Alberto Ferreira

Enfarte agudo do miocárdio após a toma de zolmitriptano

Zolmitriptan is a drug used in the acute treatment of migraine, which should not be used in high cardiovascular risk individuals because of its potential to induce vasospasm. We report a rare case of myocardial infarction precipitated by taking zolmitriptan.

Severe aneurysmal coronary artery disease in a patient with ulcerative colitis

Formation of coronary artery aneurysms in the setting of systemic inflammatory conditions is rare but has been described. We report a case of severe aneurysmal coronary artery disease leading to an acute coronary event in a patient with ulcerative colitis. A 67-year-old Caucasian man with a medical history of ulcerative colitis and hypertension presented with chest pain and diaphoresis ongoing for 12 hours. His physical examination was unremarkable; electrocardiography revealed inverted T waves in leads I, aVL and V4--V6, and troponin I

Left atrial volume index: Can it provide additional prognostic information in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention?

INTRODUCTION We sought to assess the prognostic impact of left atrial (LA) size on long-term outcomes of ST-segment elevation myocardial infarction (STEMI). METHODS We studied 200 consecutive patients admitted to a single center between January 2010 and December 2014 with non-fatal STEMI treated with primary percutaneous coronary intervention (pPCI) who underwent a comprehensive echocardiographic examination at discharge. LA volume was estimated by the area-length method. The left atrium was classified as normal, mildly, moderately or severely enlarged by LA volume index (LAVI). The endpoints were defined as all-cause mortality, a cardiac composite endpoint (all-cause mortality, reinfarction, unplanned revascularization and hospitalization for heart failure) and a cardiovascular composite endpoint (cardiac endpoint plus atrial fibrillation and ischemic stroke) during follow-up. RESULTS In this STEMI population, 58% had normal LA size, 22.5% had mild LA enlargement, 10% had moderate LA enlargement and 9.5% had severe LA enlargement. During a median follow-up of 28 (IQR 21-38) months, 14 (7.0%) patients died, 53 (26.5%) had the cardiac and 58 (29%) the cardiovascular composite endpoints. There was a stepwise increase in the incidence of all-cause mortality (p=0.020) and both cardiac (p<0.001) and cardiovascular (p<0.001) endpoints with each increment of LAVI class. In multivariate analysis, severe LA enlargement by LAVI was an independent predictor of all-cause mortality (HR: 11.153; 95% CI: 1.924-64.642, p=0.007) and the cardiac (HR: 4.351; 95% CI: 1.919-9.862, p<0.001) and cardiovascular (HR: 4.351; 95% CI: 1.919-9.862, p<0.001) endpoints during follow-up. CONCLUSIONS This contemporary study confirms the prognostic effect of LA size at discharge, applying the most recent reference values in STEMI patients treated with pPCI.

Short-term prognostic effect of prior cerebrovascular and peripheral artery disease in patients with acute coronary syndrome: Can we do better?:

Background: We sought to evaluate the impact of prior cerebrovascular and/or peripheral arterial disease (PAD) on in-hospital outcomes in patients with acute coronary syndromes. Methods: From 1 October 2010 to 26 February 2016, 13,904 acute coronary syndrome patients were enrolled in a national multicentre registry. They were divided into four groups: prior stroke/transient ischaemic attack (stroke/TIA); prior PAD; prior stroke/TIA and PAD; none. The endpoints included in-hospital mortality and a composite endpoint of death, re-infarction and stroke during hospitalization. Results: 6.3% patients had prior stroke/TIA, 4.2% prior PAD and 1.4% prior stroke/TIA and PAD. Prior stroke/TIA and/or PAD patients were less likely to receive evidence-based medical therapies (dual antiplatelet therapy: stroke/TIA= 88.6%, PAD= 86.6%, stroke/TIA+PAD= 85.7%, none= 92.2%, p<0.001; β-blockers: stroke/TIA= 77.1%, PAD= 72.1%, stroke/TIA+PAD= 71.9%, none= 80.8%, p<0.001; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: stroke/TIA= 86.3%, PAD= 83.6%, stroke/TIA+PAD= 83.2%, none= 87.1%, p=0.030) and to undergo percutaneous revascularization (stroke/TIA= 52.8%, PAD= 45.6%, stroke/TIA+PAD= 43.7%, none= 67.9%, p<0.001), despite more extensive coronary artery disease (three-vessel disease: stroke/TIA= 29.1%, PAD= 38.3%, stroke/TIA+PAD= 38.3%, none= 20.2%, p<0.001). In a multivariable analysis, prior stroke/TIA+PAD was a predictor of in-hospital mortality (odds ratio= 2.828, 95% confidence interval 1.001–7.990) and prior stroke/TIA (odds ratio= 1.529, 95% confidence interval 1.056–2.211), prior PAD (odds ratio= 1.618, 95% confidence interval 1.034–2.533) and both conditions (odds ratio= 3.736, 95% confidence interval 2.002–6.974) were associated with the composite endpoint. Conclusion: A prior history of stroke/TIA and/or PAD was associated with lower use of medical therapy and coronary revascularization and with worst short-term prognosis. An individualized management may improve their poor prognosis.

Takayasu Arteritis: From Diagnosis to a Life-Threatening Complication

DOI: 10.5935/abc.20180195 A fifty-two-year-old Caucasian woman was admitted for severe epigastric pain irradiating to the back. Physical examination and electrocardiogram were normal. Laboratory tests showed leucocytosis (11100 cells/uL) and increased levels of C-reactive protein (15.6 mg/dl). Due to the suspicion of acute aortic syndrome (AAS), she underwent computed tomography (CT), which showed a low attenuation circumferential mural thickening of the aorta (43 Hounsfield units (HU)), which enhanced (73 HU) after contrast administration (Figures 1 A-C), suggestive of aortitis.1 Transesophageal echocardiogram also revealed thickened thoracic aorta (Figure 1 D). Cardiovascular magnetic resonance imaging confirmed the diagnosis of aortitis and excluded intramural hematoma (mural thickening hypointense on T1-weighted images and hyperintense on T2-weighted images)1,2 (Figures E-F). Infectious serologies were negative.

A rare cause of aortic regurgitation and complete atrioventricular block

A 47-year-old Caucasian male presented with exertional dyspnoea and thoracic pain within the last month. At physical examination, he had bradycardia (heart rate of 45 beats per minute), fever, and a diastolic murmur. Electrocardiogram demonstrated complete atrioventricular block ( A ). Transthoracic and transoesophageal echocardiogram revealed severe aortic regurgitation due to dilatation and thickening of the …

0504: Isolated elevation of cardiac troponin is associated with better prognosis of non-ST segment elevation myocardial infarction

Purpose We sought to evaluate the effect of isolated elevation of cTn on short-term outcomes of NSTE-MI Methods From Oct 2010 to Oct 2013, 3799 patients with NSTE-MI were enrolled on a national multicenter registry. These patients were divided in 2 groups: BM+: elevation of cTn and other biomarkers of myocardial injury (n=2445); BM-: elevation of cTn without rise in the other biomarkers (n=948).The endpoints included in-hospital all-cause mortality and a composite endpoint of death, re-infarction, heart failure (Killip class >2) and resuscitated cardiac arrest during hospitalization. Logistic regression modelling was used to compute adjusted odds ratio of death and of the composite endpoint. Results The BM- patients were younger (66±12 vs. 68±13, p 1, p Conclusion In this observational nationwide study, patients with isolated cTn elevation showed a better short-term prognosis than those with elevation of all biomarkers of myocardial injury. The higher sensitivity of cTn might be associated with less myocardial damage and therefore fewer complications.

Estenose tricúspide induzida por eletrocateter de pacemaker , relato de 2 casos clínicos

Tricuspid stenosis (TS) is an uncommon complication of transvenous ventricular pacemaker implantation, with few cases reported in the literature. The mechanisms described are obstruction of right ventricular inflow by tricuspid vegetations (endocarditis), multiple pacemaker leads and tricuspid valve (TV) fibrosis secondary to perforation or laceration of the TV leaflets, or adherence between redundant portions of the lead and valvular and subvalvular tissue. We report two cases of severe TS, with different etiologies and management: one caused by leaflet perforation, resolved surgically, and the other secondary to fusion between a loop of the pacemaker lead and the subvalvular apparatus, which was treated medically.

Enfarte agudo do miocárdio duplo sequencial

Acute myocardial infarction (AMI) involving acute transmural ischemia of two vascular territories at the same time, which is known as double or combined infarction, is a well described phenomenon but rarely reported in most series of patients admitted for AMI. This may be related to the fact that AMI with multiple vessel obstruction often causes extensive myocardial injury and death before the patient arrives at the hospital. It is speculated that double infarction results from the overall prothrombotic and inflammatory conditions associated with AMI.

Cardiomiopatia de estresse e doença coronária: a coexistência das duas entidades clínicas pode ser possível

ABSTRACT Stress Cardiomyopathy and Coronary Disease:Possible Coexistance of Two Clinical Entities Stress-induced cardiomyopathy mimics acute myocardial in-farction. Significant coronary artery disease is generallyconsidered an exclusion criterion for the diagnosis of stress-induced cardiomyopathy. However, this may not be thecase for all patients, since both entities may coexist. Wepresent a case of stress-induced cardiomyopathy in a patientwith known coronary artery disease. KEY-WORDS: Cardiomyopathies. Stress, psychological. Ta-kotsubo cardiomyopathy. Ventricular dysfunction, left. clerose, incluindo hipertensao arterial de longa data,diabetes melito tipo 2 ha 10 anos, em uso de antidia-beticos orais, dislipidemia e obesidade grau 2, comindice de massa corporal (IMC) de 38 kg/m². Apresen-tava antecedentes de cardiopatia isquemica com inter-nacao em agosto de 2010 por angina instavel, cujainvestigacao revelou doenca coronaria significativa nostres vasos e funcao ventricular esquerda conservada(Figura 1). A cirurgia de revascularizacao do miocardiofoi proposta e aceita, e a paciente ficou aguardando,em seu domicilio, ser chamada para a cirurgia, perma-necendo com angina de esforco classe II da CanadianCardiovascular Society (CCS).No final de fevereiro de 2011, durante a noite, eapos estresse emocional intenso (assistiu a detencaopolicial de um de seus filhos, em sua propria casa),iniciou episodio de dor toracica anginosa intensa emrepouso, parcialmente aliviada com nitratos sublinguais.Em decorrencia da persistencia da dor, recorreu aoservico de urgencia, sendo admitida ainda sintomati-ca. O eletrocardiograma evidenciou ondas Q emDIII e aVF, infradesnivelamento do segmento ST, e in-versao da onda T de V2-V6 e em D1 e aVL (Figura 2).O estudo analitico inicial revelou elevacao dos mar-cadores de necrose do miocardio, sendo a paciente