Congenital arrhythmia in a normal newborn

We describe a case, unique to the best of our knowledge, in which bigeminal supraventricular premature contractions were detected in a normal newborn. These arrhythmias disappeared spontaneously after the twelfth day of life. Since they do not appear to evolve towards paroxysmal supraventricular tachycardia, treatment with antiarrhythmic drugs is not recommended.     

Ruptured pseudoaneurysm of aortic root graft into the pulmonary artery as a cause of severe heart failure.

A 52-year-old man presented with heart failure of 1 month duration. He had undergone aortic valve and root replacement 30 months before admission. A continuous murmur was heard in the second intercostal space at the parasternal border. Aortography showed a pseudoaneurysm surrounding the aorta, whereas color Doppler study revealed flow from the central aorta to the pseudoaneurysm and flow from the pseudoaneurysm to the pulmonary artery trunk through a fistulous communication between them. Thus, fistulous communication with pulmonary artery causing heart failure is a complication of pseudoaneurysm after aortic and root replacement, which can be diagnosed clinically and echocardiographically.     

Persistent parvovirus B19-induced anemia in an HIV-infected patient under HAART. Case report and review of literature

Recent reports document resolution of human parvovirus B19-related pure red blood cell aplasia (PB19-PRCA) in HIV-infected patients upon commencement of highly active antiretroviral therapy (HAART). This article describes a patient with PB19-PRCA who, despite fully suppressive HAART, required cyclic administration of intravenous human immunoglobulin over a period of 17 months before PB19 seroconversion and subsequent resolution of relapsing severe anemia. All reports in the English literature describing PB19-related hematologic abnormalities in the post-HAART era are also described herein.     

Chronic Chagas' heart disease in children and adolescents: a clinicopathologic study

A retrospective study of the medical records filed at the University Hospital from 1965 to 1983 and of 18456 autopsies carried out in the Department of Pathology of this Institution from 1953 to 1983, referring to patients aged less than 18 years was performed in an attempt to fully characterize chronic Chagas' heart disease in children and adolescents. Only 19 of these patients fulfilled the criteria for inclusion in the present study (12 cases with only clinical information and 7 cases with clinical and pathological information). We noted that the clinical manifestations of chronic Chagas' heart disease are congestive heart failure, thromboembolism and sudden death. Radiologic, electrocardiographic and anatomo-pathological findings demonstrated serious myocardial involvement. This set of alterations is also detected in adults with chronic Chagas' heart disease. Among adolescents, however, the disease exhibits relevant peculiarities such as rapid evolution to death within a short period of time (128 days), diagnostic difficulty related to the presence of significant mitral regurgitation (61% erroneous initial diagnosis), and low frequency of right bundle branch block (11% of cases). These findings suggest that among children and adolescents, chronic Chagas' heart disease may be of a peculiar type and therefore may be useful to clarify the pathogenetic mechanism of the disease.     

Stroke in a hospital-derived cohort of patients with chronic Chagas' disease

The aim of this study was to determine the prevalence of stroke in a hospital-derived cohort of patients with chronic Chagas' disease. Seventy-nine patients with chronic Chagas' disease were prospectively followed at the Cardiomyopathy Clinic of the Santa Casa Hospital from January 1990 to June 1993 (mean follow up = 17 +/- 12 months). Mean New York Heart Association functional class was 2.42 +/- 1.24. Fifty-six (70%) patients were on angiotensin-converting enzyme inhibitors at maximum tolerated doses, but no patient was on anticoagulation therapy. Atrial fibrillation was detected on the resting ECG in twelve (15%) patients. On echocardiography, mean left ventricular ejection fraction was 49.07 +/- 17.96% and mean left ventricular diastolic dimension 60.12 +/- 10.97 mm; mitral regurgitation was detected in 20 (29%) patients. Left ventricular thrombus was seen in three (4%) patients; all of them were in sinus rhythm and had left ventricular dysfunction on echocardiography. No thromboembolic event, however, was detected during the follow-up. One patient (1%) had a fatal stroke during the study period; she was in sinus rhythm on the resting ECG, and had mild mitral regurgitation, normal left ventricular function and no intracavitary thrombus on Doppler echocardiography. The prevalence of stroke is low in a hospital-derived cohort of patients with mild to moderate heart failure due to chronic Chagas' disease. Routine prophylactic anticoagulation, therefore, seems not to be warranted.     

Myocardial bridging of coronary arteries associated with an impending acute myocardial infarction

A 57-year-old woman developed severe substernal chest pain radiating to the left arm accompanied by pallor and marked diaphoresis. These symptoms appeared at rest, lasted 45 minutes, and terminated spontaneously. The patient had been treated for mild hypertension during the last 6 months. An ECG tracing obtained at the beginning of treatment was unremarkable. However, an ECG tracing recorded shortly after the end of the symptoms showed T-wave inversion in all anterior leads. Coronary arteriography was then performed and showed no fixed obstructive coronary artery disease. Nonetheless, a lengthened and constricted myocardial bridging of both the left anterior descending coronary artery and its major diagonal branch was detected. Also, the left anterior descending coronary artery was observed to be very short, terminating before the cardiac apex. The left ventricle was hypertrophied. The patient was treated with a beta-blocking agent which eliminated all symptoms. An ECG tracing obtained about three months after the onset of the clinical picture was normal. Our findings suggest that marked myocardial ischemia at rest does occur in patients having myocardial bridges under special circumstances, such as lengthened and constricted myocardial bridging of a short coronary artery which supplies a hypertrophied ventricle. This anomaly should be taken into account as a possible cause of a threatened myocardial infarction, which may be successfully treated with a beta-blocking agent.     

Sexually dimorphic effects of aging on rat somatotropes and lactotropes

During the aging process modified functions of hypothalamic factors may cause sexually dimorphic changes in pituitary somatotropes and lactotropes. To test this hypothesis, pituitary tissue from young adult (4 months) and old (20-22 months) male and female rats was labeled immunocytochemically for growth hormone (GH) and prolactin (PRL). The total amount of immunoreactive material as well as the total area and number of immunoreactive structures were evaluated. With increasing age the intracellular GH content was moderately increased in male and decreased in female rats. An age-dependent PRL increase, due both to increased cell number and intracellular hormone content, was present only in female rats. The amount of GH- and PRL-immunoreactive material, distributed into classes of increasing density, differed both between sex and age groups. Our results indicate that the aging process of the somatotrope and lactotrope cell populations in rats appears to be different in the two sexes.