LEA MARIA MACRUZ FERREIRA DEMARCHI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
2 resultados
Resultados de Busca
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- Case 2/2018-73-Year-Old Male with Ischemic Cardiomyopathy, Cachexia and Shock(2018) NUNES, Rafael Amorim Belo; BRUNO, Jussara de Almeida; RAMIREZ, Hilda Sara Monteiro; DEMARCHI, Lea Maria Macruz Ferreira
- Case 2/2019-Man with Arrhythmogenic Cardiopathy Followed by Rapidly Progressive Heart Failure(2019) PEREIRA, Marcella Abunahman Freitas; RIBEIRO, Wilma Noia; DEMARCHI, Lea Maria Macruz FerreiraA 36-year-old man was referred to the medical service for surgical treatment of heart failure refractory to drug treatment. At the age of 26, 1st-degree atrioventricular block and episodes of non-sustained ventricular tachycardia were detected on the electrocardiogram (ECG). After 4 years, he started to have episodes of pre-syncope. The magnetic resonance performed at that time (09/29/2010) disclosed diastolic diameter of 59 mm; systolic diameter of 49 mm; 10-mm septum; posterior wall of 11 mm; 48% left ventricular ejection fraction and 53% right ventricular ejection fraction, with no contraction abnormalities. The late enhancement imaging showed an infero-septal, medium-basal subepicardial focus, compatible with fibrosis, suggestive of myocarditis or idiopathic dilated cardiomyopathy. The magnetic resonance performed at that time (09/29/2010) disclosed diastolic diameter of 59 mm; systolic diameter of 49 mm; 10-mm septum; posterior wall of 11 mm; 48% left ventricular ejection fraction and 53% right ventricular ejection fraction, with no contraction abnormalities. The late enhancement imaging showed an infero-septal, medium-basal subepicardial focus, compatible with fibrosis, suggestive of myocarditis or idiopathic dilated cardiomyopathy. An electrophysiological study was indicated. After extra-stimuli, sustained ventricular tachycardia with hemodynamic instability was triggered and an implantable-cardioverter defibrillator (ICD) was implanted and the patient received a beta-blocker. However, several episodes of ventricular tachycardia were recorded by the ICD and the use of amiodarone was initiated. An electrophysiological study was indicated. After extra-stimuli, sustained ventricular tachycardia with hemodynamic instability was triggered and an implantable-cardioverter defibrillator (ICD) was implanted and the patient received a beta-blocker. However, several episodes of ventricular tachycardia were recorded by the ICD and the use of amiodarone was initiated. An electrophysiological study was indicated. After extra-stimuli, sustained ventricular tachycardia with hemodynamic instability was triggered and an implantable-cardioverter defibrillator (ICD) was implanted and the patient received a beta-blocker. However, several episodes of ventricular tachycardia were recorded by the ICD and the use of amiodarone was initiated. He remained asymptomatic for approximately 3 years until he developed heart failure, which rapidly evolved into functional class IV, which resulted in hospitalization for compensation and with acute pulmonary edema at 34 years of age, followed by a new hospitalization a few months later for new heart failure compensation. At that time, hypothyroidism (TSH of 88 um / L) was diagnosed, which was attributed to amiodarone use. The echocardiogram disclosed severe left ventricular systolic dysfunction, with EF = 21%. Myocardial resynchronization was indicated, with pacemaker implantation with electrodes implanted at two points in the left ventricle in March 2015, but he was readmitted due to arterial hypotension, atrial fibrillation and heart failure decompensation in September 2015. Amiodarone, dobutamine, spironolactone, furosemide and rivaroxaban were administered.