RESUMO
Three challenging educational electrocardiography cases are presented and the electrocardiographic findings discussed.
Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Adulto , Arritmias Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Two patients with the fascinating disorder of left ventricular noncompaction cardiomyopathy are reported and illustrated echocardiographically. A review of this increasingly recognized cardiomyopathy that may be accompanied by considerable morbidity and mortality, has been done.
Assuntos
Cardiomiopatias , Ventrículos do Coração/anormalidades , Hipertrofia Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/complicações , Adulto , Idoso , Cardiomiopatias/classificação , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/genética , Cardiomiopatias/mortalidade , Cardiomiopatias/terapia , Cardiomiopatia Dilatada/complicações , Desfibriladores Implantáveis , Diagnóstico Diferencial , Ecocardiografia , Ecocardiografia Transesofagiana , Eletrocardiografia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Masculino , Insuficiência da Valva Mitral/complicações , Prognóstico , Insuficiência da Valva Tricúspide/complicações , Organização Mundial da SaúdeRESUMO
OBJECTIVES: To characterize the rate of decline of forced expiratory volume in 1 second (FEV(1)) in children and adolescents with cystic fibrosis and to identify and compare risk factors associated with FEV(1) decline. STUDY DESIGN: The rate of decline in FEV(1)% predicted over 3 to 6 years in 3 different age groups was determined. Risk factors for decline were identified and compared among and within age groups as a function of disease severity with repeated-measures, mixed-model regression. RESULTS: Mean (+/-SD) baseline FEV(1)% predicted was 88.4% +/- 20.5% for 6- to 8-year-olds (n = 1811), 85.3% +/- 20.8% for 9- to 12-year-olds (n = 1696), and 78.4% +/- 22.0% for 13- to 17-year-olds (n = 1359). Decline in FEV(1)% predicted/year was -1.12, -2.39, and -2.34, respectively. High baseline FEV(1) and persistent crackles were significant independent risk factors for decline across all age groups. Female sex, Pseudomonas aeruginosa infection, low weight-for-age, sputum, wheezing, sinusitis, pulmonary exacerbations treated with intravenous antibiotics, elevated liver test results, and pancreatic insufficiency were also identified as independent risk factors in some age groups. CONCLUSIONS: This study identifies risk factors for FEV(1) decline in children and adolescents with cystic fibrosis. Clinicians should not be reassured by high lung function, particularly in young children, because this factor, among others, is independently associated with steeper decline in FEV(1).
Assuntos
Fibrose Cística/diagnóstico , Fibrose Cística/epidemiologia , Volume Expiratório Forçado , Pneumopatias/epidemiologia , Adolescente , Distribuição por Idade , Criança , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Incidência , Pneumopatias/diagnóstico , Masculino , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Espirometria/métodos , Fatores de Tempo , Capacidade VitalRESUMO
This report documents a young male with Wolff-Parkinson-White preexcitation syndrome who developed the rare occurrence of type 11 second degree Kent bundle block, and subsequently complete accessory pathway block simultaneously with complete suprahisian atrioventricular block. Also, there appears to be a mild degree of right bundle branch block associated to the preexcitation pattern. Additionally, automaticity in an accessory pathway, very rare, is suggested, but yet unproven. The Wolff-Parkinson-White (WPW) preexcitation (PE) syndrome coexisting with atrioventricular (AV) block is rare (1-3). The AV conduction disturbance may exist in the AV nodal His-Purkinje conduction pathway or in the accessory pathway (AP), or in both the AV conduction system and in a bypass tract simultaneously. The conduction disturbances may be intermittent, or fixed and permanent (1-15). Even more rare is the existence of automaticity in an accessory pathway (3, 5, 16-27). The WPW syndrome has been infrequently reported associated with a bundle branch block (BBB) (28-30). This report documents a patient with the WPW PE pattern who developed type II second degree Kent bundle AP blocks, and subsequently complete AP blocks, perhaps in two APs, simultaneously with complete suprahisian AV block in the normal conduction system. Additionally, automatic ectopic impulse formation is possible in an accessory pathway. Moreover, there is a suggestion of a mild bundle branch block pattern associated with the ventricular preexcitation.
Assuntos
Bloqueio Atrioventricular/complicações , Síndrome de Wolff-Parkinson-White/complicações , Adulto , Bloqueio Atrioventricular/diagnóstico , Humanos , Masculino , Síndrome de Wolff-Parkinson-White/diagnósticoRESUMO
Coarctation of the Aorta is frequently associated with bicuspid aortic valve. This is a risk factor for infective endocarditis. Aneurysm of a sinus of Valsalva is a rare defect with a prevalence of 0.09%. They are associated in 10% of cases with a bicuspid aortic valve and less frequently with coarctation of the aorta and atrial septal defect. It is extremely rare the association of coarctation of the aorta with an atrial septal defect. This is one of the first cases reported in Puerto Rico of an adult patient with coarctation of the aorta in association with a bicuspid aortic valve, a ruptured aneurysm of a sinus of Valsalva and an atrial septal defect. The patient is a 22 year old male with coarctation of the aorta diagnosed since childhood who was admitted at the Cardiovascular Center of Puerto Rico with signs of heart failure due to infective endocarditis secondary to a teeth infection. Upon evaluation with transthoracic and transesophageal echos, he was found to have a coarctation at the aortic isthmus, aortic root dilatation, bicuspid aortic valve with vegetation, severe aortic and tricuspid regurgitation, aneurysm of the non coronary sinus of Valsalva with perforation to the right atrium, biatrial enlargement and a dilated right ventricle. Successful antibiotic treatment of endocarditis was achieved followed by surgical replacement of the aortic valve and ascending aorta with closure of the non coronary sinus of Valsalva was done. An secundum atrial septal defect was found and was also closed. Surgical correction of the coarctation of the aorta was postponed for a future time. The patient had a successful postsurgical recovery and was discharged home with anticoagulation treatment.
Assuntos
Aneurisma Aórtico/complicações , Coartação Aórtica/complicações , Endocardite Bacteriana/complicações , Comunicação Interatrial/complicações , Seio Aórtico/anormalidades , Anormalidades Múltiplas , Adulto , Antibacterianos/uso terapêutico , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Coartação Aórtica/diagnóstico , Coartação Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/microbiologia , Valva Aórtica/cirurgia , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/terapia , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgia , Resultado do TratamentoRESUMO
A family suffered carbon monoxide toxicity, with cerebral and / or cardiac complications, while sleeping in the cabin on a recreational boat. This article describes a couple exposed to a malfunctioning air-conditioning system on the boat, which subsequently developed the unique combination of cerebral symptoms and a non Q/non-ST elevation myocardial infarction, with enzyme elevations and electrocardiographic abnormalities. This interesting complication of a myocardial infarction secondary to carbon monoxide toxicity, associated with neurological manifestations, is reviewed.
Assuntos
Ar Condicionado/efeitos adversos , Intoxicação por Monóxido de Carbono/complicações , Infarto do Miocárdio/induzido quimicamente , Doenças do Sistema Nervoso/induzido quimicamente , Navios , Adulto , Idoso , Intoxicação por Monóxido de Carbono/diagnóstico , Criança , Confusão/induzido quimicamente , Eletrocardiografia , Feminino , Seguimentos , Humanos , Oxigenoterapia Hiperbárica , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Fatores de TempoRESUMO
Myocardial infarction (MI) associated to cocaine use was originally reported in 1982 and cases are being encountered more frequently in our milieu. The literature regarding this diagnosis has included mostly cases of cocaine associated chest pain and MI without serious sequelae. A lesser number of reports however focus on the clinical presentation of severe myocardial dysfunction and severe pulmonary edema, with the mechanism for pulmonary edema still being debated. Although previously described individually, these manifestations are thought to be an uncommon complication of cocaine ingestion. In this article the subject is reviewed and we report our experience with two patients that presented to our care with severe pulmonary edema and concomitant severe left ventricular systolic dysfunction that resolved spontaneously with supportive therapy. It is felt that this clinical picture after cocaine use may be more common than expected. In this article we discuss the possible mechanisms associated to this presentation as well as review the literature regarding this subject.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/efeitos adversos , Infarto do Miocárdio/induzido quimicamente , Edema Pulmonar/induzido quimicamente , Vasoconstritores/efeitos adversos , Disfunção Ventricular/induzido quimicamente , Adulto , Cardiotônicos/uso terapêutico , Ecocardiografia , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/tratamento farmacológico , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/tratamento farmacológico , Radiografia , Resultado do Tratamento , Disfunção Ventricular/diagnóstico , Disfunção Ventricular/tratamento farmacológicoRESUMO
OBJECTIVE: To determine the relation of growth and nutritional status to pulmonary function in young children with cystic fibrosis (CF). STUDY DESIGN: The relation of weight-for-age (WFA), height-for-age (HFA), percent ideal body weight (%IBW), and signs of lung disease at age 3 years with pulmonary function at age 6 years was assessed in 931 patients with CF. Associations of changes in WFA from age 3 to 6 on pulmonary function were also assessed. RESULTS: WFA, HFA, and %IBW were poorly associated with lung disease at age 3 years, but all were strongly associated with pulmonary function at age 6 years. Those with WFA below the 5th percentile at age 3 had lower pulmonary function at age 6 compared with those above the 75th percentile (FEV(1): 86 +/- 20 [SD] versus 102 +/- 18 % predicted, respectively). Pulmonary function was highest in those whose WFA remained >10th percentile from age 3 to 6 (FEV(1): 100 +/- 19 % predicted) and lowest in those who remained <10th percentile (84 +/- 21 % predicted). Patients with signs and symptoms of lung disease at age 3 years had lower pulmonary function at age 6 years. CONCLUSIONS: Aggressive intervention early in life aimed at growth and nutrition and/or lung disease may affect pulmonary function.
Assuntos
Estatura , Índice de Massa Corporal , Fibrose Cística/fisiopatologia , Pulmão/fisiopatologia , Estado Nutricional , Peso Corporal , Criança , Pré-Escolar , Fibrose Cística/terapia , HumanosRESUMO
In this update of cardiac pacing we review the new revised ACC/AHA/NASPE Guidelines for implantation of cardiac pacemakers, including selection of pacing mode, possible new indications, and other more recent advances in cardiac pacing.
Assuntos
Arritmias Cardíacas/terapia , Marca-Passo Artificial , HumanosAssuntos
Marca-Passo Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Adulto , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , TaquicardiaRESUMO
We describe an adult patient with a large atrial septal defect, an atrial septal aneurysm and thrombus formation on a transvenous right atrial pacing lead. Because of right-to-left shunting through the atrial septal defect, she developed multiple systemic emboli to the spleen and left kidney (with infarcts), to the left leg, and probably to the brain as a cerebrovascular accident. The fundamental guiding principle of avoiding endocardial pacing leads in patients with congenital intracardiac communications, was violated in this patient, leading to serious dire consequences and complications.
Assuntos
Humanos , Feminino , Idoso , Aneurisma Cardíaco/complicações , Embolia/etiologia , Defeitos dos Septos Cardíacos/complicações , Marca-Passo Artificial/efeitos adversos , Infarto Cerebral/etiologia , Transtornos Cerebrovasculares/etiologia , Ecocardiografia Transesofagiana , Embolia/diagnóstico , Seguimentos , Defeitos dos Septos Cardíacos , Defeitos dos Septos Cardíacos/cirurgia , Infarto/etiologia , Infarto do Baço/etiologia , Rim/irrigação sanguínea , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Pacemaker atrial lead dislodgement inducing ventricular pacing is reviewed, is reviewed, and such observed cases are described. This interesting complication of the atrial lead producing ventricular depolarization results in an array of electrocardiographic manifestations and vignettes. These documented experiences emphasize the infrequent persistence of this event, even with the utilization of modern atrial passive and active fixation leads
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Marca-Passo Artificial , Ventrículos do Coração/fisiopatologia , Diagnóstico Diferencial , Eletrocardiografia , Falha de EquipamentoRESUMO
This article documents the rara, possibly coincidental, association of the Marfan and the Wolff-Parkinson-White syndromes. However, an as yet umproven, hypothetical link of a connective tissue, mesenchymal and embryologic, developmental dysplasia, offers a provocative nosological connection
Assuntos
Síndrome de Marfan/complicações , Síndrome de Wolff-Parkinson-White/complicações , Dissecção Aórtica/etiologia , Aneurisma Aórtico/etiologia , Doenças das Valvas Cardíacas/etiologia , Choque/etiologiaRESUMO
During the last two decades, islet cell transplantation has been pursued both experimentally and clinically in an effort to ameliorate diabetes mellitus. At present, however, islet cell transplantation still remains at the experimental stages as far as the treatment of diabetes is concerned. Also, culture of islet cells has proved to be rather frustrating and difficult. No consistent techniques have been developed, and simplified methods for islet cell preparation and adequate sites for islet cell placement would allow for further progress in this area. Ultimately, rejection remains the greatest obstacle to success. We report a simplified technique for enriching dog pancreatic islet cells. This preparation was injected into the renal subcapsular space in both homograft (3 experiments) and heterograft (3 experiments) situations. After six weeks, nephrectomy was performed, and histochemical techniques demonstrated many groups of live islets in betweeen the tubules in the renal cortex. No acinar cells were observed. Blood samples from the renal artery and renal vein at the time of nephrectomy revealed an average 36.9 percent increase in insulin concentration in the renal veins, supporting an active secretory role of these transported islet cells. This technique points to (i) the possible role of a "renal factor" in promoting growth of islet cells and (ii) the feasibility of successful transplantation of enriched islet cells as a potential approach to the curative treatment of diabetes mellitus. (AU)
Assuntos
Cães , 21003 , Feminino , Diabetes Mellitus/cirurgia , Ilhotas Pancreáticas/transplante , Córtex Renal/patologiaRESUMO
Este comunicado describe a un paciente on síndrome de Down al cual se le encontró anomalía de Ebstein de la válvula tricuspídea en la autopsia. La asociación de estas dos condiciones parece ser rara