Case report
An unusual case of mesenteric ischemia in a patient with cardiac myxoma
Um caso incomum de isquemia mesentérica em paciente com mixoma cardíaco
Gabriel Pérez Baztarrica
, Norberto Bornancini, Flavio Salvaggio, Rafael Porcile
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Departament of Cardiology and Physiology, Hospital of the Universidad Abierta Interamericana, Faculty of Medicine, Buenos Aires, Argentina
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dimensão da tarefa à nossa frente" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "601" "paginaFinal" => "608" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Familiarity and perceptions of Portuguese cardiologists concerning cardiac magnetic resonance and cardiac computed tomography: The extent of the task ahead" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1660 "Ancho" => 2167 "Tamanyo" => 310753 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Respostas à questão: «Como classificaria as seguintes indicações para ressonância magnética cardíaca?». AngioRM: angioressonância magnética; CAVD: cardiopatia arritmogénica do ventrículo direito; DCC: doença cardíaca congénita; EAM CN: enfarte agudo do miocárdio com coronárias normais; NS/NR: não sabe/não responde; MCH: miocardiopatia hipertrófica; RM s<span class="elsevierStyleItalic">tress</span>: ressonância magnética de sobrecarga.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "António Miguel Ferreira, Nuno Bettencourt, Pedro Matos, Luís Oliveira, Ana G. Almeida" "autores" => array:6 [ 0 => array:2 [ "nombre" => "António Miguel" "apellidos" => "Ferreira" ] 1 => array:2 [ "nombre" => "Nuno" "apellidos" => "Bettencourt" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Matos" ] 3 => array:2 [ "nombre" => "Luís" "apellidos" => "Oliveira" ] 4 => array:2 [ "nombre" => "Ana G." 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Axial (B) and sagittal (C) CT scans of the thorax showing a large filling defect in the left atrium (T). (D) Photograph of the resected mass (6.5 cm×4.5 cm). LA: left atrium; LV: left ventricle; MV: mitral valve; T: tumor.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiac myxoma is the most common type of primary cardiac tumor in adults. Symptoms of cardiac tumors depend mostly on their size and location. The clinical presentation includes one or more symptoms of the classical triad of hemodynamic compromise due to intracardiac obstruction, signs of systemic or pulmonary embolization, and nonspecific constitutional manifestations.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Due to the predominance of left-sided myxomas, systemic embolisms (cerebral and peripheral) are most frequently encountered. In more than 50% of cases, cerebral arteries, including the retinal arteries, are affected. Symptoms related to peripheral embolism are experienced in 2%–15% of cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> We present a rare case of mesenteric ischemia produced by embolism to the superior mesenteric artery from a large cardiac myxoma.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 54-year-old man with no known medical conditions was admitted to the hospital due to sudden lower abdominal pain. His heart rate was 100 bpm and his blood pressure was 130/80<span class="elsevierStyleHsp" style=""></span>mmHg. The physical examination revealed general distension of the abdomen with absence of peritoneal signs.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests showed leukocytosis of 14<span class="elsevierStyleHsp" style=""></span>800/mm<span class="elsevierStyleSup">3</span>, mild metabolic acidosis, increased blood urea nitrogen (70<span class="elsevierStyleHsp" style=""></span>mg/ml) and plasma creatinine (1.5<span class="elsevierStyleHsp" style=""></span>mg/dl). Other laboratory tests were normal.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A computed tomography (CT) scan showed occlusion of the superior mesenteric artery (SMA); the other arteries were normal (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The initial approach was to correct fluid and electrolyte imbalance and to start therapy with broad-spectrum antibiotics. As the patient presented a good clinical response, a non-invasive approach was adopted with prescription of systemic anticoagulation therapy. He had a favorable response with no clinical signs of mesenteric ischemia.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was transferred to our center for further evaluation of the cause of embolism of the SMA.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Transthoracic and transesophageal echocardiography revealed an encapsulated mobile tumor 6.65<span class="elsevierStyleHsp" style=""></span>cm in diameter in the left atrium (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A). Thoracic CT showed a large filling defect in the left atrium (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B and C). The patient underwent cardiac surgery 14 days after the episode and the cardiac mass was completely removed (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D). The histopathological diagnosis was cardiac myxoma. The patient was discharged five days later.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">As periodic CT scans showed progressive improvement of blood flow through the SMA, the patient continued therapy with acenocoumarol (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B and C).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Acute mesenteric ischemia is defined as a sudden loss of blood supply to the SMA and can result in intestinal infarction. Acute embolism of the SMA is the main cause of acute intestinal ischemia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Mesenteric artery embolism is generally caused by a thrombus in the left atrium in patients with atrial fibrillation or mitral valve stenosis, mechanical prosthetic valve, septic vegetation, left ventricular aneurysm, intracardiac thrombi after myocardial infarction or aortic atheromatous plaques.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These causes were ruled out in our patient.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Myxoma is the most common cardiac tumor, comprising 50% of all primary cardiac tumors. The clinical presentation in most patients consists of significant hemodynamic symptoms related to blood flow obstruction and/or nonspecific constitutional manifestations and/or embolic phenomena.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> Despite its benign pathologic nature, serious results can occur due to systemic embolism. Due to the predominance of left-sided myxomas, systemic embolisms (cerebral and peripheral) are most frequently encountered. Symptoms related to peripheral embolism are experienced in 2%–15% of cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Cases of mesenteric embolism are rare.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Two questions arose during this patient's follow-up. What factors determined the good initial clinical tolerance? Why was anticoagulation therapy useful? The first question may be answered by the fact that the patient sought medical care without delay and therapy was started rapidly after symptom onset. Furthermore, age less than 60 years is associated with improved survival.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The answer to the second question may be related to the nature of emboli originating from a cardiac myxoma: thrombi covering the surface of the tumor, myxoid material, or both.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a> Such thrombi may be responsible for vessel occlusion, and in this case anticoagulation therapy may be beneficial. This could be one of the reasons for our patient's favorable clinical outcome and the recovery of blood flow demonstrated by CT. At present, there is no explanation in the literature for the benefits of anticoagulation therapy in patients with embolism associated with cardiac myxoma.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0070" class="elsevierStylePara elsevierViewall">To summarize, we present an unusual case of mesenteric ischemia due to embolism originating from a cardiac myxoma. The management of this condition should include treatment of mesenteric ischemia and resection of the cardiac tumor. Although anticoagulation therapy proved to be useful in our patients, the role of this treatment is unknown.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres257766" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec245349" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres257765" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec245348" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-05-01" "fechaAceptado" => "2012-11-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec245349" "palabras" => array:4 [ 0 => "Myxoma" 1 => "Embolism" 2 => "Mesenteric artery" 3 => "Ischemia" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec245348" "palabras" => array:4 [ 0 => "Mixoma" 1 => "Embolia" 2 => "Artéria mesentérica superior" 3 => "Isquemia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Symptoms related to peripheral embolism are experienced in 2%–15% of cases of cardiac myxoma. We present a rare case of a 54-year-old man admitted due to sudden abdominal pain. A computed tomography (CT) scan showed occlusion of the superior mesenteric artery (SMA). As the patient's response to support treatment was favorable, a non-invasive approach was adopted, with prescription of oral anticoagulation (OAC) therapy. Transesophageal echocardiography revealed a tumor in the left atrium. The cardiac mass was completely removed and diagnosed as myxoma by histopathological analysis. As periodic CT scans showed progressive improvement of blood flow through the SMA, OAC was continued. OAC may have been beneficial due to the nature of emboli originating from a cardiac myxoma: thrombi covering the surface of the tumor. At present, there is no explanation in the literature for the benefits of OAC in patients with embolism associated with cardiac myxoma.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Os sintomas relacionados com a embolia periférica são experimentados por 2 a 15% dos casos. Apresentamos um caso raro de um homem de 54 anos que foi internado devido a dor abdominal súbita. Uma tomografia computadorizada (TC) mostrou a oclusão da artéria mesentérica superior (AMS). Como o paciente teve uma resposta favorável durante o tratamento de suporte foi decidida uma abordagem não-invasiva com prescrição de terapia anticoagulante oral (TAO). O ecocardiograma transesofágico demonstrou um tumor no átrio esquerdo (AE). A massa cardíaca foi completamente removida. O diagnóstico histopatológico foi de mixoma. Como a tomografia computadorizada periódica apresentou melhoria progressiva do fluxo de sangue através da AMS, o paciente continuou com TAO. A terapia anticoagulante pode ter sido útil devido aos componentes de êmbolos provenientes de mixoma cardíaco: trombos que cobrem a superfície do tumor. Atualmente, não há nenhuma bibliografia publicada que explique os benefícios da TAO em pacientes com embolia associada com mixoma cardíaco.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2250 "Ancho" => 3000 "Tamanyo" => 508012 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) A computed tomography (CT) scan within the first 24<span class="elsevierStyleHsp" style=""></span>hours showed absence of contrast in the superior mesenteric artery (SMA) (arrow). Follow-up CT scans demonstrated gradual improvement in flow through the SMA (arrows) at 10 days (B) and two months (C). Ao: aorta; SMA: superior mesenteric artery.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1875 "Ancho" => 2500 "Tamanyo" => 456024 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) A solid mass in the left atrium seen with transesophageal echocardiography, measuring 6.65 cm×4.22 cm (T). Axial (B) and sagittal (C) CT scans of the thorax showing a large filling defect in the left atrium (T). (D) Photograph of the resected mass (6.5 cm×4.5 cm). LA: left atrium; LV: left ventricle; MV: mitral valve; T: tumor.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Echocardiographic and morphologic characteristics of left atrial myxoma and their relation to systemic embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Ha" 1 => "W. Kang" 2 => "N. Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "1999" "volumen" => "83" "paginaInicial" => "1579" "paginaFinal" => "1582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10363879" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac myxomas: 24 years of experience in 49 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I. Keeling" 1 => "P. Oberwalder" 2 => "M. Anelli-Monti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2002" "volumen" => "22" "paginaInicial" => "971" "paginaFinal" => "977" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12467822" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical excision of cardiac myxomas: twenty years’ experience at a single institution" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Garatti" 1 => "G. Nano" 2 => "A. Canziani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2011.11.009" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2012" "volumen" => "93" "paginaInicial" => "825" "paginaFinal" => "831" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22296980" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical therapy for acute superior mesenteric artery embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Bingol" 1 => "N. Zeybek" 2 => "F. Cingöz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjsurg.2003.10.022" "Revista" => array:6 [ "tituloSerie" => "Am J Surg" "fecha" => "2004" "volumen" => "188" "paginaInicial" => "68" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15219487" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of multislice computed tomography in the diagnosis of acute mesenteric ischemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Yikilmaz" 1 => "O. Karahan" 2 => "S. Senol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2010.07.016" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2011" "volumen" => "80" "paginaInicial" => "297" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20719444" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac myxomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Reynen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199512143332407" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1995" "volumen" => "333" "paginaInicial" => "1610" "paginaFinal" => "1617" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7477198" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contemporary management of acute mesenteric ischemia: factors associated with survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Park" 1 => "P. Gloviczki" 2 => "K. Cherry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2002" "volumen" => "35" "paginaInicial" => "445" "paginaFinal" => "452" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11877691" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003200000078/v1_201308220036/S0870255113001212/v1_201308220036/en/main.assets" "Apartado" => array:4 [ "identificador" => "362" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003200000078/v1_201308220036/S0870255113001212/v1_201308220036/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255113001212?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 5 | 12 |
| 2024 Outubro | 34 | 31 | 65 |
| 2024 Setembro | 40 | 24 | 64 |
| 2024 Agosto | 47 | 33 | 80 |
| 2024 Julho | 29 | 29 | 58 |
| 2024 Junho | 31 | 21 | 52 |
| 2024 Maio | 32 | 36 | 68 |
| 2024 Abril | 34 | 33 | 67 |
| 2024 Maro | 34 | 19 | 53 |
| 2024 Fevereiro | 33 | 27 | 60 |
| 2024 Janeiro | 26 | 18 | 44 |
| 2023 Dezembro | 33 | 32 | 65 |
| 2023 Novembro | 35 | 33 | 68 |
| 2023 Outubro | 22 | 14 | 36 |
| 2023 Setembro | 27 | 24 | 51 |
| 2023 Agosto | 26 | 24 | 50 |
| 2023 Julho | 24 | 27 | 51 |
| 2023 Junho | 31 | 14 | 45 |
| 2023 Maio | 33 | 26 | 59 |
| 2023 Abril | 19 | 2 | 21 |
| 2023 Maro | 27 | 30 | 57 |
| 2023 Fevereiro | 27 | 19 | 46 |
| 2023 Janeiro | 20 | 17 | 37 |
| 2022 Dezembro | 31 | 29 | 60 |
| 2022 Novembro | 41 | 29 | 70 |
| 2022 Outubro | 28 | 21 | 49 |
| 2022 Setembro | 29 | 40 | 69 |
| 2022 Agosto | 26 | 40 | 66 |
| 2022 Julho | 28 | 36 | 64 |
| 2022 Junho | 26 | 27 | 53 |
| 2022 Maio | 20 | 30 | 50 |
| 2022 Abril | 33 | 27 | 60 |
| 2022 Maro | 35 | 41 | 76 |
| 2022 Fevereiro | 18 | 24 | 42 |
| 2022 Janeiro | 29 | 20 | 49 |
| 2021 Dezembro | 27 | 23 | 50 |
| 2021 Novembro | 39 | 40 | 79 |
| 2021 Outubro | 34 | 36 | 70 |
| 2021 Setembro | 27 | 27 | 54 |
| 2021 Agosto | 40 | 29 | 69 |
| 2021 Julho | 44 | 25 | 69 |
| 2021 Junho | 23 | 12 | 35 |
| 2021 Maio | 38 | 29 | 67 |
| 2021 Abril | 72 | 48 | 120 |
| 2021 Maro | 47 | 23 | 70 |
| 2021 Fevereiro | 70 | 14 | 84 |
| 2021 Janeiro | 37 | 9 | 46 |
| 2020 Dezembro | 28 | 10 | 38 |
| 2020 Novembro | 38 | 9 | 47 |
| 2020 Outubro | 19 | 9 | 28 |
| 2020 Setembro | 59 | 14 | 73 |
| 2020 Agosto | 40 | 11 | 51 |
| 2020 Julho | 63 | 9 | 72 |
| 2020 Junho | 36 | 10 | 46 |
| 2020 Maio | 38 | 4 | 42 |
| 2020 Abril | 44 | 12 | 56 |
| 2020 Maro | 49 | 12 | 61 |
| 2020 Fevereiro | 135 | 33 | 168 |
| 2020 Janeiro | 43 | 17 | 60 |
| 2019 Dezembro | 42 | 16 | 58 |
| 2019 Novembro | 51 | 8 | 59 |
| 2019 Outubro | 55 | 15 | 70 |
| 2019 Setembro | 23 | 8 | 31 |
| 2019 Agosto | 23 | 4 | 27 |
| 2019 Julho | 44 | 17 | 61 |
| 2019 Junho | 35 | 7 | 42 |
| 2019 Maio | 70 | 15 | 85 |
| 2019 Abril | 24 | 17 | 41 |
| 2019 Maro | 82 | 29 | 111 |
| 2019 Fevereiro | 91 | 18 | 109 |
| 2019 Janeiro | 130 | 6 | 136 |
| 2018 Dezembro | 73 | 20 | 93 |
| 2018 Novembro | 95 | 12 | 107 |
| 2018 Outubro | 214 | 16 | 230 |
| 2018 Setembro | 50 | 8 | 58 |
| 2018 Agosto | 46 | 13 | 59 |
| 2018 Julho | 44 | 10 | 54 |
| 2018 Junho | 59 | 6 | 65 |
| 2018 Maio | 79 | 13 | 92 |
| 2018 Abril | 46 | 5 | 51 |
| 2018 Maro | 92 | 7 | 99 |
| 2018 Fevereiro | 47 | 4 | 51 |
| 2018 Janeiro | 47 | 7 | 54 |
| 2017 Dezembro | 94 | 11 | 105 |
| 2017 Novembro | 47 | 7 | 54 |
| 2017 Outubro | 34 | 11 | 45 |
| 2017 Setembro | 40 | 5 | 45 |
| 2017 Agosto | 48 | 7 | 55 |
| 2017 Julho | 35 | 13 | 48 |
| 2017 Junho | 43 | 15 | 58 |
| 2017 Maio | 43 | 15 | 58 |
| 2017 Abril | 17 | 6 | 23 |
| 2017 Maro | 20 | 1 | 21 |
| 2017 Fevereiro | 27 | 6 | 33 |
| 2017 Janeiro | 36 | 6 | 42 |
| 2016 Dezembro | 28 | 4 | 32 |
| 2016 Novembro | 15 | 11 | 26 |
| 2016 Outubro | 24 | 8 | 32 |
| 2016 Setembro | 14 | 7 | 21 |
| 2016 Agosto | 10 | 1 | 11 |
| 2016 Julho | 6 | 2 | 8 |
| 2016 Junho | 18 | 8 | 26 |
| 2016 Maio | 10 | 7 | 17 |
| 2016 Abril | 23 | 1 | 24 |
| 2016 Maro | 40 | 20 | 60 |
| 2016 Fevereiro | 66 | 32 | 98 |
| 2016 Janeiro | 46 | 28 | 74 |
| 2015 Dezembro | 57 | 15 | 72 |
| 2015 Novembro | 44 | 18 | 62 |
| 2015 Outubro | 55 | 19 | 74 |
| 2015 Setembro | 39 | 14 | 53 |
| 2015 Agosto | 55 | 18 | 73 |
| 2015 Julho | 60 | 8 | 68 |
| 2015 Junho | 28 | 5 | 33 |
| 2015 Maio | 37 | 10 | 47 |
| 2015 Abril | 83 | 7 | 90 |
| 2015 Maro | 87 | 11 | 98 |
| 2015 Fevereiro | 85 | 8 | 93 |
| 2015 Janeiro | 94 | 11 | 105 |
| 2014 Dezembro | 99 | 5 | 104 |
| 2014 Novembro | 101 | 12 | 113 |
| 2014 Outubro | 96 | 13 | 109 |
| 2014 Setembro | 82 | 11 | 93 |
| 2014 Agosto | 98 | 7 | 105 |
| 2014 Julho | 84 | 16 | 100 |
| 2014 Junho | 87 | 5 | 92 |
| 2014 Maio | 103 | 14 | 117 |
| 2014 Abril | 91 | 6 | 97 |
| 2014 Maro | 110 | 13 | 123 |
| 2014 Fevereiro | 105 | 19 | 124 |
| 2014 Janeiro | 97 | 17 | 114 |
| 2013 Dezembro | 74 | 21 | 95 |
| 2013 Novembro | 93 | 17 | 110 |
| 2013 Outubro | 80 | 27 | 107 |
| 2013 Setembro | 87 | 49 | 136 |
| 2013 Agosto | 23 | 16 | 39 |
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