Métodos de diagnóstico: uma imagem vale mais do que mil palpites Métodos gráficos Prof. Dr. Carlos Alberto Pastore

ELETROCARDIOLOGIA

Monitorização Ambulatorial do Eletrocardiograma A partir de 1961 quando NORMAN J. HOLTER introduziu na prática clínica os equipamentos para monitoração ambulatorial do ECG. Sua utilização tem sido crescente.

MONITORIZAÇÃO AMBULATORIAL DO ELETROCARDIOGRAMA HOLTER LOOPER

TESTE ERGOMÉTRICO

MAPEAMENTO ELETROCARDIOGRÁFICO DE SUPERFÍCIE BODY SURFACE POTENTIAL MAPPING ELETROCARDIOLOGIA / INCOR-HCFMUSP

CENTRAL DE TRANSMISSÃO

ARTERIOESCLEROSE ATEROSCLEROSE

Andersen [22]; with permission.) Figure 3-7. Macroscopic view of a vulnerable plaque. A, The yellow, soft, atheromatous gruel is separated from the vascular lumen by only a thin, but intact, fibrous cap. The vascular lumen is distended by white radiographic contrast medium injected post mortem. B, This cross-sectional specimen was just a few millimeters distal to the one shown in A. The thin fibrous cap is ruptured, a big cap fragment and some of the soft atheromatous gruel are missing (owing to downstream embolization), and a mural thrombus has evolved where the thrombogenic atheromatous gruel has been exposed. White contrast medium has penetrated the soft gruel through the ruptured cap. (Adapted from Falk and Andersen [22]; with permission.) ©Copyright Science Press Internet Services

TC Multislice Anatomia Coronária Normal

Angioplastia coronária

MEDICINA NUCLEAR

CINTILOGRAFIA MIOCÁRDICA DE PERFUSÃO

SPECT

L.M.F., 65 anos, Masculino, Angor Atípico, TE com ST. REPOUSO PÓS ESTRESSE FEVE= 52% FEVE= 46%

PET: PERFUSÃO E METABOLISMO UCLA 1998

ECOCARDIOGRAMA Ultrasom

Ultra-som Renal

Repouso Adenosina Dobutamina RFM = 6,2 RFM = 6,8

Insuficiência Cardíaca QRS largo DISSINCRONIA RESSINCRONIZAÇÃO

Ressincronização Cardíaca

Ressincronização Cardíaca MARCAPASSO BIVENTRICULAR

Estimulação Biventricular Técnica Transvenosa And in this other na combination of atrio-biventricular pacing with defibrillator. PA Perfil

ULTRASOM – INTRAVASCULAR PLACA DURA x PLACA MOLE

Ultra-Som Intravascular

Placa Aterosclerótica com Ruptura Figure 1-31. (see Color Plate) Additional examples of ruptured aortic atherosclerotic plaques with exposure of their lipid cores (LC) to blood elements and subsequent thrombosis. A, The ruptured ends of the fibrous cap (FC) (arrows) are shown to be considerably thinner than the rest of the collagenous intima over the plaque. Masson trichrome, original magnification, x80. B, The extruded atheromatous debris is transformed into a sizable luminal thrombus (original magnification, x200).Although the relation between atherosclerosis and thrombosis has been recognized for more than 100 years, its importance has been downplayed. In recent years, an important link between atherosclerosis and thrombosis has been attributed to lipoprotein(a) [Lp(a)]. This lipoprotein is composed of a low-density lipoprotein particle linked by a disulfide bridge to a unique apoprotein, apo(a). Apo(a) is strikingly homologous (75% to 90%) to human plasminogen. Because of this strong homology, Lp(a) binds to fibrin, whereupon it competes with both plasminogen and tissue-type plasminogen activator (t-PA) for fibrin binding, thereby reducing the significant enhancement in t-PA`s catalytic efficiency that fibrin binding facilitates [40]. Lp(a) has been demonstrated by immunohistochemistry in atheromatous lesions. By downregulating plasmin generation, Lp(a) leads to impaired activation of transforming growth factor (TGF)-B and thus may contribute to smooth muscle cell proliferation. Lp(a) may also contribute to atherogenesis by participating in the control of angiogenesis. This latter action of Lp(a) may convert a stable to an unstable plaque. Furthermore, Lp(a) may be involved in the recruitment of monocytes to the arterial wall [41]. Finally, it has been shown that patients with high levels of Lp(a) have impairment of endothelial-dependent vasodilation of epicardial arteries [42]. A–adventitia; M–media; PH–plaque hemorrhage; T–thrombus (with cholesterol clefts). ©Copyright Science Press Internet Services

Classificação de Placa Vulnerável Normal PV c/Erosão PV Propensa a Ruptura PV Propensa a Erosão PV c/Ruptura/Cicatrizando PV com nódulo calcificado PV criticamente estenótica PV com hemorragia intra-placa

SITES RECOMENDADOS http://www.ncbi.nlm.nih.gov/sites/entrez http://prevencao.cardiol.br/ http://www.theheart.org/ http://www.thevisualmd.com/index.php

PUBLICAÇÕES RECOMENDADAS Eletrocardiologia Atual Editora/Ano de publicação: Editora Atheneu, 2009