Fernando Pivatto Júnior

Aneurysm and dissection in a patient with syphilitic aortitis

In the antibiotic era, aortic aneurysm is a rare complication of syphilis, what makes the diagnostic assumption even more difficult. Nonetheless, this condition should be suspected in patients with aortic aneurysm. Reports of aortic dissection complicating syphilitic aortitis have been distinctly rare in the literature, and their cause-effect relationship has not been definitely established. In this case report, we present a 62-year-old woman with aortic aneurysm and dissection associated with an unexpected diagnosis of syphilitic aortitis.

Vena cava filter migration after magnetic resonance imaging

Advances in magnetic resonance imaging (MRI) over the past two decades have led to it becoming an increasingly attractive imaging modality. With the growing number of patients treated with permanent implanted or temporary cardiovascular devices, it is becoming ever more important to clarify safety issues with regard to MRI examinations in patients with these devices. A 57-year-old woman was admitted to the emergency department with a one-month history of progressive anasarca. Her medical history included subarachnoid hemorrhage and a deep vein thrombosis in the same hospitalization period, treated with inferior vena cava (IVC) filter placement (ELLA ® , Hradec Králové, Czech Republic). The initial echocardiographic assessment showed hyperechoic linear images in the right chambers (Figure 1A) and severe tricuspid regurgitation (Figure 1B).

Use of HAS-BLED Score in an Anticoagulation Outpatient Clinic of a Tertiary Hospital

Mailing Address: Fernando Pivatto Júnior Rua Ramiro Barcelos, 2.350, sala 700, Postal code 90.035-903. Porto Alegre, RS – Brazil. E-mail: fpivatto@gmail.com Use of HAS-BLED Score in an Anticoagulation Outpatient Clinic of a Tertiary Hospital Rafael Coimbra Ferreira Beltrame, Franciele Taís Bandeira Giasson, André Luís Ferreira Azeredo da Silva, Bruna Sessim Gomes, Luís Carlos Amon, Marina Bergamini Blaya, Rafael Selbach Scheffel, Fernando Pivatto Júnior Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS – BrazilFundamento: O escore HAS-BLED foi desenvolvido para avaliar o risco em um ano de sangramento maior em pacientes com fibrilacao atrial (FA) anticoagulados com antagonistas da vitamina K (AVK). Objetivo: O objetivo deste estudo foi avaliar a capacidade do escore HAS-BLED e de seus componentes em predizer sangramento maior em pacientes atendidos em um ambulatorio de anticoagulacao de um hospital terciario. Metodos: Foi realizado um estudo coorte retrospectivo com pacientes com FA tratados com AVK. Analise de regressao logistica foi realizada para avaliar a capacidade de cada componente do escore em predizer sangramento maior. O nivel de significância adotado em todos os testes foi de 5%. Resultados: Foram estudados 263 pacientes com media de idade de 71,1 ± 10,5 anos ao longo de um periodo de tratamento de 237,6 pacientes-ano. A mediana do escore HAS-BLED foi de 2 (1-3). A incidencia de sangramento maior foi de 5,7%, sendo mais elevada nos pacientes de alto risco que nos pacientes de baixo risco (9,6 vs. 3,1%; p = 0,052). A area sob a curva ROC foi de 0,70 (p = 0,01). Um ponto de corte ≥ 3 mostrou sensibilidade de 66,7%, especificidade de 62,1%, valor preditivo positivo de 9,6% e valor preditivo negativo de 96,9%. Sobrevida livre de sangramento maior foi menor no grupo de alto risco (p = 0,017). Na analise multivariada, o unico preditor independente de sangramento maior entre os componentes do escore foi o uso concomitante de antiplaquetarios (OR 5,13, IC95%: 1,55-17,0; p = 0,007). Conclusao: O escore HAS-BLED foi capaz de prever sangramento maior na populacao de pacientes com FA estudada. Entre os componentes do escore, atencao especial deve ser dada para o uso concomitante de antiplaquetarios, que mostrou associacao independente. Em pacientes com FA em uso de AVK como terapia anticoagulante, o uso de antiplaquetarios deve ser realizado somente naqueles pacientes com avaliacao risco-beneficio favoravel.

Development of ventricular fibrillation after implantation of a biventricular implantable cardioverter defibrillator: what is the mechanism?

Syncopal spells in heart failure patient with cardiovascular implantable electronic devices (CIED) require multiple assessments. T‐wave oversensing is a well‐described phenomenon that remains significant in modern implantable cardioverter defibrillators (ICD) systems. It can lead to inappropriate therapies and loss of biventricular pacing in those with cardiac resynchronization devices. Strategies to overcome this problem are important.

The Role of Speckle Tracking in the Evaluation of Cardiac Amyloidosis

Male patient, 62 years old, was hospitalized due to decompensated heart failure. Echocardiogram was performed and demonstrated biatrial dilation, left ventricle with normal dimensions, borderline wall thicknesses without granular sparkling, moderately impaired systolic function (ejection fraction 40%) and diastolic function not assessable (pacemaker lead implanted due to severe atrioventricular conduction disturbances). Assessment of left ventricular longitudinal strain by speckle tracking (Figure 1A) showed low global longitudinal strain value (-10%) with worse longitudinal strain at the base and relatively well-preserved apical strain, a typical pattern of left ventricular infiltration due to amyloidosis. Endomyocardial biopsy confirmed diagnosis of cardiac amyloidosis (Figure 1B-C). Authors’ contributions

Large aortic aneurysm and dissection in a patient with Marfan's syndrome

Marfan’s syndrome is an autosomal dominant disorder of connective tissue affecting approximately1 in5000 people. In individuals with this syndrome, more than 90% of deaths from known causes result from cardiovascular complications, such as aortic dissection, aortic regurgitation, and congestive cardiac failure. In this report, we present a patient with a large symptomatic aortic aneurysm and chronic dissection, severe aortic regurgitation and cardiomegaly, treated successfully with resection of the proximal aorta and placement of a mechanic aortic valved graft.

Cardiac involvement in Erdheim-Chester disease: a case report.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis of unknown etiology characterized by proliferation of lipid-containing foamy histiocytes affecting bones and potentially every organ. There is a wide clinical spectrum of the disease, ranging from asymptomatic bone or soft-tissue lesions to life-threatening systemic involvement. Although the initial descriptions published by Jakob Erdheim and William Chester in 1930 included a patient with right atrial infiltration on autopsy, cardiovascular involvement in ECD has only gained more recognition recently. In the present report, we describe a case with cardiac involvement, presenting with symptomatic heart failure and a cardiac mass assessed with echocardiogram and cardiac magnetic resonance imaging.