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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
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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
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K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
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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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Abstract
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CLEAR FILTERS
Sometimes less intervention is for the patient's best interest
Session:
Sessão de Casos Clínicos - I
Speaker:
Rita Rocha
Congress:
CPC 2019
Topic:
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Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Rita Caldeira Da Rocha; Renato Fernandes; DAVID NEVES ; Mafalda Carrington; Antonio; Diogo Brás; Rui Azevedo Guerreiro; Kisa Hyde Congo; Bruno Cordeiro Piçarra; José Eduardo Aguiar
Abstract
<p>Introduction: Spontaneous coronary artery dissection is a rare cause of acute coronary syndromes, being responsible for 0,1-0,4% of them. It occurs more frequently in younger female patients, being responsible for up to 25% of all ACS cases in women under 50 years old.</p> <p>Case: 39 years old female patient with smoking habits (10 cigarettes per day)went to the Emergency Room(ER) with precordial pain with irradiation to right arm associated with paraesthesia, diaphoresis, nausea and vomiting. During the next days, she had no precordial discomfort, but still with arm pain and paraesthesia. On the third day, the patient had a recurrence of the chest pain, which woke her up, so she went to the ER. Physical examination was unremarkable. ECG revealed sinusal rhythm, q wave in DI, V5-V6, negative T wave in DI, aVL, V2-V6. Blood tests were positive for high sensitivity T troponin (318,9ng/L). Transthoracic echocardiogram revealed a moderate depression of global Left Ventricular function, due to anterolateral akinesia. With a diagnosis of subacute anterior MI, she was transferred to Coronary Intensive Care Unit.</p> <p>In the Cath Lab, Ventriculography was coherent with the echo, confirming moderate depression of global systolic function (Ejection Fraction 35%) because of anterolateral akinesia, apical dyskinesia and compensatory basal posterior hyperkinesia. Coronary angiogram, showed 1 vessel disease: 90% long lesion in the proximal to mid sections of the left anterior descending artery (LAD), suggestive of spontaneous coronary dissection, but with a good flow (TIMI 3). Distal left main with a 30% lesion, corresponding to the proximal intimal tear, and contiguous with an intimal flap. Second diagonal (D2) with 99% ostial obstruction.</p> <p>Due to the clinical stability of the patient (absence of angina pectoris, arrhythmias or heart failure), it was decided not to perform angioplasty, keeping with a conservative therapy. The patient was treated with antihypertensive drugs- Enalapril 10 twice a day and Carvedilol 6,25mg twice a day, due to beta blockers negative chronotropic and inotropic actions and antithrombotic therapy with aspirin 100mg id and enoxaparin 40mg id.</p> <p>The patient was asymptomatic for two weeks and then she performed an angio CT, for angiographic revision. The dissection was still present being evident its origin in the distal left main, in a significant LAD stenosis (90%) and a non- opacified false lumen.</p> <p>Conclusion: Despite the natural tendency of treating a significant lesion on the left main to LAD, in case of a spontaneous coronary dissection, a conservative therapy is generally more accepted, and is recommended to be the first line of strategy. There is no consensus on the best antithrombotic therapy for these cases. In this particular clinical situation, it was decided to use a conservative approach with a good clinical evolution, although with a concerning coronary anatomy.</p>
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