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CPC 2018
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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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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
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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
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CLEAR FILTERS
O extremo DO EXTREMO…
Session:
Sessão de Casos de Imagem II
Speaker:
Isabel Campos
Congress:
CPC 2018
Topic:
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Theme:
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Session Type:
Sessão de Casos de Imagem
FP Number:
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Authors:
Isabel Durães Campos; Catarina Vieira; Nuno Salomé; António Costeira; Glória Abreu; Catarina Quina Rodrigues; Cátia Costa Oliveira; Carla Rodrigues; Paulo Medeiros; Luciana Barbosa; Paulo Pinho; Jorge Marques
Abstract
<p>INTRODUCTION</p> <p>Mitral stenosis is becoming an infrequent disease in developed countries as its main cause, rheumatic fever, is also getting rare. However, both still persist in a large part of the world and cause important morbidity.</p> <p> </p> <p>CASE REPORT DESCRIPTION</p> <p>A 69-year-old woman was referred by the cardiology outpatient clinic to perform a control transthoracic echocardiogram, six months after mitral valve replacement by bioprosthetic valve. She had a history of severe mitral stenosis due to rheumatic disease and had refused surgery for 20 years, having developed severe pulmonary hypertension, left atrium (LA) volume enlargement with cardiomegaly and permanent atrial fibrillation. She also had hoarseness for several years because of compression of the left recurrent nerve by the LA, with left vocal cord paresis seen on laryngoscopy (Ortner´s syndrome).</p> <p> </p> <p>DESCRIPTION OF THE PROBLEM, PROCEDURES, TECHNIQUES AND/OR EQUIPMENT USED</p> <p>Transthoracic echocardiogram revealed a giant LA (area =135 cm<sup>2</sup>), abundant spontaneous contrast, two giant masses in LA suggestive of thrombi and normal size and function of the left ventricle. Transesophageal echocardiogram revealed a normal functioning mitral prosthesis and confirmed the presence of two giant thrombi.</p> <p> </p> <p>QUESTIONS, PROBLEMS OR POSSIBLE DIFFERENTIAL DIAGNOSIS</p> <p>Two weeks before, her oral anticoagulation was changed from warfarin to low molecular weight heparin for tooth extraction. As her oral anticoagulation was below the recommended levels, she was admitted for optimization of anticoagulant therapy. A control transesophageal echocardiogram performed a month later revealed that the thrombi reduced in size but didn´t dissolve totally. Attending to operative risk, the patient stayed in medical treatment and aspirin was associated to anticoagulation.</p> <p> </p> <p>DISCUSSION</p> <p>Rheumatic fever is the leading cause of mitral valve stenosis. When mitral stenosis is complicated by atrial fibrillation, it is essential to maintain adequate anticoagulation, to prevent the formation of thrombi in the LA and its consequences. Once more than mild symptoms exist or once asymptomatic pulmonary hypertension occurs, mechanical relief of mitral stenosis is indicated, which may be performed by the durable commissurotomy created at balloon mitral valvotomies or surgical correction.</p> <p> </p> <p>CONCLUSION</p> <p>This case illustrates the consequences of severe mitral valve stenosis and progressive enlargement of LA leading to Ortner´s syndrome and thrombi formation.</p>
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