RESUMO
BACKGROUND: Left ventricular (LV) dysfunction is the major reason for poor outcomes in patients with congenital complete atrioventricular block (CCAVB) and pacemaker. Long-term pacing has been associated with LV mechanical dyssynchrony. However, the relationship of dyssynchrony and LV dysfunction is not clear. OBJECTIVE: We sought to evaluate the prevalence of LV dyssynchrony by real time three-dimensional echocardiography (RT3DE) in patients with CCAVB and its association with LV dysfunction. In addition, we evaluated the agreement between RT3DE and tissue Doppler imaging (TDI) for detecting LV dyssynchrony. METHOD: We studied 50 patients [median age 20 years old (5 months to 62 years), 68% women] with CCAVB and pacemaker who underwent complete two-dimensional echocardiography and RT3DE. LV dyssynchrony was considered if the systolic dyssynchrony index (SDI) was ≥ 5%. Intraventricular mechanical delay was defined by TDI when differences in electromechanical activation between LV walls were > 65 msec. RESULTS: LV systolic dysfunction was present in 16 patients (32%) by two-dimensional and in 20 patients (40%) by RT3DE. There was a good correlation between LV ejection fraction by two-dimensional and RT3DE (r = 0.75; P < 0.001). Fourteen (28%) patients had intraventricular dyssynchrony by TDI, while 12 (24%) had intraventricular dyssynchrony by RT3DE. There was a good agreement between LV dyssynchrony by TDI and RT3DE (Kappa = 0.735; P < 0.001). There was a negative correlation between LV ejection fraction and SDI obtained by RT3DE (r = -0.58; P < 0.001) CONCLUSIONS: In patients with CCAVB and long-term pacing, LV dyssynchrony occurred in one-third of patients and was related to LV dysfunction. There was a good correlation between dyssynchrony obtained by RT3DE and TDI.
Assuntos
Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Ecocardiografia Tridimensional , Bloqueio Cardíaco/congênito , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adolescente , Adulto , Bloqueio Atrioventricular/complicações , Criança , Pré-Escolar , Comorbidade , Feminino , Bloqueio Cardíaco/complicações , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/terapia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Disfunção Ventricular Esquerda/complicações , Adulto JovemRESUMO
AIM: To review the results of myocardial perfusion during rest and post-pharmacological stress induced by dipyridamole and analyze the SPECT images in patients with complete left bundle branch block LBBB, comparing the results in the presence of a normal coronary angiographic study and with critical coronary obstructions. METHODS: Results from 50 studies of myocardial perfusion of patients with complete block of the LBBB were reviewed and segmental perfusion was analyzed comparing these results with those obtained with those from the diagnostic coronariography. RESULTS: From the 15 studied patients, divided in two groups, 9 with angiographically normal coronaries and 6 with significant coronary lesions, it was not possible to establish a typical perfusion pattern due to the small size of the sample, revealing that the perfusion defects cannot be explained only by the electrocardiographic alterations since other factors participate, such as left ventricular telediastolic hypertension on the interventricular septum as a consequence of the loss of synchrony in ventricular contraction. CONCLUSIONS: Regional myocardial perfusion in patients with complete block of the LBBB is altered in 95% of the cases without relation with the presence of significant coronary alterations.
Assuntos
Fascículo Atrioventricular , Dipiridamol , Bloqueio Cardíaco/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único , Vasodilatadores , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PerfusãoRESUMO
OBJECTIVE: Noninvasive cardiac assessment of newborns and infants of women with systemic lupus erythematosus. The children had no congenital total atrioventricular block and were compared with the children of healthy women. METHODS: We prospectively assessed 13 newborns and infants aged 1 to 60 days, children of women with systemic lupus erythematosus and without congenital total atrioventricular block. These children were compared with 30 children of women who had no lupus or anti-Ro/SSA antibodies, and no risk factors for congenital heart disease either. Their age groups matched. The following examinations were performed: cardiological physical examination, electrocardiography, echocardiography, and signal-averaged electrocardiography. RESULTS: The statistical analysis showed no significant difference in ventricular function or in the cardiac conduction system between the groups. CONCLUSION: In regard to the conduction system and ventricular function in the absence of total atrioventricular block, no statistically significant difference was observed between the children of women with systemic lupus erythematosus and children of healthy women.
Assuntos
Filho de Pais com Deficiência , Bloqueio Cardíaco/diagnóstico , Lúpus Eritematoso Sistêmico , Anticorpos Antinucleares/sangue , Ecocardiografia Doppler em Cores , Eletrocardiografia , Feminino , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/imunologia , Frequência Cardíaca , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Estatísticas não ParamétricasRESUMO
El objetivo de este trabajo es la presentación de un caso de Polimiositis que durante las sucesivas reactivaciones de su enfermedad, presentó como manifestación dominante compromiso cardiovascular. Se realiza una actualización sobre el compromiso cardiovascular de esta patología. Paciente de 57 años de edad, sexo femenino, con diagnóstico de Polimiositis y seguimiento durante 10 años (1999-2002). Durante los sucesivos brotes de reactivación, presentó compromiso cardiovascular como manifestación dominante. El tratamiento aplicado en la fase miocardiopática (Corticoides a dosis de 1 gr/día durante 3 días) con mejoría de la fracción de eyección, representa un intento terapéutico no citado en la literatura consultada.(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Polimiosite/fisiopatologia , Polimiosite/classificação , Polimiosite/imunologia , Polimiosite/etiologia , Polimiosite/diagnóstico , Polimiosite/tratamento farmacológico , Polimiosite/terapia , Polimiosite/complicações , Pericardite/etiologia , Pericardite/epidemiologia , Sistema de Condução Cardíaco/patologia , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/diagnóstico por imagem , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/mortalidade , Ecocardiografia DopplerRESUMO
The authors report a case of a 39-year-old woman with dextrocardia and situs inversus who presented with episodes of complete heart block, managed successfully with a permanent dual chamber endocardial pacemaker.
Assuntos
Dextrocardia/complicações , Bloqueio Cardíaco/complicações , Adulto , Eletrocardiografia , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/diagnóstico por imagem , Humanos , Situs Inversus/complicações , UltrassonografiaRESUMO
Se presenta el caso de una paciente de 28 años de edad que fue admitida en nuestra Institución para realizarse un estudio electrofisiológico y una eventual ablación debido a que había presentado varios episodios de taquicardia ventricular con buena tolerancia hemodinámica pero refractarios al tratamiento médico. Este procedimiento no solamente no fue exitoso sino que además durante el mismo se produjo como complicación un bloqueo AV completo. Se decidió entonces la colocación de un desfibrilador implantable con dos catéteres (uno auricular y otro ventricular) con el fin de mantener la sincronía AV. Al mes del implante presentó dos choques inapropiados y varios episodios de mareos. Se le realizó un control del dispositivo donde se observó que los parámetros de sensado de la onda R y la impedancia no habían variado con respecto a los presentados durante el implante. La radiografía de tórax tampoco reveló ninguna alteración. En el momento de interrogar el dispositivo se constató que los choques inapropiados eran debidos a un sobresensado a nivel del catéter ventricular. Después de la reprogramación de la función de sensado al límite mínimo, la paciente evolucionó favorablemente sin repetir los mareos ni presentar nuevos choques espúreos (AU)
Assuntos
Humanos , Feminino , Adulto , Taquicardia Ventricular , Ablação por Cateter , Bloqueio Cardíaco/diagnóstico por imagem , Eletrofisiologia , EcocardiografiaRESUMO
The pacemaker with rate-responsiveness was a great advance in cardiac stimulation, however, the choice of the best biosensor is still object of research. A 35 year-old woman with a responsive pacemaker implanted due to a complete heart block after interventricular septal defect surgical correction was admitted. The pacemaker showed improper cronothropic response with high frequency due to biosensing malfunction. Malfunction related to muscle stimulation in the generator pocket and a high response rate. A palliative procedure was made until the end of pregnancy, by reducing the sensitivity of biosensing.
Assuntos
Baixo Débito Cardíaco/etiologia , Bloqueio Cardíaco/terapia , Frequência Cardíaca , Marca-Passo Artificial/efeitos adversos , Adulto , Eletrocardiografia , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/diagnóstico por imagem , Humanos , Gravidez , Segundo Trimestre da Gravidez , RadiografiaRESUMO
We report a case of a 6-year-old child with a third-degree atrioventricular heart block, ventricular septal rupture, tricuspid regurgitation and pericardial effusion after closed chest trauma. The role of the two dimensional echocardiography and color Doppler flow study in the early and reliable detection of cardiac lesions due to blunt chest traumas pointed out.
Assuntos
Ecocardiografia Doppler , Bloqueio Cardíaco/diagnóstico por imagem , Ruptura Cardíaca/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Criança , Eletrocardiografia , Evolução Fatal , Bloqueio Cardíaco/etiologia , Ruptura Cardíaca/etiologia , Septos Cardíacos/lesões , Humanos , Masculino , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicaçõesRESUMO
BACKGROUND: Little information is available about the relation between right ventricular infarction (RVI) and the presence of atrioventricular block. Thus, the objective of this study was to analyse a possible correlation between the conditions, which are frequently associated with inferior acute myocardial infarction (AMI). METHODS: We studied 107 patients with inferior AMI, of whom 49 had RVI, assessed by ST-segment elevation in right precordial leads (V3R-V4R) and by technetium-99m (99mTc) pyrophosphate scintigraphy. The diagnosis of atrioventricular block was made by continuous ECG monitoring during the first week of admission. RESULTS: The patients were divided into two groups: group A with RVI and group B with isolated inferior AMI. These groups were similar regarding sex, age, coronary risk factors, and time from the onset of precordial pain to hospital admission. Group A had a predominance of atrioventricular block (61.2 versus 15.5%, P < 0.0004), peak creatine kinase MB (82.5 +/- 22.4 versus 65.2 +/- 25.1 IU/l, P < 0.05), congestive heart failure or cardiogenic shock (57.1 versus 18.9%, P < 0.002), and proximal right coronary artery occlusion (80.4 versus 25.0%, P < 0.001). Non-Q-wave infarction was more frequent in group B patients (14.2 versus 34.4%, P < 0.01). The mortality rate was similar in the two groups (12.2 versus 13.7%). CONCLUSIONS: These data suggest that infarction extension from inferior wall to the right ventricle may be related to the development of atrioventricular block and does not increase mortality.
Assuntos
Bloqueio Cardíaco/complicações , Infarto do Miocárdio/complicações , Idoso , Cineangiografia , Angiografia Coronária , Feminino , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/fisiopatologia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Função Ventricular DireitaRESUMO
The authors report the case of a congenital atrio-ventricular block (AVB) diagnosed after 32 weeks of amenorrhea in a woman, suffering from AVB, fitted with a pacemaker and who had already given birth to two children suffering from congenital AVB. The authors recall the physiopathology and antenatal diagnostic criteria of AVB and how it should be managed.