RESUMO
A 26-year-old pregnant woman with 29 weeks of gestational age reported two months of cough, dyspnea, orthopnea, and palpitations. Chest tomography revealed a 10x12cm solid mass in the right lung. Echocardiography showed that the tumor compromised the right atrium and ventricle, and was diagnosed by transcutaneous biopsy as Primary Mediastinal B-Cell Lymphoma (PMCBL). The patient presented 2:1 atrial flutter, sinus bradycardia, and ectopic atrial bradycardia. Due to the rapid poor evolution, it was decided to terminate the pregnancy by cesarean section and start chemotherapy, after which the cardiovascular complications resolved. PCML is a very rare lymphoma that can affect pregnant women in any trimester, its symptoms are related to its rapid growth and compromise of the heart, causing various cardiovascular manifestations (heart failure, pericardial effusion, cardiac arrhythmias). PCMLC is characteristically chemosensitive and has a good prognosis.
RESUMO
An 82-year-old woman, Katz A, with a history of type 2 diabetes mellitus and high blood pressure, was admitted for ischemic stroke complicated by Takotsubo´s syndrome with subsequent readmission for atrial fibrillation after discharge. These three clinical events have criteria to be integrated as a Brain Heart Syndrome, which is a high-risk condition for mortality.
RESUMO
We present a patient who was admitted to the emergency room due to unstable angina, with an initial electrocardiogram without signs of acute ischemia and a favorable clinical evolution. During hospitalization, she developed the Wellens electrocardiographic pattern, noted in the literature as an infrequent, poorly identified finding and with an ominous prognosis. This electrocardiographic pattern is described in precordial derivatives, suggesting a significant lesion of a principal epicardial artery; our patient had similar electrocardiographic alterations in the high lateral leads, in whom the coronary bifurcation lesion not previously described in this scenario was confirmed.
RESUMO
El ápex de ventrículo derecho (AVD) es el sitio convencional de estimulación cardiaca; sin embargo, no ha conseguido un patrón de activación y sincronía fisiológico. La evidencia de su efecto deletéreo ha hecho que se cuestione su práctica tradicional, por lo que nace el interés de búsqueda de sitios alternativos. El tracto de salida de ventrículo derecho (TSVD) ha demostrado ser un lugar adecuado para estimulación, sin diferencias entre umbrales de estimulación entre ambos sitios. Objetivo: Comparar los resultados del implante a nivel del ápex con los del implante en tracto de salida de ventrículo derecho. Material y métodos: Estudio descriptivo, comparativo de serie de casos retrospectivo. Se incluyeron 54 pacientes con implante de marcapaso entre 2010 y 2011. Se tomaron en cuenta datos clínicos, datos del implante propiamente dicho y sus complicaciones. Resultados: La edad promedio fue 73,7 años. La indicación más frecuente de implante fue bloqueo auriculoventricular (55,6%). La vía de acceso del electrodo ventricular fue disección de vena cefálica izquierda (76,7%). En 66,7% se consiguió estimulación en AVD y en 33,3% en TSVD. La complicación más frecuente fue hematoma de bolsillo (7,4%). No se evidenció diferencias en parámetros y umbrales de estimulación al momento del implante en ambos grupos. Conclusiones: El TSVD ha demostrado ser un lugar adecuado para estimulación; no existiendo diferencias en los umbrales estimulación o impedancia con el AVD.
The right ventricular apex (RVA) is the conventional pacing site, however, but it does not induce a pattern of activation and physiological synchrony. The evidence of its deleterious effect has raised questions about the traditional practice and therefore, an alternative site is being searched. The right ventricle outflow tract (RVOT) has proven to be a suitable site for stimulation, with not difference in stimulation thresholds between the two sites. Objective: Compare the outcomes of the implantation of pacemakers in the apex and in the outflow tract of the right ventricle. Methods: A descriptive and retrospective case series. We included 54 patients with pacemaker implantation between 2010 and 2011. Patient records were reviewed for clinical data, implant itself and its complications. Results: Mean age was 73.7 years. The most common indication for implantation was atrioventricular block (55.6%). The path to address ventricular electrode was through left cephalic vein dissection (76.7%). The stimulation was achieved 66.7% in RVA and 33.3% in RVOT. The most common complication pocket hematoma (7.4%). No differences were evident in the stimulation parameters and stimulation thresholds in both groups. Conclusions: RVOT has proven to be a suitable site for stimulation, no differences were found in stimulation thresholds or the RVA impedance.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Cinetocardiografia , Estimulação Cardíaca Artificial , Ventrículos do Coração , Epidemiologia Descritiva , Estudos Retrospectivos , Relatos de CasosRESUMO
Reportamos el caso de un varón de 18 años quien sufrió contusión cervical por impacto con balón de fútbol. Tres días después fue hospitalizado con hemiplejia derecha directa y afasia de expresión. La resonancia magnética cerebral mostró lesión isquémica izquierda en ganglios basales. El doppler carotideo evidenció trombo desde el origen de la arteria carótida común izquierda extendida a la arteria carótida interna izquierda (CII) y la angiotomografía documentó disección de CII (lesión traumática carotídea tipo IV). Se optó por anticoagulación con warfarina y fisioterapia de rehabilitación; con evolución favorable. La incidencia de la injuria traumática carotídea es muy rara, más aún en futbolistas; el tratamiento es aún controversial, por lo que consideramos de interés el reporte de este caso.
We report the case of an 18-year-old male patient who suffered cervical trauma with a soccer ball. He presented three days after with right hemiparesis and expressive aphasia. The magnetic resonance image showed an ischemic lesion on the left basal ganglia area. The Doppler ultrasound revealed a thrombus extending from the left common carotid artery to the left internal carotid artery, and the angio-computed tomographic scan revealed a dissection of the left internal carotid artery (carotid lesion type IV). Anticoagulation with warfarin and physiotherapy were started with good clinical evolution. The traumatic injury of the carotid artery is very rare. Treatment is controversial, so we consider interest report of this case.