Endomyocardial fibrosis (EMF) is a neglected but prevalent disease in underdeveloped countries. Despite its frequency, it is still considered a rare disease. It is marked by the following findings: architectural distortion, ventricular filling changes, and segmental mobility changes affecting not only diastolic and systolic dynamics but also heart valve function. Apical thrombi can be formed in more advanced disease. In this case report, we revisit EMF and present the challenging case of a 52-year-old woman with New York Heart Association (NYHA) functional classification (FC) IV heart failure. Resting electrocardiography revealed sinus rhythm with left ventricular (LV) overload, high voltage vectors, rectified ST-segment depression, and a negative T-wave in the anterolateral region compatible with the strain pattern. The evaluation of echocardiographic images showed marked left atrial dilation, no ventricular dilatation, and hyper-refringent apical occupation within the LV suggestive of a large sessile thrombus superimposed on the endocardial fibrous layer. Although surgery is the most supported approach in the literature in such situations, this patient was treated with oral anticoagulants (OAC) for 1 month and 24 days. The patient progressed well with an improved NYHA FC. Endocavitary contrast echocardiography performed 2 months after OAC initiation showed regression of the apical thrombus image.
Introduction:Echocardiography is a diagnostic tool that is increasingly used in clinical practice in different medical scenarios; however, the preventive (PM) or corrective maintenance (CM) care and processes for this equipment are still poorly standardized. To describe the maintenance process currently implemented for echocardiographic equipment (ECHO) in a medium-sized laboratory in a tertiary-level public teaching hospital. The description of the process includes damage characterization and MP and MC implementation.Methods: This was a descriptive and exploratory single-center observational study. Data on the maintenance process of echocardiographic equipment were obtained from electronic files from the hospital's equipment management system between 2003 and 2018.Results: Together with the description of the equipment maintenance process, the ten most common types of malfunctions were identified, including software (23.8%), parts (23.1%), and power outage and accessory damage (13.8%). The implementation of the PM process significantly decreased the maintenance costs (USD 44,472.10 vs USD 25,807.59, p = 0.029). Even after the MP, the CM costs related to transesophageal echocardiography equipment (TEE) (USD 7,789.17) were higher than those with other equipment modalities (USD 3,184.37 for transthoracic echocardiography equipment (TTE) and USD 1,813.00 for stress testing).
Conclusion:The maintenance process for ECHO equipment was described. ECHO equipment damage has high costs, especially in special modalities such as TEE. PM significantly reduced maintenance costs.
Introduction: Vascular and neuronal impairment is one of the reasons for early hospitalization of diabetic patients, mainly affecting the extremities of the lower limbs. Photobiomodulation is a non-pharmacological therapeutic line that has been increasingly used in recent years, and its effects are attributed to the modulatory capacity to increase the level of cellular energy metabolism. Objective: to evaluate the influence of photobiomodulation with light emitting diode (LED) in the red (V), infrared (IV) and associated (V + IV) spectrum on pain and blood flow in patients with diabetic neuropathy. Methods: The study sample consisted of 58 patients, aged between 45 and 70 years, totaling 116 evaluated lower limbs. The study procedure was carried out in 5 days. On the first day (pre-treatment), patients were assessed for vascular impairment and the level of neuropathic pain. From the second to the fourth day, photobiomodulation was applied directly to the skin of the patients' legs, using a blanket (33x42cm2) of red LEDs (620nm; 52.86 mW / cm²), infrared (940nm; 33.7 mW / cm²) or associated (620nm; 52.86 mW / cm² and 940nm; 33.7 mW / cm²) during 1'30 ". On the fifth day, patients underwent reassessment. Results: Regarding the assessment of neuropathic pain, there was an average reduction (p <0.05) between 4.7 and 5.5 points in the Douleur Neuropathique 4 Questions in all groups irradiated with LED, with a large clinical effect size. In the blood flow assessment, there were no statistically significant changes (p> 0.05), despite the moderate effect size. Conclusion: Photobiomodulation therapy with light emitting diode (LED) has been shown to be effective in relieving neuropathic pain in the lower limbs of diabetic patients, with a clinical effect in improving blood flow.
A endomiocardiofibrose é uma doença negligenciada e predominante em países subdesenvolvidos. Apesar de sua frequência, ainda é considerada rara. Assim, a doença é marcada pelos seguintes achados: distorção arquitetural, alterações no enchimento ventricular e alterações da mobilidade segmentar. Ela afetando não só a dinâmica diastólica e sistólica, como também as funções das válvulas cardíacas. Em uma condição mais avançada da doença, pode haver formação de trombos apicais. Neste relato de caso, revisitamos a endomiocardiofibrose, apresentando um caso desafiador de paciente do sexo feminino de 52 anos, com clínica de insuficiência cardíaca classe funcional IV da New York Heart Association. A eletrocardiografia de repouso revelou ritmo sinusal com sobrecarga do ventrículo esquerdo com vetores de alta voltagem, infradesnivelamento retificado do segmento ST e onda T negativa em região anterolateral, podendo ser compatível com padrão de strain. Já na avaliação de imagens ecocardiográficas, revelou dilatação acentuada do átrio esquerdo, com ventrículos sem dilatações e imagem de ocupação apical hiperrefringente no interior do ventrículo esquerdo, sugerindo grande trombo séssil sobreposto à capa fibrosa endocárdica. Embora a conduta cirúrgica seja a mais apoiada em literatura em tais situações, a paciente aqui apresentada recebeu tratamento com anticoagulação oral por 1 mês e 24 dias. Ela evoluiu clinicamente bem, com melhora da classe funcional da New York Heart Association e, em ecocardiografia realizada 2 meses após o início da anticoagulação oral, houve demonstração da regressão da imagem de trombo apical, apoiada com a técnica de contraste endocavitário.
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