RESUMO
A total of 70 blood-donor volunteers were studied to determine the utility of the echocardiogram and Doppler in the diagnosis of cardiopathies in asymptomatic patients with Chagas disease. These patients came from endemic areas and had humoral positive reactions for South American Trypanosomiasis. They were checked against a control group of blood-donors with no environmental antecedents and with negative reactions. Both groups were similar in age and sex. The chagasic group showed an abnormal electrocardiogram in twelve cases (17.4%), being left anterior hemiblock the most frequent alteration found (nine cases, 62.5%). In the control group no alterations were found (p = 0.0005). The echocardiogram and Doppler were abnormal in 29 cases of the chagasic group (38.8%): alterations in ventricular relaxation were found in 8 cases (27.6%), enlargement of cavities in 9 (31%), both phenomena in 9 (31%) and alteration of parietal motility in 3 (10.3%). In the control group, 1 case presented alteration in ventricular relaxation (p = 0.000008). These results confirmed that the abnormal discoveries were related to Chagas disease. Out of 70 chagasic patients, 31 (44.29%) showed some alteration in the tests: 12 had an abnormal electrocardiogram, and of these only 2 had normal echocardiogram and Doppler, the rest showed abnormal echocardiogram and Doppler. Other 29 (of these 70 patients) showed some alteration in the echocardiogram and Doppler, and 20 of them presented a normal electrocardiogram. It can be concluded that the echocardiogram and Doppler are more accurate to detect cardiac involvement in asymptomatic chagasic patients than the electrocardiogram, showing abnormality in many cases where there are no electrocardiographic alterations. On the other hand, patients with abnormal electrocardiogram and Doppler are less frequent. Therefore, to define the undetermined period of Chagas disease echocardiogram and Doppler should be incorporated as a routine resource of diagnosis considering the high percentage of cases in which cardiac participation is detected when there is no clinic, radiologic and electrocardiographic disturbance.
Assuntos
Cardiomiopatia Chagásica/fisiopatologia , Ecocardiografia , Eletrocardiografia , Adulto , Estudos de Casos e Controles , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
A total of 70 blood-donor volunteers were studied to determine the utility of the echocardiogram and Doppler in the diagnosis of cardiopathies in asymptomatic patients with Chagas disease. These patients came from endemic areas and had humoral positive reactions for South American Trypanosomiasis. They were checked against a control group of blood-donors with no environmental antecedents and with negative reactions. Both groups were similar in age and sex. The chagasic group showed an abnormal electrocardiogram in twelve cases (17.4
), being left anterior hemiblock the most frequent alteration found (nine cases, 62.5
). In the control group no alterations were found (p = 0.0005). The echocardiogram and Doppler were abnormal in 29 cases of the chagasic group (38.8
): alterations in ventricular relaxation were found in 8 cases (27.6
), enlargement of cavities in 9 (31
), both phenomena in 9 (31
) and alteration of parietal motility in 3 (10.3
). In the control group, 1 case presented alteration in ventricular relaxation (p = 0.000008). These results confirmed that the abnormal discoveries were related to Chagas disease. Out of 70 chagasic patients, 31 (44.29
) showed some alteration in the tests: 12 had an abnormal electrocardiogram, and of these only 2 had normal echocardiogram and Doppler, the rest showed abnormal echocardiogram and Doppler. Other 29 (of these 70 patients) showed some alteration in the echocardiogram and Doppler, and 20 of them presented a normal electrocardiogram. It can be concluded that the echocardiogram and Doppler are more accurate to detect cardiac involvement in asymptomatic chagasic patients than the electrocardiogram, showing abnormality in many cases where there are no electrocardiographic alterations. On the other hand, patients with abnormal electrocardiogram and Doppler are less frequent. Therefore, to define the undetermined period of Chagas disease echocardiogram and Doppler should be incorporated as a routine resource of diagnosis considering the high percentage of cases in which cardiac participation is detected when there is no clinic, radiologic and electrocardiographic disturbance.
RESUMO
The study covers a group of 100 asymptomatic blood donors (14 women and 86 men) with positive serological test for Chagas' disease. All of them were living in urban non endemic areas at the moment of the test, but before they had lived in endemic areas. Patients with coronary heart disease, congenital heart disease, hypertension, diabetes, alcoholism or thyroid disease were not included. The sample was split in two groups: Group I: 23 patients (aged 41.95 +/- 10.52) with evidence of myocardial involvement at physical examination, chest roentgenograms and/or EKG, that we considered inherent to Chagas cardiopathy; and Group II: 77 patients (aged 38.36 +/- 10.57) without abnormal findings. There were no significant differences between the two groups in age, sex, type of house in the endemic area and familial history of Chagas' disease. We found significant differences in the period of residence in endemic areas of Chagas' disease (Group I 21.26 years +/- 7.21 vs Group II: 15.56 years +/- 5.91; p = 0.0015). Additionally, patients in Group I were more frequently able to describe or recognize the transmitting insect than patients in group II (p = 0.05) and to accept the possibility of a triatomide bite (p = 0.024). In group I, more people were coming from Santiago del Estero province, an area with a large bug infection. The results of our research suggest that the myocar-dial damage in patients with positive serological test for Chagas' disease is more likely when there is a larger exposure to the transmitting insect, and when its infestation is larger. All of this, probably, as a consequence of incoulation reiterations.
Assuntos
Doadores de Sangue , Doença de Chagas/epidemiologia , Adulto , Fatores Etários , Cardiomiopatia Chagásica/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de TempoRESUMO
Malignant mesothelioma is a tumor which occurs in one out of every 4,000 patients autopsied for malignant neoplasia. Pericardial location is the least frequently encountered, accounting for less than 2% of the total cardiac tumors. We are presenting here a patient in whom the tumor resulted in a syndrome of cardiac tamponade. It could not be diagnosed in the living patient in spite of having performed a subxiphoideal pericardic biopsy. The patient died suddenly, and the tumor was found during autopsy, infiltrating the right atrium and protruding into the cavity, involving the right coronary artery. This latter situation could have been responsible for the patient's death. Clinical and pathological findings are compared with those of 30 cases found in recent literature.
Assuntos
Neoplasias Cardíacas/patologia , Mesotelioma/patologia , Pericárdio/patologia , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Pleurais/patologiaRESUMO
Malignant mesothelioma is a tumor which occurs in one out of every 4,000 patients autopsied for malignant neoplasia. Pericardial location is the least frequently encountered, accounting for less than 2
of the total cardiac tumors. We are presenting here a patient in whom the tumor resulted in a syndrome of cardiac tamponade. It could not be diagnosed in the living patient in spite of having performed a subxiphoideal pericardic biopsy. The patient died suddenly, and the tumor was found during autopsy, infiltrating the right atrium and protruding into the cavity, involving the right coronary artery. This latter situation could have been responsible for the patients death. Clinical and pathological findings are compared with those of 30 cases found in recent literature.
RESUMO
El mesotelioma maligno es un tumor que se presenta en relación 1: 4000 pacientes autopsiados por neoplasias malignas. La localización pericárdica es la menos frecuente, constituyendo menos del 2 por ciento del total de tumores cardíacos. Se presenta un caso en el que el tumor produjo un síndrome de taponamiento cardíaco, sin ser diagnosticado en vida a pesar de efectuarse una biopsia pericárdica subxifoidea. El paciente murió bruscamente, halládose en la autopsia dicho tumor infiltrando la aurícula derecha y haciendo protusión en la cavidad, englobando la arteria coronaria derecha. Esto último podría ser responsable de la muerte. Se comparan los hallazgos clínicos y patológicos con 30 casos extraídos de la literatura reciente (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Mesotelioma/patologia , Pericárdio/patologia , Neoplasias Cardíacas/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pleurais/patologia , Invasividade Neoplásica , Evolução FatalRESUMO
El mesotelioma maligno es un tumor que se presenta en relación 1: 4000 pacientes autopsiados por neoplasias malignas. La localización pericárdica es la menos frecuente, constituyendo menos del 2 por ciento del total de tumores cardíacos. Se presenta un caso en el que el tumor produjo un síndrome de taponamiento cardíaco, sin ser diagnosticado en vida a pesar de efectuarse una biopsia pericárdica subxifoidea. El paciente murió bruscamente, halládose en la autopsia dicho tumor infiltrando la aurícula derecha y haciendo protusión en la cavidad, englobando la arteria coronaria derecha. Esto último podría ser responsable de la muerte. Se comparan los hallazgos clínicos y patológicos con 30 casos extraídos de la literatura reciente
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Mesotelioma/patologia , Neoplasias Cardíacas/patologia , Pericárdio/patologia , Evolução Fatal , Neoplasias Pulmonares/secundário , Invasividade Neoplásica , Neoplasias Pleurais/patologiaRESUMO
Ambulatory electrocardiography was performed for 24 hours in 30 University students (12 males and 18 females) without over heart disease, with normal cardiac physical examination, EKG and echocardiogram. Their age ranged from 18 to 33 years, with a mean of 23.9 years (SD 2.8). All of them were asymptomatic. Ventricular arrhythmias were detected in 13 of the subjects (43.4%); 12 had ventricular ectopy (VE) and one parasystole. Only one VE was detected in 24 hours in 8 cases; multiform VE occurred in only one and showed a repetitive form. In 58% of the cases it originated in the left ventricle. There was a positive relationship between cardiac frequency (CF) and VE: when the arrhythmia was registered, CF was 107.2 beats/min (SD = 23.9) and the average at the same hour was 89.7 beats/min (SD = 15.9; p less than 0.001). No significant association of the presence or absence of VE with sex, age, ingestion of alcohol or coffee was noted, except for cigarette smoking (p less than 0.04).
Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial , Frequência Cardíaca , Adolescente , Adulto , Consumo de Bebidas Alcoólicas , Arritmias Cardíacas/fisiopatologia , Café , Feminino , Humanos , Masculino , FumarRESUMO
Ambulatory electrocardiography was performed for 24 hours in 30 University students (12 males and 18 females) without over heart disease, with normal cardiac physical examination, EKG and echocardiogram. Their age ranged from 18 to 33 years, with a mean of 23.9 years (SD 2.8). All of them were asymptomatic. Ventricular arrhythmias were detected in 13 of the subjects (43.4
); 12 had ventricular ectopy (VE) and one parasystole. Only one VE was detected in 24 hours in 8 cases; multiform VE occurred in only one and showed a repetitive form. In 58
of the cases it originated in the left ventricle. There was a positive relationship between cardiac frequency (CF) and VE: when the arrhythmia was registered, CF was 107.2 beats/min (SD = 23.9) and the average at the same hour was 89.7 beats/min (SD = 15.9; p less than 0.001). No significant association of the presence or absence of VE with sex, age, ingestion of alcohol or coffee was noted, except for cigarette smoking (p less than 0.04).
RESUMO
Se efectuó control electrocardiográfico ambulatorio (Holter) de 24 horas a 30 estudiantes universitarios sin evidencia de enfermedad cardiovascular, cuyas edades estaban comprendídas entre 18 y 33 años. Se detectaron arritmias ventriculares en 13 casos (43,3%); en 12 se trató de extrasistolia y en un caso de parasistolia ventricular. En una sola oportunidad se resgistraron arritmias ventriculares complejas: extrasistolia polifocal y una dupla monomorfa. Las extrasístoles se originaron en el ventrículo izquierdo en el 58% de los caso, en el derecho en el 33,35%; en uno el origen no se pudo determinar con seguridad. En el momento de registrarse la arritmia, la frecuencia cardíaca fue de 107 latidos por minuto de promedio, siendo la diferencia estadísticamente muy significativa (p < 0,001). La presencia de arritmia ventricular no se vinculó con la edad, sexo ingestión de alcohol o café, práctica de deporte a nivel recreativo ni con la existencia de antecedentes familares de afección cardiocirculatoria, peri sí con el hábito de fumar (p < 0,04) (AU)
Assuntos
Adolescente , Adulto , Humanos , Masculino , Feminino , Arritmias Cardíacas/diagnóstico , Frequência Cardíaca , Eletrocardiografia Ambulatorial , Nicotiana , Consumo de Bebidas Alcoólicas , CaféRESUMO
Se efectuó control electrocardiográfico ambulatorio (Holter) de 24 horas a 30 estudiantes universitarios sin evidencia de enfermedad cardiovascular, cuyas edades estaban comprendídas entre 18 y 33 años. Se detectaron arritmias ventriculares en 13 casos (43,3%); en 12 se trató de extrasistolia y en un caso de parasistolia ventricular. En una sola oportunidad se resgistraron arritmias ventriculares complejas: extrasistolia polifocal y una dupla monomorfa. Las extrasístoles se originaron en el ventrículo izquierdo en el 58% de los caso, en el derecho en el 33,35%; en uno el origen no se pudo determinar con seguridad. En el momento de registrarse la arritmia, la frecuencia cardíaca fue de 107 latidos por minuto de promedio, siendo la diferencia estadísticamente muy significativa (p < 0,001). La presencia de arritmia ventricular no se vinculó con la edad, sexo ingestión de alcohol o café, práctica de deporte a nivel recreativo ni con la existencia de antecedentes familares de afección cardiocirculatoria, peri sí con el hábito de fumar (p < 0,04)