Uso do escore SAME-TT2R2 em ambulatório de anticoagulação para predição de tempo na faixa terapêutica e de eventos adversos

O escore SAMe-TT2R2 foi desenvolvido visando predizer quais pacientes em anticoagulação oral com antagonistas da vitamina K (AVKs) atingirão um tempo na faixa terapêutica (TFT) adequado (> 65-70%) no seguimento. Estudos também o relacionaram com a ocorrência de eventos adversos. Na presente dissertação, tivemos por objetivo descrever o TFT de acordo com o escore, além de relacionar a pontuação obtida com a ocorrência de eventos adversos em pacientes com fibrilação atrial (FA) não valvar em anticoagulação oral com AVKs. Foi realizado um estudo de coorte retrospectivo incluindo pacientes com FA não valvar em acompanhamento em ambulatório de anticoagulação de um hospital terciário, sendo feita uma avaliação retrospectiva de consultas ambulatoriais, visitas a emergência e internações hospitalares na instituição no período de janeiro-dezembro/2014. O TFT foi calculado aplicando-se o método de Rosendaal. No estudo, foram analisados 263 pacientes com TFT mediano de 62,5%. O grupo de baixo risco (0-1 ponto) obteve um TFT mediano maior em comparação com o grupo de alto risco ( 2 pontos): 69,2% vs. 56,3%, P = 0,002. Da mesma forma, o percentual de pacientes com TFT 60%, 65% ou 70% foi superior nos pacientes de baixo risco (P 65-70%). Studies have reported a relationship between this score and the occurrence of adverse events. In this dissertation, we aimed to describe the TTR according to the score, in addition to relating the score obtained with the occurrence of adverse events in patients with nonvalvular atrial fibrillation AF on oral anticoagulation with VKAs. A retrospective cohort study including patients with nonvalvular AF attending an outpatient anticoagulation clinic of a tertiary hospital was conducted. Visits to the outpatient clinic and emergency, as well as hospital admissions to the institution, during 2014 were evaluated. The TTR was calculated through the Rosendaal´s method. In the study, we analyzed 263 patients (median TTR: 62.5%). The low-risk group (score 0-1) had a better median TTR as compared with the high-risk group (score 2): 69.2% vs. 56.3%, P = 0.002. Similarly, the percentage of patients with TTR 60%, 65% or 70% was higher in the low-risk group (P < 0.001, P = 0.001 and P = 0.003, respectively). The high-risk group had a higher percentage of adverse events (11.2% vs. 7.2%), although not significant (P = 0.369). In this way, this dissertation demonstrates that the SAMe-TT2R2 score seems to represent an effective tool to predict patients with a better TTR, although was not associated with adverse events

Development of ventricular fibrillation after implantation of a biventricular implantable cardioverter defibrillator : what is the mechanism?

Syncopal spells in heart failure patient with cardiovascular implantable electronic devices (CIED) require multiple assessments. T-wave oversensing is a welldescribed phenomenon that remains significant in modern implantable cardioverter defibrillators (ICD) systems. It can lead to inappropriate therapies and loss of biventricular pacing in those with cardiac resynchronization devices. Strategies to overcome this problem are important

Large aortic aneurysm and dissection in a patient with Marfan’s syndrome

Marfan’s syndrome is an autosomal dominant disorder of connective tissue affecting approximately 1 in 5000 people. In individuals with this syndrome, more than 90% of deaths from known causes result from cardiovascular complications, such as aortic dissection, aortic regurgitation, and congestive cardiac failure. In this report, we present a patient with a large symptomatic aortic aneurysm and chronic dissection, severe aortic regurgitation and cardiomegaly, treated successfully with resection of the proximal aorta and placement of a mechanic aortic valved graft

Intestinal intussusception : a presentation of Crohn’s disease

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Early improvement of pacing threshold following primary right coronary angioplasty

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ST elevation myocardial infarction with extensive coronary thrombus in a patient with sickle cell anemia myocardial infarction in patients with sickle cell

O infarto agudo do miocárdio em pacientes com anemia falciforme é, muitas vezes, subdiagnosticado em virtude de fatores de confusão (por exemplo, doença vaso-oclusiva, levando a crises dolorosas). Na maioria dos casos relatados na literatura, as artérias coronárias estavam pérvias e sem lesões. Neste relato de caso, descrevemos a presença de trombo coronariano extenso em paciente com anemia falciforme, apresentando-se sob a forma de infarto agudo do miocárdio com supradesnivelamento do segmento ST, manejado satisfatoriamente com a associação de anticoagulantes e antiplaquetários.Myocardial infarction in patients with sickle cell anemia is often underdiagnosed due to confounding factors (e.g., vaso-occlusive disease leading to painful crisis). In the majority of reported cases, the coronary arteries were pervious and without stenotic lesions. In this case report, we describe the presence of an extensive coronary thrombus in a patient with sickle cell anemia presenting with ST elevation myocardial infarction, managed satisfactorily with the association of anticoagulants and antiplatelet drugs

Miocardite aguda sob a forma de síndrome coronariana aguda após infecção do trato urinário

A miocardite é cada vez mais diagnosticada, principalmente pela maior disponibilidade de métodos como a ressonância magnética cardíaca. A apresentação clínica é variável, geralmente posterior a uma infecção respiratória ou gastrointestinal, manifestando-se como síndrome coronariana aguda (SCA), insuficiência cardíaca aguda ou crônica, arritmias cardíacas ou mesmo choque cardiogênico inexplicável. Relatos de casos de miocardite após infecção do trato urinário (ITU) são escassos. Neste relato, descrevemos o caso de um paciente masculino de 24 anos com miocardite após ITU que se apresentou sob a forma de SCA.The diagnosis of myocarditis has increased mainly due to greater availability of methods such as cardiac magnetic resonance (CMR). Its clinical presentation varies, usually following respiratory or gastrointestinal tract infection, in patients presenting with acute coronary syndrome (ACS), acute or chronic heart failure, cardiac arrhythmias, or even unexplained cardiogenic shock. Case reports of patients with myocarditis following urinary tract infection (UTI) are scarce. This is a case report of a 24-year-old male patient with myocarditis with symptoms of ACS following UTI