Precordial Research Articles

Fulminant myocarditis mimicking extensive anterior wall myocardial infarction

A 17-year-old boy presented with precordial chest pain and dyspnoea of three days duration. The patient was in heart failure at presentation and had persistent chest discomfort. There was no histor...

Wolf-Parkinson-White syndrome

We report the case of a 59-year-old patient with no cardiovascular risk factors and medical history. He consults in the emergency room for rapid onset of palpitations with precordial pain. Clinical examination was normal. The electrocardiogram shows a short PR interval <120 ms, an initial QRS foot base, enlargement of the QRS complexes with repolarization anomalies. Wolf Parkinson White syndrome is defined by the presence of a permeable accessory pathway (Kent bundle) leading to ventricular pre-excitation which by passes the normal conduction. The ventricular myocardium is therefore depolarized in advance by the accessory bundle, which results in a fusion between the first atrioventricular activation and that the one that passes through the normal pathway. The electric aspect combines a short PR interval <120 ms, an initial QRS foot base called the delta wave, an enlargement of the QRS complex with frequent repolarization anomalies. The pre-excitation of wolf parkinson white is usually asymptomatic. Tachycardia and/or arrhythmia may cause the following symptoms: palpitations, dizziness, faintness, syncope, chest pain, and sudden death. It had numerous etiologies: idiopathic, Epstein´s disease, coronary artery disease, hyperthyroidism, or high blood pressure. Episodes of paroxysmal supraventricular tachycardia due to Wolff Parkinson´s white syndrome can be stopped by any vagal maneuver which slows the heart rate. When these maneuvers are ineffective, drugs such as verapamil and adenosine are usually used to stop the arrhythmia. Arrhythmic drugs can then be taken indefinitely to prevent further episodes. Catheter ablation of the accessory bundle is successful in over 95% of cases.

Pericarditis in systemic lupus eythematosis

Pericarditis is a common cardiac manifestation in Systemic Lupus Erythematosus (SLE). However, little is known about clinical or immunological associations of pericarditis. The aim of this study is to analyze predictors’ factors of lupus pericarditis as well as the treatment response and long-term outcomes. We retrospectively reviewed the records of 238 patients with SLE, as defined by the ACR who were admitted in Fattouma Bourguiba University Hospital between 2010 and 2020. The diagnosis of pericarditis was defined as the presence of pericardial effusion by echocardiography. Forty-tow patients (17.6%, 7 men and 35 women) had pericerditis. Median age was 37 years (range 13–64). pericarditis was the first sign of SLE in 11/42 cases (26,1%). The mean duration of SLE at the time of pericarditis was 17 months. typical sharp precordial pain and dyspnea occurred in 10/42 (23.8%) cases. in patients with lupus pericarditis 50% had pleuritis. Clinical factors significantly associated with pericarditis were lupus nephritis ( P = 0.000), pulmonary hypertension ( P = 0.041), fever (0.026) and haemolytic anemia (0.046). Serological profile in patients with lupus pericarditis included; 92.7% AAN, 69% anti-DNA 69% antibodies, 29.3% anti SM antibodies, 36,6% anti SSA antibodies and 22% anti RNP antibodies. It was highly associated with antiphospholipide antibodies ( P = 0.029). Fifteen patients were treated with at least 0.5 mg/kg/day of prednisone. In tow patients with tomponad, a higher dose of corticosteroid was necessary. Pericarditis is one of the most characteristic disease manifestations. It may remain clinically silent and evidence of previous pericardial disease is often observed on echocardiography. Cardiac tamponade is a critical diagnosis to consider, though is an uncommon presentation in SLE.

New imaging methods in assessing the pediatric patient with suspected myocarditis

Due to the variability of the clinical presentation, acute myo­car­di­tis is an underdiagnosed pathology. The importance of this pathology derives from the need to establish the diag­no­sis as early as possible, in order to establish an adap­ted therapeutic strategy and to avoid the occurrence of complications. Acute myocarditis is one of the causes of sud­den death in infants and children. The most common cause is viral etiology. Myocarditis should be suspected in all children who have precordial pain associated with in­creased cardiac enzymes and a history of viral infection. The current gold standard for diagnosis is endomyocardial biop­sy, but this investigation cannot be performed routinely. Car­diac magnetic resonance imaging has become an im­por­tant tool for the noninvasive diagnosis of acute myo­car­di­tis, being performed after an well-established pro­to­col, ac­cor­ding to the Lake Louise criteria. With the help of cardiac mag­ne­tic resonance imaging there can be detected multiple path­olo­gies, but for establishing the diag­no­sis of myocarditis and of the alterations associated with this pathology, the location and extent of edema, the hyperemia, inflammation and fi­bro­sis, the presence of seg­men­tal or global wall-motion ab­nor­ma­li­ties, pericardial ef­fu­sion, the size of interventricular sep­tum and of ventricle free wall, the ventricle diameter, right and left ventricle func­tions, along with atrioventricular and ven­tri­cu­lo­ar­te­rial con­cor­dance are of paramount im­por­tance. New mapping tech­niques are particularly useful in myo­car­di­tis due to their abi­li­ty to quantify focal and diffuse changes.

Texidor’s twinge a rare cause of benign paroxysmal chest pain

Objective: Precordial catch syndrome was described by Miller and Texidor in 1955. It deserves wider recognition because it is rarely discussed in the differential diagnosis of precordial pain. Case summary: Case characteristics include a young 8-year-old female that presented with 4th episode of chest pain to the hospital. On attempting maneuver like deep breaths slowly in lying down position, pain subsided within 5 minutes although all other modalities of chest pain investigation as electrocardiography, echocardiography, chest high-resolution computed tomography, cardiac enzymes were normal. Discussion and conclusion: Various maneuvers like lying down or sitting upright and attempting deep inspiration tends to help in such conditions. This case report is reporting an unusual presentation of this syndrome due to its long duration of episode than the duration described in the previous reports. Prognosis is good. Key words: precordial catch syndrome, sharp chest pain, sagged posture, Texidor’s twinge, case report

Management of a giant aortic root aneurysm in a young patient with Marfan syndrome: a case report

IntroductionMarfan syndrome (MFS) is a common heritable connective tissue disease involving multiple organs. Even though the clinical manifestations of MFS can be various, aortic root aneurysm is estimated as one of the most serious complications. We herein describe an individualized treatment decision-making process for a 23-year-old male with MFS, suffering from a giant but stable aortic root aneurysm which is extremely rare at his age.CaseThe patient, a 23-year-old male with a family history of MFS, presented to our cardiovascular department because of progressive exertional chest distress, fatigue and occasional precordial pain. Physical examinations revealed 190.5 cm of height, high myopia, and a diastolic murmur at the aortic valve area. Laboratory examinations for systemic vasculitis and infectious diseases were negative. Transthoracic echocardiography and enhanced thoracic computed tomography (CT) scan revealed the existence of a giant aortic root aneurysm (125.1 mm in short-axis), severe aortic valve regurgitation, cardiac dilatation (LV; 99 mm in diastolic diameter) and a poor ejection fraction (EF; 18%). Considering the risk of rupture or dissection of the dilated aortic root, we performed Bentall procedure based on the results of multidisciplinary team discussion and intraoperative exploration. Postoperative thoracic CT scan revealed a normal sized reconstructed aortic root, and the patient was discharged uneventfully 7 days later.ConclusionIt is extremely rare to report such a giant aortic root aneurysm in a young patient. In the treatment decision-making process, the patient’s specific situation should be taken into consideration. A mechanical Bentall procedure seems to be an acceptable option for some selected cases.

Frecuencia de consultas cardiológicas y paros cardíacos extrahospitalarios durante la pandemia COVID-19

Introduction: the COVID-19 pandemic has determined the application of emergency health measures aimed at preventing progression at national level. International reports have suggested that these measures lead to a lack of care in other pathologies, mainly cardiovascular, and eventually increase out-of-hospital cardiac arrests.Objective: to determine the frequency of emergency consultation for chest pain and out-of-hospital cardiac arrests, assisted by the main pre-hospital emergency services of Montevideo, during the COVID-19 pandemic.Methods: information was requested to the medical institutions of Montevideo and all over the country, on the numberof consultations for chest pain and total consultations, in the period March 13- April 30 of 2018, 2019 and 2020. The frequency of out-of-hospital cardiac arrests in Montevideo was requested to the pre-hospital emergency services during the same period. The data is expressed as absolute frequency and incidence rates (x 100,000) with its 95% CI calculated by Fisher.Results: the number of consultations for precordial pain was stable during the 2018-2019 period. During 2020, theseconsultations decreased and represented between 11.3% and 21.7% of the total number of consultations. Out-of-hospital cardiac arrests showed a non significant increase in its incidence rate in 2020 (9.05, 95%IC: 7.15-11.30) compared with 2019 (7.94, 95%IC: 6.19-10.04) and 2018 (7.43, 95%IC: 5.75-9.45).Conclusions: the raw data presented shows that from March 13 to April 30 of 2020, there was a decrease in emergency visits for precordial pain and a non-significant increase in the incidence rate of out-of-hospital cardiac arrests.

Spontaneous community-acquired PVL-producing Staphylococcus aureus mediastinitis in an immunocompetent adult \u2013 a case report

BackgroundMediastinitis caused by hematogenous spread of an infection is rare. We report the first known case of community-acquired mediastinitis from hematogenous origin in an immunocompetent adult. This rare invasive infection was due to Panton-Valentine Leucocidin-producing (PVL+) methicillin-susceptible Staphylococcus aureus (MSSA).Case presentationA 22-year-old obese man without other medical history was hospitalized for febrile precordial chest pain. He reported a cutaneous back abscess 3 weeks before. CT-scan was consistent with mediastinitis and blood cultures grew for a PVL+ MSSA. Intravenous clindamycin (600 mg t.i.d) and cloxacillin (2 g q.i.d.), secondary changed for fosfomycin (4 g q.i.d.) because of a related toxidermia, was administered. Surgical drainage was performed and confirmed the presence of a mediastinal abscess associated with a fistula between the mediastinum and right pleural space. All local bacteriological samples also grew for PVL+ MSSA. In addition to clindamycin, intravenous fosfomycin was switched to trimethoprim-sulfamethoxazole after 4 weeks for a total of 10 weeks of antibiotics.ConclusionsWe present the first community-acquired mediastinitis of hematogenous origin with PVL+ MSSA. Clinical evolution was favorable after surgical drainage and 10 weeks of antibiotics. The specific virulence of MSSA PVL+ strains played presumably a key role in this rare invasive clinical presentation.

SUN-449 PATIENT WITH FABRY DISEASE IN CHRONIC HEMODIALYSIS FOR 7 YEARS AND 9 YEARS OF ENZYME REPLACEMENT THERAPY (ERT) IN TOTAL

Fabry disease (FD) is a lysosomal storage disease of inheritance linked to the X chromosome caused by the deficiency of the enzyme alpha-galactosidase A. It is a multisystemic disease with mainly renal, cardiac and nervous system involvement. Before the advent of dialysis and transplantation, men commonly died of chronic renal failure in the fifth decade of life. In a 2006 study of more than 100 patients with FD, all patients who survived older than 56 years developed ESRD and no patient survived beyond 60 years. Case report of a 60-year-old FD patient treated with agalsidase beta for 9 years. At first consultation, he presented hypertension and moderate proteinuria that reached a nephrotic range. Nitrogen products rose gradually, proteinuria values decreased to a moderate range and were maintained over time. The renal biopsy reported zebra bodies in the cytoplasm of podocytes. Molecular diagnosis of FD was made, detecting mutation c.520 T>G in exon 3 of the GLA gene. He started ERT with agalsidase beta immediately. After more than one year of ERT, the patient began hemodialysis (HD) at age 52. He continued infusions of intradialysis ERT without complications. The patient evolved with severe hyperparathyroidism that required parathyroidectomy. In 2017, brown tumor was diagnosed in the right wrist region. Surgery was performed to remove it. Despite good control of blood pressure and ERT, the patient evolved with left ventricular hypertrophy. In 2018 he presented mild precordial pain and then syncope. Acute non-ST elevation myocardial infarction was diagnosed. Medical treatment was performed without the need for angioplasty. Then he presented no more cardiovascular complications. He was evaluated for cross-kidney transplantation, because he had a different blood group donor. But this did not prosper. The patient received ERT uninterruptedly from the beginning, during 2009 he received agalsidase alfa for a short period due to the shortage of agalsidase beta. He currently remains in HD. Medication: Bisoprolol, valsartan, acetylsalicylic acid. Calcium, calcitriol, sevelamer and paricalcitol. Vitamin B, folic acid, erythropoietin and iron. Renal biopsy: Podocyte cytoplasm shows the typical structure of glycosphingolipid deposits, arranged in onion-like or zebra-like-figures. Echo doppler: Hypertrophy of the LV with septal predominance. Fey estimated by Simpson: 62%. Fibrosis of the ring and mitral valve. Fibrosis of the aortic sigmoids, with preserved opening. Pericardial effusion of mild grade. Initially, 3-year survival of FD patients on dialysis in the US was significantly lower compared to non-diabetic controls: 63% vs. 74% (95% CI, 67 to 80%; P _ 0.03). A study recently showed a mortality rate of patients with FD in HD of 7.38 (95% [CI] 7.33–7.42) per 100 people per year, lower than the mortality of patients with nephroangiosclerosis or diabetes. Mutation c.520 T>G was described as a renal variant. Although then the patient evolved with hypertrophy of LV. This is a complication of both hypertension and FD and being able to determine the cause with accuracy is difficult. In Argentina, cross-donor transplantation was legislated recently. FD is a multisystemic disease leading to life-threatening complications. ERT can have a positive impact on patient survival despite the progression of the disease and noble organs affeted.

Syringomyelia: Report of a Clinical Case and Bibliographical Review.

Introduction Syringomyelia is a pathological involvement of the spinal cord, which consists of a central cavitation, which mainly affects the cervical area. In 90% of cases, it may be closely related to Chiari disease, however, there are other alterations such as intra or extramedullary tumor, trauma, hydrocephalus, among others that can cause syringomyelia as well. The diagnosis is completed with imaging studies (MRI). The treatment is usually surgical in most cases, as long as the patient is a candidate for it. However, there are other alternatives with promising results. Clinical Case: A 47-year-old female patient, who goes to the outpatient clinic, referring pain in the upper extremities, mainly in the right, irradiated to the dorsal region, in addition to presenting other signs and symptoms such as tachycardia, medium intensity precordial pain, headache, nausea and dizziness As a pathological personal history, the patient reports having suffered seizures during childhood, in addition to being hit by a truck with an evolution time of 15 years. Conclusions: with the studies obtained and the evaluation of the patient, the diagnosis of syringomyelia associated with Chiari is reached. The patient is followed up and scheduled for neurosurgical treatment due to the presence of symptoms.

Clinical presentation of acute coronary syndromes according to gender and age: Five-year analysis on 11,556 patients

Differences in symptoms of Acute Coronary Syndromes (ACS) according to gender are documented. There is no recent data from population-based registries in France. To compare clinical presentation of ACS between genders in hospitalized patients. We analyzed data from the French MONICA registries on 11,556 patients aged 35–74 and hospitalized for a first ACS between 2011 and 2015. Precordial pain was more frequent in men (86.0% vs. 80.7% P < 10 −4 ), whereas more women reported non-precordial pain (6.0% vs. 4.7% P < 10 −3 ) and no pain (13.3% vs. 9.2% P < 10 −4 ). Dyspnea, malaise or severe symptoms (acute pulmonary edema, shock, cardiac arrest) were more frequent in women than in men (25.4% vs. 17.9% P < 10 −4 , 19.6% vs. 14.2% P < 10 −4 and 16.0% vs. 12.4% P < 10 −4 , respectively). With age, in both genders, proportions of precordial pain decreased whereas those of no pain, severe symptoms and dyspnea increased ( Table 1 ). Only for malaise the sex difference was significant in all groups. In women aged 35–44 and 45–54, the proportion of severe symptoms was not significantly higher as compared with men of the same age. Difference between genders for dyspnea was significant for all patients except for those aged 45–54. In patients aged 35–44, no significant differences were observed for pain. Except for malaise, differences of symptoms between genders were affected by age. Age and sex-specific characteristics of ACS may partially explain these results.

Acupuncture on treating angina pectoris: A systematic review.

Background:Coronary heart disease angina pectoris is a common clinical symptom in patients with coronary heart disease, due to coronary atherosclerotic stenosis or sputum leading to coronary insufficiency, myocardial transient ischemia, hypoxia caused by precordial pain as the main clinical manifestations Group syndrome. Coronary heart disease angina causes coronary blood flow insufficiency, cannot meet the normal activities of myocardial cells, leading to myocardial ischemia or necrosis. When the disease occurs, there is paroxysmal and crushing pain in the precordial area of the patient. Therefore, we recognize the importance of the disease and have paid enough attention. Clinical studies in recent years have found that the use of acupuncture in the treatment of angina pectoris has a good clinical application prospect. This study was conducted to study the effect of using acupuncture to treat angina pectoris.Methods and analysis:We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet, Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of angina pectoris.Ethics and dissemination:This systematic review will evaluate the efficacy and safety of acupuncture for angina pectoris. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.Registration number:PROSPERO CRD42019138003.

P260 Left ventricular pseudoaneurysm manifesting as syncope

Abstract Introduction Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. LV pseudoaneurysm is one of the mechanical complications of myocardial infarctions (MI), particularly inferior wall MI. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. Transthoracic echocardiography is commonly used in clinical practice and is usually sufficient to make the diagnosis of LV pseudoaneurysm. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Description of the clinical case 74 years-old woman, with previous history of hypertension, dyslipidaemia and type 2 diabetes and stable coronary disease. In June 2018 the patient underwent coronary angiography that revealed left main and 3 vessels coronary disease, Cardiac revascularization surgery was proposed that the patient refused. The patient was stable during 6 months. Four days before presenting to emergency department the patient mentioned intermittent pre-cordial pain associated with exertion. At admission day she felt intense pre-cordial pain, accompanied by sudoresis and nausea, relieving with sublingual nitrate. The patient was hemodynamically stable at admission. Electrocardiogram showed sinus rhythm 65 bpm with 2mm ST-elevation of inferior leads. Troponin I was positive 30 ng/dL. Echocardiogram revealed marked hypokinesia of inferior and lateral wall with moderate depression of global systolic function ans presence of slight circumferential pericardial effusion (6mm in diastole on lateral wall) Emergent coronariography was performed and revealed progression of coronary disease of the right coronary artery with sub-occlusion of the mid segment. Cardiac revascularization surgery was proposed and the patient accepted this time. Echocardiogram was repeated during hospitalization revealed a stable pericardial effusion with reduced dimension comparing to admission. After 3 weeks, while waiting surgery in the ward, the patient was a syncope that resulted in fracture of the distal peroneum. Ecocardiogram was performed and revealed a LV posterior wall pseudoaneurysm through a narrow neck in parasternal long axis view and the presence of large pericardial effusion (Fig 1). The patient was submitted to definitive reparative cardiac surgery with pericardium patch and coronary artery bypass graft from left internal mammary to anterior descending coronary artery. The patient recovered well from the cardiac surgery and at 2 months follow up is alive and without signs of heart failure. This case illustrates the complexity in the management of patients with LV pseudoaneurysm. These patients require substantial critical care, imaging and surgical expertise. A high clinical index of suspicion is needed to avoid missing the diagnosis LV pseudoaneurysm and transthoracic echocardiography is essential to establish the diagnosis. Abstract P260 Figure. Fig 1 - LV pseudoaneurysm

Hemorrhagic esophagitis caused by chewing areca nut

Background: Eosinophilic esophagitis arising from edibles is unusual while acute esophageal variceal hemorrhage and mediastinal hematoma caused by food consumption are even rarer. These underlying conditions may lead to severe deasease patterns, which can lead to dire consequences when untreated or mistreated. Case presentation: A 62-year-old male presented with precordial catch syndrome, chest pain and dyspnea, yet stable vital signs. The patient was initially misdiagnosed with acute coronary syndrome in a local hospital and treated for it. However, during treatment the symptoms gradually worsened. After transfer to our hospital, medical history and eating habits were explored. The medical history was unremarkable. However, one of his eating habits was chewing of areca nuts. Based on this, the clinical manifestations and examination, he was diagnosed with food-induced acute eosinophilic esophagitis and esophageal hematoma. The patient responded to treatment by food and fluid restriction, prevention of infection, inhibition of gastric acid, parenteral nutrition, and glucocorticoids well, recovered completely and could be discharged soon after. Conclusion: As an esophagitis is mostly asymptomatic, it is often overlooked or misdiagnosed, which delays treatment. The rarer condition of eosinophilic esophagitis and its complications are challenging to diagnose and thus, the careful collection of medical history as well as eating habits and their evaluation in combination with clinical manifestations and examination are anticipated to avoid misdiagnosis considerably.

Evolutionary and Prognostic Aspects of Thrombolysed Patients for Acute Coronary Syndrome ST+ at CHU Ernesto Guevara De La Serna. Las Tunas (Cuba)

Introduction: Acute myocardial infarction (IDM) occupies the first place in terms of mortality, among ischemic pathologies. Thrombolysis in the case of medical treatment for acute myocardial infarction (AMI) is undoubtedly the most revolutionary performed to date in this context, with a significant reduction in the mortality rate. The aim of our study was to describe the epidemiological aspects, the criteria for myocardial reperfusion post thrombolysis, the complications during thrombolysis and the complications of acute myocardial infarction in the cardiology department of the CHU Ernesto Guevara De La Serna of Las Tunas (Cuba). Methods: A retrospective cross-sectional descriptive study was carried out from June 2009 to December 2011. The patients hospitalized during this period in the USIC (coronary intensive care unit) for SCA ST(+) were included in the study. The variables studied were: Age, sex, myocardial reperfusion criteria, complications during thrombolysis and complications of myocardial infarction. Results: A total of 207 patients were included. The male sex represented 72.5% of the cases, giving a sex ratio of 2.63. The age group > 60 years was predominant with 54.2% of the cases. Thrombolysed patients represented 65.2% of the cases. Myocardial reperfusion criteria were observed in the majority of thrombolysed patients: relief of precordial pain (77%), regression of the ST segment to 50% of its previous level (81.5% of patients). Bleeding was observed in 1.5% of thrombolysed cases. Complications were encountered in 57% of non thrombolysed patients with a lethality of 5.6%. Conclusion: The male sex was the most affected. Thrombolysis was effective in the majority of patients. The post thrombolysis bleeding rate was low. More than half of the cases of SCA ST(+) not thrombolysed presented complications.

P804 Heart complication of chikungunya fever: ecocardiographic evaluation of late effects

Abstract Introduction Chicungunya fever, epidemic caused by Alphavirus (CHIKV) transmitted by mosquitoes of the genus Aedes, is characterized by highly debilitating joint pain and can cause atypical cardiac complications in 10% of patients. CHIKV produces direct damage to myofibrils (inflammation and infiltration) and secondary damage due to hypersensitivity and necrosis. Objective To evaluate, by echocardiography, the chronic cardiac alterations of the CHIKV infection. Methods Thirty-two patients were studied (mean age was 56 ± 14 years, 17 females) with CHIKV-confirmed infection and signs of cardiac involvement between 5 and 25 months of evolution. The dimensions and function of the ventricles were measured by two-dimensional and Doppler echocardiography. The global longitudinal strain (GLS) of the left ventricle (LV) and left atrial longitudinal strain (LALS) were evaluated. Patients were divided into Group A, with duration of CHIKV infection shorter than 12 months (12 patients) and Group B, with disease duration equal to or greater than 12 months (20 patients). Comparative statistical data were considered significant when p &amp;lt;0.05. Results The diameters and volumes of LV, Left atrium (LA), right ventricular (RV) diameter and RV wall thickness were increased in Group B. LV ejection fraction (EF) was lower in Group B patients. The GLS was decreased in both Groups and the regression equation with EF were significant (r = 0.74, r ² = 0.55, p &amp;lt;0.00001). LALS was decreased in Group B. Diastolic dysfunction was predominantly grade 1 in Group A and restrictive in Group B. Segmental alteration (akinesia, dyskinesia) occurred in 7 patients. No patient had a history of precordial pain or coronary disease, nor clear signs of myocardial infarction on the ECG. Seven patients were hypertensive and four were diabetic. Eccentric LV hypertrophy and concentric remodeling of the walls were observed in 14 patients. Two patients had atrial fibrillation. Nine patients presented other types of arrhythmia, mainly ventricular extrasystoles. Conclusion Decreased EF of LV and SLG was observed in most patients with chronic CHIKV infection. In the first 12 months of evolution, the dimensions of the LV were normal, but after one year, most of the patients had dilatation of the cavity. LV concentric remodeling was more frequent in the first year and eccentric hypertrophy after one year of evolution. Segmental changes were observed in almost a quarter of the cases, as well as a high incidence of arrhythmias. All these findings suggest the progressive nature of the disease. Echocardiography plays an important role in the detection of cardiovascular alterations caused by Chicungunya fever and should be used after confirmation of infection, to initiate appropriate treatment already in the acute phase, which will probably minimize the deleterious effects of disease.

Left Ventricular Longitudinal Global Strain to Predict Severe Coronary Disease in Patients with Precordial Pain Suggestive of Non-ST-Segment Elevation Acute Coronary Syndrome.

Background:Diagnosing non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not always straightforward. Left ventricular global longitudinal strain (LVGLS) is an echocardiographic method capable of detecting subclinical regional and global ventricular contractile dysfunction due to myocardial ischemia. The objectives of this study were to evaluate the efficacy of LVGLS in diagnosing severe coronary disease in patients with chest pain suggestive of NSTE-ACS and to assess the relationships between LVGLS reduction and ultrasensitive troponin T (UsTnT) elevation, electrocardiographic changes suggestive of ischemia, and the number of vessels with severe obstructions.Methods:This prospective, observational study evaluated hospitalized patients with chest pain of presumed coronary etiology. All patients underwent electrocardiography (ECG), UsTnT measurement, Doppler echocardiography, LVGLS measurement, and coronary angiography Coronary angiogram (CA) within 48 h of hospitalization.Results:A total of 75 patients with a mean age of 58 ± 17 years were included, of whom 84% (63 patients) were men. An LVGLS value of <-16.5, as determined by the Youden index proved to be useful for the detection of severe coronary obstructions (lesions >70%). The sensitivity, specificity, and positive and negative predictive values were 96%, 88%, 92%, and 92%, respectively. The number of coronary arteries involved had a direct relationship with the degree of LVGLS reduction (P < 0.001). Elevated UsTnT levels occurred more frequently in patients with reduced LVGLS than in those with normal LVGLS (83% vs. 17%, P < 0.0001). Abnormal strain was not associated with electrocardiographic changes suggestive of ischemia.Conclusions:LVGLS measurement in patients with presumed NSTE-ACS is efficient in predicting the presence of severe coronary disease. The number of coronary arteries involved has a direct relationship with the degree of LVGLS reduction. Abnormal strain is associated with UsTnT elevations but not with electrocardiographic changes suggestive of ischemia.

Qual o Diagnóstico?

Paciente do sexo feminino, 82 anos, branca, com história de fibrilação atrial paroxística (FA) há vários anos, com crises de palpitação com duração variável entre poucos minutos e várias horas, sem controle clínico, com uso de betabloqueadores e diltiazem. Apresentava queixas de cansaço aos esforços moderados, sem dor precordial ou síncope, com progressiva astenia e indisposição. Informou três internações prévias para cardioversão química de FA. Apresentava antecedente de hipertensão arterial sistêmica, hipotireoidismo e doença aterosclerótica do coração, tendo sido submetida a angioplastia coronariana em 2014 com colocação de stent não farmacológico, sem infarto prévio. Vinha em uso regular de irbesartana 300 mg, clopidogrel 75 mg e levotiroxina 75 mcg. Ao longo dos últimos oito meses, houve piora das crises de FA, passando a fazer uso de propafenona em doses crescentes, inicialmente 150 mg BID, sem melhora dos sintomas, passando para 300 mg BID e atualmente 750 mg/dia (300 – 150 – 300 mg, distribuídos de 8/8 horas), sem controle das palpitações e com sensação de mal-estar e fraqueza.

What is the Diagnosis?

A female 82-year-old Caucasian patient with a history of paroxysmal atrial fibrillation (AF) for several years, with palpitation crises of varying duration between a few minutes and several hours, without clinical control, using beta-blockers and diltiazem. The patient presented complaints of fatigue on moderate efforts, without precordial pain or syncope, with progressive asthenia and indisposition. She informed three previous hospitalizations for chemical cardioversion of AF.

The Tumoral Etiology of the Superior Cava Vein Syndrome Presenting as Exsudative Pericarditis in a Young Patient

Abstract We present the case of a 36-year-old patient admitted with dyspnea, subjective sensation of edema of the cervical region, and precordial pain with sudden onset. Pathological antecedents revealed a respiratory intercourse three weeks ago. Laboratory findings indicated an inflammatory syndrome accompanied by hypoproteinemia. We performed an echocardiographic examination which revealed important pericardial effusion and swinging heart aspect with diastolic collapse of the right atrium and ventricle. According to the existing guidelines pericardiocentesis was immediately required. The hemorrhagic pericardial effusion had an intense positive Rivalta reaction with frequent macrophages and malignant atypical cells. The next step was a full-body computer tomography scan, which revealed an expansive mediastinal mass, invading the upper cava vein and pericardium, with mediastinal adenopathy. A biopsy was performed and the pathology examination concluded there was a classical Hodgkin’s lymphoma nodular sclerosis type. Finally the patient was directed to oncology department.