen cardíaco, y que es más frecuente el isquémico, no es posible descartar otras causas sólo con el diagnóstico clínico. Son necesarios la necropsia y los estudios histológicos y toxicológicos en todas las víctimas de PCS y MS para determinar la causa precisa de la muerte; cuando estos estudios se efectúan se han encontrado causas de origen no cardíaco hasta en 40% de las personas. El tipo de arritmia causante de un episodio de PCS y MS ha cambiado a través de los años; ahora se detectan con mayor frecuencia asistolia y actividad eléctrica sin pulso (AESP) que la fibrilación ventricular (FV) o la taquicardia ventricular sin pulso (TVSP). Estos y otros aspectos de importancia en el comportamiento actual del PCS y la MS se analizan en este artículo.
Asunto(s)
Humanos , Adulto , Arritmias Cardíacas/complicaciones , Salud Global , Muerte Súbita Cardíaca/epidemiología , Arritmias Cardíacas/epidemiología , Autopsia , Salud Pública , Incidencia , Causas de Muerte , Muerte Súbita Cardíaca/etiologíaRESUMEN
Sudden cardiac arrest (SCA) and sudden death (SD) continues to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCD victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Autopsy, histological and toxicological studies are necessary in all victims of SCA and SD to determine the precise cause of death; when these studies are carried out, causes of non-cardiac origin have been found in up to 40% of victims. The type of arrhythmia responsible for an episode of SCA and SD has changed over the years, now asystole and pulseless electrical activity (PEA) are detected more frequently than ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). These and other aspects that we consider important in the current behavior of SCA and SD are analyzed in this article.
El paro cardíaco súbito (PCS) y la muerte súbita (MS) continúan siendo un problema de salud pública mundial; aunque su verdadera incidencia se desconoce, se calcula que producen el 30% de la mortalidad de origen cardíaco y pueden representar el 20% de la mortalidad total en los adultos. Desafortunadamente, la mayor parte de los casos se presenta en la población general, de forma extrahospitalaria, en los hogares y en personas que no se conocían portadoras de cardiopatía. Aunque se considera que la mayoría de las víctimas de PCS es de origen cardíaco, y que es más frecuente el isquémico, no es posible descartar otras causas sólo con el diagnóstico clínico. Son necesarios la necropsia y los estudios histológicos y toxicológicos en todas las víctimas de PCS y MS para determinar la causa precisa de la muerte; cuando estos estudios se efectúan se han encontrado causas de origen no cardíaco hasta en 40% de las personas. El tipo de arritmia causante de un episodio de PCS y MS ha cambiado a través de los años; ahora se detectan con mayor frecuencia asistolia y actividad eléctrica sin pulso (AESP) que la fibrilación ventricular (FV) o la taquicardia ventricular sin pulso (TVSP). Estos y otros aspectos de importancia en el comportamiento actual del PCS y la MS se analizan en este artículo.