Background: Heart failure occurs in ~10% of patients with acute rheumatic fever (RF), and several studies have shown that cardiac decompensation in RF results primarily from valvular disease and is not due to primary myocarditis. However, the literature on this topic is scarce, and a recent case series has shown that recurrent RF can cause ventricular dysfunction even in the absence of valvular heart disease.Methods: The present study evaluated the clinical, laboratory and imaging characteristics of 25 consecutive patients with a clinical diagnosis of myocarditis confirmed by 18F-FDG PET/CT or gallium-67 cardiac scintigraphy and RF reactivation according to the revised Jones Criteria. Patients underwent three sequential echocardiograms at (1) baseline, (2) during myocarditis and (3) post corticosteroid treatment. Patients were divided according to the presence (Group 1) or absence (Group 2) of reduced left ventricular ejection fraction (LVEF) during myocarditis episodes.Results: The median age was 42 (17–51) years, 64% of patients were older than 40 years, and 64% were women. Between Group 1 (n = 16) and in Group 2 (n = 9), there were no demographic, echocardiographic or laboratory differences except for NYHA III/IV heart failure (Group 1: 100.0% vs. Group 2: 50.0%; p = 0.012) and LVEF (30 [25–37] vs. 56 [49–62]%, respectively; p < 0.001), as expected. Group 1 patients showed a significant reduction in LVEF during carditis with further improvement after treatment. There was no correlation between LVEF and valvular dysfunction during myocarditis. Among all patients, 19 (76%) underwent 18F-FDG PET/CT, with a positive scan in 68.4%, and 21 (84%) underwent gallium-67 cardiac scintigraphy, with positive uptake in 95.2%, there was no difference between these groups.Conclusion: Myocarditis due to rheumatic fever reactivation can cause left ventricular dysfunction despite valvular disease, and it is reversible after corticosteroid treatment.
Background
Endomyocardial fibrosis (EMF) is a rare and underdiagnosed cause of restrictive cardiomyopathy. Its etiology is not yet defined and could be caused by the influence of different clinical factors that seem to combine with genetic aspects of individuals susceptible to an inflammatory process that leads to formation of fibrosis.
Case summary
We describe a case of a 50-year-old man from the northeastern region of Brazil, where there is high prevalence of schistosomiasis. He presented to our center with symptoms of right heart failure. The echocardiogram showed normal left ventricular ejection fraction. Right ventricular had normal systolic function but in the apical region was filled with a homogeneous and hypoechoic image causing obliteration and restriction of the apex. The late gadolinium enhancement with cardiac magnetic resonance showed diffuse and heterogeneous subendocardial fibrosis in the right ventricle apex consistent with endomyocardial fibrosis, but declined endocardiectomy.
Discussion
This report presents an interesting case of endomyocardial fibrosis and schistosomiasis simultaneously. The hypothesis of parasitosis as a probable cause of endomyocardial fibrosis was raised by helminth-induced hypereosinophilia. Complementary imaging tests such as magnetic resonance imaging and echocardiography, in addition to clinical and epidemiological suspicion, are essential for its diagnosis. Early surgical resolution becomes crucial for long-term survival.
Los beneficios de la revascularización precoz en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCSST) son incuestionables. La reperfusión miocárdica precoz, ya sea por intervención coronaria percutánea (ICP) o trombólisis, limita el tamaño del infarto, preserva la función ventricular izquierda y mejora la supervivencia en pacientes con IAMCSST.
Introducción: Actualmente, los estudios de resonancia magnética (RM) se realizan con mucha frecuencia debido a que no utilizan radiaciones ionizantes y no son invasivos. Sin embargo, existe confusión en el personal médico sobre cómo proceder cuando se requiere este estudio en personas con enfermedades cardiovasculares portadores de prótesis o dispositivos (marcapasos, desfibriladores y/o resincronizadores) con componentes ferromagnéticos que suponen un riesgo para el paciente.
Presentación de caso: Mujer de 47 años de edad, con clínica compatible con sincope neuromediado en los dos últimos años. Tuvo un test de mesa basculante positivo para sincope vasovagal con repuesta cardioinhibidora (asistolia durante 20 segundos). Recibió tratamiento no farmacológico y farmacológico sin que desaparezcan los episodios sincopales, por lo que se realizó implante de un marcapaso bicameral, con algoritmo para caída de la frecuencia cardíaca. Tres años después del implante presentó un evento cerebro vascular por lo que se realizó una resonancia magnética cerebral. Afortunadamente el marcapaso y cables implantados soportaron este estudio sin que se produjeran alteraciones en el marcapaso, programación, o en los cables y sin afectación del paciente.
Conclusiones: Este caso añade evidencia a la literatura sobre la seguridad del estudio de resonancia magnética en pacientes portadores de dispositivos ferromagnéticos como el marcapaso bicameral. Aunque hace falta más evidencia, en lo posible se debería implantar marcapasos u otros dispositivos compatibles con estudios de resonancia magnética, sobre todo en poblaciones con mayor riesgo de que en algún momento requiera de estos.
Dextrocardia with situs inversus totalis is a rare congenital abnormality. Most coronary artery bypass grafting surgeries in patients with dextrocardia were performed with anastomosis, using the right internal thoracic artery to revascularize the left anterior descending. It should be noted that in the literature there are few reports of coronary artery bypass grafting surgery, in a patient with this abnormality, its anatomical complexity constitutes a challenge in planning the surgical technique and the grafts to be used. We present an unusual case of a patient with situs inversus totalis and coronary artery disease who underwent coronary artery bypass grafting surgery making it a more technically complex procedure for surgeons, in addition to the difficulty in choosing grafts.
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