<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><FONT class="Apple-style-span" face="Arial">Español - Portugués</FONT><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Español</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Estimada Dra. Priori:</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Muchas gracias por su respuesta. Estoy plenamente de acuerdo con lo que Ud. afirma. Pero para la realización práctica de su enfoque y la identificación de pacientes con enfermedades en alto riesgo de MSC, jóvenes (<45 años), posiblemente sea importante incluir muerte súbita familiar en clase 1 de indicación de ECG y monitoreo Holter (en primer lugar para los médicos generalistas). Y según la siguiente afirmación, pregunto - ¿"Caso familiar de muerte súbita" es un diagnóstico o no para los familiares de la víctima?</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Leonid Makarov</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">------------------</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Portugués</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Cara Dra. Priori, muito obrigada pela sua resposta. Eu concordo completamente com sua menção. Mas para realização prática desta estratégia e identificação de pacientes jovens com doença de alto risco de MCS (<45anos), possivelmente é importante incluir morte súbita familiar na 1º classe de indicação para ECG e monitorização por Holter (primeiramente para médicos generalistas). E de acordo com a próxima menção, questão - "caso de morte súbita familiar" isto é diagnóstico ou não para membros da família da vítima? </FONT></DIV><P style="margin: 0.0px 0.0px 0.0px 0.0px"><FONT class="Apple-style-span" face="Arial"> </FONT></P><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Leonid Makarov</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">--</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Dr.</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Sergio</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Dubner</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">President</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">of</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Scientific</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Committee</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR style="font-family: Lucida Grande; font-size: 13px; "></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Dr.</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Edgardo</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Schapachnik</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">President</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">of</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Steering</FONT><SPAN class="Apple-converted-space"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Committee</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR class="Apple-interchange-newline"></FONT></SPAN><FONT class="Apple-style-span" face="Arial"> </FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT><DIV><BLOCKQUOTE type="cite"><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; min-height: 14px; "><FONT class="Apple-style-span" face="Arial"><BR></FONT></DIV> <DIV><FONT class="Apple-style-span" face="Arial">Español - Portugués</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Español</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><FONT class="Apple-style-span" face="Arial">El Dr. Leonid Makarov desde Rusia pregunta</FONT><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">- </FONT><SPAN style=""><FONT class="Apple-style-span" face="Arial">¿Sería necesario realizar</FONT></SPAN><SPAN lang="ES-AR" style=""><FONT class="Apple-style-span" face="Arial"> estudios diagnósticos a los familiares de una víctima de</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">muerte súbita de origen no coronario, en el caso si esta víctima fuera joven (hasta 45 años) y no tuviera antecedentes de patología cardiológica? Si existiera tal necesidad, ¿qué 3 primeros estudios diagnósticos habría que realizarles?, tanto en el nivel de los consultorios externos no especializados, cuanto en un centro cardiológico especializado de alta complejidad.</FONT></SPAN></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">La Dra. Silvia Priori desde Italia, responde</FONT></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">- </FONT><SPAN lang="ES" style=""><FONT class="Apple-style-span" face="Arial">En cualquier caso de muerte súbita cardíaca inexplicable, especialmente en jóvenes, una evaluación de los familiares es razonable.</FONT></SPAN><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">La primera cosa importante según mi punto de vista, es realizar una recolección cuidadosa de la historia familiar, construyendo un árbol genealógico. <BR></FONT></SPAN></SPAN></DIV></TD></TR></TBODY></TABLE></SPAN></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">Hay que hacer preguntas a los familiares por ocurrencias de muerte súbita (especialmente muerte asociada con estrés, ejercicio y emoción o muerte durante <BR></FONT></SPAN></SPAN></DIV></TD></TR></TBODY></TABLE></SPAN></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">el sueño); y hacer preguntas sobre la ocurrencia familiar de síncope y arritmias. Resulta útil recordar que la epilepsia con frecuencia es un diagnóstico en <BR></FONT></SPAN></SPAN></DIV></TD></TR></TBODY></TABLE></SPAN></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">pacientes con síncope repetido y convulsiones como manifestación: por lo tanto, puede ser útil distinguir entre la típica epilepsia que responde a terapia vs. <BR></FONT></SPAN></SPAN></DIV></TD></TR></TBODY></TABLE></SPAN></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">epilepsia atípica que no responde a terapia. La segunda puede de hecho, ser un diagnóstico erróneo de síndrome arritmogénico. </FONT></SPAN><SPAN class="Apple-style-span" style="border-collapse: collapse;"><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></SPAN></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">En términos de investigación de familiares, el primer paso es una búsqueda ECG/Holter para el diagnóstico de Brugada, síndrome de QT prolongado y signos <BR></FONT></SPAN></SPAN></DIV></TD></TR></TBODY></TABLE></SPAN></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">ECG de miocardiopatías. Se indica eco para la identificación de miocardiopatía del ventrículo derecho, miocardiopatía hipertrófica y miocardiopatía dilatada. </FONT></SPAN><SPAN class="Apple-style-span" style="border-collapse: collapse;"><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></SPAN></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">Si ocurre muerte súbita durante ejercicio físico y/o si cualquier familiar ha experimentado síncope durante actividad física, una prueba de esfuerzo también puede realizarse. </FONT></SPAN><SPAN class="Apple-style-span" style="border-collapse: collapse;"><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></SPAN></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">En resumen: recolección cuidadosa de historia familiar más evaluación no invasiva completa de familiares cercanos a la víctima de MSC (hermanos, hermanas e hijos)<BR></FONT></SPAN></SPAN></DIV></TD></TR></TBODY></TABLE></SPAN></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial"> es el enfoque en nuestra clínica para las enfermedades arritmogénicas hereditarias. En base a los resultados de la evaluación clínica descrita, se definirá la <BR></FONT></SPAN></SPAN></DIV></TD></TR></TBODY></TABLE></SPAN></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">necesidad/valor del análisis genético. </FONT></SPAN><SPAN class="Apple-style-span" style="border-collapse: collapse;"><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></SPAN></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><SPAN class="Apple-style-span" style="border-collapse: collapse;"><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></SPAN></SPAN></DIV><DIV class="MsoNormal"><SPAN lang="ES" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">Silvia G. Priori</FONT></SPAN></SPAN><SPAN style=""><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></SPAN></DIV></TD></TR></TBODY></TABLE></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">---------------------</FONT></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></SPAN></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Portugués</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; "><FONT class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR></SPAN></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Dr. Leonid Makarov de Russia pergunta</FONT></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="PT-BR" style="; font-family: Arial; "><FONT class="Apple-style-span" face="Arial">- </FONT></SPAN><SPAN lang="PT-BR" style=""><FONT class="Apple-style-span" face="Arial">Seria necessário realizar estudos diagnósticos nos familiares de uma vítima de morte súbita de origem não coronariana, e no caso da vítima ser jovem (até 45 anos) e sem antecedentes de patologias cardíacas? Se existir tal necessidade, quais os 3 primeiros estudos a serem realizados, tanto a nível de consultórios externos não especializados até centros cardiológicos de alta complexidade?</FONT></SPAN></SPAN></DIV><DIV><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></SPAN></DIV><DIV><FONT class="Apple-style-span" face="Arial">Dr. Silvia Priori de Italy responde</FONT><FONT class="Apple-style-span" face="Arial"><SPAN class="Apple-style-span" style="border-collapse: collapse; "></SPAN></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">- </FONT><SPAN lang="EN-US" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">Em qualquer caso de morte súbita cardíaca inexplicada, especialmente em idade jovem, uma avaliacao dos membros da família e razoável.</FONT></SPAN></SPAN><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">Em minha opinião, a primeira coisa importante e realizar uma cuidadosa coleta da historia familiar com construção da arvore familiar. O questionamento dos membros </FONT></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Arial">familiares da ocorrência de morte súbita (especialmente morte associada com estresse, exercício e emoção ou morte durante o sono); o questionamento da ocorrência <BR></FONT></SPAN></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Arial">familiar de sincope e arritmias. E útil manter em mente que a epilepsia e um freqüente diagnostico em pts com sincope de repetição e manifestada como convulsão: portanto <BR></FONT></SPAN></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Arial">pode ser útil distinguir entre a típica epilepsia responsiva a terapia versus epilepsia atípica não responsiva a terapia. O ultimo pode ser de fato um erro diagnostico de uma<BR></FONT></SPAN></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Arial"> síndrome arritmogenica. </FONT></SPAN></SPAN></SPAN></P><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style="font-size:10.0pt;font-family: Arial;mso-ansi-language:EN-US"><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style="; font-family: Lucida Grande; "><FONT class="Apple-style-span" face="Arial">Em termos de investigação dos membros da família, o primeiro passo e a pesquisa por ECG/holter do diagnostico, tais como, Brugada, QT longo, e sinais do ECG <BR></FONT></SPAN></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style="font-size:10.0pt;font-family: Arial;mso-ansi-language:EN-US"><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style="; font-family: Lucida Grande; "><FONT class="Apple-style-span" face="Arial">de miocardiopatias. Um eco esta indicado para a identificação de miocardiopatia do ventrículo direito, miocardiopatia hipertrófica, e miocardiopatia diladata. </FONT></SPAN></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style="font-size:10.0pt;font-family: Arial;mso-ansi-language:EN-US"><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style="; font-family: Lucida Grande; "><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Arial">Se ocorreu a MCS durante o exercício e/ou se um membro da família experimentou sincope durante atividade física, um teste de esforço deve também ser realizado. </FONT></SPAN></SPAN></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style="font-size:10.0pt;font-family: Arial;mso-ansi-language:EN-US"><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style="; font-family: Lucida Grande; "><SPAN lang="EN-US" style=""><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Arial">Para resumir: coleta cuidadosa da historia familiar mais uma avaliação não invasiva completa dos parentes próximos de uma vitima de MCS (irmãos e irmãs e <BR></FONT></SPAN></SPAN></SPAN></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style="font-size:10.0pt;font-family: Arial;mso-ansi-language:EN-US"><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style="; font-family: Lucida Grande; "><SPAN lang="EN-US" style=""><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Arial">descendentes) e a estratégia utilizada na nossa clinica para doenças arritmogenicas herdadas. Baseado nos resultados da avaliacao clinica acima será definida <BR></FONT></SPAN></SPAN></SPAN></SPAN></SPAN></P></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE><FONT class="Apple-style-span" face="Arial"><BR></FONT><BLOCKQUOTE type="cite"><DIV><TABLE border="1" cellspacing="0" cellpadding="0" width="1584" style="width: 1584pt; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; "><TBODY><TR><TD width="122" valign="top" style="width:122.0pt;border:solid windowtext .5pt; padding:0cm 5.4pt 0cm 5.4pt"><P class="MsoNormal" style="mso-pagination:none;mso-layout-grid-align:none; text-autospace:none"><SPAN lang="EN-US" style="font-size:10.0pt;font-family: Arial;mso-ansi-language:EN-US"><SPAN class="Apple-style-span" style="border-collapse: collapse; "><SPAN lang="EN-US" style="; font-family: Lucida Grande; "><SPAN lang="EN-US" style=""><SPAN lang="EN-US" style=""><FONT class="Apple-style-span" face="Arial">a necessidade/valor da analise genética. </FONT></SPAN></SPAN></SPAN></SPAN></SPAN></P><DIV class="MsoNormal"><SPAN lang="EN-US" style=""><SPAN class="Apple-style-span" style="border-collapse: collapse; "><FONT class="Apple-style-span" face="Arial">Silvia G Priori</FONT></SPAN></SPAN><SPAN lang="PT-BR" style=""><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></SPAN></DIV></TD></TR></TBODY></TABLE></DIV></BLOCKQUOTE></DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT></DIV></BODY></HTML>