Renato Côrtes de Lacerda

Paraplegia aguda. Uma complicação rara da dissecção aórtica

A 67 year-old normotensive woman had a syncope followed by shock and remained anuric after hemodynamic stabilization. Paraplegia and paresis of the right upper limb, as well as signs of ischemia of the distal lower limbs were noted. The possibility of acute aortic dissection was raised and confirmed by computed tomography. The paraplegia was attributed to an ischemic infarction of the spinal cord. The patient died on the fourth hospital day due to a pericardial tamponade. This rare and not well recognized complication of aortic dissection is briefly reviewed.A 67 year-old normotensive woman had a syncope followed by shock and remained anuric after hemodynamic stabilization. Paraplegia and paresis of the right upper limb, as well as signs of ischemia of the distal lower limbs were noted. The possibility of acute aortic dissection was raised and confirmed by computed tomography. The paraplegia was attributed to an ischemic infarction of the spinal cord. The patient died on the fourth hospital day due to a pericardial temponade. This rare and not well recognized complication of aortic dissection is briefly reviewed.

Complications related to carotid sinus massage in 502 ambulatory patients

BACKGROUND The carotid sinus massage (CSM) is a simple and low-cost technique with many indications. OBJECTIVE To determine the safety of CSM in outpatients with high prevalence of atherosclerotic disease and cardiopathy. METHODS A transversal study. INCLUSION CRITERIA Outpatients aged >or= 50 years, referred for ECG. EXCLUSION CRITERIA Individuals that refused to participate in a study on the prevalence of the cardioinhibitory response to CSM, patients with dementia, patients with pacemakers, individuals with carotid murmur or history of stroke or AMI in the last three months. The CSM was carried out in the supine position during 10 seconds. The occurrence of sustained arrhythmias or the occurence of neurological deficit during the CSM or in the first 24 hours after its end were considered complications of the CSM. RESULTS 562 patients were randomly selected from a total of 1,686 individuals that met the inclusion criteria. Sixty individuals met the exclusion criteria. The remaining 502 patients (52% males, 69% with cardiopathies and 50% with atherosclerotic disease) were submitted to 1,053 CSM. Two patients presented complications (0.4%; 95%CI:0%-0.9%). A 71-yr-old man developed left arm monoparesis with complete regression within 30 minutes. Another 56-yr-old man presented left homonymous hemianopsia, with regression after 7 days. CONCLUSION The incidence of CSM-related complications was small, particularly when considering that the population submitted to the maneuver was elderly, with high incidence of structural heart disease and atherosclerotic disease.FUNDAMENTO: A massagem do seio carotideo (MSC) e uma tecnica simples, de baixo custo e com muitas indicacoes. OBJETIVO: Determinar a seguranca da MSC em pacientes ambulatoriais com alta prevalencia de doenca aterosclerotica e de cardiopatia. METODOS: Estudo transversal. Criterios de inclusao: pacientes ambulatoriais com idade > 50 anos, encaminhados para realizacao de eletrocardiograma (ECG). Criterios de exclusao: individuos que nao aceitaram participar de um estudo sobre a prevalencia da resposta cardioinibitoria a MSC, pacientes com demencia, portadores de marca-passo, individuos com sopro carotideo ou com historia de AVC ou IAM nos ultimos 3 meses. A MSC foi realizada na posicao supina durante 10 segundos. Foram consideradas complicacoes da MSC a ocorrencia de arritmias sustentadas e o aparecimento de deficit neurologico durante a MSC ou nas primeiras 24 horas apos o seu termino. RESULTADOS: Foram selecionados aleatoriamente 562 pacientes de um total de 1.686 individuos com criterios de inclusao. Sessenta individuos apresentaram criterios de exclusao. Os 502 pacientes restantes (52% homens, idade media de 65 anos, 69% cardiopatas e 50% com doenca aterosclerotica) foram submetidos a 1.053 MSC. Dois pacientes apresentaram complicacoes (0,4%; IC95%:0%-0,9%). Um homem de 71 anos apresentou monoparesia do braco esquerdo com regressao completa em 30 minutos. Outro homem, de 56 anos, apresentou hemianopsia homonima a esquerda que regrediu em 7 dias. CONCLUSAO: A incidencia de complicacoes relacionadas a MSC foi pequena, particularmente quando se considerou que a populacao submetida a manobra era idosa e com alta prevalencia de cardiopatia estrutural e de doenca aterosclerotica.

Prevalência e preditores da resposta cardioinibitória à massagem do seio carotídeo em 502 pacientes ambulatoriais

BACKGROUND: Cardioinhibitory response (CIR) is defined as asystole >3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). Pacemaker implantation is indicated for patients with unexplained syncope episodes and CIR. OBJECTIVE: To determine the prevalence and predictors of CIR in patients with a high prevalence of cardiovascular disease, and assess the clinical significance of CIR in patients with a history of unexplained syncope or falls. METHODS: Cross-section design study. Outpatients, aged >50 years, referred to the electrocardiography sector of a tertiary hospital. Those with dementia, carotid bruit, and history of myocardial infarction, stroke or transient ischemic attack in the preceding 3 months were excluded. CSM was performed by a single investigator, with the patients in the supine position. CSM was applied on the right side and then on the left side during 10 seconds each time. RESULTS: 502 patients underwent CSM. CIR was present in 52 patients (10.4%; 95% CI: 7.7%-13%). Independent predictors of CIR were male gender (OR: 2.61%; CI 95%: 1.3%-5.1%), structural heart disease (OR: 3.28%; CI 95%: 1.3%-7.9%) and baseline heart rate (P 50 years. In males and in patients with structural heart disease CIR was more common. In women and patients with no apparent structural heart disease, the presence of CIR was a highly specific finding in the evaluation of syncope or falls.

Incidencia de complicaciones relacionadas al masaje del seno carotídeo en 502 pacientes ambulatorios

BACKGROUND The carotid sinus massage (CSM) is a simple and low-cost technique with many indications. OBJECTIVE To determine the safety of CSM in outpatients with high prevalence of atherosclerotic disease and cardiopathy. METHODS A transversal study. INCLUSION CRITERIA Outpatients aged >or= 50 years, referred for ECG. EXCLUSION CRITERIA Individuals that refused to participate in a study on the prevalence of the cardioinhibitory response to CSM, patients with dementia, patients with pacemakers, individuals with carotid murmur or history of stroke or AMI in the last three months. The CSM was carried out in the supine position during 10 seconds. The occurrence of sustained arrhythmias or the occurence of neurological deficit during the CSM or in the first 24 hours after its end were considered complications of the CSM. RESULTS 562 patients were randomly selected from a total of 1,686 individuals that met the inclusion criteria. Sixty individuals met the exclusion criteria. The remaining 502 patients (52% males, 69% with cardiopathies and 50% with atherosclerotic disease) were submitted to 1,053 CSM. Two patients presented complications (0.4%; 95%CI:0%-0.9%). A 71-yr-old man developed left arm monoparesis with complete regression within 30 minutes. Another 56-yr-old man presented left homonymous hemianopsia, with regression after 7 days. CONCLUSION The incidence of CSM-related complications was small, particularly when considering that the population submitted to the maneuver was elderly, with high incidence of structural heart disease and atherosclerotic disease.FUNDAMENTO: A massagem do seio carotideo (MSC) e uma tecnica simples, de baixo custo e com muitas indicacoes. OBJETIVO: Determinar a seguranca da MSC em pacientes ambulatoriais com alta prevalencia de doenca aterosclerotica e de cardiopatia. METODOS: Estudo transversal. Criterios de inclusao: pacientes ambulatoriais com idade > 50 anos, encaminhados para realizacao de eletrocardiograma (ECG). Criterios de exclusao: individuos que nao aceitaram participar de um estudo sobre a prevalencia da resposta cardioinibitoria a MSC, pacientes com demencia, portadores de marca-passo, individuos com sopro carotideo ou com historia de AVC ou IAM nos ultimos 3 meses. A MSC foi realizada na posicao supina durante 10 segundos. Foram consideradas complicacoes da MSC a ocorrencia de arritmias sustentadas e o aparecimento de deficit neurologico durante a MSC ou nas primeiras 24 horas apos o seu termino. RESULTADOS: Foram selecionados aleatoriamente 562 pacientes de um total de 1.686 individuos com criterios de inclusao. Sessenta individuos apresentaram criterios de exclusao. Os 502 pacientes restantes (52% homens, idade media de 65 anos, 69% cardiopatas e 50% com doenca aterosclerotica) foram submetidos a 1.053 MSC. Dois pacientes apresentaram complicacoes (0,4%; IC95%:0%-0,9%). Um homem de 71 anos apresentou monoparesia do braco esquerdo com regressao completa em 30 minutos. Outro homem, de 56 anos, apresentou hemianopsia homonima a esquerda que regrediu em 7 dias. CONCLUSAO: A incidencia de complicacoes relacionadas a MSC foi pequena, particularmente quando se considerou que a populacao submetida a manobra era idosa e com alta prevalencia de cardiopatia estrutural e de doenca aterosclerotica.

Incidência de complicações relacionadas à massagem do seio carotídeo em 502 pacientes ambulatoriais

BACKGROUND The carotid sinus massage (CSM) is a simple and low-cost technique with many indications. OBJECTIVE To determine the safety of CSM in outpatients with high prevalence of atherosclerotic disease and cardiopathy. METHODS A transversal study. INCLUSION CRITERIA Outpatients aged >or= 50 years, referred for ECG. EXCLUSION CRITERIA Individuals that refused to participate in a study on the prevalence of the cardioinhibitory response to CSM, patients with dementia, patients with pacemakers, individuals with carotid murmur or history of stroke or AMI in the last three months. The CSM was carried out in the supine position during 10 seconds. The occurrence of sustained arrhythmias or the occurence of neurological deficit during the CSM or in the first 24 hours after its end were considered complications of the CSM. RESULTS 562 patients were randomly selected from a total of 1,686 individuals that met the inclusion criteria. Sixty individuals met the exclusion criteria. The remaining 502 patients (52% males, 69% with cardiopathies and 50% with atherosclerotic disease) were submitted to 1,053 CSM. Two patients presented complications (0.4%; 95%CI:0%-0.9%). A 71-yr-old man developed left arm monoparesis with complete regression within 30 minutes. Another 56-yr-old man presented left homonymous hemianopsia, with regression after 7 days. CONCLUSION The incidence of CSM-related complications was small, particularly when considering that the population submitted to the maneuver was elderly, with high incidence of structural heart disease and atherosclerotic disease.FUNDAMENTO: A massagem do seio carotideo (MSC) e uma tecnica simples, de baixo custo e com muitas indicacoes. OBJETIVO: Determinar a seguranca da MSC em pacientes ambulatoriais com alta prevalencia de doenca aterosclerotica e de cardiopatia. METODOS: Estudo transversal. Criterios de inclusao: pacientes ambulatoriais com idade > 50 anos, encaminhados para realizacao de eletrocardiograma (ECG). Criterios de exclusao: individuos que nao aceitaram participar de um estudo sobre a prevalencia da resposta cardioinibitoria a MSC, pacientes com demencia, portadores de marca-passo, individuos com sopro carotideo ou com historia de AVC ou IAM nos ultimos 3 meses. A MSC foi realizada na posicao supina durante 10 segundos. Foram consideradas complicacoes da MSC a ocorrencia de arritmias sustentadas e o aparecimento de deficit neurologico durante a MSC ou nas primeiras 24 horas apos o seu termino. RESULTADOS: Foram selecionados aleatoriamente 562 pacientes de um total de 1.686 individuos com criterios de inclusao. Sessenta individuos apresentaram criterios de exclusao. Os 502 pacientes restantes (52% homens, idade media de 65 anos, 69% cardiopatas e 50% com doenca aterosclerotica) foram submetidos a 1.053 MSC. Dois pacientes apresentaram complicacoes (0,4%; IC95%:0%-0,9%). Um homem de 71 anos apresentou monoparesia do braco esquerdo com regressao completa em 30 minutos. Outro homem, de 56 anos, apresentou hemianopsia homonima a esquerda que regrediu em 7 dias. CONCLUSAO: A incidencia de complicacoes relacionadas a MSC foi pequena, particularmente quando se considerou que a populacao submetida a manobra era idosa e com alta prevalencia de cardiopatia estrutural e de doenca aterosclerotica.