Case report
An unusual ST-segment elevation: Apical hypertrophic cardiomyopathy shows the ace up its sleeve
Elevação do segment St pouco usual: cardiomiopatia hipertrófica apical mostra o às na manga
Francesco de Santis, Amedeo Pergolini, Giordano Zampi
, Gaetano Pero, Paolo Giuseppe Pino, Giovanni Minardi
Autor para correspondência
Department of Cardiovascular Science, “S. Camillo-Forlanini” Hospital, Rome, Italy
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Camillo-Forlanini” Hospital, Rome, Italy" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Elevação do segment St pouco usual: cardiomiopatia hipertrófica apical mostra o às na manga" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1493 "Ancho" => 2500 "Tamanyo" => 433498 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The ECG shows an unusual 4-mm convex ST segment elevation in C4–C6 with biphasic T waves.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Apical hypertrophic cardiomyopathy (AHCM) is part of the broad clinical and morphologic spectrum of hypertrophic cardiomyopathy (HCM).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Cases of AHCM with and without apical aneurysm mimicking myocardial infarction have occasionally been reported.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> We report a patient with abnormalities on the electrocardiogram (ECG) in whom acute coronary syndrome (ACS) was excluded and AHCM was demonstrated by careful differential diagnosis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 77-year-old Caucasian woman was examined by a primary care physician because of dyspnea and atypical chest pain. The ECG showed atrial fibrillation, mean heart rate of 85 bpm, right bundle branch block and 4-mm convex ST segment elevation in C4-C6 with biphasic T waves (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Due to this atypical ECG, similar to a previous one performed two years before, rest-stress myocardial perfusion scintigraphy was prescribed. This revealed a reduction of left ventricular chamber volume suggestive of HCM without signs of ischemia or previous myocardial necrosis (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). The patient was referred to our echo lab in order to complete the diagnostic procedure. Transthoracic echocardiography (TTE) demonstrated AHCM, showing left ventricular (LV) apical hypertrophy with the typical ace of spades shape (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A1). The ace of spades was therefore studied in depth using color Doppler (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A2, Video 1), Sonovue contrast TTE (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A3, Video 2) and real-time three-dimensional echocardiography (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A4, Video 3). A small area of turbulent flow and a mid-ventricular gradient of about 63<span class="elsevierStyleHsp" style=""></span>mmHg were found (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>a). In order to evaluate possible modification of the mid-ventricular gradient, an intravenous bolus of atenolol (3<span class="elsevierStyleHsp" style=""></span>mg) was administered. A significant decrease of about 40<span class="elsevierStyleHsp" style=""></span>mmHg was observed while the ECG was unchanged (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>b). Beta-blocker therapy was prescribed indefinitely. At six-month follow-up, the patient was asymptomatic and in good clinical condition.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">AHCM is characterized by segmental hypertrophy confined to the distal portion of the LV chamber. The prevalence of AHCM among HCM patients is 15% in Japan, whereas in the USA it is only 3%. Among AHCM patients 54% are symptomatic, the most common symptoms being chest pain, palpitations, dyspnea and syncope. This condition may cause various complications including atrial fibrillation, acute myocardial infarction, embolic events, ventricular fibrillation, congestive heart failure, apical aneurysm and cardiac arrest. Moreover, it may mimic other conditions, such as cardiac tumors, LV apical thrombus, isolated ventricular non-compaction, endomyocardial fibrosis and coronary artery disease. The most common ECG findings, seen in about 93% of patients, are negative T waves in the precordial leads (>10<span class="elsevierStyleHsp" style=""></span>mm deep in 47%), followed by signs of LV hypertrophy in 63% of cases. TTE usually shows LV apical hypertrophy and is thus usually the standard diagnostic tool for AHCM. Symptomatic patients may be treated with verapamil, beta-blockers and antiarrhythmic drugs, all of which may improve the signs and symptoms of this condition.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, AHCM is a clinical condition that can cause various complications and simulate ACS. Its diagnosis enables ACS to be excluded in patients with atypical ST-segment elevation. TTE is usually sufficient to make the diagnosis, enabling appropriate medical treatment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres257756" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec245338" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres257755" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec245339" "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:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-09-26" "fechaAceptado" => "2012-11-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec245338" "palabras" => array:3 [ 0 => "Electrocardiogram" 1 => "Hypertrophic cardiomyopathy" 2 => "Congenital heart disease" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec245339" "palabras" => array:3 [ 0 => "Eletrocardiograma" 1 => "Miocardiopatia hipertrófica" 2 => "Cardiopatias congénitas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Apical hypertrophic cardiomyopathy is part of the broad clinical and morphologic spectrum of hypertrophic cardiomyopathy. We report a patient with electrocardiographic abnormalities in whom acute coronary syndrome was excluded and apical hypertrophic cardiomyopathy was demonstrated by careful differential diagnosis.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A miocardiopatia hipertrófica apical faz parte do amplo espectro clínico e morfológico da miocardiopatia hipertrófica. Nós reportamos um doente com alterações electrocardiográficas no qual foi excluída uma síndrome coronária aguda e foi demonstrada uma miocardiopatia hipertrófica apical usando um processo correto de diagnóstico diferencial.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0050" class="elsevierStylePara elsevierViewall">The following are the 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" => "sec0050" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1493 "Ancho" => 2500 "Tamanyo" => 433498 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The ECG shows an unusual 4-mm convex ST segment elevation in C4–C6 with biphasic T waves.</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" => 2594 "Ancho" => 3000 "Tamanyo" => 841342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Rest-stress myocardial perfusion scintigraphy revealing reduced left ventricular chamber volume suggestive of hypertrophic cardiomyopathy without signs of ischemia or previous myocardial necrosis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2563 "Ancho" => 1667 "Tamanyo" => 291285 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Apical hypertrophic cardiomyopathy shows the ace up its sleeve. A1: two-dimensional transthoracic echocardiography; A2: color Doppler transthoracic echocardiography; A3: contrast-enhanced transthoracic echocardiography; A4: real-time three-dimensional reconstruction.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2240 "Ancho" => 1667 "Tamanyo" => 287952 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography, apical 4-chamber view showing (a) a mid-ventricular gradient of about 63 mmHg and (b) a significant decrease in the gradient after administration of an intravenous bolus of atenolol.</p>" ] ] 4 => array:7 [ "identificador" => "upi0005" "etiqueta" => "Video 1" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 10065 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography, apical four chamber view, color comparison, showing left ventricular apical hypertrophy with the typical spade-shaped appearance.</p>" ] ] 5 => array:7 [ "identificador" => "upi0010" "etiqueta" => "Video 2" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 9108 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography, apical four chamber view, echocontrastography with Sonovue improving the definition of the endorcardial border.</p>" ] ] 6 => array:7 [ "identificador" => "upi0015" "etiqueta" => "Video 3" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 6354 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Off-line three dimensional reconstruction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertrophic cardiomyopathy with ventricular septal hypertrophy localized to the apical region of the left ventricle (apical hypertrophic cardiomyopathy)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.J. 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Kervancıoglu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2001" "volumen" => "80" "paginaInicial" => "77" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11575264" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003200000078/v1_201308220036/S0870255113001273/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/S0870255113001273/v1_201308220036/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255113001273?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 15 | 4 | 19 |
| 2024 Outubro | 45 | 32 | 77 |
| 2024 Setembro | 58 | 27 | 85 |
| 2024 Agosto | 70 | 33 | 103 |
| 2024 Julho | 66 | 37 | 103 |
| 2024 Junho | 39 | 37 | 76 |
| 2024 Maio | 57 | 27 | 84 |
| 2024 Abril | 46 | 39 | 85 |
| 2024 Maro | 49 | 26 | 75 |
| 2024 Fevereiro | 41 | 26 | 67 |
| 2024 Janeiro | 42 | 27 | 69 |
| 2023 Dezembro | 41 | 31 | 72 |
| 2023 Novembro | 43 | 31 | 74 |
| 2023 Outubro | 39 | 24 | 63 |
| 2023 Setembro | 29 | 17 | 46 |
| 2023 Agosto | 34 | 22 | 56 |
| 2023 Julho | 50 | 17 | 67 |
| 2023 Junho | 35 | 15 | 50 |
| 2023 Maio | 62 | 34 | 96 |
| 2023 Abril | 32 | 9 | 41 |
| 2023 Maro | 36 | 20 | 56 |
| 2023 Fevereiro | 45 | 18 | 63 |
| 2023 Janeiro | 38 | 17 | 55 |
| 2022 Dezembro | 45 | 33 | 78 |
| 2022 Novembro | 47 | 26 | 73 |
| 2022 Outubro | 46 | 29 | 75 |
| 2022 Setembro | 43 | 36 | 79 |
| 2022 Agosto | 49 | 37 | 86 |
| 2022 Julho | 52 | 46 | 98 |
| 2022 Junho | 36 | 36 | 72 |
| 2022 Maio | 32 | 35 | 67 |
| 2022 Abril | 53 | 21 | 74 |
| 2022 Maro | 30 | 43 | 73 |
| 2022 Fevereiro | 35 | 23 | 58 |
| 2022 Janeiro | 31 | 23 | 54 |
| 2021 Dezembro | 30 | 34 | 64 |
| 2021 Novembro | 53 | 47 | 100 |
| 2021 Outubro | 121 | 43 | 164 |
| 2021 Setembro | 56 | 34 | 90 |
| 2021 Agosto | 51 | 30 | 81 |
| 2021 Julho | 46 | 30 | 76 |
| 2021 Junho | 34 | 24 | 58 |
| 2021 Maio | 32 | 36 | 68 |
| 2021 Abril | 53 | 33 | 86 |
| 2021 Maro | 80 | 30 | 110 |
| 2021 Fevereiro | 75 | 13 | 88 |
| 2021 Janeiro | 48 | 10 | 58 |
| 2020 Dezembro | 24 | 5 | 29 |
| 2020 Novembro | 42 | 12 | 54 |
| 2020 Outubro | 28 | 11 | 39 |
| 2020 Setembro | 45 | 12 | 57 |
| 2020 Agosto | 29 | 10 | 39 |
| 2020 Julho | 63 | 9 | 72 |
| 2020 Junho | 33 | 9 | 42 |
| 2020 Maio | 53 | 6 | 59 |
| 2020 Abril | 39 | 7 | 46 |
| 2020 Maro | 45 | 13 | 58 |
| 2020 Fevereiro | 98 | 21 | 119 |
| 2020 Janeiro | 50 | 12 | 62 |
| 2019 Dezembro | 59 | 15 | 74 |
| 2019 Novembro | 57 | 7 | 64 |
| 2019 Outubro | 66 | 9 | 75 |
| 2019 Setembro | 38 | 14 | 52 |
| 2019 Agosto | 29 | 9 | 38 |
| 2019 Julho | 41 | 16 | 57 |
| 2019 Junho | 52 | 8 | 60 |
| 2019 Maio | 46 | 18 | 64 |
| 2019 Abril | 32 | 25 | 57 |
| 2019 Maro | 83 | 22 | 105 |
| 2019 Fevereiro | 96 | 18 | 114 |
| 2019 Janeiro | 77 | 5 | 82 |
| 2018 Dezembro | 100 | 19 | 119 |
| 2018 Novembro | 101 | 10 | 111 |
| 2018 Outubro | 164 | 38 | 202 |
| 2018 Setembro | 59 | 11 | 70 |
| 2018 Agosto | 52 | 40 | 92 |
| 2018 Julho | 37 | 9 | 46 |
| 2018 Junho | 59 | 10 | 69 |
| 2018 Maio | 64 | 12 | 76 |
| 2018 Abril | 69 | 6 | 75 |
| 2018 Maro | 113 | 10 | 123 |
| 2018 Fevereiro | 54 | 7 | 61 |
| 2018 Janeiro | 64 | 5 | 69 |
| 2017 Dezembro | 85 | 9 | 94 |
| 2017 Novembro | 56 | 11 | 67 |
| 2017 Outubro | 27 | 18 | 45 |
| 2017 Setembro | 53 | 5 | 58 |
| 2017 Agosto | 56 | 8 | 64 |
| 2017 Julho | 67 | 10 | 77 |
| 2017 Junho | 73 | 10 | 83 |
| 2017 Maio | 112 | 15 | 127 |
| 2017 Abril | 68 | 7 | 75 |
| 2017 Maro | 83 | 43 | 126 |
| 2017 Fevereiro | 129 | 11 | 140 |
| 2017 Janeiro | 36 | 5 | 41 |
| 2016 Dezembro | 61 | 10 | 71 |
| 2016 Novembro | 50 | 14 | 64 |
| 2016 Outubro | 115 | 16 | 131 |
| 2016 Setembro | 168 | 5 | 173 |
| 2016 Agosto | 165 | 4 | 169 |
| 2016 Julho | 29 | 3 | 32 |
| 2016 Junho | 3 | 13 | 16 |
| 2016 Maio | 27 | 15 | 42 |
| 2016 Abril | 52 | 3 | 55 |
| 2016 Maro | 76 | 15 | 91 |
| 2016 Fevereiro | 95 | 30 | 125 |
| 2016 Janeiro | 63 | 19 | 82 |
| 2015 Dezembro | 72 | 20 | 92 |
| 2015 Novembro | 80 | 19 | 99 |
| 2015 Outubro | 78 | 21 | 99 |
| 2015 Setembro | 69 | 16 | 85 |
| 2015 Agosto | 78 | 14 | 92 |
| 2015 Julho | 127 | 5 | 132 |
| 2015 Junho | 52 | 3 | 55 |
| 2015 Maio | 49 | 7 | 56 |
| 2015 Abril | 45 | 11 | 56 |
| 2015 Maro | 56 | 7 | 63 |
| 2015 Fevereiro | 51 | 9 | 60 |
| 2015 Janeiro | 50 | 8 | 58 |
| 2014 Dezembro | 73 | 14 | 87 |
| 2014 Novembro | 46 | 9 | 55 |
| 2014 Outubro | 66 | 10 | 76 |
| 2014 Setembro | 50 | 19 | 69 |
| 2014 Agosto | 56 | 11 | 67 |
| 2014 Julho | 42 | 9 | 51 |
| 2014 Junho | 47 | 8 | 55 |
| 2014 Maio | 58 | 13 | 71 |
| 2014 Abril | 72 | 9 | 81 |
| 2014 Maro | 84 | 15 | 99 |
| 2014 Fevereiro | 72 | 19 | 91 |
| 2014 Janeiro | 100 | 18 | 118 |
| 2013 Dezembro | 57 | 13 | 70 |
| 2013 Novembro | 81 | 29 | 110 |
| 2013 Outubro | 83 | 37 | 120 |
| 2013 Setembro | 107 | 44 | 151 |
| 2013 Agosto | 21 | 9 | 30 |
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