Assuntos
Cardiologia , Sistema Cardiovascular , Humanos , Brasil , Eletrocardiografia , Sociedades MédicasRESUMO
Until the mid-1980s, it was believed that the vectorcardiogram (VCG) presented a greater specificity, sensitivity and accuracy in comparison to the 12-lead electrocardiogram (ECG), in the cardiology diagnosis. Currently, the VCG still is superior to the ECG in specific situations, such as in the evaluation of myocardial infarctions when associated with intraventricular conduction disturbances, in the identification and location of accessory pathways in ventricular preexcitation, in the differential diagnosis of patterns varying from normal of electrical axis deviation, in the evaluation of particular aspects of Brugada syndrome, Brugada phenocopies, concealed form of arrhythmogenic right ventricular cardiomyopathy and zonal or fascicular blocks of the right bundle branch on right ventricular free wall.VCG allows us to analyze the presence of left septal fascicular block more accurately than ECG and in the diagnosis of the interatrial blocks and severity of some chambers enlargements. The three-dimensional spatial orientation of both the atrial and the ventricular activity provides a far more complete observation tool than the linear ECG. We believe that the ECG/VCG binomial simultaneously obtained by the technique called electro-vectorcardiography (ECG/VCG) brought a significant gain for the differential diagnosis of several pathologies. Finally, in the field of education and research, VCG provided a better and more rational tridimensional insight into the electrical phenomena that occurs spatially, and represented an important impact on the progress of electrocardiography.
Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/diagnóstico por imagem , Vetorcardiografia/métodos , Bloqueio de Ramo/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , HumanosRESUMO
Abstract Complete heart block (CHB) results from dysfunction of the cardiac conduction system, which results in complete electrical dissociation. The ventricular escape rhythm can have its origin anywhere from the atrioventricular node to the bundle branch-Purkinje system. CHB typically results in bradycardia, hypotension, fatigue, hemodynamic instability, syncope, or even Stokes-Adams syndrome. Escape rhythm originating above the bifurcation of the His bundle (HB) produces narrow QRSs with relatively rapid heart rate (HR) (except in cases of His system disease). We present a middle-aged man with an HR of 34 bpm, progressive fatigue, in whom a temporary pacemaker was implanted in the subtricuspid region. The post-intervention electrocardiogram had unusual features.
Resumen El bloqueo cardíaco completo (BCC) resulta de la disfunción del sistema de conducción cardíaco, lo que ocasiona una disociación eléctrica completa entre aurículas y ventrículos. El ritmo de escape resultante puede tener su origen en cualquier lugar desde el nodo auriculoventricular hasta el sistema His Purkinje. El BCC generalmente produce bradicardia, hipotensión, fatiga, inestabilidad hemodinámica, síncope o incluso el síndrome de Stokes-Adams. El ritmo de escape que se origina por encima de la bifurcación del haz de His produce intervalos QRS estrechos con frecuencia cardíaca no muy lenta (excepto en casos de enfermedad del sistema Hisiano). Presentamos a un hombre de mediana edad con una frecuencia cardíaca de 34 lpm, fatiga progresiva, en el que se implantó un marcapasos temporario en la región subtricuspídea. El electrocardiograma resultante a la intervención presentó características inusuales.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Estimulação Cardíaca Artificial/efeitos adversos , Frequência Cardíaca/fisiologia , Ventrículos do Coração/fisiopatologia , Eletrocardiografia , Fadiga/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologiaRESUMO
Complete heart block (CHB) results from dysfunction of the cardiac conduction system, which results in complete electrical dissociation. The ventricular escape rhythm can have its origin anywhere from the atrioventricular node to the bundle branch-Purkinje system. CHB typically results in bradycardia, hypotension, fatigue, hemodynamic instability, syncope, or even Stokes-Adams syndrome. Escape rhythm originating above the bifurcation of the His bundle (HB) produces narrow QRSs with relatively rapid heart rate (HR) (except in cases of His system disease). We present a middle-aged man with an HR of 34 bpm, progressive fatigue, in whom a temporary pacemaker was implanted in the subtricuspid region. The post-intervention electrocardiogram had unusual features.
El bloqueo cardíaco completo (BCC) resulta de la disfunción del sistema de conducción cardíaco, lo que ocasiona una disociación eléctrica completa entre aurículas y ventrículos. El ritmo de escape resultante puede tener su origen en cualquier lugar desde el nodo auriculoventricular hasta el sistema His Purkinje. El BCC generalmente produce bradicardia, hipotensión, fatiga, inestabilidad hemodinámica, síncope o incluso el síndrome de Stokes-Adams. El ritmo de escape que se origina por encima de la bifurcación del haz de His produce intervalos QRS estrechos con frecuencia cardíaca no muy lenta (excepto en casos de enfermedad del sistema Hisiano). Presentamos a un hombre de mediana edad con una frecuencia cardíaca de 34 lpm, fatiga progresiva, en el que se implantó un marcapasos temporario en la región subtricuspídea. El electrocardiograma resultante a la intervención presentó características inusuales.
Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Frequência Cardíaca/fisiologia , Ventrículos do Coração/fisiopatologia , Eletrocardiografia , Fadiga/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
AIM: To evaluate the influence of functional training on cardiorespiratory parameters and cardiac autonomic modulation in postmenopausal women. METHODS: A total of 39 apparently healthy postmenopausal women were randomized into two groups and analyzed: the group that carried out the functional training (FTG; n = 19; age 60 ± 4.5 years; weight 67.64 ± 11.64 kg) for 18 weeks, and the control group (CG) who did not undergo the training (n = 20; age 58.45 ± 4.8 years; weight 66.91 ± 13.24 kg). Blood pressure, heart rate, respiratory rate and autonomic modulation trough heart rate variability were evaluated. The Student's t-test or Mann-Whitney test were used to compare the differences (P < 0.05). RESULTS: The results obtained from the training showed improvement of the following cardiac parameters in the FTG: systolic blood pressure (CG -5.50 ± 12.76 vs FTG -18.36 ± 18.05, P = 0.021), diastolic blood pressure (CG 5.00 ± 20.13 vs FTG -9.47 ± 10.25, P = 0.002), heart rate (CG 7.00 ± 9.79 vs FTG -4.73 ± 8.41, P = 0.000), root mean square of the successive differences index (CG -0.18 ± 5.66 vs FTG 5.10 ± 11.93, P = 0.035) and RR intervals (CG -22.66 ± 75.75 vs FTG 70.17 ± 104.30, P = 0.003). CONCLUSION: Functional training promoted beneficial effects on cardiac autonomic modulation and cardiorespiratory parameters in postmenopausal women. Geriatr Gerontol Int 2019; 19: 823-828.
Assuntos
Sistema Nervoso Autônomo , Aptidão Cardiorrespiratória/fisiologia , Pós-Menopausa/fisiologia , Treinamento Resistido/métodos , Sistema Nervoso Autônomo/fisiologia , Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea/fisiologia , Feminino , Coração/inervação , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Taxa Respiratória/fisiologia , Resultado do TratamentoRESUMO
The existence of a tetrafascicular intraventricular conduction system remains debatable. A consensus statement ended up with some discrepancies and, despite agreeing on the possible existence of an anatomical left septal fascicle, the electrocardiographic and vectorcardiographic characteristics of left septal fascicular block (LSFB) were not universally accepted. The most important criteria requested to confirm the existence of LSFB is its intermittent nature. So far, our group has published cases of transient ischemia-induced LSFB and phase 4 or bradycardia-dependent LSFB. Finally, anatomical, anatomopathological, histological, histopathological, electrocardiographic, vectorcardiographic, body surface potential mapping, and electrophysiology studies support the fact that the left bundle branch divides into three fascicles or a "fan-like interconnected network."
Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Bloqueio de Ramo/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Bloqueio de Ramo/diagnóstico , HumanosRESUMO
In left bundle branch block (LBBB), the ventricles are activated in a sequential manner with alterations in left ventricular mechanics, perfusion, and workload resulting in cardiac remodeling. Underlying molecular, cellular, and interstitial changes manifest clinically as changes in size, mass, geometry, and function of the heart. Cardiac remodeling is associated with progressive ventricular dysfunction, arrhythmias, and impaired prognosis. Clinical and diagnostic notions about LBBB have evolved from a simple electrocardiographic alteration to a critically important finding affecting diagnostic and clinical management of many patients. Advances in cardiac magnetic resonance imaging have significantly improved the assessment of patients with LBBB and provided additional insights into pathophysiological mechanisms of left ventricular remodeling. In this review, we will discuss the epidemiology, etiologies, and electrovectorcardiographic features of LBBB and propose a classification of the conduction disturbance.
Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/epidemiologia , Eletrocardiografia/métodos , Idoso , Bloqueio de Ramo/classificação , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Vetorcardiografia/métodosRESUMO
Down syndrome occurs more frequently in the offsprings of older pregnant women and may be associated with atrioventricular septal defect. This refers to a broad spectrum of malformations characterized by a deficiency of the atrioventricular septum and abnormalities of the atrioventricular valves caused by an abnormal fusion of the superior and inferior endocardial cushions with the midportion of the atrial septum and the muscular portion of the ventricular septum.
Assuntos
Ablação por Cateter/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Síndromes de Pré-Excitação/diagnóstico por imagem , Anormalidades Múltiplas/diagnóstico , Adolescente , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/genética , Síndrome de Down/complicações , Síndrome de Down/genética , Eletrocardiografia/métodos , Feminino , Cardiopatias Congênitas/genética , Cardiopatias Congênitas/cirurgia , Defeitos dos Septos Cardíacos/genética , Humanos , Masculino , Idade Materna , Síndromes de Pré-Excitação/genética , Síndromes de Pré-Excitação/cirurgia , Gravidez , Prognóstico , Vetorcardiografia/métodos , Adulto JovemRESUMO
Transcatheter aortic valve implantation (TAVI) is indicated in severe symptomatic aortic stenosis, when there is intermediate-high surgical risk, or a condition considered inoperable, as in the case of "porcelain aorta" that could turn clamping or cannulation of the ascending aorta hazardous in open-heart surgery. Among the complications of this less invasive procedure, intraventricular conduction disorders subsequent to the procedure stand out. TAVI causes worsening of intraventricular dromotropic disorders in more than 75% of the cases, with the presence of preexisting right bundle branch block and first-degree atrioventricular block, deep prosthesis implant, male gender, size of the aortic annulus smaller than the prosthesis, and porcelain aorta being predictive of requirement for permanent pacemaker implant.
Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/etiologia , Bloqueio de Ramo/etiologia , Complicações Pós-Operatórias/diagnóstico , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Cateterismo Cardíaco , Eletrocardiografia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Resultado do TratamentoRESUMO
Aortitis is one of many possible manifestations of tertiary syphilis. Aortic disease is the most common of all cardiovascular syphilitic lesions. Aortic diseases caused by tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation and coronary ostial stenosis. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 40-year-old male patient admitted with a clinical picture of acute coronary syndrome (unstable angina). He had no risk factors for coronary artery disease. The physical examination revealed nothing remarkable. The admission electrocardiogram (ECG) showed ST segment depression in the anterolateral and inferior leads (Figure 1). The coronary angiogram showed critical ostial stenosis of the right (RCA) and left main coronary artery (Figure 2a, b). Cardiac-computed tomography showed aortic wall thickening with involvement of bilateral coronary ostia (Figure 2b, c). The patient was referred for coronary bypass surgery after treatment with two doses of penicillin G. The laboratory test was strongly positive for syphilitic infection. Postoperative treatment with benzathine penicillin, in doses recommended for tertiary syphilis, was implemented.
Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/etiologia , Eletrocardiografia/métodos , Sífilis/complicações , Síndrome Coronariana Aguda/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Angiografia Coronária/métodos , Ponte de Artéria Coronária , Estenose Coronária/cirurgia , Humanos , Masculino , Penicilinas/uso terapêutico , Sífilis/diagnóstico , Sífilis/tratamento farmacológicoRESUMO
Recently, it has been shown that even experts in electrocardiography cannot differentiate the electrocardiographic pattern of genuine Brugada syndrome (BrS) from Brugada phenocopy (BrP). For this reason, this differentiation depends on the presence of established criteria both for BrS and BrP. In this manuscript, we present a patient with type 1 Brugada electrocardiographic pattern caused by expansive anterior mediastinal non-Hodgkin's lymphoma (NHL) with mechanical compression on the right ventricular outflow tract. The electrocardiographic pattern disappeared rapidly after antineoplastic measures.
Assuntos
Síndrome de Brugada/etiologia , Neoplasias do Mediastino/complicações , Idoso , Síndrome de Brugada/diagnóstico , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Fenótipo , Tomografia Computadorizada por Raios XRESUMO
Catecholaminergic polymorphic ventricular tachycardia is a rare devastating lethal inherited disorder or sporadic cardiac ion channelopathy characterized by unexplained syncopal episodes, and/or sudden cardiac death (SCD), aborted SCD (ASCD), or sudden cardiac arrest (SCA) observed in children, adolescents, and young adults without structural heart disease, consequence of adrenergically mediated arrhythmias: exercise-induced, by acute emotional stress, atrial pacing, or ß-stimulant infusion, even when the electrocardiogram is normal. The entity is difficult to diagnose in the emergency department, given the range of presentations; thus, a familiarity with and high index of suspicion for this pathology are crucial. Furthermore, recognition of the characteristic findings and knowledge of the management of symptomatic patients are necessary, given the risk of arrhythmia recurrence and SCA. In this review, we will discuss the concept, epidemiology, genetic background, genetic subtypes, clinical presentation, electrocardiographic features, diagnosis criteria, differential diagnosis, and management.
Assuntos
Eletrocardiografia/métodos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Adolescente , Criança , Pré-Escolar , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Taquicardia Ventricular/genética , Adulto JovemRESUMO
BACKGROUND: To evaluate the influence of functional training on the geometric indices of heart rate variability (HRV) and fractal correlation properties of the dynamics of heart rate in menopausal women. METHODS: Of 39 women who were in the period of menopause for more than a year and who did not practice any regular physical activity were divided into: Functional training group (FTG = 50 ± 4.5 years; 67.64 ± 11.64 kg; 1.5 ± 0.05 m) that executed the functional training (FT) and all proposals by reviews and the Control group (58.45 ± 4.8 years; 66.91 ± 13.24 kg; 1.55 ± 0.05 m) who performed all assessments but not FT. The training consisted of 18 weeks (three times a week) and the volunteers performed three sets of 11 functional exercises followed by a walk in each of the sessions. The autonomic nervous system modulation was evaluated by analysis of HRV and the indices obtained were: RR intervals, RRTRI, TINN, SD1, SD2, SD1/SD2, qualitative analysis of Poincaré plot and DFA (alfa-1, alfa-2 and alfa-1/alfa-2). The Student's t-test for unpaired samples (normal data) or Mann-Whitney test nonnormal data) were used to compare the differences obtained between the final moment and the initial moment of the studied groups (p < .05). CONCLUSION: Were observed in the FTG: increased SD1 (CG 0.13 ± 4.00 vs. 3.60 ± 8.43), beat-to-beat global dispersion much greater as an increased in the dispersion of long-term RR intervals and increased fractal properties of short-term (α1) (CG -0.04 ± 0.13 vs. 0.07 ± 0.21). FT promoted a beneficial impact on cardiac autonomic modulation, characterized by increased parasympathetic activity and short-term fractal properties of the dynamics of the heart rate.
Assuntos
Terapia por Exercício/métodos , Frequência Cardíaca/fisiologia , Pós-Menopausa , Feminino , Fractais , Humanos , Pessoa de Meia-IdadeAssuntos
Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia , Infarto do Miocárdio/complicações , Idoso , Bloqueio de Ramo/complicações , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Infarto do Miocárdio/fisiopatologiaRESUMO
Down syndrome is the most common chromosomal abnormality, with an incidence of one case in every 650 live births. It is strongly associated with heart disease, which constitutes the main cause of mortality during the first 2 years of life in this population. Most of the cardiac abnormalities in patients with Down syndrome can be suspected by analysing the surface 12-lead ECG. The purpose of this systematic review was to analyse all available published material on surface ECG and cardiac rhythm and conduction abnormalities in patients with Down syndrome to facilitate the search to the clinical cardiologist and paediatrician.
Assuntos
Arritmias Cardíacas , Síndrome de Down/fisiopatologia , Eletrocardiografia , Cardiopatias Congênitas/complicações , Arritmias Cardíacas/complicações , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Síndrome de Down/complicações , Saúde Global , Cardiopatias Congênitas/fisiopatologia , Humanos , IncidênciaRESUMO
AIMS: Previous studies have reported right bundle branch block in Brugada syndrome. Subsequent analysis of electrocardiograms (ECGs) found one-third of cases classified as right bundle branch block did not meet criteria of a wide final S wave in the left leads. We aimed to study the role of the vectorcardiogram to characterize Brugada type 1 ECG pattern. METHODS AND RESULTS: Compare Frank-method vectorcardiogram in 11 patients with Brugada type 1 ECG pattern (BrS group) with vectorcardiogram of 20 healthy individuals with ECGs depicting incomplete right bundle branch block (IRBBB group) and 12 patients with complete right bundle branch block (CRBBB group). Initial 10-20 ms vector of the QRS loop in the horizontal plane (HP): BrS and IRBBB groups: Vector heading anterior and leftward. CRBBB group: Vector directed anterior and rightward. Right end conduction delay of the QRS loop: BrS group: Upper right quadrant of the frontal plane, right posterior quadrant of the HP. IRBBB group: Upper right quadrant of the frontal plane (30%) and right anterior quadrant of the HP (90%). CRBBB group: Upper right quadrant on the frontal plane (30%); all cases in the right anterior quadrant of the HP. 0 point (onset of QRS loop) and J point (end of QRS loop) relationship: BrS group: Not coincidental. IRBBB and CRBBB groups: Coincidental. T loop morphology, size, and appearance: BrS group: Circular, with symmetrical afferent and efferent limbs in 10 cases (90%). IRBBB and CRBBB groups: Elliptical or linear with slow inscription of efferent limb and rapid inscription of afferent limb. CONCLUSIONS: Vectorcardiograms in patients with Brugada type 1 ECG pattern have distinctive characteristics compared with healthy individuals with incomplete and CRBBB. These differences relate to the spatial location of the end conduction delay (right superior and posterior quadrant in the BrS group) and the morphology, size, and velocity of inscription of afferent and efferent limbs of the T loop (circular, small, of symmetrical limbs) and with a 1:1 length/width ratio.