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#22 De:  Jamil Mattar Valente < jamil@centrocor.med.br >
Enviado: Lunes. 19 de Marzo de 2000
Asunto: Ateneu de ecocardiografia - Caso 1/Athenaeum on Echocardiography - Case 1
Sponsored by: Agilent Techonologies
Prezados colegas
Foi colocado em http://pcvc.sminter.com.ar/cvirtual/listas/echo/cases/case1/index.htm o caso numero 1 do ateneu de ecocardiografia do PCVC.
Esperamos suas opinioes sobre o ecocardiograma de estresse apresentado e tambem sobre a conduta clinica que deve ser tomada.
Respondendo `a pergunta do Dr. Guilherme Gustavo do Valle, durante o ecocardiograma de estresse o paciente apresentou a mesma dor
precordial de que estava se queixando.
Cordiais saudacoes,

Dear colleagues:
I have placed at http://pcvc.sminter.com.ar/cvirtual/listas/echo/cases/case1/index.htm the case number 1 of the athenaeum on echocardiography of the FVCC.
We expect your opinions about the echocardiogram of stress presented, and also about the clinical management that must be adopted.
As a reply to Dr. Guilherme Gustavo do Valle's question, during the echocardiogram of stress, the patient presented the same precordial pain of which he was complaining.
Cordially,
Jamil Mattar Valente

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#23 De:  Ricardo Obregon <ecografia@funcacorr.com.ar>
Enviado: Jueves, 23 de Marzo de 2000  10:04 am
Asunto: [ECHO-PCVC] Caso Eco 1/Case Echo 1
Sponsored by: Laboratorios Bago
En el eco stress se evidencia una aquinesia apical peque=F1a con el esfuerzo. Este hallazgo en un paciente sintom=E1tico, avala la
presencia de enfermedad coronaria. El hecho de presentar s=EDntomas a alta carga, y sin cambios electrocardiogr=E1ficos, con un area
de akinesia peque=F1a, y posiblemente sin tratamineto m=E9dico nos evidencia una angina de bajo riesgo. Se deber=EDa evaluar 1) Si el paciente responde a la medicaci=F3n
2) Que tipo de actividad realiza (si es de alto riesgo Ej: piloto de avi=F3n, o conductor de colectivos) se podr=EDa tomar una conducta m=E1s agresiva para una eventual resoluci=F3n del problema (cine coronariograf=EDa, PTCA etc.) , de no tener estas actividades se lo podr=EDa medicar adecuadamente y repetir las pruebas de provocaci=F3n con medicaci=F3n completa para seguir una conducta af=EDn seg=FAn dichos resultados.
Atentamente

In echo stress, a small apical akinesia becomes evident with the effort. This finding in a symptomatic patient, confirms the presence of coronary disease. The fact of presenting symptoms in high load, and without electrocardiographic changes, with a small area of akinesia, and possibly without medical treatment, show low risk angina. It should be assessed:
1) If the patient responds to medication
2) What kind of job he has (if it is of high risk, e.g.: plane pilot, or bus driver), a more aggressive management could be adopted
for a possible solution of the problem (cineangiography, PTCA, etc.). If he is not in these activities, he could be properly
medicated, and repeat test for provocation with complete medication to follow a related management according to the mentioned
results.
Sincerely, Dr. Ricardo Obregon

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#24 De:  Jamil Mattar Valente < jamil@centrocor.med.br >
Enviado: Viernes, 24 de Marzo de 2000 06:49 p.m.
Asunto: [ECHO-PCVC] Ateneu de eco. Caso 1 - Continuacao/Athenaeum of echo. Case 1 - Next part
Sponsored by: Laboratorios Bago
Dando prosseguimento `a apresentacao do caso, e agradecendo pelas opinioes enviadas ate' o momento, achamos que o ecocardiograma de
estresse mostrou hipocinesia transitoria da regiao antero-apical do ventriculo esquerdo, coincidindo com dor precordial tipica no
pico do esforco, sugerindo isquemia de area irrigada pela arteria descendente anterior.
Decidimos por indicar uma cineangiocoronariografia, a qual mostrou um ventriculo esquerdo normal e oclusao total da arteria
descendente anterior logo apos a emergencia da primeira diagonal. Observava-se fracamente a porcao distal da descendente anterior
enchendo por circulacao colateral.
Favor enviarem opinioes sobre a conduta a seguir.
Cordiais saudacoes,

Following with "the presentation of the case, and thanking you for the opinions expressed until now, we inform you that the
echocardiogram of stress showed transitory hypokinesia of the antero-apical region of the left ventricle, coinciding with precordial
pain typical of the peak of the effort, suggesting ischemia of the area irrigated by the anterior descending artery.
We decided to indicate a cineangiography, which displayed a normal left ventricle, and total occlusion of anterior descending artery
after origin of first diagonal artery. It was openly observed a distal portion of the descending artery filled by collateral
circulation.
Please, send your opinions about the management to be adopted.
Cordially, Jamil Mattar Valente

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