Case 3/2015-53-Year-Old Female with Cardiogenic Shock 12 Years after Surgical Correction of Endomyocardial Fibrosis
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2
Tipo de produção
article
Data de publicação
2015
Título da Revista
ISSN da Revista
Título do Volume
Editora
ARQUIVOS BRASILEIROS CARDIOLOGIA
Autores
Citação
ARQUIVOS BRASILEIROS DE CARDIOLOGIA, v.105, n.3, p.309-315, 2015
Resumo
Paciente feminina de 53 anos de idade, submetida a
tratamento cirúrgico de endomiocardiofibrose (EMF) há
12 anos, foi trazida ao hospital com hipotensão e bradicardia.
Queixava-se de palpitações desde os 29 anos de
idade. Os sintomas se intensificaram depois de 5 anos,
quando se somou dispneia desencadeada por esforços
moderados. Mais 5 anos se passaram e a dispneia passou a
ser desencadeada por mínimos esforços e com o decúbito.
Foi então encaminhada ao hospital.
O exame físico em 1994 revelou paciente com pulso
irregular, frequência cardíaca de 88 bpm, pressão arterial
de 104/80 mmHg e aumento da pressão venosa jugular.
A semiologia pulmonar foi normal. A semiologia cardíaca
revelou bulhas arrítmicas e sopro sistólico mitral (+/4).
O exame do abdome e dos membros foi normal.
O eletrocardiograma (ECG) (fevereiro 94) revelou fibrilação
atrial, bloqueio de ramo esquerdo e sobrecarga ventricular
esquerda (Figura 1).
As dimensões das câmaras cardíacas ao ecocardiograma
(1996) eram: átrio esquerdo, 57 mm; ventrículo esquerdo,
51 mm (diástole) e 33 mm (sístole). Foi identificada
obliteração da região apical de ambos os ventrículos, com
sinais sugestivos de calcificação. O aspecto morfológico
identificado foi considerado sugestivo de EMF.
As ventriculografias (1996) mostraram obliteração
da região apical do ventrículo esquerdo e do ventrículo
direito, além de insuficiência mitral de pequena magnitude.
Na cineangiocoronariografia, o ramo circunflexo da artéria
coronária esquerda originava-se da coronária direita. Não foram
identificadas obstruções nas artérias coronárias. O aspecto da
ventriculografia foi considerado sugestivo de EMF.
Foi indicado o tratamento cirúrgico.
A 53-year-old female, submitted to surgical correction of endomyocardial fibrosis (EMF) 12 years before, sought medical care with hypotension and bradycardia. She complained of palpitations since the age of 29 years. Her symptoms aggravated 5 years later, with the appearance of dyspnea on moderate exertion. After 5 more years, the dyspnea intensified, being triggered on mild exertion and in the dorsal decubitus position. The patient was then referred to a hospital. In 1994, the physical examination revealed irregular pulse, heart rate of 88 bpm, blood pressure of 104/80 mm Hg, and increased jugular venous pressure. The pulmonary exam was normal, and the heart auscultation showed arrhythmic heart sounds and mitral systolic murmur (+/4). The exam of the abdomen and limbs was within the normal range. In February 1994, the electrocardiogram (ECG) showed atrial fibrillation, left bundle-branch block and left ventricular hypertrophy (Figure 1). In 1996, on echocardiogram, the dimensions of the cardiac chambers were: left atrium, 57 mm; left ventricle, 51 mm (diastole) and 33 mm (systole). Obliteration of the apical region of both ventricles was observed, with suggestive signs of calcification. The morphological aspect was considered suggestive of EMF. In 1996, a ventriculography showed obliteration of the apical region of left and right ventricles, in addition to mild mitral regurgitation. On coronary cineangiography, the circumflex branch of the left coronary artery originated from the right coronary artery. No obstruction of the coronary arteries was identified. The ventriculography findings were suggestive of EMF. Surgical treatment was indicated. In September 1996 the surgery was performed with incision in the apical region of the left ventricle and resection of a fibrous and calcified mass. Then, through the interatrial
A 53-year-old female, submitted to surgical correction of endomyocardial fibrosis (EMF) 12 years before, sought medical care with hypotension and bradycardia. She complained of palpitations since the age of 29 years. Her symptoms aggravated 5 years later, with the appearance of dyspnea on moderate exertion. After 5 more years, the dyspnea intensified, being triggered on mild exertion and in the dorsal decubitus position. The patient was then referred to a hospital. In 1994, the physical examination revealed irregular pulse, heart rate of 88 bpm, blood pressure of 104/80 mm Hg, and increased jugular venous pressure. The pulmonary exam was normal, and the heart auscultation showed arrhythmic heart sounds and mitral systolic murmur (+/4). The exam of the abdomen and limbs was within the normal range. In February 1994, the electrocardiogram (ECG) showed atrial fibrillation, left bundle-branch block and left ventricular hypertrophy (Figure 1). In 1996, on echocardiogram, the dimensions of the cardiac chambers were: left atrium, 57 mm; left ventricle, 51 mm (diastole) and 33 mm (systole). Obliteration of the apical region of both ventricles was observed, with suggestive signs of calcification. The morphological aspect was considered suggestive of EMF. In 1996, a ventriculography showed obliteration of the apical region of left and right ventricles, in addition to mild mitral regurgitation. On coronary cineangiography, the circumflex branch of the left coronary artery originated from the right coronary artery. No obstruction of the coronary arteries was identified. The ventriculography findings were suggestive of EMF. Surgical treatment was indicated. In September 1996 the surgery was performed with incision in the apical region of the left ventricle and resection of a fibrous and calcified mass. Then, through the interatrial
Palavras-chave
Shock, Cardiogenic, Endomyocardial Fibrosis / surgery, Arrhythmias, Cardiac, Pacemaker, Artificial, Choque Cardiogênico, Fibrose Endomiocárdica / cirurgia, Arritmias Cardíacas, Marca-Passo Artificial
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