RESUMO
Background: Coronary anomalies are rare heart diseases that can cause sudden cardiac death, especially in young individuals. Coronary computed tomography angiography delivers a three-dimensional view of excellent quality with information of the origin, course and anatomic relationships of the anomalous vessel, allowing differentiation between benign and malignant variants, entities that require different management and treatment. Aim: To show that coronary computed tomography angiography is the non-invasive technique of choice for the evaluation of a coronary anomaly due to its high diagnostic accuracy. Material and Methods: Between 2008 and 2014, 368 coronary computed tomography angiographies were carried out. Six (1.6%) patients had a coronary anomaly. Results: The age of these six patients ranged from 38 to 82 years (five were women). The coronary computed tomography angiography was requested due to cardiac symptoms (angina and dyspnea) in two patients, after a selective coronary arteriography to obtain additional information of the coronary anomaly in three patients, and after a cardiorespiratory arrest in one patient. Three patients had an anomaly of the right coronary artery, two patients had an anomaly of the left coronary artery and one patient had absent left main coronary artery. In five patients the coronary anomaly was malignant. Conclusions: Coronary computed tomography angiography is a robust diagnostic method to evaluate patients with suspected coronary anomalies.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Aorta/anormalidades , Aorta/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Reprodutibilidade dos Testes , Anomalias dos Vasos Coronários/patologiaRESUMO
BACKGROUND: Coronary anomalies are rare heart diseases that can cause sudden cardiac death, especially in young individuals. Coronary computed tomography angiography delivers a three-dimensional view of excellent quality with information of the origin, course and anatomic relationships of the anomalous vessel, allowing differentiation between benign and malignant variants, entities that require different management and treatment. AIM: To show that coronary computed tomography angiography is the non-invasive technique of choice for the evaluation of a coronary anomaly due to its high diagnostic accuracy. MATERIAL AND METHODS: Between 2008 and 2014, 368 coronary computed tomography angiographies were carried out. Six (1.6%) patients had a coronary anomaly. RESULTS: The age of these six patients ranged from 38 to 82 years (five were women). The coronary computed tomography angiography was requested due to cardiac symptoms (angina and dyspnea) in two patients, after a selective coronary arteriography to obtain additional information of the coronary anomaly in three patients, and after a cardiorespiratory arrest in one patient. Three patients had an anomaly of the right coronary artery, two patients had an anomaly of the left coronary artery and one patient had absent left main coronary artery. In five patients the coronary anomaly was malignant. CONCLUSIONS: Coronary computed tomography angiography is a robust diagnostic method to evaluate patients with suspected coronary anomalies.
Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/anormalidades , Aorta/diagnóstico por imagem , Anomalias dos Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Reprodutibilidade dos TestesRESUMO
Coronary artery anomalies arising from the opposite sinus of Valsalva and having an interarterial course between the aorta (AO) and pulmonary artery (PA) are the second most common cause of sudden cardiac death among young athletes, after hypertrophic cardiomyopathy. The right coronary artery (RCA) originating from the AO above the left sinus of Valsalva (LSV) is an extremely rare anomaly. We report the first case of a RCA arising from the AO above the LSV that subsequently runs between the AO and the PA, discovered by a 64-slice multidetector coronary CT, in a patient who was successfully resuscitated from ventricular fibrillation (VF) cardiac arrest while running in a marathon race.
Assuntos
Doença da Artéria Coronariana/patologia , Anomalias dos Vasos Coronários/diagnóstico , Morte Súbita Cardíaca/prevenção & controle , Artéria Pulmonar/patologia , Seio Aórtico/patologia , Adulto , Atletas , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Anomalias dos Vasos Coronários/patologia , Feminino , Humanos , Seio Aórtico/anormalidades , Seio Aórtico/fisiopatologiaRESUMO
We report a 74-year-old man with diabetes mellitus type 2 and hypertension, who recently underwent coronary bypass surgery due to severe triple vessel disease receiving cardiological and combined antidiabetic therapy, including metformin 4 g/day. He was admitted with abdominal pain, nausea, vomiting, diarrhea and loss of consciousness. At admission, he was disoriented and agitated with signs of poor perfusion. His blood pressure was 80/70 mmHg, pulse rate 40 beats/min, respiratory rate 20-breaths/min, and axillary temperature 35 °C. Biochemical profile revealed an extreme hyperkalemia of 15.4 mEq/L (double checked), elevated creatinine, uremia and brain natriuretic peptide; hypoglycemia (blood glucose 68 mg/dl) and normal C Reactive Protein. Arterial blood gases revealed severe lactic acidemia. The electrocardiogram showed sinus bradycardia, simple AV block, widened QRS with prominent T wave and prolonged QT. He was admitted to the Intensive Care Unit (ICU) with the suspicion of lactic acidosis associated with metformin, receiving fluid management, intravenous hypertonic glucose plus insulin and sodium bicarbonate, mechanical ventilation, vasopressor therapy, a temporary pacemaker lead, in addition to continuous venovenous hemodiafiltration. Two days later, the patient experienced a significant clinical improvement with normalization of the acid-base status, plasma lactate and potassium levels. On day 9, diuresis was recovered, creatinine and uremia returned to normal levels and the patient was discharged from the ICU.
Assuntos
Acidose Láctica/induzido quimicamente , Overdose de Drogas , Hiperpotassemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Idoso , Diabetes Mellitus Tipo 2/complicações , Humanos , MasculinoRESUMO
We report a 74-year-old man with diabetes mellitus type 2 and hypertension, who recently underwent coronary bypass surgery due to severe triple vessel disease receiving cardiological and combined antidiabetic therapy, including metformin 4 g/day. He was admitted with abdominal pain, nausea, vomiting, diarrhea and loss of consciousness. At admission, he was disoriented and agitated with signs of poor perfusion. His blood pressure was 80/70 mmHg, pulse rate 40 beats/min, respiratory rate 20-breaths/min, and axillary temperature 35°C. Biochemical profile revealed an extreme hyperkalemia of 15.4 mEq/L (double checked), elevated creatinine, uremia and brain natriuretic peptide; hypoglycemia (blood glucose 68 mg/dl) and normal C Reactive Protein. Arterial blood gases revealed severe lactic acidemia. The electrocardiogram showed sinus bradycardia, simple AV block, widened QRS with prominent T wave and prolonged QT. He was admitted to the Intensive Care Unit (ICU) with the suspicion of lactic acidosis associated with metformin, receiving fluid management, intravenous hypertonic glucose plus insulin and sodium bicarbonate, mechanical ventilation, vasopressor therapy, a temporary pacemaker lead, in addition to continuous venovenous hemodiafiltration. Two days later, the patient experienced a significant clinical improvement with normalization of the acid-base status, plasma lactate and potassium levels. On day 9, diuresis was recovered, creatinine and uremia returned to normal levels and the patient was discharged from the ICU.
Assuntos
Idoso , Humanos , Masculino , Acidose Láctica/induzido quimicamente , Overdose de Drogas , Hiperpotassemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , /complicaçõesRESUMO
In the last 2 decades, there have been significant advances in medical treatment of heart failure. However, there is a group of patients who are refractory to the available medical therapy and progress inevitably to a state of end-stage heart failure, whose only therapeutic alternative is cardiac transplantation. But this is an option limited by the scarce availability of donors. Therefore many patients die waiting for an organ. Recently, extra or intracorporeal left ventricular devices have emerged as a viable alternative for patients with end-stage heart failure waiting for a heart transplant. These devices discharge the left ventricle, increasing cardiac output and improving systemic perfusion. This year, in our hospital we began a left ventricular device implantation program for the most severely ill patients on the waiting list for cardiac transplantation. We report two males aged 30 and 53 years, in whom a left ventricular device was successfully implanted, using a minimally invasive surgical technique developed at the University of Hannover in Germany.
Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Implantação de Prótese/métodos , Adulto , Humanos , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Arrhythmogenic right ventricular dysplasia is an inherited condition characterized by replacement of normal myocardium by fatty or fibro-fatty tissue, which mainly affects the right ventricle. The most frequent form of presentation is ventricular tachycardia or sudden death, whose origin is considered to be a product of fibrous or fatty infiltration of the myocardium. This structural damage can be detected by cardiac magnetic resonance imaging (MR). We report two patients with ventricular tachycardia due to arrhythmogenic right ventricular dysplasia. A 49 year-old female with a history of ventricular tachycardia. EKG showed epsilon waves and a prolonged QTc. Echocardiogram showed right ventricular dilatation and dysfunction. MR showed right ventricular fatty infiltration. An implantable cardioverter-defibrillator was installed to the patient. A 37 year-old male was admitted for recurrent syncope. On admission a ventricular tachycardia was detected. An echocardiogram showed right ventricular dilatation and dysfunction. MR showed a large zone of fibrosis in the right ventricle. An implantable cardioverter-defibrillator was also installed.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Imageamento por Ressonância Magnética , Eletrocardiografia , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/fisiopatologiaRESUMO
Bilateral renal vein thrombosis is an unusual etiology of acute renal failure and usually is associated with nephrotic syndrome. We report a 77-year-old man, consulting in the emergency room for anuria that appeared 24 hours after a syncope. The patient was carrier of an inferior vena cava filter prophylactically installed 17 months earlier and was not receiving anticoagulation. Serum creatinine on admission was 5.45 mg/dl and blood urea nitrogen was 54 mg/dl. Computed tomography and Doppler ultrasonography showed an extensive thrombosis of inferior vena cava and both renal veins. Heparin therapy was started with a rapid recovery of renal function and diuresis.
Assuntos
Idoso , Humanos , Masculino , Injúria Renal Aguda/etiologia , Veias Renais , Filtros de Veia Cava/efeitos adversos , Trombose Venosa/etiologia , Heparina/uso terapêutico , Embolia Pulmonar/prevenção & controleRESUMO
In the last 2 decades, there have been significant advances in medical treatment of heart failure. However, there is a group of patients who are refractory to the available medical therapy and progress inevitably to a state of end-stage heart failure, whose only therapeutic alternative is cardiac transplantation. But this is an option limited by the scarce availability of donors. Therefore many patients die waiting for an organ. Recently, extra or intracorporeal left ventricular devices have emerged as a viable alternative for patients with end-stage heart failure waiting for a heart transplant. These devices discharge the left ventricle, increasing cardiac output and improving systemic perfusion. This year, in our hospital we began a left ventricular device implantation program for the most severely ill patients on the waiting list for cardiac transplantation. We report two males aged 30 and 53 years, in whom a left ventricular device was successfully implanted, using a minimally invasive surgical technique developed at the University of Hannover in Germany.
Assuntos
Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Implantação de Prótese/métodos , Ilustração Médica , Resultado do TratamentoRESUMO
Arrhythmogenic right ventricular dysplasia is an inherited condition characterized by replacement of normal myocardium by fatty or fibro-fatty tissue, which mainly affects the right ventricle. The most frequent form of presentation is ventricular tachycardia or sudden death, whose origin is considered to be a product of fibrous or fatty infiltration of the myocardium. This structural damage can be detected by cardiac magnetic resonance imaging (MR). We report two patients with ventricular tachycardia due to arrhythmogenic right ventricular dysplasia. A 49 year-old female with a history of ventricular tachycardia. EKG showed epsilon waves and a prolonged QTc. Echocardiogram showed right ventricular dilatation and dysfunction. MR showed right ventricular fatty infiltration. An implantable cardioverter-defibrillator was installed to the patient. A 37 year-old male was admitted for recurrent syncope. On admission a ventricular tachycardia was detected. An echocardiogram showed right ventricular dilatation and dysfunction. MR showed a large zone of fibrosis in the right ventricle. An implantable cardioverter-defibrillator was also installed.
Assuntos
Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Imageamento por Ressonância Magnética , Adulto , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/fisiopatologiaRESUMO
Bilateral renal vein thrombosis is an unusual etiology of acute renal failure and usually is associated with nephrotic syndrome. We report a 77-year-old man, consulting in the emergency room for anuria that appeared 24 hours after a syncope. The patient was carrier of an inferior vena cava filter prophylactically installed 17 months earlier and was not receiving anticoagulation. Serum creatinine on admission was 5.45 mg/dl and blood urea nitrogen was 54 mg/dl. Computed tomography and Doppler ultrasonography showed an extensive thrombosis of inferior vena cava and both renal veins. Heparin therapy was started with a rapid recovery of renal function and diuresis.
Assuntos
Injúria Renal Aguda/etiologia , Veias Renais , Filtros de Veia Cava/efeitos adversos , Trombose Venosa/etiologia , Idoso , Heparina/uso terapêutico , Humanos , Masculino , Embolia Pulmonar/prevenção & controleRESUMO
We report a 50 year-old hypertensive and asymptomatic woman in whom a left ventricular tumor was found on a routine two-dimensional transthoracic echocardiogram. Complementary 3D echocardiography, cardiac magnetic resonance and cardiac computed tomography allowed the diagnosis of a calcified left ventricular myxoma. Surgical treatment was performed through a transaortic transvalvular approach with tumor resection and implantation of a pericardial bovine patch. This case confirms the importance of transthoracic echocardiography in the diagnosis of cardiac tumors and the complementary role of 3D echocardiography, cardiac magnetic resonance imaging and computed tomography for the differential diagnosis before surgery.
Assuntos
Animais , Bovinos , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Cardíacas , Mixoma , Diagnóstico Diferencial , Ecocardiografia Tridimensional/métodos , Ecocardiografia/métodos , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Xenoenxertos , Imageamento por Ressonância Magnética/métodos , Mixoma/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
Celiac disease may be associated with other autoimmune diseases and exceptionally with glomerulopathies and nephrotic syndrome. Associations have been reported with IgA nephropathy, membranoproliferative glomerulonephritis, membranous glomerulopathy and minimal change disease. We report a 63-year-old woman who simultaneously presented with massive nephrotic syndrome (proteinuria 46 g/day) and cachexia due to a malabsorption syndrome secondary to celiac disease. The course of her diseases was complicated with cardiomyopathy due to severe malnutrition, septic shock, acute kidney injury that required dialysis for seven weeks and severe hypertension. A renal biopsy showed a membranoproliferative pattern of injury secondary to a thrombotic microangiopathy and diffuse podocyte damage. Four years later, the patient was in good general health, the glomerular filtration rate was 30 ml/min/1.73m² and there was non-nephrotic proteinuria.
Assuntos
Injúria Renal Aguda/complicações , Doença Celíaca/complicações , Glomerulonefrite/complicações , Síndrome Nefrótica/complicações , Microangiopatias Trombóticas/complicações , Injúria Renal Aguda/patologia , Doença Celíaca/patologia , Feminino , Glomerulonefrite/patologia , Humanos , Pessoa de Meia-Idade , Síndrome Nefrótica/patologia , Microangiopatias Trombóticas/patologiaRESUMO
Celiac disease may be associated with other autoimmune diseases and exceptionally with glomerulopathies and nephrotic syndrome. Associations have been reported with IgA nephropathy, membranoproliferative glomerulonephritis, membranous glomerulopathy and minimal change disease. We report a 63-year-old woman who simultaneously presented with massive nephrotic syndrome (proteinuria 46 g/day) and cachexia due to a malabsorption syndrome secondary to celiac disease. The course of her diseases was complicated with cardiomyopathy due to severe malnutrition, septic shock, acute kidney injury that required dialysis for seven weeks and severe hypertension. A renal biopsy showed a membranoproliferative pattern of injury secondary to a thrombotic microangiopathy and diffusepodocyte damage. Fouryears later, the patient was in good general health, the glomerular filtration rate was 30 ml/min/1.73m² and there was non-nephrotic proteinuria.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Injúria Renal Aguda/complicações , Doença Celíaca/complicações , Glomerulonefrite/complicações , Síndrome Nefrótica/complicações , Microangiopatias Trombóticas/complicações , Injúria Renal Aguda/patologia , Doença Celíaca/patologia , Glomerulonefrite/patologia , Síndrome Nefrótica/patologia , Microangiopatias Trombóticas/patologiaRESUMO
We report a 50 year-old hypertensive and asymptomatic woman in whom a left ventricular tumor was found on a routine two-dimensional transthoracic echocardiogram. Complementary 3D echocardiography, cardiac magnetic resonance and cardiac computed tomography allowed the diagnosis of a calcified left ventricular myxoma. Surgical treatment was performed through a transaortic transvalvular approach with tumor resection and implantation of a pericardial bovine patch. This case confirms the importance of transthoracic echocardiography in the diagnosis of cardiac tumors and the complementary role of 3D echocardiography, cardiac magnetic resonance imaging and computed tomography for the differential diagnosis before surgery.
Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Animais , Bovinos , Diagnóstico Diferencial , Ecocardiografia/métodos , Ecocardiografia Tridimensional/métodos , Feminino , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Xenoenxertos , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Mixoma/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
Endomyocardial fibrosis (EMF) is a rare progressive restrictive cardiomyopathy of unknown etiology that mainly presents with heart failure. The presence of a small ventricle with obliteration of the apex and a large atrium are two-dimensional echocardiographic findings that are highly suggestive of EMF. Cardiac magnetic resonance with delayed enhancement allows detection of subendocardial fibrosis with good histopathological correlation, providing a noninvasive modality for diagnosing EMF. We herein report a case of EMF in which the complementary role of two-dimensional color Doppler imaging and myocardial contrast echocardiography proved to be useful in the diagnosis of this clinical entity, which was later confirmed by cardiac magnetic resonance, surgery, and histopathology.
Assuntos
Ecocardiografia Doppler/métodos , Fibrose Endomiocárdica/diagnóstico por imagem , Adulto , Meios de Contraste , Ecocardiografia/métodos , Feminino , HumanosRESUMO
Phaeochromocytomas are rare catecholamine secreting tumours that usually present as paroxysms of hypertension associated with headache, palpitations and sweating. We report the case of a 50-year-old man with a phaeochromocytoma who presented with sudden onset of hypertension, syncope, and fever who later developed a multiple-organ failure secondary to a multiple organism bacteraemias due to transient episodes of intestinal ischaemia. After receiving full intensive care support, antibiotics and tumour removal, the patient made a complete recovery and he is at present doing well. This case illustrates that high concentrations of catecholamine secreted by a phaeochromocytoma might cause multiple organ failure syndrome secondary to multiple organism bacteraemias due to transient episodes of intestinal ischaemia.
RESUMO
We report a 16 year old male with a history of angina on exertion. A treadmill exercise test was positive for ischemia in concordance with a Thallium-201 scintigraphy showing a septal and infero-posterior reversible myocardial perfusión defect. Coronary angiography disclosed severe aneurysmal coronary artery disease. Bilateral internal mammary coronary artery bypass grafting was successfully performed. Kawasaki disease is the most likely etiology, although not confirmed.
Assuntos
Aneurisma Coronário/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Adolescente , Angina Pectoris/diagnóstico por imagem , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/cirurgia , Angiografia Coronária , Ponte de Artéria Coronária , Ecocardiografia , Teste de Esforço , Humanos , Masculino , Cintilografia , Radioisótopos de TálioRESUMO
We report a 16 year old male with a history of angina on exertion. A treadmill exercise test was positive for ischemia in concordance with a Thallium-201 scintigraphy showing a septal and infero-posterior reversible myocardial perfusi¢n defect. Coronary angiography disclosed severe aneurysmal coronary artery disease. Bilateral internal mammary coronary artery bypass grafting was successfully performed. Kawasaki disease is the most likely etiology, although not confirmed.