RESUMO
BACKGROUND: Brugada syndrome (BrS) includes a group of patients with a typical pattern of ST segment elevation in right precordial leads who are at risk for sudden cardiac death. The electrocardiogram pattern may be intermittent and unmasked by sodium channel blockers. The main objective of this study is to describe a serie of consecutive patients in whom oral administration of flecainide was used to unmask BrS type I electrocardiographic pattern. METHODS: We prospectively studied 14 symptomatic (palpitations/syncope) patients referred to our laboratory presenting a suggestive but not diagnostic Brugada ECG or family history of sudden death. Single oral dose of flecainide 400 mg was administered. Resting 12-lead ECG with upper and standard right precordial leads were performed after flecainide administration at 15, 30, 60 and 90 min and hourly until ECG became normal. RESULTS: Median age was 37.5 years (range = 22-50). None of them had structural heart disease. In 7 patients (50%) the typical coved-type ECG pattern of BrS was unmasked. PR interval, QRS duration and QTc median difference after-before test was 20 msec (min-max = -17-+57), 21 ms (min-max = 0 to +59) and 20 ms (min-max = -11-+77), respectively. There were no episodes of AV block, atrial or ventricular tachyarrhythmia. CONCLUSIONS: In our experience we found that oral administration of flecainide in a single dose of 400 mg is useful to unmask type 1 Brugada electrocardiographic pattern.
Assuntos
Síndrome de Brugada/diagnóstico , Eletrocardiografia , Flecainida , Bloqueadores dos Canais de Sódio , Administração Oral , Adulto , Síndrome de Brugada/fisiopatologia , Feminino , Flecainida/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Bloqueadores dos Canais de Sódio/administração & dosagemRESUMO
Amniotic fluid embolism still remains an important cause of maternal mortality. We present information obtained by echocardiography and right cardiac catheterization of two patients who developed amniotic fluid embolism and died from shock and disseminated intravascular coagulation despite intensive medical treatment. Although the pathophysiology remains controversial, amniotic fluid embolism can be presumptively diagnosed and managed with hemodynamic values and echocardiography.
Assuntos
Coagulação Intravascular Disseminada/diagnóstico , Embolia Amniótica/diagnóstico , Choque Hemorrágico/diagnóstico , Adulto , Diagnóstico Diferencial , Coagulação Intravascular Disseminada/fisiopatologia , Embolia Amniótica/fisiopatologia , Evolução Fatal , Feminino , Humanos , Gravidez , Embolia Pulmonar/diagnóstico por imagem , Choque Hemorrágico/etiologia , Choque Hemorrágico/fisiopatologia , UltrassonografiaRESUMO
La embolia de líquido amniótico continúa siendo una causa importante de mortalidad materna. Presentamos la información obtenida por medio de la cateterización cardíaca derecha y la ecocardiografía, en dos pacientes que desarrollaron embolia de líquido amniótico y fallecieron por shock y coagulación intravascular diseminada a pesar del tratamiento intensivo. Aunque la fisiopatología continúa siendo discutida, la embolia por líquido amniótico se puede diagnosticar y manejar a partir de los valores hemodinámicos y el ecocardiograma.
Amniotic fluid embolism still remains an important cause of maternal mortality. We present information obtained by echocardiography and right cardiac catheterization of two patients who developed amniotic fluid embolism and died from shock and disseminated intravascular coagulation despite intensive medical treatment. Although the pathophysiology remains controversial, amniotic fluid embolism can be presumptively diagnosed and managed with hemodynamic values and echocardiography.