<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">Estimado Dr. Alizadeh: </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">¡Qué caso más interesante! Y difícil también.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Se parece a una miocardiopatía dilatada familiar versus fase dilatada final de miocardiopatía hipertrófica, pero me gustaría tener más información. ¿Cuál es exactamente su fracción de eyección del VI? ¿Hubo anormalidades en el movimiento de pared VI en su Eco? ¿Alguna vez tuvo dolor torácico típico? ¿Qué se sabe sobre sus niveles de colesterol? (La dislipemia familiar podría explicar un inicio prematuro de cardiopatía isquémica en este paciente).</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">¿Tiene historia de hipertensión? Quiero decir, incluso aunque la hipertrofia del VI secundaria a hipertensión es generalmente concéntrica, a veces la hipertensión severa puede llevar a hipertrofia asimétrica del VI. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Suponiendo que no haya enfermedad valvular significativa del lado izquierdo, la presencia de disfunción del VD grave e hipertensión pulmonar de moderada a severa (tensión sistólica de la arteria pulmonar 65-70 mmHg) significa disfunción VI grave de larga data en este paciente y generalmente un pronostico pobre (y falta de respuesta a TRC). Además, si este paciente tiene regurgitación mitral severa secundaria a dilatación VI severa, la TRC probablemente no la beneficiará.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Con respecto a su tratamiento médico, supongo que está tomando dosis bajas de diuréticos e IECA; pero no beta bloqueantes y medicamentos anti-aldosterona. Después del implante de marcapasos, un tratamiento médico optimizado que incluya dosis apropiadas de IECA, beta bloqueantes y medicamentos anti-aldosterona, probablemente mejorarán su función sistólica VI, con lo que la terapia CDI/TRC sería innecesaria.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Finalmente, hay una indicación clara de implante de marcapasos permanente (bloqueo AV completo con escape del complejo QRS ancho que sugiere bloqueo infra-hisiano). Una estimulación apical del VD inducirá disincronía VI, que a su vez, probablemente conducirá a empeoramiento de la función sistólica VI y síntomas ICC, pero es menos probable que la estimulación VD septal elevada cause disincronía VD severa. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">En resumen, si su FEVI es superior al 30%, optaría por un marcapasos DDD con una derivación de fijación activa en el septo superior del VD además de una optimización del tratamiento medico (IECA, BB, anti-aldosterona). Sin embargo, si su FEVI es claramente inferior al 30% (mediante ventriculografía nuclear en forma ideal), implantaría un CDI-TRC en el caso de falta de regurgitación mitral severa o CDI DDD (generalmente como un puente para el transplante cardíaco) cuando se presenta regurgitación mitral severa. La falta de respuesta a la TRC hará de su joven paciente una buena candidata para transplante cardíaco.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Gracias a todos.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Felicitaciones a los organizadores.</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">Aldo Alberto Furlani MD</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Cardiac Electrophysilogist</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Consultant Cardiologist</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Heart Institute of the Caribbean</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"><A href="mailto:afurlani@caribbeanheart.com">afurlani@caribbeanheart.com</A></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">www.caribbeanheart.com</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></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Portugués</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">Caro Dr Alizadeh:</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Que caso interessante! E difícil também.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Isto soa como miocardiopatia dilatada familiar versus fase final da miocardiopatia hipertrófica, mas eu gostaria de ter mais informações. Qual é exatamente a fração de ejeção do VE? Existiu alguma anormalidade de motilidade de parede no eco? Ela alguma vez teve dor torácica típica? E sobre os níveis de colesterol? (uma dislipidemis familiar poderia explicar um início precoce de doença isquêmica neste paciente).</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Ela tem alguma história de hipertensão? Eu quero dizer, mesmo assim a hipertrofia secundária a hipertensão é normalmente concêntrica, algumas vezes a hipertensão severa pode levar a hipertrofia septal assimétrica.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Assumindo que não existe uma doença valvar esuqerda significativa, a presença de disfunção do VD e hipertensão pulmonar moderada (PSAS 65-70mmHg) implica disfunção severa de longo tempo do VE neste paciente e normalmento um prognóstico pobre (e ausência de resposta a TRC). Além disso, se esta paciente tiver uma insuficiência mitral severa secundária a severa dilatação do VE a TRC provavelmente não a beneficiará. .</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">A despeito do tratamento médico, eu assumo que ela está em uso de diuréticos e IECA, mas não está em uso de betabloqueadores e drogas anti-aldosterona. Após o implante do marcapasso, a otimização da terapia médica incluindo dose aprpriada de IECA, betabloqueadores e drogas anti-aldosterona irá provavelmente melhorar a função sistólica do VE sendo desnecessário a terapia com CDI/TRC.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Finalmente, existe uma indicação clara para o implante do marcapasso definitivo (bloqueio AV completo com escape de QRS largo sugerindo ser bloqueio infra hissiano). A estimulação do ápice do VD induzirá dissincronia do VE que, por sua vez, irá levar provavelmente a piora de ambas a função sistólica e os sintomas de ICC, mas a estimulação atrial septal alta é menos provável causar dissincronia do VE.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Em resumo, se a sua FEVE for maior do 30% eu colocaria um marcapasso DDD com um eletrodo de fixação ativa no septo alto do VD mais a otimização do tratamento médico (IEC,BB, anti-aldo). Contudo, se sua FEVE é claramente abaixo de 30% (idealmente por ventriculografia) ei implantaria tanto um CDI-TRC no caso de ausência de regurgitação mitral severa ou CDI-DDD (normalmente como ponte para transplante) quando IM severa está presente. A ausência de resposta a TRC irá fazer que esta jovem paciente se torne candidata para o transplante cardíaco. </FONT></DIV><P style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 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">Obrigadol.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Congratulações aos organizadores</FONT></DIV><P style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 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">Aldo Alberto Furlani MD</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Eletrofisiologista Cardíaco</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Cardiologista</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Instituto do Coração do Caribe</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="http://br.f305.mail.yahoo.com/ym/Compose?To=afurlani@caribbeanheart.com"><FONT class="Apple-style-span" face="Arial">afurlani@caribbeanheart.com</FONT></A></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="http://www.caribbeanheart.com/"><FONT class="Apple-style-span" face="Arial">www.caribbeanheart.com</FONT></A></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><DIV><FONT class="Apple-style-span" face="Arial">El 13/10/2006, a las 12:04, SCD Symposium escribió:</FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR class="Apple-interchange-newline"></FONT><BLOCKQUOTE type="cite"><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Forum of the ISHNE Sudden Cardiac Death World-Wide Internet Symposium</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; min-height: 14px; "><FONT class="Apple-style-span" face="Arial"><BR></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Medtronic's free physician resource center:</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"><A href="http://www.medtronicconnect.com">http://www.medtronicconnect.com</A></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; min-height: 14px; "><FONT class="Apple-style-span" face="Arial"><BR></FONT></DIV> <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">Estimado Dr. Dubner:</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Gracias por este excelente sitio educativo. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Una mujer de 38 años fue derivada a nuestro centro con inicio de disnea desde hacía unos pocos meses atrás. Tenía historia familiar de muerte súbita cardíaca. Tenía bloqueo cardíaco completo con ritmo ventricular de escape. Ecocardiografía TT reveló disfunción sistólica del VI y el VD, hipertrofia septal asimétrica, hipertensión pulmonar (presión arterial pulmonar=65-70 mmHg) y sin gradiente de TSVD. La disnea del paciente mejoró con dosis baja de diuréticos, inhibidores ECA e implante de marcapasos transitorio. </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">¿Recomendaría marcapasos DDD para este paciente?</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">O </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">¿Recomendaría CDI bicameral o CDI con TRC?</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">¿Cuál es su opinión sobre el curso clínico de su enfermedad?</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">¿Precisa más pruebas diagnósticas antes del implante del dispositivo?</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Atentamente, </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Hormoz Alizadeh MD</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Department of Pacemaker and Electrophysiology</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Rajaie Cardiovascular Medical and Research Center</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Tehran, Iran</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">Caro Dr Dubner</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">Obrigado por este excelente site educacional</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"> Uma muher de 38 anos de idade referida para o nosso centro com início recente de dispnéia há poucos meses. Ela tem história familiar de morte cardíaca súbita. Ela tinha Bloqueio cardíaco completo com ritmo ventriculçar de escape. O ecocardiograma TT revelou disfunção sistólica severa do VE e do VD, hipertrofia septal assimétrica, hipertensão pulmonar (PAP = 65-70mmHg) e sem gradiente na VSVE. A dispnéia da paciente melhorou com baixa dose de diuréticos, inibidor da ECA e implante de MP provisório.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Você recomenda um marcapasso DDD para esta paciente? ou</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Você recomenda CDI-DR ou CDI-TRC? </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Qual a sua opinião sobre o curso clínico da doença dela? Ela precisa de mais exames antes do implante do dispositivo?</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"> sinceramente,</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"> Hormoz Alizadeh MD</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"> Departmento de Marcapasso e Eletrofisiologia</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Centro Cardiovarcular Médico e de Pesquisa Rajaie </FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Tehran, Iran</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; -khtml-border-horizontal-spacing: 0px; -khtml-border-vertical-spacing: 0px; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: normal; -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 class="Apple-style-span" face="Arial" size="3"><SPAN class="Apple-style-span" style="font-size: 12px;"><BR style=""></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><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">Scd-forum-lat mailing list</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"><A href="mailto:Scd-forum-lat@scd-symposium.org">Scd-forum-lat@scd-symposium.org</A></FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial"><A href="http://www.grupoakros.com.ar/mailman/listinfo/scd-forum-lat">http://www.grupoakros.com.ar/mailman/listinfo/scd-forum-lat</A></FONT></DIV> </BLOCKQUOTE></DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT></DIV></BODY></HTML>