RESUMO
A síndrome de Wellens foi descrita em 1982 por Zwaan, Bär e Wellens. No eletrocardiograma, observam-se alterações morfológicas da onda T nas derivações precordiais, sugerindo estenose proximal grave da artéria coronária descendente anterior que representa iminente risco de infarto agudo do miocárdio e/ou morte súbita, com discreta ou nenhuma alteração da troponina sérica. Seu reconhecimento antecipado e a abordagem com reperfusão miocárdica precoce evitam desfechos desfavoráveis. A intervenção coronária percutânea e a revascularização miocárdica cirúrgica são as estratégias mais utilizadas para tratamento. Os autores descrevem dois casos de síndrome de Wellens tipos A e B tratados por diferentes estratégias de reperfusão.
Wellens syndrome was described by Zwaan, Bär and Wellens, in 1982. On the electrocardiogram, T wave morphological alterations are observed in precordial leads, suggesting severe proximal stenosis of the left anterior descending coronary artery and an imminent risk of acute myocardial infarction and/or sudden death, with slight or no alteration in serum troponin. Its early recognition and management with early myocardial reperfusion avoid unfavorable outcomes. Percutaneous coronary intervention and surgical myocardial revascularization are the most used strategies for treatment. The authors describe two cases of types A and B Wellens syndrome treated with different reperfusion strategies.
RESUMO
background: Early management of myocardial infarction in the area of public health requires the integration of specific programs for the coordination of healthcare services. Objective: The aim of this study was to evaluate the impact on delay times and reperfusion rate of a comprehensive program for the reperfusion of myocardial infarction in a hospital network of the Southern Greater Buenos Aires. Methods: The network consists of six low-mid-complexity hospitals and a third-level referral center with 24-hour cath-lab. Stage 1 of the program (2009-2010) evaluated the existing barriers to reperfusion; Stage 2 (2011-2013) implemented the progressive incorpora-tion of improvements and Stage 3 assessed the program (2013-2014) complemented with fellows in each hospital. Program impact was evaluated by the proportion of patients reperfused and time to its implementation. results: A total of 432 patients referred from the network were hospitalized with diagnosis of ST-segment elevation myocardial infarction. Mean age was 56±9 years and 83.3% were men. The proportion of reperfused patients progressively increased: S1 60.7%, S2 69% and S3 78%, p for trend=0.01. Time to reperfusion decreased significantly between S1 and S3, from 120 minutes (IQR 55-240) to 90 minutes (IQR 35-150), p=0.04, with a median reduction of 30 minutes in the door-to-balloon and door-to-needle times. Conclusions: The application of a program for myocardial reperfusion based on the diagnosis of barriers was associated with 28.5% increase in reperfusion, and a significant reduction in the implementation times. This public network model built on algorithms adapted to local barriers may contribute to improve the care of myocardial infarction in our country.
RESUMO
A Síndrome de Turner (ST) é uma doença genéticacaracterizada pela monossomia completa ou parcial docromossomo X e possui uma grande variabilidade fenotípica,podendo se manifestar na forma clássica oucom poucos sinais dismórficos que possam chamaratenção ao diagnóstico. Mulheres com Síndrome deTurner têm um risco cardiovascular duas vezes maiorque a população geral e apresentam maior prevalênciade hipertensão arterial sistêmica, dislipidemia, aumentoda resistência insulínica e deficiência estrogênica,além de doenças cardíacas congênitas, principalmenteacometendo grandes vasos, podendo estar presenteem até 50% das mulheres com ST. Devido a essas complicaçõescardiovasculares, o reconhecimento de possíveismanifestações cardíacas agudas em pacientescom anomalias genéticas torna-se imprescindível parao sucesso terapêutico. O objetivo do presente artigo édescrever um caso de infarto agudo do miocárdio emuma paciente jovem com Síndrome de Turner.
Turner?s syndrome is a genetic disease related eitherto a homogeneous complete or a partial XO monosomyand has a fenotipic variability, presenting suchin a classic syndrome or with few dysmorfic signs thatcan draw attention to diagnosis. Womem with Turner?ssyndrome have a cardiovascular risk twice higher thangeneral population and presents more prevalence inhypertension, dyslipidemia, insulin resistence and estrogendeficiency, besides cardiac congenital cardiacdiseases, mainly affecting big vassels, in approximately50% of these patients. Due to these cardiovascularcomplications, recognition of possible acute cardiacmanifestations in patients with genetic abnormalities isnecessary to therapeutic success. The goal of this articleis to present a case report of a young woman with AMIand Turner syndrome.