RESUMO:O tabagismo é atualmente a principal causa de enfermidades evitáveis e incapacidades prematuras em âmbito mundial, sendo que a Organização Mundial de Saúde (OMS) estima cerca de 10 milhões de mortes anuais nos próximos 30 a 40 anos em virtude de complicações de saúde decorrentes do tabaco. Apesar de possuir uma função preventiva em programas antitabagistas, estudos recentes revelam que a classe médica possui porcentagem signifi cativa de profi ssionais fumantes, abalando a credibilidade da mensagem de que fumar é lesivo à saúde. Devido a diversos fatores, dentre eles as difi culdades acadêmicas impostas pelo treinamento médico, parcela signifi cativa de médicos começa a fumar durante a faculdade. O trabalho atual tem como meta analisar a prevalência de tabagismo entre 241 acadêmicos de medicina, através de questionário validado. Verifi cou-se uma incidência média de 17,8% de fumantes cuja idade média foi de 21,6 anos e tempo médio de consumo de tabaco de 5,9 anos. Os autores do trabalho concluem a importância de se conhecer os dados de tabagismo dentre os estudantes de medicina consiste em reforçar a necessidade de campanhas de cessação do fumo em todas as classes da sociedade, inclusive e, principalmente, dentre os futuros profi ssionais médicos que serão os principais agentes na prevenção do tabagismo.

IntroductionPosteroseptal 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 reportA 22-year-old man was referred for re-do ablation of an accessory left septal-septal (PSE) pathway. Inside the CS, a precocity of 25 ms was found in the region of the median cardiac vein (VCM) (Fig. 2, panel A). Radiofrequency (RF) was administered with a non-irrigated bidirectional catheter within this vessel with resolution of the pre-excitation after 5 seconds. Immediately after, the patient presented chest pain and revealed a ST segment elevation of 1 mm in the inferior leads of ECG. Coronary angiography showed occlusion of the middle third of the posterior ventricular branch of the right coronary artery, with no signs of thrombus or dissection. Arterial angioplasty was performed with a bare metal stent, followed by TIMI III distal flow. Retrograde aortic mapping was performed and a precocity of 20 ms was found in the PSE region. The RF was applied followed by loss of pre-excitation after 1.5 seconds of application.ConclusionThis case demonstrates the risks involving delivering radiofrequency within the coronary sinus. We discuss some strategy that could help electrophysiologists in similar cases.

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 atrial fibrillation based on the latest updates on the subject with a focus on the assessment and prevention of thromboembolic phenomena, control of frequency x control of rhythm and strategies for cardioversion and restoration of sinus rhythm or for heart rate control.

Hypertrophic cardiomyopathy (HCM) may be associated with considerable mortality in athletes. However, differentiating myocardial hypertrophy as a physiological adaptation of the heart to exercise can be a clinical challenge. In this context, nuclear magnetic resonance imaging has been shown to be a essential exam for diagnostic elucidation. The case report aimed to depict a young athlete with syncope and an initial investigation suggestive of HCM, which was excluded after deconditioning and serial MRI.