Infarto agudo de miocardio inferior enmascarando el síndrome de la onda J: A propósito de cuatro observaciones
TL;DR: El sindrome de the onda J puede estar oculto por un infarto agudo de miocardio inferior with depresion simultanea del segmento ST in las derivaciones precordiales derechas.
About: This article is published in Medicina Intensiva.The article was published on 2008-01-01 and is currently open access. It has received 2 citations till now. The article focuses on the topics: J wave & Benign early repolarization.
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TL;DR: This case illustrates the possible deleterious effects of beta-blockers in patients with Brugada syndrome and the stabilizing membrane effect of high concentration of propranolol and/or inhibition of ICaL.
6 citations
01 Jan 2011
Abstract: 136 marzo 2011 SEMG El término infarto agudo de miocardio (IAM) hace referencia a un riego sanguíneo insuficiente con daño tisular en una parte del corazón, producido por una obstrucción en una de las arterias coronarias, frecuentemente por ruptura de una placa de ateroma vulnerable. La isquemia o suministro deficiente de oxígeno resultante de la obstrucción produce la angina de pecho, que, si se recanaliza precozmente, no produce muerte del tejido cardíaco; si se mantiene esta anoxia se produce la lesión del miocardio y finalmente la necrosis, es decir, el infarto. El IAM es la principal causa de muerte, tanto en hombres como mujeres, en todo el mundo1. La facilidad de producir arritmias, sobre todo la fibrilación ventricular, es la causa más frecuente de muerte en el IAM en los primeros minutos2. Tiene una prevalencia de 0,5% de la población general y constituye el problema de salud más importante en los países desarrollados. El 5% de los IAM no son diagnosticados en el momento de la consulta y son dados de alta. Para conocer la base fisiopatológica de los síndromes coronarios agudos es fundamental manejar la anatomía coronaria básica3. El corazón esta irrigado por dos arterias principales: la coronaria izquierda y la coronaria derecha. La arteria coronaria izquierda está conformada por: • El tronco. • La descendente anterior, que da dos tipos de ramas principales: las septales y las diagonales, que irrigan los dos tercios ántero-apicales del septum interventricular y la pared ántero-lateral del ventrículo izquierdo (VI), respectivamente; también da la rama obtusa marginal que irriga la pared lateral del VI y las ramas pósterolaterales, si es dominante la descenderte posterior. • La arteria circunfleja. La coronaria derecha (CD) esta constituida por las siguientes ramas fundamentales: • Descendente posterior: irriga el tercio posterior del septum interventricular. • Aurículo-ventricular: irriga la pared posterior del VI. • Rama del nódulo sinusal: en el 60% de los casos se origina de la CD y en los restantes de la circunfleja. • Ramas ventriculares anteriores: irrigan la pared libre del ventrículo derecho (VD). • Ramas auriculares. • Rama del nodo aurículo-ventricular. Clásicamente el IAM se define por la presencia de dos de los siguientes criterios3: angor, cambios en el electrocardiograma (ECG), elevación enzimática. Según el ECG se puede clasificar en: • IAM con supradesnivel del ST (tipo Q). • IAM sin supradesnivel del ST (no Q -Tipo ST o subendocárdico). • Tipo T. • Indeterminado. • Bloqueo completo de rama izquierda (BCRI). Para realizar un buen manejo clínico y terapéutico de IAM es muy importante saber hacer un diagnóstico topográfico del mismo, es decir, conocer la localización del área del corazón infartada de acuerdo con los hallazgos en el ECG y la clínica del paciente2 (Tabla 1). Infarto agudo de miocardio póstero-inferior con “imagen en espejo” en el electrocardiograma
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TL;DR: To the authors' knowledge, this is the first report of an intracavitary demonstration of complete RBBB in Brugada syndrome.
12 citations
TL;DR: A 58 year old man was referred following the diagnosis of recent onset inferior myocardial infarction andCoronary arteriography showed a critical stenosis in the proximal segment of the right coronary artery.
Abstract: A 58 year old man was referred following the diagnosis of recent onset inferior myocardial infarction (A). Coronary arteriography showed a critical stenosis in the proximal segment of the right coronary artery. Percutaneous transluminal coronary angioplasty …
12 citations
TL;DR: The described association can be important because interaction between ischemia and Brugada syndrome electrophysiological substrate could modulate individual susceptibility to life‐threatening ventricular tachyarrhythmias.
Abstract: This report describes a case of an unusual association between vasospastic angina, coronary myocardial bridging, and Brugada syndrome. The patient complained of chest pain followed by rhythmic palpitation and syncope. Brugada syndrome ECG markers were documented with transient ST-segment elevation in lateral leads. A coronary angiogram showed a myocardial bridging in the left anterior descending artery and coronary vasospasm was reproduced after intracoronary ergonovine injection in the circumflex coronary artery. Ventricular fibrillation was induced by programmed electrical stimulation. The described association can be important because interaction between ischemia and Brugada syndrome electrophysiological substrate could modulate individual susceptibility to life-threatening ventricular tachyarrhythmias.
10 citations
TL;DR: A 35-year-old man screamed during sleep and became unresponsive; personnel from emergency medical services found him in ventricular fibrillation; normal rhythm was restored, but he did not regain consciousness.
Abstract: A 35-year-old man screamed during sleep and became unresponsive. Personnel from emergency medical services found him in ventricular fibrillation; normal rhythm was restored, but he did not regain consciousness. An electrocardiographic examination in the emergency department showed ST-segment elevation, and there was evidence of pseudoephedrine in the serum. The results of cardiac catheterization were normal. A diagnostic procedure was performed.
9 citations
TL;DR: In a 51-year-old man, without detectable structural heart disease, the double localization of the typical Brugada-pattern and the paradoxical effect of ajmaline on the ECG abnormalities confirmed the possibility of a phenotype heterogeneity in the Brugadas.
Abstract: Aims The typical Brugada ECG pattern consists of a prominent J-wave associated with ST-segment elevation localized in the right precordial leads V1–V3. In many patients, the ECG presents periods of transient normalization and the Brugada-phenotype can be unmasked by the administration of class-I antiarrhythmics. Reports have documented the heterogeneity of the Brugada syndrome ECG-phenotype characterized by unusual localization of the ECG abnormalities in the inferior leads.
Case report A 51-year-old man, without detectable structural heart disease, was referred to us because of a history of syncope, dizziness, and palpitations. The ECG showed a J-wave and ST-segment elevation in the right precordial leads, suggesting Brugada syndrome. As other causes of the ECG abnormalities were excluded, the patient underwent an electrophysiological study that documented easy induction of ventricular fibrillation. During infusion of ajmaline, new prominent J-waves and ST-segment elevation appeared in the inferior leads, whereas the basal ECG abnormalities in the right precordial leads normalized. After infusion of isoprenaline, the ECG-pattern resumed the typical Brugada pattern. An implantable cardioverter-defibrillator was recommended.
Conclusion In our patient, the double localization of the typical Brugada-pattern and the paradoxical effect of ajmaline on the ECG abnormalities confirmed the possibility of a phenotype heterogeneity in the Brugada syndrome.
8 citations