PrECon São Paulo
Transcript of PrECon São Paulo
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Arritmias ventriculares idiopáticas
Fenótipos / Sintomas
Avaliação clínica
Avaliação eletrocardiográfica
Prognóstico
Situações especiais (Induzidas no esforço; Atletas)
Tratamento
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• FENÓTIPO
EV ISOLADAS
EVs PAREADAS
TVNS
TV SUTENTADA
Arritmias ventriculares idiopáticas
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• SINTOMAS
Típicos
Palpitações (“falhas” ou taquicardia)
Atípicos
Mal estar, cansaço, fadiga, dor torácica
ALERTA: síncope
Arritmias ventriculares idiopáticas
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• AVALIAÇÃO CLÍNICA
Objetivos:
Estratificar risco de morte súbita
Identificar cardiopatia de base pré-existente
Estratégia de tratamento
Arritmias ventriculares idiopáticas
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Arritmias ventriculares idiopáticas
• AVALIAÇÃO CLÍNICA
Anamnese ECG
Ecocardiograma Teste ergométrico
Holter RNM
PET – CT Teste genético
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• AVALIAÇÃO CLÍNICA
Arritmias ventriculares idiopáticas
SINAIS DE ALERTA!
MORTE SÚBITA NA FAMÍLIA
SÍNCOPE
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BRUGADA DAVD MCPH
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N Eng J Med 2000;323:826–33
Arritmias Ventriculares Idiopáticas Induzidas no Esforço em Pacientes Assintomáticos
Arch Intern Med. 1991;151(2):349-353
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Heart Rhythm 2015 Jan;12(1):78-85
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Heart Rhythm, Vol 7, No 7, July 2010
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• QUANDO TRATAR?
Sintomas
Evolução para disfunção ventricular
Densidade > 10%
Arritmias ventriculares idiopáticas
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• Tratamento medicamentoso
Simples
Baixo índice de efeitos colaterais (Betabloq, bloq de Ca, etc)
Alto índice de efeitos colaterais com Amiodarona
Tx de sucesso baixa / intermediária
Não é curativo
Arritmias ventriculares idiopáticas
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• Tratamento intervencionista
Invasivo
Baixo risco (0,5% a 0,8% de complicações)
Tx de sucesso elevada (90%)
Curativo
Arritmias ventriculares idiopáticas
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Arritmias Ventriculares Relacionadas à Cardiopatia
Estrutural
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• Mecanismos
• Avaliação clínica
• Tratamento
• Terapias adjuvantes
• Perspectivas futuras
Taquicardia ventricular associada a cardiopatia estrutural
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56 anos, MCP chagásica FE:30%, Terapia para IC otimizada, admitido no PS com quadro de mal estar e palpitações
AUSÊNCIA DE R / S NAS PRECORDIAIS
INÍCIO DA ONDA R ATÉ NADIR S > 100MS
DISSOCIAÇÃO AV
CRITÉRIOS MORFOLÓGICOS
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• AVALIAÇÃO CLÍNICA
Atendimento na emergência conforme protocolo ACLS
Pesquisa de causa secundárias
Isquemia
Distúrbios eletrolíticos, Intoxicações
Pró-arritmia de fármacos anti-arrítmicos
Aneurismas
Taquicardia ventricular associada a cardiopatia estrutural
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• TRAMENTO
Correção das causas secundárias
Drogas anti-arrítmicas (amiodarona, betabloqueadores, Magnésio)
Prevenção de morte súbita (CDI)
Contra-indicação: Tempestade elétrica
Taquicardia ventricular associada a cardiopatia estrutural
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N Engl J Med 2016; 375:111-121
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Lancet 2010; 375: 31–40
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• Ablação bipolar
• simpatectomia
• Infusão de etanol
• Ablação com agulhas
• Ablação por radioterapia
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OAD OAE
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Heart Rhythm 2014 Jan;11(1):143-5
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J Am Coll Cardiol. 2019 Apr 2;73(12):1413-1425
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N Engl J Med 2017; 377:2325-2336
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