Pneumothorax – ABC CARDIOL

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Editorial

Cost-Effectiveness Related to Implantable Electronic Cardiac Devices: An Ever-Constant Concern

Implantable electronic cardiac devices (IECDs) play a crucial role in patients with bradyarrhythmias, with proven effectiveness in improving quality of life and maintaining life itself, and their use in clinical practice is unquestionable. However, the technology used and its possible complications represent a considerable cost to regulatory agencies and the respective paying sources. If, on the one hand, the benefit of IECDs in different clinical scenarios is not questioned, on the other hand, the associated cost, including possible complications, should also be a reason for reflection.

The initial cost related to the procedure is high, as is the cost related to possible complications, such as pneumothorax, hemothorax, electrode disposition, infection, and clinical complications in general.^–

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Anatomopathological Session

Case 1/2013: 69-year-old male patient with sudden back and lower right limb pain and shock

Carlos Vinícius Abreu do Espirito Santo et al. Rafael Alves Franco Luiz Alberto Benvenuti

The patient, MSM, a 69-year-old man, sought medical care due to left dorsal and right lower limb pain. The chest x-ray showed mediastinal enlargement. He was undergoing examination when he lost consciousness and went into shock. Subcutaneous emphysema was observed in the left hemithorax, as well as abolition of breath sounds at auscultation. Tracheal intubation was performed with draining of blood-tinged fluid from the left hemithorax. Echocardiography showed left ventricle with 44/29 mm; septum, 12 mm; posterior wall, 13 mm; mild aortic root dilation, dissection of the lamina and periaortic hematoma. The valves and pericardium were normal. The patient was transferred to Instituto do Coraçao – InCor. Physical examination (21 Oct 2004: 10:45) showed that the patient was sedated with tracheal intubation, pale, heart rate at 90 bpm, blood pressure 130 x 80 mmHg, bloody drainage in the chest tube. Electrocardiogram – frequency 90 bpm, sinus rhythm, low voltage in the frontal plane and decreased voltage in left leads (Fig. 1). Computed tomography showed bilateral subcutaneous emphysema, thoracic aorta with inaccurate borders in its descending portion (from the subclavian artery to the middle portion), collapsed left lung and extensive collection of hematic characteristics in same hemithorax and middle and posterior mediastinum. Small right pneumothorax; small right pleural effusion with underlying parenchymal alterations. The analysis of the heart was impaired by the presence of hemothorax. While undergoing computed tomography, the patient showed no pulse, mydriasis, with asystole unresponsive to resuscitation and died (21 Oct 2011; 15:00 h).

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Cost-Effectiveness Related to Implantable Electronic Cardiac Devices: An Ever-Constant Concern

Case 1/2013: 69-year-old male patient with sudden back and lower right limb pain and shock

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