Bestetti R B, Santos C R, Machado-Júnior O B, Ariolli M T, Carmo J L, Costa N K, de Oliveira R B
Department of Pathology, Faculty of Medicine of Ribeirão Preto, São Paulo University, Brazil.
Int J Cardiol. 1990 Oct;29(1):39-46. doi: 10.1016/0167-5273(90)90271-6.
Sustained ventricular tachycardia was diagnosed in 15 patients undergoing ordinary activity with Chagas' disease seen at our Institute from 1978 to 1989. Palpitations were observed in 11 (66%) of the patients, dyspnea in 7 (46%), atypical chest pain in 5 (33%) and syncope in 2 (13%). Cardiac arrhythmia was detected in 4 (26%) on physical examination. The resting electrocardiogram showed premature ventricular contractions in 13 (86%) patients, ST-T changes in 12 (80%), left axis deviation in 9 (60%) and right bundle branch block in 4 (26%). Chest X-rays showed mild cardiomegaly in 8 (53%) and moderate cardiomegaly in 3 (20%) patients. Mild left ventricular dysfunction was detected echocardiographically in 1 (10%), moderate in 3 (30%) and severe in 1 (10%) of the 10 patients studied. During sustained ventricular tachycardia, dyspnea was found in 7 of 15 (46%) patients, palpitations in 6 (40%), atypical chest pain in 6 (40%), syncope in 1 (6%), systemic arterial hypotension in 3 (20%) and cardiogenic shock in 2 (13%). The electrocardiographic findings were as follows: mean heart rate was 201 bpm; mean QRS lengthening was 0.16 sec; right bundle branch block plus right axis deviation was seen in 5 of 15 (33%) patients; right bundle branch block plus left axis deviation in 4 (26%); and a positive concordance of all precordial leads in 5 (33%) patients. Based on these findings, we conclude that the majority of patients with Chagas' disease who develop sustained ventricular tachycardia do not have severe myocardial disease, show an uncommon electrocardiographic pattern of this arrhythmia, and most importantly, have a benign clinical course.
1978年至1989年期间，在我院就诊的15例患有恰加斯病且正在进行日常活动的患者被诊断为持续性室性心动过速。11例（66%）患者出现心悸，7例（46%）出现呼吸困难，5例（33%）出现非典型胸痛，2例（13%）出现晕厥。体格检查发现4例（26%）患者存在心律失常。静息心电图显示，13例（86%）患者有室性早搏，12例（80%）有ST-T改变，9例（60%）有左轴偏移，4例（26%）有右束支传导阻滞。胸部X线检查显示，8例（53%）患者有轻度心脏扩大，3例（20%）有中度心脏扩大。在接受研究的10例患者中，超声心动图检查发现1例（10%）有轻度左心室功能不全，3例（30%）有中度左心室功能不全，1例（10%）有重度左心室功能不全。在持续性室性心动过速期间，15例患者中有7例（46%）出现呼吸困难，6例（40%）出现心悸，6例（40%）出现非典型胸痛，1例（6%）出现晕厥，3例（20%）出现体循环动脉低血压，2例（13%）出现心源性休克。心电图检查结果如下：平均心率为201次/分钟；平均QRS波增宽为0.16秒；15例患者中有5例（33%）出现右束支传导阻滞加右轴偏移；4例（26%）出现右束支传导阻滞加左轴偏移；5例（33%）患者所有胸前导联呈正向一致性。基于这些发现，我们得出结论，大多数发生持续性室性心动过速的恰加斯病患者没有严重的心肌疾病，表现出这种心律失常不常见的心电图模式，最重要的是，具有良性的临床病程。
