José Nunes de Alencar

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Verified

José Nunes verified their affiliation via an institutional email.

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• MD
• Medical Doctor at Instituto Dante Pazzanese de Cardiologia - Fundação Adib Jatene

Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff–Parkinson–White syndrome where usually overt ventricular...

Electrocardiograms (ECGs) are a cornerstone in cardiac care. Traditional statistical metrics like sensitivity and specificity are commonly used for diagnostic evaluations but are limited when applied in clinical settings due to their inability to incorporate pre-test likelihoods or individual patient context. Traditional diagnostic metrics do not p...

Objective To evaluate the diagnostic sensitivity and specificity of ST-segment elevation on a 12‑lead ECG in detecting ACO across any coronary artery, challenging the current STEMI-NSTEMI paradigm. Methods Studies from MEDLINE and Scopus (2012−2023) comparing ECG findings with coronary angiograms were systematically reviewed and analyzed following...

To develop a novel diagnostic electrocardiogram (ECG) score to improve the early detection of right atrial disease (RAD) in pediatric patients with congenital heart disease (CHD). We conducted a retrospective case–control study involving 219 pediatric patients aged 0 to 14 years with confirmed CHD and 1,418 controls without congenital disease. The...

(none) " We would like to take this opportunity to discuss some numerical data presented, to contribute to a deeper understanding of the occlusion myocardial infarction (OMI) paradigm. "

Background Painful left bundle branch block (PLBBB) syndrome remains a poorly understood cardiac anomaly. This systematic review consolidates case report evidence to elucidate effective management strategies and patient outcomes. Methods Databases including PubMed, Scopus, Web of Science, and Scielo were searched without restrictions on language o...

Background Wolff-Parkinson-White (WPW) syndrome is characterized by ventricular pre-excitation, which can lead to severe arrhythmic events such as supraventricular tachycardia and pre-excited atrial fibrillation. The diagnostic value of non-invasive exercise tests in detecting high-risk accessory pathways remains inconsistent in the literature. Obj...

Resumo Fundamento A síndrome de Wolff-Parkinson-White (WPW) é caracterizada por pré-excitação ventricular, que pode levar a eventos arrítmicos graves, como taquicardia supraventricular e fibrilação atrial pré-excitada. O valor diagnóstico de testes ergométricos não invasivos para detectar vias acessórias de alto risco permanece inconsistente na lit...

The evolution of medical reasoning is deeply intertwined with philosophical thought, beginning with Aristotle’s foundational work in deductive logic. Aristotle’s principles significantly influenced early medical practice, shaping the works of Galen and Avicenna, who made empirical observations that expanded clinical knowledge. During the Enlightenm...

A generation ago thrombolytic therapy led to a paradigm shift in myocardial infarction (MI), from Q-wave/non-Q-wave to ST-segment elevation MI (STEMI) vs non-STEMI. Using STE on the electrocardiogram (ECG) as a surrogate marker for acute coronary occlusion (ACO) allowed for rapid diagnosis and treatment. But the vast research catalyzed by the STEMI...

Objective(s): To develop a novel diagnostic electrocardiogram (ECG) score to improve the early detection of right atrial disease (RAD) and hypertrophy (RAH) in pediatric patients with congenital heart disease (CHD). Study design: We conducted a retrospective case-control study involving 219 pediatric patients aged 0 to 14 years with confirmed CHD a...

Link to full text: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12641 #evidencebasedmedicine #Likelihoodratios #medicine #JournalofEvidenceBasedMedicine #diagnostictests #diagnostic #clinicaldecisionmaking #diagnosticaccuracy #diagnostictest #medicina #medicinabaseadaemevidências #testesdiagnósticos #diagnóstico #Likelihoodratio #medicina...

A medicina de emergência exige ações rápidas e decisivas, muitas vezes baseadas em testes diagnósticos. No entanto, a dependência dos testes diagnósticos, apesar de sua aparente precisão, pode, às vezes, levar a resultados subótimos. Este artigo explora três cenários clínicos que destacam a importância de uma abordagem bayesiana criteriosa na práti...

Resumo Embora o modelo existente de classificação do infarto agudo do miocárdio (IAM) em IAMCSST e IAMSSST tenha sido benéfico, considera-se hoje que ele falha em abordar a complexidade das síndromes coronarianas agudas. O estudo tem como objetivo examinar o atual paradigma IAMCSST-IAMSSST e defender um modelo mais detalhado, chamado de oclusão cor...

Although the existing framework for classifying acute myocardial infarction (AMI) into STEMI and NSTEMI has been beneficial, it is now considered to be falling short in addressing the complexity of acute coronary syndromes. The study aims to scrutinize the current STEMI-NSTEMI paradigm and advocate for a more nuanced framework, termed as occlusion...

Cognitive biases can cause diverse medical errors and lead to malpractice with potential harm to patients. Some cognitive biases are due to social behavior, professional specialization, and personal experience, leading to commission or omission in medical conduct. We would like to propose a previously undescribed cognitive bias called “Schrödinger’...

Introduction: There are algorithms to estimate the location of an accessory pathway (AP). However, in right-sided APs, they tend to present low accuracy. This paper presents a new electrocardiographic criterium to estimate the location of a right-sided AP. Materials and methods: Rest ECGs from patients with manifest pre-excitation of right-sided AP...

Atrial fibrillation is the most common cardiac arrhythmia in emergency departments. There is growing evidence that certain patients with acute atrial fibrillation can be safely managed in the emergency room without the need for hospitalization, minimizing costs and reducing unnecessary exposures. This review addresses the emergency management of at...

As medical education evolves, some traditional teaching methods often get forgotten. For generations, the Lewis ladder diagram (LLD) has helped students understand the mechanisms of cardiac arrhythmias and conduction disorders. Similarly, clinicians have used LLDs to communicate their proposed mechanisms to their colleagues and trainees. In this ar...

Introduction Posteroseptal accessory pathways account for 34.5% of the total. Of these, 36% are located within the coronary sinus (CS). Its ablation requires technical alternatives to avoid damage to surrounding tissues, especially branches of the right coronary artery. Case report A 22-year-old man was referred for re-do ablation of an accessory...

T wave inversion in inferior and lateral leads of a 12-lead electrocardiogram (ECG) warrants further investigation for cardiomyopathies, ischaemic heart disease, and pericarditis. T wave inversion in the right precordial leads V1 to V3, namely V1 and V2, is a relatively common finding in children, adolescents, and athletes, but an infrequent and in...

Since it was first reported in 1912, acute coronary syndrome (ACS) has become the leading cause of death in the Western world. Several improvements that have been made over the years in the pharmacological treatment of ACS have reduced the relative risk of death due to myocardial infarction from 35-45% previously to approximately 3.5% at present. U...

The concomitant diagnosis of left bundle branch block and antero- superior hemi-block is controversial among cardiologists, especially when there is left vectorcardiographic axis deviation. In a brief lite- rature review, we describe His bundle’s anatomy and its trifascicular nature, we present Medrano’s quadrifascicular theory and revise the diagn...

Arrhythmogenic right ventricular dysplasia or cardiomyopathy (ARVD/C) is a pathologic condition where the right ventricle is partially or totally replaced by fatty and fibrous tissue. The electrocardiogram (ECG) has a central role for diagnosis since it comprises two major and two minor criteria in the diagnostic criteria published by the Task 1 Fo...

Vagal maneuver is considered as the rst step in treatment of stable supraventricular tachycardias with good safety. We present a case where an otherwise healthy 47 year old woman presenting supraventricular tachycardia had non-sustained polymorphic ventricular tachycardia following the modi ed Valsalva maneuver. To our knowledge, this is the second...

Background: Electrocardiogram is the initial test in the investigation of heart disease. Electrocardiographic changes in hypertrophic cardiomyopathy have no set pattern, and correlates poorly with echocardiographic findings. Cardiac magnetic resonance imaging has been gaining momentum for better assessment of hypertrophy, as well as the detection o...

Diabetes Mellitus (DM) is a chronic cardio-metabolic disease and plays an important role on cardiovascular outcomes, most importantly when associated with an already established heart disease. Its effects in the body involve both metabolic and structural changes. To avoid such complications, in addition to the strategies already used and known, ris...

Heart failure (HF) is a crescent, solemn and multiple etiology worldwide health problem, which, besides potentially fatal, decreases the life quality of the affected people, mainly the elderly. Despite having obtained drugs that help in the disease development control, have been sought new alternatives for better management of these individuals. Th...