This is the case of a 48-year-old patient with Chagas disease admitted to the ICU with heart failure and 35 bpm bradycardia due to complete AV block with QRS complex of 147 ms and right bundle branch block (Fig. 1). A transient pacemaker was implanted and an echocardiogram was performed (video 1) with left ventricular ejection fraction (LVEF) of 33% due to global hypokinesis and severely depressed global longitudinal strain (GLS) (−9.9%) with elevated mechanical dispersion of 91 ms (Fig. 1). For all this and due to the cardiac magntic resonance imaging findings that confirmed the presence of biventricular dilatation with LVEF of 33%, and areas of late gadolinium enhancement (Fig. 2), it was decided to implant a cardiac resynchronization therapy device associated with a defibrillator (video 2). Fifteen (15) days after implantation, the patient showed significant functional improvement, ECG with left ventricular pacing with QRS complex of 127 ms (Fig. 3), and an increased LVEF of 48% (video 3) and GLS up to −14% on the echocardiogram with mechanical dispersion reduction of 28.4 msg (Fig. 3).
array:24 [ "pii" => "S2173572722001874" "issn" => "21735727" "doi" => "10.1016/j.medine.2022.07.010" "estado" => "S300" "fechaPublicacion" => "2022-12-01" "aid" => "1566" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2022;46:726-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S021056912030259X" "issn" => "02105691" "doi" => "10.1016/j.medin.2020.07.008" "estado" => "S300" "fechaPublicacion" => "2022-12-01" "aid" => "1566" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2022;46:726-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imágenes en Medicina Intensiva</span>" "titulo" => "Respuesta ecocardiográfica y clínica precoz a la resincronización cardiaca en paciente con miocardiopatía dilatada secundaria a enfermedad de Chagas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "726" "paginaFinal" => "727" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cardiac resynchronization therapy rapid reponse in a dilated cardiomyopathy due to Chagas disease" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1588 "Ancho" => 1625 "Tamanyo" => 651912 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Navarro Martínez, I. Keituqwa Yáñez, S. Nicolás Franco" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Navarro Martínez" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Keituqwa Yáñez" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Nicolás Franco" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572722001874" "doi" => "10.1016/j.medine.2022.07.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722001874?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056912030259X?idApp=WMIE" "url" => "/02105691/0000004600000012/v1_202211260632/S021056912030259X/v1_202211260632/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173572722001862" "issn" => "21735727" "doi" => "10.1016/j.medine.2022.07.009" "estado" => "S300" "fechaPublicacion" => "2022-12-01" "aid" => "1561" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2022;46:728" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Intensive Medicine</span>" "titulo" => "Tracheal rupture caused by mediastinal lymphoma: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "728" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rotura traqueal por linfoma mediastínico. A propósito de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 657 "Ancho" => 1592 "Tamanyo" => 135763 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT scan and 3D reconstruction image.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Lorenzo Martín, M. Rodrigo Garzón, L. Santana-Cabrera" "autores" => array:3 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Lorenzo Martín" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Rodrigo Garzón" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Santana-Cabrera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569120302540" "doi" => "10.1016/j.medin.2020.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569120302540?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722001862?idApp=WMIE" "url" => "/21735727/0000004600000012/v1_202211260614/S2173572722001862/v1_202211260614/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173572722002788" "issn" => "21735727" "doi" => "10.1016/j.medine.2022.05.013" "estado" => "S300" "fechaPublicacion" => "2022-12-01" "aid" => "1797" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2022;46:724-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The customization of mechanical ventilation: Yes, but… Keep calm" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "724" "paginaFinal" => "725" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La personalización de la ventilación mecánica: sí, pero… mantengamos la calma" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. González-Castro, V. Modesto, A. Medina" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "González-Castro" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Modesto" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Medina" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569122001577" "doi" => "10.1016/j.medin.2022.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569122001577?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722002788?idApp=WMIE" "url" => "/21735727/0000004600000012/v1_202211260614/S2173572722002788/v1_202211260614/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Intensive Medicine</span>" "titulo" => "Cardiac resynchronization therapy rapid reponse in a dilated cardiomyopathy due to Chagas disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "726" "paginaFinal" => "727" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Navarro Martínez, I. Keituqwa Yáñez, S. Nicolás Franco" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Navarro Martínez" "email" => array:1 [ 0 => "julian.navarro@um.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Keituqwa Yáñez" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Nicolás Franco" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cuidados Intensivos y Electroestimulación Cardiaca, Hospital General Universitario Rafael Méndez, Lorca (Murcia), Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta ecocardiográfica y clínica precoz a la resincronización cardiaca en paciente con miocardiopatía dilatada secundaria a enfermedad de Chagas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1636 "Ancho" => 1633 "Tamanyo" => 225521 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This is the case of a 48-year-old patient with Chagas disease admitted to the ICU with heart failure and 35 bpm bradycardia due to complete AV block with QRS complex of 147 ms and right bundle branch block (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A transient pacemaker was implanted and an echocardiogram was performed (video 1) with left ventricular ejection fraction (LVEF) of 33% due to global hypokinesis and severely depressed global longitudinal strain (GLS) (−9.9%) with elevated mechanical dispersion of 91 ms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). For all this and due to the cardiac magntic resonance imaging findings that confirmed the presence of biventricular dilatation with LVEF of 33%, and areas of late gadolinium enhancement (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), it was decided to implant a cardiac resynchronization therapy device associated with a defibrillator (video 2). Fifteen (15) days after implantation, the patient showed significant functional improvement, ECG with left ventricular pacing with QRS complex of 127 ms (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and an increased LVEF of 48% (video 3) and GLS up to −14% on the echocardiogram with mechanical dispersion reduction of 28.4 msg (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0015" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:6 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1568 "Ancho" => 1634 "Tamanyo" => 591800 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1636 "Ancho" => 1633 "Tamanyo" => 225521 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1597 "Ancho" => 1634 "Tamanyo" => 592757 ] ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 538624 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 4 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 7461870 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 5 => array:5 [ "identificador" => "upi0015" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 389069 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004600000012/v1_202211260614/S2173572722001874/v1_202211260614/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004600000012/v1_202211260614/S2173572722001874/v1_202211260614/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722001874?idApp=WMIE" ]