<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 class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Ante todo felicitarlos por tremendo logro.</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"> </FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Caso: Hombre de 64 años, DLP,HTA,TBQ Sedenterio,obeso</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Portador de Miocardiopatia Dilatada Valvular con antecedentes de</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">Cirugia de Bentall de Bono N27 mas Puente Venoso a Diagonal Posterior</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">(VI severo) setiembre 2004.</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Noviembre 2004 presenta episodio de muerte subita, se coloca CDI</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Enero 2005 episodio sincopal, se realiza SPECT que informa: Isquemia</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">medial/apical, Fey 32%,se realiza CCG Y PTCA con Stent a CD.</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Junio 2005 infeccion de cables de CDI: Recambio de cables y generador</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">y tto correspondiente.</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Octubre 2005 ingresa por multiples episodios de TV y 1 choque espureo</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">por FA, en relacion a descenso de amiodarona de 400 a 200mg segun</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">refiere paciente</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">IRC no dialitica</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Hipertiroidismo con TSH 0.06 por lo que hace 3 meses se suspende</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">amiodarona e inicia danantizol- deltisona.</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">setiembre 2006 presenta tormenta electrica,se optimiza tto con</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">danantizol 20mg/12hs elevando TSH 0.159, se suspende flecainida,</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">inicia propafenona, lidocaina. Evoluciona con multiples episodios de</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">TVNS. TV sostenida que requirio choques</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Actualmente con carvedilol25mg /12hs,lidocaina ev.</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">se realizo nueva CCG para valorar progresion de enf coronaria, que no</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">justifica gatillante de arritmia</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Evaluado por servicio de Electrofisiologia quienes plantean</FONT><SPAN style="mso-spacerun: yes"><FONT class="Apple-style-span" face="Arial"> </FONT></SPAN><FONT class="Apple-style-span" face="Arial">dificultad de acceso para mapeo de foco ectopico y eventual ablacion.</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">nos derivan al paciente para evaluar transplante cardiaco.</FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"> </FONT><FONT class="Apple-style-span" face="Arial"><O:P></O:P></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Dr. Carlos Fernandez</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">---------</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Portugués</FONT></DIV><DIV class="MsoNormal"><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">Antes de tudo felicitamos pelo por tremendo trabalho.</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">Caso: Homem de 64 anos, DLP, HAS, TBQ, Sedentário,obeso</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Portador de Miocardiopatia Dilatada Valvular com antecedentes de Cirurgia de Bentall de Bono N27 mais Ponte Venosa na Diagonal Posterior (VE severo) em setembro de 2004.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Em Novembro de 2004 apresenta episódio de morte súbita, se coloca CDI.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Em janeiro de 2005 tem episódio sincopal, se realiza SPECT que informa: Isquemia medial/apical, FE 32%, se realiza CATE e PTCA com Stent na CD.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Junho de 2005 tem infecção dos cabos do CDI: Troca os cabos e gerador e faz tto correspondente.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Outubro de 2005 é admitido por múltiplos episódios de TV e 1 choque espureo por FA, com relação ao descenso da amiodarona de 400 para 200mg segundorefere o paciente</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">IRC não dialítica</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Hipertiroidismo com TSH 0.06 por que há 3 meses se suspendeu amiodarona e iniciou danantizol- deltisona.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Em setembro de 2006 apresenta tempestade elétrica, se otimiza o tto com danantizol 20mg/12hs elevando TSH 0.159, se suspende a flecainida, inicia propafenona, lidocaina. Evoluiu com múltiplos episódios de TVNS. TV sustentada que necessitou choques.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Atualmente está com carvedilol 25mg /12hs, lidocaina IV.</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Foi realizado novo CATE para avaliar a progressão da doença coronária, que não justifica o desencadeamento de arritmia</FONT></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial">Foi avaliado pelo serviço de Eletrofisiologia que colocam a dificuldade de acesso para o mapeamento do possível foco e eventual ablação. Nos devolvem o paciente para avaliar transplante cardíaco.</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. Carlos Fernandez</FONT></DIV><DIV class="MsoNormal"><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></BODY></HTML>