Hélder Ribeiro

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

Lesão tumoral gigante na aurícula esquerda: um caso incomum de sarcoma cardíaco indiferenciado

Primary cardiac tumors are rare, with an incidence ranging from 0.0001% to 0.030%; 80% are benign, while sarcomas account for 95% of malignant tumors. The authors report the case of a 75-year-old patient with a giant mass in the left atrium. The final diagnosis was of an undifferentiated cardiac sarcoma. This tumor represents a real challenge not only for timely diagnosis, but especially the therapeutic approach to adopt.

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.

Lesão cardíaca no contexto de carcinoma hepatocelular metastático

Hepatocellular carcinoma with extension or metastasis to the right atrium is an uncommon form of cardiac malignancy. The authors report the case of a 51-year-old patient with hepatocellular carcinoma and thrombi in the portal and mesenteric veins, which histopathology revealed to be metastatic. Echocardiography showed a right atrial mass which in this context has to be considered as a possible cardiac metastasis.Resumo O carcinoma hepatocelular com extensao ou mestastases para a auricula direita e uma forma de doenca cardiaca maligna pouco frequente. Os autores relatam o caso de um doente de 51 anos de idade a quem foi diagnosticado carcinoma hepatocelular com trombos a nivel das veias porta e mesenterica, cuja analise histopatologica revelou ser compativel com metastases. O ecocardiograma revelou uma massa na auricula direita que, neste contexto, deve ser considerada como possivel metastase cardiaca.

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.

Cardiac injury in the context of metastatic hepatocellular carcinoma

Abstract Hepatocellular carcinoma with extension or metastasis to the right atrium is an uncommon form of cardiac malignancy. The authors report the case of a 51-year-old patient with hepatocellular carcinoma and thrombi in the portal and mesenteric veins, which histopathology revealed to be metastatic. Echocardiography showed a right atrial mass which in this context has to be considered as a possible cardiac metastasis.

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