Eduardo Cavalcanti Lapa Santos

Paradoxical Embolism in a Patient with Aortic Valve Endocarditis: A Case Report

This report describes a case of aortic valve endocarditis with systemic and paradoxical pulmonary embolism in a patient with congenital interventricular communication. The patient underwent cardiac surgery and did not have a favorable outcome, presenting refractory cardiogenic shock and subsequently dying while in the hospital. This is an extremely rare case of paradoxical embolism in a patient with infective endocarditis; only four similar cases have been reported in the literature.

Myocardial Infarction in a Young Cocaine User with Atrial Myxoma: What is the Central Cause?

The differential diagnosis of myocardial infarction in patients with a number of potential causes can be challenging, especially when there is no angiographic evidence of coronary obstruction. We describe a case of extensive anterior ST-elevation myocardial infarction in a young male smoker who had a left atrial myxoma and a history of cocaine use 10 hours before the event. Clinical reasoning during a myocardial infarction investigation should be oriented by the probability of the causal relationship between the ischemic event and each factor present in the clinical context.

Controversial Fibrinolytic Therapy for Submassive Pulmonary Embolism Related to Right Heart Thrombus

A embolia pulmonar submaciça (EPS) representa um subgrupo de pacientes com embolia pulmonar (EP) hemodinamicamente estáveis, mas que apresentam sinais de disfunção ventricular direita (VD) ao ecocardiograma.1 O papel da terapia trombolítica para EPS é controverso.1 Descrevemos um caso de EPS relacionada a trombo na câmara cardíaca direita (CCD) complicado com parada cardiorrespiratória (PCR) e óbito após a terapia fibrinolítica.

Acute Myocarditis Caused by Chikungunya Virus Assessed by Cardiac Magnetic Resonance Imaging

A 80-year-old female patient with a history of systemic arterial hypertension, heart failure (HF) with preserved left ventricular ejection fraction (EF), mild aortic stenosis, and paroxysmal atrial fibrillation (AF) presented dyspnea and palpitations approximately 4 months after an acute febrile syndrome caused by the Chikungunya virus. On physical examination: blood pressure of 132x80 mmHg, heart rate of 86 bpm, systolic murmur in the aortic area with carotid radiation, absence of pulmonary rales, minimal jugular vein distension at a 30-degree angle, no edema and weighing 83.3 kg. Electrocardiogram (ECG) demonstrated regular sinus rhythm and right bundle branch block (already present in a previous ECG). On cardiovascular complaints (4 months after the acute event), an echocardiogram was requested, which did not show any change compared to the previous year’s examination. Due to the possibility of myocarditis caused by the Chikungunya virus, gadolinium cardiac magnetic resonance imaging (CMR) was performed, which showed normal cardiac chambers, preserved biventricular systolic function (right ventricular EF = 59%; left ventricular EF = 68%), absence of myocardial edema, absence of pericardial effusion and changes in pericardial thickness, presence of mesoepicardial fibrosis in the lower segment of the medial region of the left ventricle, compatible with previous inflammatory cardiomyopathy (Figure 1). The patient was treated with oral diuretics and beta-blockers, with progressive improvement of symptoms. Discussion

Peñaloza-Tranchesi sign secondary to ascending aortic aneurysm and not due to right atrium enlargement

Low QRS amplitude in V1, with relative three-to-fourfold or greater increase in V2, is considered an indirect sign of right atrium enlargement (Peñaloza-Tranchesi sign). We describe a patient with Peñaloza-Tranchesi sign caused by an ascending aortic aneurysm, with normalization of the QRS complex amplitude in V1 after aortic replacement.

LV Pseudoaneurysm after Acute Myocardial Infarction

LV Pseudoaneurysm after Acute Myocardial Infarction Eduardo Cavalcanti Lapa Santos,1,3 Aluísio Roberto Andrade Macedo Júnior,1,3 André Gustavo Santos Lima,1 Paloma Peter Travassos,3 Leonardo Godoy de Mello Motta,1,2 Fernando Augusto Marinho dos Santos Figueira1,2 Hospital Dom Hélder Câmara,1 Santo Agostinho, PE; Instituto de Medicina Integral Professor Fernando Figueira,2 Recife, PE; Hospital das Clínicas da Universidade Federal de Pernambuco,3 Recife, PE – Brazil

Recurrent Constrictive Pericarditis after Pericardiectomy: Case Report

Constrictive pericarditis (CP) consists of a chronic inflammation leading to dense fibrosis and adhesion of the pericardial layers, resulting in rigid unmalleable pericardium, with consequent restriction of the diastolic ventricular filling .1,2 Possible etiologies for CP are tuberculosis, collagenoses, neoplasias, and heart surgery, which can have different presentation according to location, extension and thickening degree.3 Tuberculosis is the most common cause of pericardial disease in the world, especially in underdeveloped countries, where it is endemic and it is frequently associated with immunodeficiency.2,4 In this report, we describe a case of recurrent CP that occurred several years after incomplete pericardiectomy.

Atypical Presentation of Ventricular Septal Defect Following Myocardial Infarction

Atypical Presentation of Ventricular Septal Defect Following Myocardial Infarction Eduardo Cavalcanti Lapa Santos,1,2 Sandro Gonçalves Lima,1,2 Brivaldo Markman Filho,1,2 Andréa Bezerra de Melo da Silveira Lordsleem,1,2 George Augusto da Fonseca Carvalho Antunes Lima,1,2 Priscila Costa dos Santos Moreira1 Hospital das Clínicas UFPE (HC-UFPE);1 Universidade Federal de Pernambuco (UFPE),2 Recife, Pernambuco – Brazil