Cardiovascular System – ABC CARDIOL

IJCS

Editorial

Strengthening Our Understanding of Muscle Metaboreflex Control in Patients with Coronary Artery Disease: (Dis)association Between Physical Fitness and Hemodynamic Responses

Ischemic Heart Disease remains a leading cause of mortality worldwide. In addition to pharmacologic therapy and coronary revascularization, healthy lifestyle interventions such as diet and exercise are essential components of disease management. Although exercise training is a Class I recommendation for patients with ischemic heart disease, physical exertion is not without risk in this population. Indeed, an exercise stress test is a well-established method for inducing myocardial ischemia. Furthermore, patients with ischemic heart disease often exhibit abnormal cardiovascular responses during exercise, which makes exercise prescription both challenging and potentially risky in this clinical population. Therefore, understanding the physiological mechanisms underlying the altered cardiovascular control at rest and during exercise, as well as the cardioprotective effects of exercise training in patients with ischemic heart disease, is critical for improving treatment strategies and optimizing disease management.

The cardiovascular responses to exercise are orchestrated by several integrative neural control mechanisms, including central command, the exercise pressor reflex, the arterial and cardiopulmonary baroreflexes, and the central and peripheral chemoreflexes. The exercise pressor reflex comprises group III and IV skeletal muscle afferents that discharge in response to mechanical deformation (i.e., muscle mechanoreflex) and the accumulation of metabolic by-products of muscle contraction (i.e., muscle metaboreflex).^, Inputs from group III/IV afferent fibers synapse within cardiovascular control areas in the brainstem that reflexively decrease parasympathetic and increase sympathetic nerve activity, leading to increased Heart Rate (HR), cardiac output, total peripheral resistance, and arterial blood pressure during exercise.^, It has been shown that the blood pressure responses to exercise and metaboreflex activation are directly associated with absolute muscle strength in young, healthy adults.^, Moreover, exercise training-induced improvements in cardiorespiratory fitness can modulate metaboreflex control. Nevertheless, the extent to which the cardiovascular responses to muscle metaboreflex activation are related to markers of physical fitness in patients with Coronary Artery Disease (CAD) is currently unknown.

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IJCS

Original Article

Frequent Cardiovascular Manifestations Associated With SARS Cov-2 Infection: Experience at a Tertiary Hospital In Cali, Colombia

Duvan Arley Galindes-Casanova et al. Edith Norela Benitez-Escobar Luis Álvaro Melo-Burbano Nelson Eduardo Murillo-Benitez … Juan Carlos Avila-Valencia Jorge Enrique Daza-Arana

Abstract

Background:

Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system, while the most common extrapulmonary complication of COVID-19 is cardiovascular involvement.

Objective:

To identify the frequency of electrocardiographic changes and cardiac arrhythmias in patients hospitalized with COVID-19 infection.

Methods:

This was a cross-sectional study, including patients aged >18 years with diagnosis of severe acute respiratory syndrome coronavirus 2 infection in a high-complexity hospital in Santiago de Cali, Colombia, from March to September 2020. A descriptive analysis with an analytical component and multiple logistic regression analysis were performed; all estimates were established with a 95% confidence level (CI) and a 5% significance level.

Results:

This study included 183 individuals; of whom 160 were considered for electrocardiographic analysis, 63% of which evidenced significant findings, the most frequent being sinus tachycardia (29.4%). The frequency of myocardial injury was 21.9% and was more common among non-survivors than among survivors (41.7% vs. 12.2%, p < 0.001). Myocardial injury was also significantly more common in patients who presented electrocardiographic findings than those who did not (26.5% vs. 12.1%, p = 0.032) and in those who required intensive care admission (31.8% vs 10.5%, p < 0.001). The strongest mortality-associated factor was the need for mechanical ventilation — odds ratio (OR), 9.14; 95% confidence interval, 3.4–24.5.

Conclusions:

Electrocardiographic findings in patients with COVID 19 are frequent, including newly diagnosed arrhythmias, justifying the use of cost-effective tools for the initial approach and follow-up of this affected population. Worse outcomes depend on factors such as invasive mechanical ventilation, comorbidities, age, and superinfection.

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Review Article

Effect of Physical Training on Nitric Oxide Levels in Patients with Arterial Hypertension: An Integrative Review

Tábata de Paula Facioli et al. Mariana Colombini Buranello Eloisa Maria Gatti Regueiro Renata Pedrolongo Basso-Vanelli Marina de Toledo Durand

Abstract

The regular practice of physical exercise as a non-pharmacological treatment of arterial hypertension (AH) has been encouraged due to causing a series of physiological responses in the cardiovascular system, such as the production of vasoactive substances, including nitric oxide (NO). NO is a relaxation factor released by the endothelium, and the decrease in its bioavailability is related to coronary and arterial diseases, such as AH. This study aimed to perform an integrative literature review to elucidate the effect of physical training on NO levels in patients with AH and to establish a relationship between these levels and blood pressure (BP) control. A literature review was was performed by searching PubMed / MEDLINE, Lilacs, Scielo, Cinahl and Embase databases. The search string used was (“arterial hypertension” OR hypertension) AND (exercise OR “physical exercise” OR “aerobic exercise” OR “exercise training” or “physical activity”) AND (“nitric oxide”). We included fully available controlled and uncontrolled clinical trials published in English and Portuguese languages in the last 10 years. The review consisted of 16 articles, of which 13 reported an increase in NO production after the physical training intervention, and three studies found no change. In addition, 15 studies observed a reduction in BP after the intervention. In conclusion, regular practice of physical exercises, advocating moderate intensity, can improve NO bioavailability in pre-hypertensive and hypertensive individuals, which seems to be one of the mechanisms responsible for BP reduction.

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Review Article

Effects of Chloroquine and Hydroxychloroquine on the Cardiovascular System – Limitations for Use in the Treatment of COVID-19

Stephani Correia Brazão et al. Lis Jappour Autran Rosane de Oliveira Lopes Christianne Brêtas Vieira Scaramello … Fernanda Carla Ferreira de Brito Nadia Alice Vieira Motta

Abstract

Chloroquine (CQ) and Hydroxychloroquine (HCQ) are antimalarial drugs, with anti-inflammatory properties that justify their use in the treatment of systemic lupus erythematosus and rheumatic diseases. A pandemic caused by the new coronavirus led the entire world’s scientific community to look for drugs already available on the market, capable of exercising beneficial actions in the fight against the disease. Preliminary studies in patients, as well as in vitro studies, suggested possible therapeutic effects associated with the use of HCQ and CQ in the treatment of COVID-19. Despite controversies over the effects of these drugs in combating the “cytokine storm” associated with COVID and the dismal of results in different clinical trials in Brazil, their use has been encouraged and several ongoing investigative studies are underway. In addition to the possible beneficial effects on the prognosis of patients with SARS-CoV-2, such drugs include varied effects on the cardiovascular system, ranging from positive developments related to their vasodilator properties to potential negative effects, such as cardiotoxicity. This work presents the main effects exerted by these drugs on the cardiovascular system, in order to contribute to a scientific discussion about the repurposing of these drugs in the context of COVID-19.

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Review Article

Effects of Exercise Training on Cardiovascular and Autonomic Parameters in Stroke Survivors: A Systematic Review

Bruno Bavaresco Gambassi et al. Fabiano de Jesus Furtado Almeida Ana Eugênia Araújo Furtado Almeida João Alberto Ribeiro … Tânia Maria Gaspar Novais Paulo Adriano Schwingel Ciro Oliveira Queiroz Clarcson Plácido Conceição dos Santos Bruno Rodrigues

Abstract

Negative changes in cardiovascular and autonomic variables in stroke survivors have encouraged the global scientific community to focus on investigating therapeutic strategies to mitigate stroke damage. The objective of the present study was to describe the effects of exercise training on cardiovascular and autonomic variables in stroke survivors. We used the PICO (population, intervention, control/comparison, and outcome variables) model for the search of articles in PubMed and Physiotherapy Evidence Databases from 2009 to December 2018. The following data were also recorded: type of study, author, year of publication, participants (time after stroke, sample size, and age) and benefits of exercise training. A total of 544 articles were initially selected, of which nine peer-reviewed articles met the search criteria. These nine studies enrolled 611 participants (middle-aged or elderly), and pointed to positive effects of training on maximal oxygen uptake, peak aerobic capacity, 6-minute walk test and resting heart rate. However, more well-controlled studies are needed to confirm the benefits of exercise training on cardiovascular and autonomic variables in this population.

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Strengthening Our Understanding of Muscle Metaboreflex Control in Patients with Coronary Artery Disease: (Dis)association Between Physical Fitness and Hemodynamic Responses

Frequent Cardiovascular Manifestations Associated With SARS Cov-2 Infection: Experience at a Tertiary Hospital In Cali, Colombia

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Effect of Physical Training on Nitric Oxide Levels in Patients with Arterial Hypertension: An Integrative Review

Abstract

Effects of Chloroquine and Hydroxychloroquine on the Cardiovascular System – Limitations for Use in the Treatment of COVID-19

Abstract

Effects of Exercise Training on Cardiovascular and Autonomic Parameters in Stroke Survivors: A Systematic Review

Abstract

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