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F Morgado

Publications and source records attributed to F Morgado.

35 records · Page 2Linked to original sources
PubMed1996

[The radiofrequency catheter ablation of occult accessory atrioventricular pathways].

OBJECTIVE: The aim of this study was to evaluate our results of radiofrequency catheter ablation (RFCA) of concealed accessory atrioventricular pathways (CP). PATIENT SELECTION: We treated with RFCA 19 patients, with 21 CP, 10 men and 9 women, mean age 37 +/- 16 years, with supraventricular tachycardia (SVT) and absence of ventricular pre-excitation in the electrocardiogram (ECG). These patients comprised 50% of the patients who underwent RFCA for SVT and had no ventricular pre-excitation in the ECG. The diagnosis of CP was made by electrophysiologic study, based on the demonstration of a pathway capable of retrograde conduction only. METHODS: The RFCA was performed without antiarrhythmic drugs in the same session of the electrophysiologic diagnosis. The location of the CP site was obtained by catheter mapping, looking for the earliest atrial retrograde activation during tachycardia or ventricular pacing. RESULTS: The CP had a right-sided location in only 2 patients who had an incessant form of SVT, the CP in these patients exhibit decremental conduction--permanent junctional reciprocating tachycardia. In the other patients the CP was left-sided, lateral in 11 patients, posterior in 3, postero-septal in 3 and medial septal in one patient. In 9 patients there was a simultaneous ventricular activation in the his bundle electrogram and in the electrogram of the ablation site, suggesting partial anterograde penetration of the stimuli on the accessory pathway. Success criteria were achieved in 18 patients (95%) corresponding to 20 CP. CONCLUSIONS: The prevalence of CP in the presence of SVT without ventricular pre-excitation is high, almost all left-sided. The CP displays eccentric atrial activation during SVT. It is possible that CP are capable of partial anterograde conduction as well. The success rate of RFCA is high.

Adolescent↗
PubMed1996

[The radiofrequency catheter ablation of ventricular tachycardia].

OBJECTIVE: The aim of this study was to evaluate our results of radiofrequency catheter ablation (RFCA) of ventricular tachycardia. PATIENT SELECTION: We treated with RFCA nine patients, six male and three female, mean age 36 +/- 12 years with ventricular tachycardia (VT), who fulfilled the following criteria; 1) recurrent VT; 2) resistant fo medical therapy despite the use of more than one antiarrhythmic drug; 3) inducible by programmed ventricular stimulation; 4) hemodynamically well tolerated. The VT etiology was coronary artery disease (CAD) in three patients, dilated cardiomyopathy in one, right ventricular dysplasia in one and it was idiopathic in four (being fascicular in three and catecholaminergic right ventricular outflow tract VT in one). METHODS: The RFCA was performed under antiarrhythmic medication. The adequate ablation site was obtained by mapping of the VT, looking for the earliest ventricular activation, identification of isolated mid-diastolic potentials during sinus rhythm or presystolic during VT, good pace mapping (at least 10 of the 12 standard ECG leads), and high frequency short duration spikes, the so called P potentials in fascicular VT. Primary success achieved when occurred termination of VT during application of RF energy and/or VT was no longer inducible by programmed stimulation with the same stimulation protocol. RESULTS: Global primary success rate was 89%, being 100% in idiopathic VT, and 80% in VT associated with structural heart disease. In a follow-up period of 12 +/- 14 months all patients were alive, 75% free of VT in the idiopathic VT group; and 50% in patients with structural heart disease. One of these patients underwent cardioverter defibrillator implantation to treat a fast VT with a new morphology not treated by ablation, and the other two had VT modification with a significant reduction in the number of episodes. CONCLUSIONS: Radiofrequency catheter ablation of VT has shown a good success rate, and it is a valuable alternative in patients with hemodynamically tolerable VT, refractory to drug treatment, highly symptomatic and without surgical indication. In cases of idiopathic VT we had a high rate success and we think that RFCA will probably become the primary indication in symptomatic patients.

Adult↗
PubMed1996

[Exertion syncopal crisis in the young, associated with idiopathic long QT syndrome].

The cases of two young patients with repetitive syncopal attacks due to idiopathic long QT syndrome (ILQTS) are reported. Both had been primarily misdiagnosed for seizures. In one of the cases the QT interval in the ECG at rest was normal. The same patient had a previous episode of cardiac arrest with ventricular fibrillation. The treadmill stress test was of great value, revealing polymorphic ventricular tachycardia induced by exercise, and evaluating the efficacy of beta-blocking therapy in the follow-up. The ILQTS should be considered a possible etiology in any patient presenting with new onset seizures, especially in the young. The treatments were different in both cases. In the first one, the treatment with nadolol (100 mg od) revealed to be very effective with total remission of symptoms. The treadmill stress test performed 15 days after the beginning of treatment did not show any ventricular arrhythmias, and it was assumed that the patient was effectively protected against ventricular arrhythmias. After 4.5 months of follow up, no syncopal episodes occurred. In the second case due to young age, the frequency, and the severity of the attacks (cardiac arrest with ventricular fibrillation), and the inefficacy of beta-adrenergic-blocking agents, the implantable cardioversor-defibrillator was the treatment chosen, although the beta blocking therapy was maintained to reduce the number of arrhythmic events. The ILQTS is a rare anomaly related to sudden cardiac death. The ILQTS is characterised by the association of several distinctive electrocardiographic features, among which prolongation of the QT interval is the best known. Life-threatening arrhythmia occurs usually under conditions of physical or psychological stress. Relatively effective therapies do exist and are represented by antiadrenergic interventions: beta-adrenergic-blocking agents are the treatment of choice. When they fail, left sympathetic denervation or the automatic implantable cardioversor-defibrillator have also proved to be effective.

Adult↗
PubMed1996

[Acute myocardial infarct in a young cocaine user].

In patients less than 40 years of age, acute myocardial infarction (AMI) has special clinical and pathophysiologic characteristics. Its prevalence varies between 5 and 10%. In such patients, AMI associated with chronic cocaine abuse has a non-negligible prevalence of 6%. The purpose of this report is to describe the case of a 24-year old male patient with smoking habits and chronic abuse of cocaine and hallucinogenic drugs. This patient developed clinical, enzymatic and electrocardiographic criteria of anterior AMI, two hours after the ingestion of an LSD-like hallucinogenic drug. The coronary angiography revealed a critical stenosis of the medium segment of the left anterior descendent artery, and a pre-stenotic aneurysmatic dilatation. In order to determine the etiology of the aneurysm, various laboratory and histologic tests were performed. The results of these were normal. We review the pathophysiology, clinical manifestations and prognosis of cocaine-associated AMI.

Adult↗
PubMed1996

[Experience with dl-sotalol in the treatment of supraventricular arrhythmia].

OBJECTIVES: To review the results of our experience with oral dl-sotalol for preventive treatment of supraventricular tachyarrhythmias (atrial fibrillation and paroxysmal supraventricular tachycardia). POPULATION: 51 patients, 28 female and 23 male, mean age 46.2 +/- 14.4 years, from outpatient arrhythmology clinics of our institution, with recurrent supraventricular tachyarrhythmias (atrial fibrillation in 24 patients and paroxysmal supraventricular tachycardia in 27). All the patients, but one, had normal left ventricular function. Dl-sotalol was first choice medication in only three patients. Previously 2 +/- 1.3 antiarrhythmic drugs had been used. METHODS: Retrospective evaluation of therapeutic response (number of clinical recurrences according to a semi-quantitative scale) and secondary effects of dl-sotalol during a minimum follow-up of 18 months. The mean daily dose was 205 +/- 90 mg (80 to 400 mg). RESULTS: In 37% of the patients there were no clinical recurrences of arrhythmia during follow-up. In 37% of the patients there was a significant reduction in recurrences. In 26% there was no change in the number of recurrences. There were no significant differences in response between patients with atrial fibrillation and those with paroxysmal supraventricular tachycardia. Secondary effects occurred in 16% of the patients: symptomatic bradycardia, asthma or sexual dysfunction. No patient had heart failure, torsades de pointes, syncope or death. CONCLUSIONS: From our experience, DL-sotalol seems to be a good therapeutic alternative for the preventive treatment of supraventricular tachyarrhythmias, with a low risk in patients with good ventricular function.

Adult↗
PubMed1993

Neurologic involvement in patients with rheumatoid arthritis with atlantoaxial subluxation--a clinical and neurophysiological study.

Anterior subluxation of the atlantoaxial joint (AAS) is a frequent and potentially serious complication of rheumatoid arthritis (RA). The results of neurological evaluation, obtained in 30 patients with RA with AAS, and of somatosensory evoked potentials (SEP) studies, accomplished in 25 of these patients, were compared with the findings observed in 20 patients with RA without AAS, all of whom underwent neurological evaluation and SEP studies. Abnormal plantar responses were found only in patients with RA with AAS. There were more frequent SEP abnormalities in patients with RA with AAS than in patients without AAS, namely increased latencies of the N13 potentials evoked by stimulation of the median and radial nerves, which correspond to conduction delays at the cervical spinal cord level. A sensitivity of 56% and a specificity of 90% for SEP studies in the diagnosis of AAS in patients with RA were found. On the other hand, the observation that the mean values for the latencies of the N11 and N13 potentials evoked by stimulation of the radial nerves were significantly higher in patients with RA with AAS compared to patients with RA without AAS may suggest the existence of a frequent subclinical involvement of the cervical spinal cord caused by AAS.

Adult↗
PubMed1993

[Prognosis in unstable angina as a function of the clinical presentation].

OBJECTIVE: To assess the prognosis of Unstable Angina according to its clinical presentation using Braunwald's Classification. DESIGN: Retrospective study of hospital admissions from January 1982 to September 1990. SETTING: Coronary Care Unit and a Cardiology Department of a Central Hospital. PATIENTS: There were 132 patients, 109 men and 23 women, with a mean age of 56 +/- 9 years, all submitted to cardiac catheterization at least 90 days after hospital admission followed up during 34.2 +/- 24.2 months. MATERIAL AND METHODS: Patients were divided in three groups according to the clinical presentation of Unstable Angina: Group A--Aggravated Chronic Angina and/or "De Novo" Angina; Group B--Angina at Rest but not in the last 48 hours, and Group C--Angina at Rest in the last 48 hours. Group A was also sub-divided, and the patients with Unstable Angina after myocardial infarction were excluded. The previous clinical profile was evaluated as well as the circumstances in which Unstable Angina occurred, need of Coronary Care Unit, angiographic findings and follow-up. RESULTS: Within the 132 patients, 86 were in the group A, (59 with Aggravated Angina and 27 with "De Novo" Angina), 11 in group B, and 35 in group C. The group with Aggravated Angina had higher incidence of previous myocardial infarction and bypass surgery (p < 0.01 and p = 0.05), compared to group with "De Novo" Angina and B, and also three vessels disease associated to ventricular dysfunction. "Culprit Lesion" appeared more frequently as eccentric type I in group A, and as concentric in group C. Revascularization procedures were performed in 95 patients (CABG in 66 and PTCA in 29) being respectively: 21 and 6 were urgent, 19 and 18 were elective and 26 and 5 were late procedures. CABG were more frequent in group A. There were 73 major cardiac events in 44 patients (8 deaths, 12 myocardial infarction and 53 new episodes of Unstable Angina), which were more frequent in group with Aggravated Angina and group C. The chance of patients with major cardiac events was in a 78 months follow-up, about 25% for group with "De Novo" Angina, 50% for patients with Aggravated Chronic Angina, and was greater than 75% in patients with Angina at Rest and episodes in the last 48 hours (p < 0.05)--Log-rank Test. The worse prognosis was seen in patients with Aggravated Chronic Angina, when a gathering of clinic patterns of Braunwald's classification were present. CONCLUSIONS: In summary, the group with Aggravated Angina and group C had more severe disease, required more urgent CABG and PTCA, and had also a higher incidence of cardiac events. The group with better prognosis was the group with "De Novo" Angina, which should be distinguished of the group with Aggravated Angina who was the worst prognosis.

Aged↗
PubMed1990

Mesencephalic haematoma: case report with autopsy study.

A 70-year-old hypertensive woman suffered sudden onset of bilateral blepharoptosis. Within a few hours she developed focal signs attributable to a lesion of the mesencephalon, and a stuporous state, from which she did not recover. Neuropathological examination showed a mesencephalic haematoma, but no arteriovenous malformation. A review of reported cases suggests that mesencephalic haematomas have a worse prognosis when they occur in aged hypertensive patients, as compared with younger normotensive patients, in whom they are probably related to arteriovenous malformations.

Aged↗