The presence of a large ostium secundum atrial septal defect (OS-ASD) results in right atrial and right ventricular volume overload followed by pulmonary hypertension. In this context, a Crochetage electrocardiographic pattern can be observed in some cases, indicating a particular clinical and cardiological evolution.We present a case of an 8-year-old boy with OS-ASD and pulmonary hypertension, whose electro-vectorcardiogram reveal the typical characteristics first described in 1958.

The first confirmed case of COVID-19 was notified to the Brazilian Ministry of Health on February 26, 2020. On November 20, 2021, by the end of Epidemiological Week-46 (EW-46) 257,168,692 confirmed cases of COVID-19 reported worldwide. Among the countries with the highest number of accumulated cases the United States of America ranks number one (47,701,872), followed by India (34,510,413), Brazil (22,012,150), the United Kingdom (9,857,658), and Russia (9,135,149). Concerning deaths, 5,146,467 were confirmed worldwide until November 20, 2021. The United States was the country with the highest accumulated number of deaths (771,013), followed by Brazil (612,587), India (465,662), Mexico (292,145), and Russia (257,891).

Introduction: accelerated idioventricular rhythm (AIVR) is a typically regular ventricular rhythm with a heart rate between 50 and 110 (-120) beats per minute, absence of P waves or sinus P waves with atrioventricular dissociation, and a wide QRS interval. It is most commonly observed in the setting of acute myocardial infarction, reperfusion therapy, and structural heart diseases. Objective: This article aims to review and update the current knowledge on accelerated idioventricular rhythm (AIVR) in adults, addressing its pathophysiology, underlying mechanisms, clinical presentation, differential diagnoses, and prognostic implications. Additionally, it seeks to synthesize the latest scientific evidence on the topic, discussing advances in clinical management and potential therapeutic approaches. Methods: a comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science to identify recent studies on AIVR in adults. Articles discussing its mechanisms, clinical presentation, prognosis, and treatment approaches were analyzed and synthesized. Results: AIVR is generally considered a benign arrhythmia, often self-limiting and not requiring specific treatment. However, it may indicate underlying cardiac pathology and, in some cases, contribute to hemodynamic instability. The differential diagnosis includes other ventricular arrhythmias, such as ventricular tachycardia, which necessitates careful electrocardiographic analysis. Current management strategies focus on treating the underlying condition rather than the arrhythmia itself. Conclusion: AIVR in adults remains an important electrocardiographic finding, particularly in the context of acute coronary syndromes. While usually benign, recognition and appropriate differentiation from malignant arrhythmias are essential for optimal patient management. Further research is needed to clarify its prognostic implications and therapeutic considerations.

Exercise-induced complete right bundle branch block (CRBBB) remains a rare finding during a treadmill test. Both exercise-induced CRBBB and left anterior fascicular block (LAFB) have been associated with coronary artery disease, more specifically with stenosis of the left anterior descending coronary artery. Left septal fascicular block (LSFB) has been associated with acute and chronic coronary syndromes. We describe a patient case with severe left main coronary artery disease. In an exercise test, a rare combination of these three ventricular conduction disorders developed. In a second exercise test after coronary bypass surgery, LAFB and typical CRBBB developed without LSFB.

Left bundle branch area pacing (LBBAP) is a type of conduction system pacing wherein the left bundle branch and/or the left side of the interventricular septum are stimulated with a permanent pacing lead to maintain physiological electrical activation of the left ventricle. As understanding grows regarding trifascicular activation in the left ventricle and left septal fascicular block (LSFB), there is an indication that new electrocardiographic alterations may emerge, particularly in instances of arterial occlusions. Here, we present a case study delineating LSFB subsequent to LBBAP.

Propafenone is a class IC anti-arrhythmic drug used for the rhythm control strategy in atrial fibrillation worldwide, including in Latin America countries. Propafenone intoxication is a potentially life-threatening condition. Ventricular tachycardia and the Brugada electrocardiographic (ECG) pattern are possible pro-arrhythmic manifestations of propafenone poisoning. We present a rare patient case, where therapeutic range dosage of propafenone resulted in a wide complex tachycardia, followed by the Brugada ECG pattern during atrial fibrillation. We discuss the possible mechanisms related to this unusual ECG manifestation.

There is growing awareness that a considerable proportion of patients with acute coronary syndrome, who potentially benefit from emergent coronary intervention, do not present with persistent ST elevation. Subtle ECG changes can provide valuable diagnostic clues. We describe a case in which a de Winter-like ECG pattern was followed by unexplained prominent anterior forces. One possible explanation is a transient left septal fascicular block, a phenomenon previously reported in association with myocardial ischemia.

We present a case of a pre-adolescent girl with mitral stenosis caused by rheumatic fever. The 12‑lead ECG showed prolonged P-wave duration indicating interatrial block. In addition, the P waves in the inferior leads showed a transient atypical interatrial block with a triphasic pattern in lead II. The appearance of the atypical interatrial block resulted in the attenuation of the P terminal force in lead V1. Atypical interatrial block is associated with atrial cardiomyopathy and is a potential risk factor for atrial fibrillation or stroke.

Introduction: it is known that the proportions of different blood cell components are new inflammatory markers that have good predictive value in the outcome of chronic kidney disease, cardiovascular diseases, rheumatic diseases, among others, including the neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and platelet/lymphocyte ratio. Objective: to evaluate the inflammatory profile, through the neutrophil/lymphocyte, platelet/lymphocyte, and monocyte/lymphocyte parameters in patients with chronic kidney disease on hemodialysis. Methods: analytical cross-sectional study. The analyses were conducted using R software (version 4.2.2). A total of 112 hemodialysis patients were evaluated, excluding cases with missing data per variable. Biomarkers such as neutrophil/lymphocyte, platelet/lymphocyte, and monocyte/lymphocyte ratios were analyzed by boxplot to verify symmetrical and outliers and compared between patients with and without inflammation. Student’s t-tests, preceded by assessments of normality (Shapiro-Wilk) and homogeneity of variance (Levene), compared the groups and the reference values of the biomarkers. Results: the comparison between groups without inflammation and with inflammation, identified by the neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratio, showed a significant difference between the three parameters (p<0.05). To verify the consistency of the inflamed and non-inflamed groups, the parameters were compared to the reference values, in the three biomarkers, two groups differed statistically (p<0.05) from the reference value, with the exception of patients with inflammation, who in the platelet/lymphocyte ratio marker did not differ from the reference value, suggesting that this biomarker, alone, may not be sufficient to detect inflammation in this group. Conclusion: the study highlights the relevance of hematological biomarkers in identifying inflammation in hemodialysis patients. Although isolated platelets/lymphocytes were not sufficient for this diagnosis, other markers stood out, indicating the need for an integrated analysis for greater diagnostic accuracy.

IntroductionBrugada syndrome (BS) is a genetic channelopathy characterized by an increased risk of sudden cardiac death (SCD) in the absence of structural heart disease. Prognostic stratification is necessary to determine which patients are candidates for implantable cardioverter defibrillator (ICD). The present study aims to evaluate EKG changes during exercise stress tests in patients with BS and to identify any poor prognosis variables.MethodsThis was an observational, case-control study. Three comparison groups were created: patients with Type 1 BS with or without prior arrhythmic events (BE and BNoE subgroups) and age- and sex-matched healthy individuals. Patients underwent EST and electrocardiographic variables were analyzed.ResultsThe study recruited 36 patients with type 1 BS, 12 with prior Event (BE) and 24 without (BNoE). Patients in the BE group, in all postexercise recordings, had lower heart rates, notably in the first minute. A significant difference was also observed in the HR drop in the recovery phase, with a greater drop in relation to maximum HR in the first minute in the group of patients who had events.ConclusionBS patients with prior events had a lower capacity to increase heart rate at peak effort and a greater proportional drop in the recovery phase. No relationship was observed between the occurrence of arrhythmic events and ST-segment elevation during the exercise test.

Brugada Syndrome is an inherited cardiac channelopathy with a high incidence of ventricular fibrillation and sudden cardiac death in patients with structurally normal hearts. Diagnosis is based on a characteristic electrocardiographic pattern (coved type ST-segment elevation ≥2 mm followed by a negative T-wave in ≥1 in the right precordial leads V1-V2) combined with an absence of gross structural abnormalities and several other criteria. The cornerstone of BrS diagnosis and definition, is its characteristic ECG pattern that can be present spontaneously or unmasked by drugs. This entity was described by the Brugada brothers in 1992 and belongs to a group of diseases known as inherited primary arrhythmia syndromes. The prevalence varies among regions and ethnicities, affecting mostly males. Despite several genes identified, SCN5A seems to be the most affected gene related BrS (≈ 30% of patients). The current main therapy is an implantable cardioverter-defibrillator, but radiofrequency catheter ablation has been recently reported as an effective new treatment.

Introdução: A doença renal crônica (DRC) tem aumentado nos últimos anos de forma epidêmica. Fatores como obesidade, hipertensão arterial, diabetes melito tipo 2 (DM2), senescência, doença cardiovascular, histórico familiar com DRC e medicações nefrotóxicos aumentam a suscetibilidade e a instalação e progressão da DRC. Além desses fatores, existem evidências de inflamação na fisiopatologia da DRC. Objetivo: Avaliar os biomarcadores inflamatórios mais examinados em pacientes portadores de doença renal crônica hemodialisados. Material e Métodos: Trata-se de uma revisão sistemática nos motores de busca National Library of Medicine (PubMed) e Biblioteca Virtual em Saúde (BVS) pelos descritores ((hemodialysis) AND (inflammation)) AND (chronic kidney disease). Para a seleção dos artigos foram incluídos aqueles que seguiam os critérios: (1) população do estudo com diagnóstico doença renal crônica, (2) população da amostra ≥ de 18 anos. (3) aqueles que foram avaliados IL-6, TNF alfa, PCR ou VHS. Resultados: 98 artigos foram encontrados realizados em diversos países, 20 completaram os critérios de inclusão. A maior parte dos estudos eram compostos predominantemente por homens. Conclusão: Pacientes hemodialíticos apresentam aumento dos níveis de biomarcadores inflamatórios, principalmente TNF-α e IL-6.

This paper describes a case of patient post-TAVI who developed Left Septal Fascicular Block (LSFB) and Right Bundle Branch Block (RBBB). This combination has not been previously reported and must be actively sought out, given the possible increased risk of complete atrioventricular block and sudden cardiac death. RBBB following transcatheter aortic valve replacement is rare and is associated with complete atrioventricular block and permanent pacemaker implantation. LFSB on ECG may be a surrogate maker of diffuse conduction systemic damage following TAVI. Therefore, there should be a low threshold for permanent pacing in patients who develop new RBBB and LSFB post-TAVI.

Background: A COVID-19 pandemic erupted, causing a global viral pneumonia outbreak, marking the most significant public health crisis of the 21st century. These changes profoundly impacted population health and well-being, leading to shifts in dietary habits. This study aimed to evaluate the consumption of ultra-processed foods in the Brazilian Amazon before, during, and after the COVID-19 pandemic. Methods: This is a secondary data analysis study derived from the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel, 2019–2021) of the Brazilian Ministry of Health. All statistical analyses were performed using the Stata 17 statistical program in the survey module (svy). Results: We found an increased frequency in the subgroups of consumption of ultra-processed foods in the capital of the Brazilian Amazon region between the years 2019 and 2021. In the cities of Boa Vista and Macapá, there was a significant increase in the consumption of snacks, salty snacks, cookies, and meat products. Boa Vista and Macapá showed an increase in the percentage difference in the consumption ≥5 of ultra-processed subgroups, being 30.4% (p = 0.014) and 53.7% (p = 0.014), respectively. Conclusions: The study indicated an increase in the consumption of ultra-processed foods in the Brazilian Amazon region during and after social distancing.

The north region of Brazil is characterized by significant vulnerabilities, notably surpassing national poverty indicators. These disparities exacerbated the impact of respiratory illnesses on the healthcare system during the COVID-19 pandemic, particularly in areas with limited healthcare resources, inadequate infrastructure, and barriers to healthcare access. The crisis was further influenced by multiple lineages that emerged as significant virus variants associated with increased transmissibility. Within this context, our ecological study focused on analyzing the epidemiological evolution of COVID-19 in the state of Acre. We constructed time-series trends in incidence, lethality, and mortality from March 2020 to December 2022 using the Prais–Winsten regression model. Our findings revealed that in 2020, there was an increasing trend in incidence, while mortality and lethality continued to decrease (p < 0.05). In the following year, both incidence and mortality decreased, while lethality increased at a rate of 1.02% per day. By the end of 2022, trends remained stationary across all rates. These results underscore the importance of ongoing surveillance and adaptive public health measures to bolster the resilience of healthcare systems in remote and vulnerable regions. Indeed, continuous monitoring of the most predominant SARS-CoV-2 lineages and their dynamics is imperative. Such proactive actions are essential for addressing emerging challenges and ensuring effective responses to adverse situations.

Congenital short QT syndrome is a very low prevalence inherited primary arrhythmia syndrome first reported in 2000 by Gussak et al., who described two families with a short QT interval, syncope, and sudden cardiac death. In 2004, Ramon Brugada et al. identified the first genetic type of this entity. To date, a total of nine genotypes have been described. The diagnosis is easy from the electrocardiogram (ECG), not only due to the short QT duration, but also based on other aspects covered in this review. During 24-h Holter monitoring, paroxysmal atrial fibrillation spontaneously converting to sinus rhythm may be found. Even though the T wave may appear symmetric on the ECG, the T loop of the vectorcardiogram confirms that the T wave is constantly asymmetric due to the presence of dashes closer to each other in the efferent branch. In this review, we also describe the minus-plus T wave sign that we have described in a previously published article. In addition to congenital causes, we briefly highlight the existence of numerous acquired causes of short QT interval.

Professor Dr. José Manuel Rivero Carvallo (Fig. 1) was an eminent Mexican cardiologist, born in the state of Puebla on April 1, 1905, and died on February 15, 19931.

Northeast Brazil is a region with great international tourist potential. Among the states that make up this region, Paraíba stands out due to the presence of vulnerable groups and factors that contribute to adverse outcomes of COVID-19. Therefore, the aim of this study was to analyze the epidemiological data on the incidence, mortality, and case fatality of COVID-19 in Paraíba. An ecological, population-based study was performed, with data extracted from the Brazilian Ministry of Health database. All cases and deaths from COVID-19 from March 2020 to December 2022 were included. The time series was built by applying the Prais–Winsten regression model, and the daily percent change was calculated to analyze the trends. The highest case fatality of the entire period was in April 2020 (7.8%), but in March 2021, the state broke the dismal record of 1248 deaths and the highest mortality rate (30.5 deaths per 100,000 inhabitants). Stationary mortality and case fatality were better in 2022; however, in February 2022, the mortality rate was at levels similar to the same month of the previous year. These results illustrate that COVID-19 is evolving and needs to be constantly monitored.

was an eminent Mexican cardiologist, born in the state of Puebla on