Biomedical subjects
J Pimenta
Publications and source records attributed to J Pimenta.
[Uhl's anomaly in adults associated with coronary disease].
A 56-year-old male patient was submitted to coronary artery bypass graft surgery. Pericarditis and dilatation of the right ventricle with thinning of the walls of the right ventricle was observed. Intraoperative right ventricle biopsy revealed fibro-adipose tissue. The diagnosis of concomitant Uhl's syndrome was made.
Return ventricular rhythm: new mechanism for tachyarrhythmia.
A case study is presented in which the electrocardiographic patterns during tachycardia showed ventricular premature depolarizations with retrograde conduction to the atria probably using a left-sided anomalous pathway and reentry to the ventricles with normal ventricular activation and duplication of the heart rate. This type of tachycardia is being labeled "return ventricular rhythm" and, as far as it is known, this is the first description of its mechanism.
[Clinical and angiographic characteristics of acute anteroseptal and upper lateral myocardial infarction: obliquous infarction; proposal of a new denomination for a specific type of infarction].
PURPOSE: Analysis of clinical and angiographic characteristics of oblique (anteroseptal and high lateral) myocardial infarction. MATERIAL AND METHODS: Forty-two patients, 33 men, aged 30 to 79 years (mean 57) with oblique myocardial infarction were clinically evaluated and through coronary arteriography between ten day and eight months (mean of two months) of the acute event. RESULTS: Twenty patients had severe proximal lesions of left anterior descending artery (LAD), being single in thirteen. Four cases showed severe lesions in two arteries and three cases in three arteries. Fourteen patients exhibited collateral circulation to LAD or recanalization. Ejection fraction values were between 0.12 and 0.65 (mean 0.38). Eight patients died, four of them due to myocardial failure and four due to noncardiac causes. During follow-up angina pectoris was present in five, stroke in three and pulmonary embolism in two patients. CONCLUSION: Oblique myocardial infarction is associated with single and proximal lesion of LAD in the majority of the patients who underwent coronary arteriography, with low incidence of cardiac failure and death.
[Total A-V block due to tuberous sclerosis. A case report].
Tuberous sclerosis is a neurologic disease affecting various organs with a triade: sebaceum adenoma, mental retardation and seizures. This report presents a case of a patient with tuberous sclerosis and third degree A-V block with complete invasive and non-invasive evaluation. The patient had sincope and complete A-V block with QRS complexes showing right bundle branch block morphology. The echocardiogram showed dilated cardiomyopathy with diffuse left ventricular dysfunction and had normal coronary arteriography. The eletrophysiologic evaluation showed complete infra-hisian A-V block and QRS with left bundle branch block pattern with normal sinus nodal and A-V nodal function. It was not possible to induce ventricular tachtyarrhythmias up to two extrastimuli. Histologic study showed normal myocardium under light and electronic microscopy. After permanent VVI pacemaker implant, the patient in follow-up for 16 years. This case seems to be the first in the international medical literature of tuberous sclerosis with complete heart block.
Tachycardia mediated by an AV universal (DDD) pacemaker triggered by a ventricular depolarization.
A 44-year-old female had Chagas' disease with right bundle branch block, right axis deviation, and ventricular ectopic beats. An invasive evaluation showed a prolonged HV interval of 100 ms. A Medtronic Versatrax 7000 was implanted, after which a pacemaker-mediated tachycardia was observed. The esophageal lead ruled out the possibility of an atrial triggered tachycardia. The diagnosis was pacemaker-mediated tachycardia due to abnormal sensing of the terminal forces of the ventricular activation because of malposition of the atrial lead in the right ventricular out-flow tract.
[Demonstration of re-entry in the His-Purkinje system in chronic Chagas' disease. Possible mechanisms of tachyarrhythmia].
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[Double pathway of intranodal AV conduction in chronic Chagas cardiopathy].
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Double ventricular response to an extrastimulus in a patient with triple atrioventricular pathways.
A patient with the Wolff-Parkinson-White Syndrome was studied through recordings of the intracardiac potentials and programmed atrial stimulation. During programmed atrial stimulation at progressively shorter coupling intervals (A1-A2 intervals), the His deflection was always recorded after the ventricular complex. Thus, at coupling intervals between 295 and 250 msec, there was a double ventricular response, one through the accessory pathway (QRS complex of the Wolff-Parkinson-White morphologic pattern) and the other by the normal atrioventricular pathway (normal QRS complex or with pattern of left bundle-branch block). At a coupling interval of 295 msec, the atrio-His (A-H) interval increased from 200 to 350 msec. This fact and the presence of two distinct A2-H2 intervals are suggestive of the existence of dual atrioventricular pathways, coexisting functionally with a lateral accessory bypass (Kent's bundle).
[Use of an artificial electrical pacemaker in chronic Chagas' cardiopathy].
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[Coronary radiography, coronary spasm and myocardial infarct].
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