1. Definição do Problema […] Diretriz de Avaliação Cardiovascular Perioperatória da Sociedade Brasileira de Cardiologia – 2024 1. Definição do Problema […] Diretriz de Avaliação Cardiovascular Perioperatória da Sociedade Brasileira de Cardiologia – 2024

1. Definition of the Problem […] Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology – 2024 1. Definition of the Problem […] Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology – 2024

Chest pain is a frequent, potentially life-threatening condition in the emergency department and requires immediate investigation and treatment. This case report highlights a rare differential diagnosis of pleuritic chest pain: epipericardial fat necrosis. A 29-year-old man presented with normal clinical evaluation, electrocardiography, point-of-care ultrasound, and unremarkable laboratory tests. The initial hypothesis was acute pleuritis. Chest radiography revealed peri-cardiac nonspecific findings, and computed tomography revealed epicardial fat necrosis. Despite the rarity of this condition, accurate diagnosis allows for better practices.

Infective endocarditis is an infection of the endocardium, associated with high morbidity and mortality, particularly when the left heart chambers are involved. Timely diagnosis and appropriate intervention can attenuate these outcomes. The objective of this study was to create and validate the EndoPredict-Px score for early in-hospital mortality prediction in patients with left-sided infective endocarditis. This analysis focused on patients admitted to the emergency department with left-sided infective endocarditis defined by the Duke-ISCVID criteria, from January 2011 to January 2020. The main outcome was in-hospital mortality. Among 530 patients with left-sided infective endocarditis, 160 (30.2%) died during hospitalization. The score included age ≥ 60 years, absence of fever, NYHA functional class III or IV heart failure, suspected embolism, hemoglobin level ≤ 10 g/dL, leukocyte level ≥ 12 × 10⁹/L, platelet level ≥ 150 × 10⁹/L, and creatinine level ≥ 1.3 mg/dL. Patients were categorized into three mortality risk groups. The model displayed an AUROC of 0.76 (95% CI 0.71–0.80) and 0.74 in the bootstrap validation. Both the derivation and validation models showed accurate calibration. In conclusion, the EndoPredict-Px score accurately and early predicted in-hospital mortality in patients with left-sided infective endocarditis.

Objective: This study aimed to describe the clinical characteristics of the pediatric population with COVID-19 in an Emergency Department (ED) of a Brazilian general hospital. Methods: Epidemiological and clinical data of patients younger than 20 years old were collected from patients’ medical records from February 2020 to July 2021. Most of the epidemiological data described pertains to hospitalized patients. We also reviewed coinfections, treatment, and outcomes and compared the first and second waves of COVID-19. Results: We identified a total of 1303 episodes of SARS-CoV-2 infection. The median time from symptom onset to diagnosis was three days. Symptoms were present in 92.3% of the patients. The most common symptoms were fever (45.2%), nasal congestion/discharge (44.2%), and cough (39.4%). Chest radiography and tomography were performed in 7.7 and 3.3% of cases, with abnormal findings in 29.7 and 53.4%, respectively. Hospital admissions occurred in 3.5% of patients, mainly in the presence of comorbidities, in children under five years old and in those who presented to the ED during the first wave of COVID-19. Coinfection with a viral agent was identified in 20% of the 71 cases tested in this study, and a positive rapid test for Streptococcus pyogenes was found in 8% of the 174 cases tested, with no impact of these coinfections on hospitalization. Conclusions: We found that COVID-19 was a mild disease in most children in our study population, with most hospitalizations and readmissions occurring during the first wave of COVID-19.

Adenosine is an antiarrhythmic drug that slows conduction through the atrioventricular node and acts as a coronary blood vessel dilator. This case report highlights two unusual life-threatening events following the use of adenosine to revert supraventricular tachycardia in a structurally normal heart: non-sustained polymorphic ventricular tachycardia and myocardial infarction. A 46-year-old woman presented to the emergency department with a two-hour history of palpitations and was diagnosed with supraventricular tachycardia. Vagal maneuvers were ineffective, and after intravenous adenosine administration, the