Paciente de 45 anos do sexo masculino, com diagnóstico de cardiomiopatia hipertrófica septal assimétrica, tendo sido submetido a implante de cardiodesfibrilador no passado. Apesar do tratamento clínico otimizado, evoluiu com progressiva deterioração clínica suscitando tratamento invasivo. Entretanto, não havia gradiente importante na via de saída do ventrículo esquerdo (VSVE) ao ecocardiograma de repouso e o teste provocativo com dobutamina foi inconclusivo por não atingir a frequência cardíaca preconizada. A avaliação intraoperatória com ecocardiograma transesofágico em uso de isoproterenol foi fundamental no diagnóstico de obstrução da VSVE. A miectomia septal foi realizada com sucesso e o paciente apresentou boa evolução pós-operatória.

A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergone a cardiofibrilator implant in the past. Despite the optimized clinical treatment, he evolved to a progressive clinical deterioration that led to invasive treatment. However, there was not an important gradient in the exit pathway of the left ventricle (EPLV) at the echocardiogram in rest and the challenging test with dobutamine was non conclusive because it did not reach the preconized cardiac frequency. The intraoperative evaluation with a transesophageal echocardiogram using isoproterenol was fundamental for the diagnosis of the EPLV obstruction. The septum myectomy was performed successfully and the patient presented good post-operative evolution.

Paciente de 45 años del sexo masculino, con diagnóstico de cardiomiopatía hipertrófica septal asimétrica, habiendo sido sometido a implante de cardiodesfibrilador en el pasado. A pesar del tratamiento clínico optimizado, evolucionó con progresivo deterioro clínico suscitando tratamiento invasivo. Entre tanto, no había gradiente importante en la vía de salida del ventrículo izquierdo (VSVI) al ecocardiograma de reposo y el test provocativo con dobutamina fue inconclusivo por no alcanzar la frecuencia cardíaca preconizada. La evaluación intraoperatoria con ecocardiograma transesofágico en uso de isoproterenol fue fundamental en el diagnóstico de obstrucción de la VSVI. La miectomía septal fue realizada con éxito y el paciente presentó buena evolución postoperatoria.

OBJECTIVE: To assess the relation between P-wave and QT dispersions in elderly patients with heart failure. METHODS: Forty-seven elderly patients (75.6±6 years) with stable heart failure in NYHA functional classes II or III and with ejection fractions of 37±6% underwent body surface mapping to analyze P-wave and QT dispersions. The degree of correlation between P-wave and QT dispersions was assessed, and P-wave dispersion values in patients with QT dispersion greater than and smaller than 100 ms were compared. RESULTS: The mean values of P-wave and QT dispersions were 54±14 ms and 68±27 ms, respectively. The correlation between the 2 variables was R=0.41 (p=0.04). In patients with QT dispersion values > 100 ms, P-wave dispersion was significantly greater than in those with QT dispersion values < 100 ms (58±16 vs 53±12 ms, p=0.04 ). CONCLUSION: Our results suggest that, in elderly patients with heart failure, a correlation between the values of P-wave and QT dispersions exists. These findings may have etiopathogenic, pathophysiologic, prognostic, and therapeutic implications, which should be investigated in other studies.