Login
Search
Search
0 Dates
2025
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
CPC 2025
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Syncope and Cardiac Arrest: A Complex Diagnostic Puzzle
Session:
CASOS CLÍNICOS DE ARRITMOLOGIA
Speaker:
Sofia Nogueira Fernandes
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.6 Arrhythmias, General – Clinical
Session Type:
Sessão de Casos Clínicos
FP Number:
---
Authors:
Sofia Nogueira Fernandes; Mónica Dias; Carla Ferreira; Filipe Vilela; Inês Conde; Jorge Marques; Sérgia Rocha; Catarina Vieira
Abstract
<p style="text-align:justify"><strong>Case Description:</strong><br /> A 72-year-old male with a history of hypertension was admitted after experiencing a syncopal episode without prodromes, chest pain, or palpitations, with spontaneous recovery. Initial lab results showed elevated troponin I (0.46 ng/dL). ECG revealed sinus bradycardia (HR 54 bpm), nonspecific intraventricular conduction delay, and T-wave inversion from V2 to V5.<br /> Upon admission, the patient suffered a cardiac arrest due to ventricular tachycardia (VT), which was treated with defibrillation. Echocardiography showed severe left ventricular (LV) hypertrophy with preserved systolic function, distal inferior wall hypokinesia, and no significant pericardial effusion or valvular disease. Cardiac catheterization revealed no epicardial coronary disease.<br /> Later, complete atrioventricular block was detected, prompting the implantation of a temporary pacemaker. On the same day, the patient experienced another cardiac arrest due to VT lasting about 3 minutes (HR 180-190 bpm), which was treated with amiodarone. Troponin I subsequently peaked at 21 ng/mL. An implantable cardioverter-defibrillator (ICD) was implanted, and no further arrhythmic events occurred.<br /> Cardiac MRI later revealed an inferolateral infarction scar and severe interventricular septal hypertrophy (max 19 mm), with late gadolinium enhancement at the inferior interventricular junction, consistent with hypertrophic cardiomyopathy. Progressive deterioration led to severe LV systolic dysfunction, and the device was upgraded to a cardiac resynchronization therapy defibrillator (CRT-D).<br /> Genetic testing confirmed a heterozygous c.148G>A variant in the Transthyretin (TTR) gene. The patient disclosed that his daughter had recently been diagnosed with familial amyloid polyneuropathy (FAP). However, DPD scintigraphy was negative for ATTR amyloidosis (score = 0). A myocardial biopsy showed mild interstitial fibrosis, thickened and hyalinized vessels with Congo red birefringence, confirming amyloidosis.</p> <p style="text-align:justify"><strong>Discussion:</strong><br /> This case presented a significant diagnostic challenge, from the initial presentation to the final diagnosis of ATTR amyloidosis. The atypical presentation—marked by contradictory findings, including a non-suggestive cardiac MRI, negative DPD scintigraphy, a concealed family history of PAF, exclusive cardiac involvement, and an older age group—complicated the diagnostic process. Ultimately, this case underscores the importance of persistence in the diagnostic journey, especially when clinical data is inconclusive. It highlights the critical role of biopsy when needed, as specific treatments for ATTR amyloidosis are available and can significantly impact patient outcomes.</p>
Our mission: To reduce the burden of cardiovascular disease
Visit our site