RESUMO
A complete ECG thoracic circle allows exploring some heart structures not explored by the conventional electrocardiogram. It provides a direct indication on the location of the damaged myocardium. In fact, posterolateral infarctions can be limited to the inferior third of the left ventricle or can cover the entire free left ventricular wall from the base up to the heart apex and can be univentricular or biventricular. On the other side, the unipolar thoracic leads and the high abdominal leads MD, ME, MI show the evolution of the signs of injury, characteristic of the acute stage of infarction, toward necrosis. We present the example of a 61-year-old man, whose ECG shows signs of subepicardial or transmural injury and of necrosis in the low precordial leads V5 and V6, as well as in the high left posterior leads V8 and V9. This fact suggests the presence of an acute extensive myocardial infarction extending from the base to the heart apex. Moreover, the moderate elevation of the RS-T segment from to V9R to V7R indicates the presence of subepicardial injury in the high posterior regions of the right ventricular wall. These electrocardiographic data were confirmed by the radioactive isotope study and, definitively, by the anatomical findings.
Assuntos
Eletrocardiografia , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A complete ECG thoracic circle allows exploring some heart structures not explored by the conventional electrocardiogram. It provides a direct indication on the location of the damaged myocardium. In fact, posterolateral infarctions can be limited to the inferior third of the left ventricle or can cover the entire free left ventricular wall from the base up to the heart apex and can be univentricular or biventricular. On the other side, the unipolar thoracic leads and the high abdominal leads MD, ME, MI show the evolution of the signs of injury, characteristic of the acute stage of infarction, toward necrosis. We present the example of a 61-year-old man, whose ECG shows signs of subepicardial or transmural injury and of necrosis in the low precordial leads V5 and V6, as well as in the high left posterior leads V8 and V9. This fact suggests the presence of an acute extensive myocardial infarction extending from the base to the heart apex. Moreover, the moderate elevation of the RS-T segment from to V9R to V7R indicates the presence of subepicardial injury in the high posterior regions of the right ventricular wall. These electrocardiographic data were confirmed by the radioactive isotope study and, definitively, by the anatomical findings.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Eletrocardiografia , Infarto do Miocárdio/patologia , Infarto do MiocárdioRESUMO
The increasing demographic and life expectancy rates, together with the vertiginous technological development during the last two decades, have raised the number of cardiac patients requiring surgical treatment. Therefore, several institutions have been forced to give priority to advanced or more serious cases and to postpone those that do not demand an urgent surgery. This analysis was made from June 15, 1999 to June 15, 2000 and demonstrates the results obtained from maintaining a fast track at the National Institute of Cardiology "Ignacio Chávez". This has favored the practice of surgeries in cases with noncomplex pathologies, null mortality, and low morbidity rates. The analysis also compares results from patients who had been subjected to surgery for the same type of pathologies but following the usual course of admittance and surgery scheduling, proving to be cost-efficient. It also demonstrates the high incidence of inter-auricular communication and the Von Willebrand disease that exist in our environment. Based on the results, we propose to maintain and increase this type of surgeries, addressing their limitations.
Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de TempoRESUMO
The course of ischemic heart disease has undergone significant changes since the beginning of coronary care units (CCU), antithrombotic protection, coronary artery by pass grafting (CABG), and percutaneous transluminal angioplasty (PTCA). Intrahospital mortality before CCU was 35% and at the present is lower than 10%. The quality of life for those who have suffered an acute ischemic event has changed favorably. On the other hand, this has allowed that a large number of patients with coronary disease reach advanced stages of the disease after having been treated with surgery, angioplasties, etc., besides medical treatments, and due to the advanced coronary obstructions it is not feasible any more to offer them any of the conventional procedures. These patients are considered "end stage" patients. To treat these conditions, cooperation of the patient is indispensable, he/she must adapt his/her life style realistically and abandon completely any potential risk factors. Therapy should be adapted with maximal tolerated doses and scheduled according to the possibility of the presentation of angina. Laser transmyocardial revascularization is an option; this procedure is still under study and the first reports have shown that although there is clinical improvement, but it has failed to demonstrate a decrease in ischemic segments.
Assuntos
Isquemia Miocárdica/terapia , Humanos , Isquemia Miocárdica/mortalidade , Índice de Gravidade de DoençaRESUMO
We inform about the utility of Color-Doppler to identify dissection in aortic aneurysm. We studied five patients, fourth with dissection and one without dissection. All of them were in the fourth decade of life, except the patient without dissection, who developed symptoms at the age of 62. Two-dimensional echocardiography displayed the alterations of the aorta, such as dilatation of the walls, the presence or absence of dissection and in the cases with dissection the extension of it (three patients had DeBakey Type I, one DeBakey Type III an other DeBakey Type II). In all patients with dissection the Doppler study determined the presence or absence of flow through the false channel, in particular in the second and fifth patient and with Color-Doppler we observed that the flow was bidirectional. Also the degree of aortic incompetence could be quantified. It is concluded that with two-dimentional echocardiography it is possible to identify the anatomical features of aortic aneurysm and that Doppler study gives additional hemodynamic information which has importance in therapy and prognosis.
Assuntos
Aneurisma Aórtico/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Adulto , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Following a brief historical introduction, we review the currently accepted clinical, etiological and hemodynamic classifications of the cardiomyopathies. The typical clinical and hemodynamic pattern of each variety, as well as a description of the echocardiographic data which raises the suspicion or supports the diagnosis of the particular cardiomyopathy are discussed. We attempt to demonstrate the usefulness of echocardiography as a non-invasive procedure in the doubtful cases of cardiomyopathy, without exposing the patient to the risks of the invasive procedures. The echocardiographic data of hypertrophic abnormalities of the intraventricular septum, mitral valve, aortic valve, free wall of the left ventricle and cardiac function are presented. The association of valvular heart disease an cardiomyopathy is considered. The differential diagnosis of valvular heart disease which present with echocardiographic abnormalities similar to those of the cardiomyopathies is discussed. We have reviewed the most important literature and have illustrated some of our cases. The future of the procedure in the early diagnosis during the asymptomatic period of the disease in the evaluation of the natural evolution of the illness and the patient's response to therapy is presented.