2021;117(1 suppl 1) – ABC CARDIOL

Case Report

Anomalous Origin of the Circumflex Coronary Artery from the Right Pulmonary Artery: Diagnosis Through Cardiac CT

Bebiana Faria et al. Lucy Calvo Sílvia Ribeiro Catarina Ruivo António Lourenço

Introduction

Anomalous origin of the left circumflex coronary artery (LCx) from the right pulmonary artery (PA) is an extremely rare coronary anomaly. Although the clinical course may be silent, the risk of sudden cardiac death is increased. The symptoms are related to collateralization and amount of myocardium that it supplies, and some patients need surgical treatment.^,

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Case Report

Transcatheter Aortic Valve Implantation Assisted by Extracorporeal Membrane Oxygenation for the Treatment of Aortic Stenosis with Cardiogenic Shock

Gangping Huang et al. Huaidong Chen Weimin Zhang Fan He

Introduction

Aortic stenosis is a common heart valve disease, mostly caused by degenerative aortic valve disease in the elderly. Aortic stenosis obstructs the forward flow of the left ventricle to the aorta, leading to a pressure differential between the left ventricle and the aorta and increased left ventricular pressure secondary to left ventricular hypertrophy. As the disease progresses, it leads to left ventricular systolic and diastolic dysfunction and myocardial ischemia due to decreased coronary blood flow. However, cardiogenic shock secondary to aortic stenosis is one of the most serious complications and has a high mortality rate due to its limited therapeutic effect. Since its inception in 2002, transcatheter aortic valve implantation (TAVI) has become the first choice of treatment for elderly patients with severe aortic stenosis and high surgical risk due to its advantages of minimally invasive, non-extracorporeal circulation, and good medium-long term efficacy.^– With the development of device technology and low-resistance transmission systems, TAVI has recently been shown to be no less effective than traditional surgery, even in medium-risk patients. However, for patients with a long medical history, significantly reduced cardiac ejection fraction (EF), cardiogenic shock, decompensated aortic valve disease, and severe complications such as intraoperative hemodynamic breakdown and malignant arrhythmia, still exist during TAVI surgery, greatly increasing the risk of TAVI. The present study reports a case of severe aortic stenosis complicated by cardiogenic shock that was successfully treated with TAVI assisted by extracorporeal membrane oxygenation.

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Case Report

The Effect of Respiratory Protective Surgical Mask on Physiological Markers of Endurance Performance in a Recreational Runner

Danilo Marcelo Leite do Prado et al. Valmir Oliveira Silvino Ewerton Gomes Vieira Bruno Viana Rosa … Acácio Salvador Veras e Silva Marcos Antonio Pereira dos Santos

Introduction

The advent of the Coronavirus 19 (COVID-19) pandemic, which has quickly spread worldwide, has raised the attention regarding the use of respiratory protective face masks (PFM) not only by healthcare personnel, but also the general population. In this context, wearing a PFM during physical exercise in an external environment can reduce COVID-19 infection risks. On the other hand, the use of PFM can increase the subjective perception of breathing difficulty through the formation of microclimates inside the face mask (i.e., temperature and humidity) and airflow restriction.

In recent years, the number of amateur runners has significantly increased among many populations around the world, as running can be performed with minimal equipment, and by a broad variety of people. Interestingly, during endurance exercise, the adaptability of the cardiorespiratory system is of paramount importance, as it increases both convective and diffusive oxygen transport, thus enabling the body to meet the demands for oxygen, substrate delivery, and carbon dioxide removal. Moreover, the so-called physiological markers of endurance performance, such as ventilatory anaerobic threshold, respiratory compensation point, running economy, and maximal oxygen uptake, also seem to be important in determining absolute exercise intensity (i.e., pace, power output).

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Case Report

Family Screening in the Diagnosis of Short QT Syndrome after Sudden Cardiac Death as First Manifestation in Young Siblings

Guilherme Augusto Teodoro Athayde et al. Natália Quintella Sangiorgi Olivetti Francisco Carlos da Costa Darrieux Luciana Sacilotto … Gabrielle D’Arezzo Pessente Maurício Ibrahim Scanavacca

Introduction

In 2000, Gussak et al., published a case series in which atrial tachyarrhythmias, syncope, and sudden cardiac death (SCD) were associated with a short QT interval, being the first to correlate all of these finding in one single study. Since then, efforts have been made to better understand the behavior of and find alternatives to treat short QT syndrome (SQTS); however, researchers face the barrier of the rarity of the disease, the difficulty in establishing diagnostic parameters, and its complex clinical manifestation. This article reports on the case of young siblings with SCD and SQTS and discusses the syndrome’s diagnostic and therapeutic difficulties.

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Case Report

Life-Threatening Ventricular Arrhythmia Induced by Atrial Tachycardia in a Child with an SCN5A Mutation

Márcio Augusto Silva et al. Jorge Elias Neto Guilherme Muller de Campos Futuro Erick Sessa Merçon … Deborah Vasconcelos Ricardo Kuniyoshi

Introduction

Mutations in the SCN5A gene, encoding the cardiac Na+channel, can result in several life-threatening arrhythmias. These mutations have proven to be causative for inherited and primarily electrical diseases, including Brugada Syndrome (BrS), Long QT Syndrome, and other cardiac conduction disturbances.^, BrS, the most reported condition in this group of disorders, has typically been described in adult populations and related to approximately 20% of all sudden deaths (SD) in patients with apparently normal hearts.^– Therefore, few reports have shown significant arrhythmic events (AE) caused by this mutation in childhood.

Atrial arrhythmias, as well as sick sinus syndrome (SSS), may be related to Na+channel abnormalities. In BrS, atrial arrhythmias are being diagnosed in up to 38% of patients and are related to worse prognosis.

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Special Article

Chagas Disease: Are Kissing Bugs the Only Culprit?

Abilio Augusto Fragata Filho

Preface

Chagas disease, first described by Carlos Chagas in 1909, is caused by a single-celled parasite (Trypanosoma cruzi). Throughout history, the main mechanism of transmission has been via contact with the feces of an insect infected with the parasite. This insect, known as the “kissing bug” in English, is popularly known as “barbeiro,” “chupão,” or “chupança” in Brazil. The “kissing bugs” are not born with the parasite in their intestine; rather, they acquire it by feeding on the blood of infected mammals. (This disease only affects mammals). When taking a blood meal, the insects eliminate feces, where the parasites are present, and the parasites can contaminate the bite, allowing the parasite to enter the organism. In this manner, the disease begins. The kissing bugs mainly make their nests in cracks in clay walls of houses made in a style known as “pau-a-pique” in Brazil. These houses are very common in diverse regions of Brazil, especially throughout the sertão of the Northeast Region. Other mechanisms of transmission can occur, for example, via blood transfusion, organ donation, mother-to-child transmission, ingestion of contaminated foods, etc.

During the acute phase of the disease, complaints may be mild or even non-existent. They may include general manifestations, such as low fever, malaise or more severe ones, such as shortness of breath and swelling. As bites from kissing bugs usually occur on the face, swelling of the eyebrows, known as the Romaña sign, may occur. As the years pass, generally after 10 years or more, cardiac complaints appear in one third of patients, such as fatigue, shortness of breath, and swelling in the body (heart failure). In some cases, the electrical system of the heart may be compromised, with alterations in cardiac rhythm, fainting, and even sudden death. Dilatation of the esophagus and the colon can also occur, with progressive difficulty in swallowing food and defecating.

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Case Report

Novel Mutation in DSP Gene – A Case of Arrhythmogenic Cardiomyopathy with Isolated Left Ventricular Phenotype and High Risk of Sudden Cardiac Death

Pedro von Hafe Leite et al. Olga Azevedo Geraldo Dias Filipa Cardoso … Tamara Pereira António Lourenço

Introduction

Sudden cardiac death (SCD) in young adults (18–35 years) most commonly results from previously undiagnosed inherited cardiomyopathies. The most common causes of sudden cardiac death are hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy (ACM), followed by congenital anomalies of coronary arteries, myocarditis, aortic rupture in Marfan’s syndrome, conduction defects, and valve diseases.

ACM accounts for up to 20% of sudden cardiac death in individuals under 35 years of age. In a series of 86 victims of SCD at a young age, ACM accounted for 10.3% of the cases, being the second major cause of SCD. Dilated cardiomyopathy (DCM) is a less frequent cause of SCD in young individuals, accounting for nearly 2% of cases in athletes.

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Case Report

Dilated Cardiomyopathy: New Variant in the Filamin-C Gene

Murilo Zomer Frasson et al. Cristiano Pederneiras Jaeger

Case Report

This is a case report of a 50-year-old male patient who came to the emergency department of our institution with a complaint of progressive dyspnea for a week. The patient reported a previous history of fibromyalgia and denied other comorbidities, such as myocardial infarction or stroke. He denied current smoking, but occasionally used alcohol. His routine medications included duloxetine, pregabalin and zolpidem. His mother and cousins had a history of heart failure due to idiopathic dilated cardiomyopathy, with no other cardiovascular comorbidities in his family history.

On physical examination, he showed stable vital signs, crackles in the lung bases and edema in the lower limbs. Cardiac auscultation showed normal heart sounds. The electrocardiogram showed sinus rhythm, with no signs of atrial or ventricular overload (). The chest radiography revealed cardiomegaly. The laboratory tests showed an NT-pro-BNP of 2335 pg/mL, and the series of ultrasensitive T-troponins revealed consecutive values of 0.074 ng/mL and 0.072 ng/mL (reference value < 0.014 ng/mL).

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