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  2. Palavra-chave: unstable angina
ABC
Original Article

Analysis of Plasma Homocysteine Levels in Patients with Unstable Angina

José Roberto Tavares et al. Vânia D'Almeida Daniela C. Diniz Carolina A. Terzi … Edison N. Cruz Edson Stefanini Adagmar Andriollo Angelo A.V. de Paola Antonio C. Carvalho

OBJECTIVE – To determine the prevalence of hyperhomocystinemia in patients with acute ischemic syndrome of the unstable angina type. METHODS – We prospectively studied 46 patients (24 females) with unstable angina and 46 control patients (19 males), paired by sex and age, blinded to the laboratory data. Details of diets, smoking habits, medication used, body mass index, and the presence of hypertension and diabetes were recorded, as were plasma lipid and glucose levels, C-reactive protein, and lipoperoxidation in all participants. Patients with renal disease were excluded. Plasma homocysteine was estimated using high-pressure liquid chromatography. RESULTS – Plasma homocysteine levels were significantly higher in the group of patients with unstable angina (12.7±6.7 µmol/L) than in the control group (8.7±4.4 µmol/L) (p<0.05). Among males, homocystinemia was higher in the group with unstable angina than in the control group, but this difference was not statistically significant (14.1±5.9 µmol/L versus 11.9±4.2 µmol/L). Among females, however, a statistically significant difference was observed between the 2 groups: 11.0±7.4 µmol/L versus 6.4±2.9 µmol/L (p<0.05) in the unstable angina and control groups, respectively. Approximately 24% of the patients had unstable angina at homocysteine levels above 15 µmol/L. CONCLUSION – High homocysteine levels seem to be a relevant prevalent factor in the population with unstable angina, particularly among females.

  • acute ischemic syndrome
  • homocysteine
  • unstable angina
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Creative Commons Attribution (CC BY) Creative Commons license
10/09/2002 DOI: 10.1590/S0066-782X2002001100008 Visualizações 1
ABC
Original Article

Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room

Roberto Bassan et al. Roberto Gamarski Lúcia Pimenta André Volschan … Marcelo Scofano Hans Fernando Dohmann Monica Araujo Cristina Clare Marcelo Fabrício Carlos Henrique Sanmartin Kalil Mohallem Renato Macaciel Sergio Gaspar

PURPOSE: To evaluate the efficacy of a systematic model of care for patients with chest pain and no ST segment elevation in the emergency room. METHODS: From 1003 patients submitted to an algorithm diagnostic investigation by probability of acute ischemic syndrome. We analyzed 600 ones with no elevation of ST segment, then enrolled to diagnostic routes of median (route 2) and low probability (route 3) to ischemic syndrome. RESULTS: In route 2 we found 17% acute myocardial infarction and 43% unstable angina, whereas in route 3 the rates were 2% and 7%, respectively. Patients with normal/non–specific ECG had 6% probability of AMI whereas in those with negative first CKMB it was 7%; the association of the 2 data only reduced it to 4%. In patients in route 2 the diagnosis of AMI could only be ruled out with serial CKMB measurement up to 9 hours, while in route 3 it could be done in up to 3 hours. Thus, sensitivity and negative predictive value of admission CKMB for AMI were 52% and 93%, respectively. About one-half of patients with unstable angina did not disclose objective ischemic changes on admission. CONCLUSION: The use of a systematic model of care in patients with chest pain offers the opportunity of hindering inappropriate release of patients with ACI and reduces unnecessary admissions. However some patients even with normal ECG should not be released based on a negative first CKMB. Serial measurement of CKMB up to 9 hours is necessary in patients with medium probability of AMI.

  • Acute Myocardial Infarction
  • chest pain
  • emergency room
  • unstable angina
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Creative Commons Attribution (CC BY) Creative Commons license
08/01/2002 DOI: 10.1590/S0066-782X2000000500002 Visualizações 1
ABC
Original Article

Does a circadian variation occur in myocardial ischemia over 48 hours in patients with unstable angina?

Luiz Antônio Machado César et al. João Fernando Monteiro Ferreira César J. Grupi David Pamplona … Miguel A. Moretti Elcio Pferfmann José A. F. Ramires

OBJECTIVE: To study the incidence of and variation in myocardial ischemia over 48 hours in patients with unstable angina. METHODS: Thirty-nine patients with unstable angina underwent long-term electrocardiography for 48 hours. The number of events and the period of time of ischemia (in minutes) were analyzed for the 48 hours, in two periods of 24 hours, and in periods of 4 hours. RESULTS: We analyzed 1755.8 hours of monitoring tapes, and ischemic episodes were detected in 18 (46.2%) patients, corresponding to 173 ischemic episodes, allowing the evaluation of 1304 minutes of ischemia.only 4 of which were (2.2%) symptomatic, Considering the entire period of time of recording and the predetermined time intervals, we observed a higher number of ischemic episodes (38) and a longer duration of ischemia (315.4 minutes) between 11:00 am and 3:00 pm. However, no significant differences occurred among the values in the different intervals. CONCLUSION: Long-term electrocardiography over 48 hours showed a high incidence (97.8%) of silent ischemic episodes in patients with unstable angina. No evidence of a circadian variation of myocardial ischemia in unstable angina was observed.

  • Holter monitoring
  • Myocardial Ischemia
  • unstable angina
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Creative Commons Attribution (CC BY) Creative Commons license
08/01/2002 DOI: 10.1590/S0066-782X2000000700002
ABC
Original Article

Chest pain in the emergency room. Importance of a systematic approach

Roberto Bassan et al. Marcelo Scofano Roberto Gamarski Hans Fernando Dohmann … Lúcia Pimenta André Volschan Mônica Araujo Cristina Clare Marcelo Fabrício Carlos Henrique Sanmartin Kalil Mohallem Sergio Gaspar Renato Macaciel

OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74% of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12%) had AMI without ST segment elevation and 202 (31%) had unstable angina (UA). In route 2 (high probability of ACS) 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability) 2% had AMI and 7 % had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49%), with a positive predictive value considered only satisfactory (79%). CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.

  • Acute Myocardial Infarction
  • chest pain
  • emergency room
  • unstable angina
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Creative Commons Attribution (CC BY) Creative Commons license
05/09/2000 DOI: 10.1590/S0066-782X2000000100003 Visualizações 2

Como citar este artigo

EndNote RIS

Formato de Documento Eletrônico (Vancouver)

Tavares JR, D’Almeida V, Diniz DC, Terzi CA, Cruz EN, Stefanini E, Andriollo A, et al. Analysis of Plasma Homocysteine Levels in Patients with Unstable Angina. Arquivos Brasileiros de Cardiologia 2002;79(2):167-72.

Formato de Documento Eletrônico (ABNT)

Tavares, José Roberto; D’Almeida, Vânia; Diniz, Daniela C.; Terzi, Carolina A.; Cruz, Edison N.; Stefanini, Edson; Andriollo, Adagmar; Paola, Angelo A.V. de; Carvalho, Antonio C.. Analysis of Plasma Homocysteine Levels in Patients with Unstable Angina. Arquivos Brasileiros de Cardiologia, v. 79, n. 2, p. 167-172, set. 2002.

Formato de Documento Eletrônico (APA)

Tavares, J. R., D’Almeida, V., Diniz, D. C., Terzi, C. A., Cruz, E. N., Stefanini, E., Andriollo, A., Paola, A. A. , & Carvalho, A. C. (2002). Analysis of Plasma Homocysteine Levels in Patients with Unstable Angina. Arquivos Brasileiros de Cardiologia, 79(2), 167-172.

Formato de Documento Eletrônico (ISO)

Tavares, José Roberto and D’Almeida, Vânia and Diniz, Daniela C. and Terzi, Carolina A. and Cruz, Edison N. and Stefanini, Edson and Andriollo, Adagmar and Paola, Angelo A.V. de and Carvalho, Antonio C.. Analysis of Plasma Homocysteine Levels in Patients with Unstable Angina. Arquivos Brasileiros de Cardiologia [online]. 2002, vol. 79, n. 2, [citado 2026-10-14], pp. 167-172. Disponível em: <https://journals.cardiol.br/article/analysis-of-plasma-homocysteine-levels-in-patients-with-unstable-angina-2/>. ISSN 0066-782X

EndNote RIS

Formato de Documento Eletrônico (Vancouver)

Bassan R, Gamarski R, Pimenta L, Volschan A, Scofano M, Dohmann HF, Araujo M, et al. Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room. Arquivos Brasileiros de Cardiologia 2002;74(5):412-7.

Formato de Documento Eletrônico (ABNT)

Bassan, Roberto; Gamarski, Roberto; Pimenta, Lúcia; Volschan, André; Scofano, Marcelo; Dohmann, Hans Fernando; Araujo, Monica; Clare, Cristina; Fabrício, Marcelo; Sanmartin, Carlos Henrique; Mohallem, Kalil; Macaciel, Renato; Gaspar, Sergio. Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room. Arquivos Brasileiros de Cardiologia, v. 74, n. 5, p. 412-417, jan. 2002.

Formato de Documento Eletrônico (APA)

Bassan, R., Gamarski, R., Pimenta, L., Volschan, A., Scofano, M., Dohmann, H. F., Araujo, M., Clare, C., Fabrício, M., Sanmartin, C. H., Mohallem, K., Macaciel, R., & Gaspar, S. (2002). Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room. Arquivos Brasileiros de Cardiologia, 74(5), 412-417.

Formato de Documento Eletrônico (ISO)

Bassan, Roberto and Gamarski, Roberto and Pimenta, Lúcia and Volschan, André and Scofano, Marcelo and Dohmann, Hans Fernando and Araujo, Monica and Clare, Cristina and Fabrício, Marcelo and Sanmartin, Carlos Henrique and Mohallem, Kalil and Macaciel, Renato and Gaspar, Sergio. Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room. Arquivos Brasileiros de Cardiologia [online]. 2002, vol. 74, n. 5, [citado 2026-10-14], pp. 412-417. Disponível em: <https://journals.cardiol.br/article/efficacy-of-a-diagnostic-strategy-for-patients-with-chest-pain-and-no-st-segment-elevation-in-the-emergency-room-2/>. ISSN 0066-782X

EndNote RIS

Formato de Documento Eletrônico (Vancouver)

César LAM, Ferreira JFM, Grupi CJ, Pamplona D, Moretti MA, Pferfmann E, Ramires JAF, et al. Does a circadian variation occur in myocardial ischemia over 48 hours in patients with unstable angina?. Arquivos Brasileiros de Cardiologia 2002;75(1):14-8.

Formato de Documento Eletrônico (ABNT)

César, Luiz Antônio Machado; Ferreira, João Fernando Monteiro; Grupi, César J.; Pamplona, David; Moretti, Miguel A.; Pferfmann, Elcio; Ramires, José A. F.. Does a circadian variation occur in myocardial ischemia over 48 hours in patients with unstable angina?. Arquivos Brasileiros de Cardiologia, v. 75, n. 1, p. 14-18, jan. 2002.

Formato de Documento Eletrônico (APA)

César, L. A. M., Ferreira, J. F. M., Grupi, C. J., Pamplona, D., Moretti, M. A., Pferfmann, E., & Ramires, J. A. F. (2002). Does a circadian variation occur in myocardial ischemia over 48 hours in patients with unstable angina?. Arquivos Brasileiros de Cardiologia, 75(1), 14-18.

Formato de Documento Eletrônico (ISO)

César, Luiz Antônio Machado and Ferreira, João Fernando Monteiro and Grupi, César J. and Pamplona, David and Moretti, Miguel A. and Pferfmann, Elcio and Ramires, José A. F.. Does a circadian variation occur in myocardial ischemia over 48 hours in patients with unstable angina?. Arquivos Brasileiros de Cardiologia [online]. 2002, vol. 75, n. 1, [citado 2026-10-14], pp. 14-18. Disponível em: <https://journals.cardiol.br/article/does-a-circadian-variation-occur-in-myocardial-ischemia-over-48-hours-in-patients-with-unstable-angina-2/>. ISSN 0066-782X

EndNote RIS

Formato de Documento Eletrônico (Vancouver)

Bassan R, Scofano M, Gamarski R, Dohmann HF, Pimenta L, Volschan A, Araujo M, et al. Chest pain in the emergency room. Importance of a systematic approach. Arquivos Brasileiros de Cardiologia 2000;74(1):22-9.

Formato de Documento Eletrônico (ABNT)

Bassan, Roberto; Scofano, Marcelo; Gamarski, Roberto; Dohmann, Hans Fernando; Pimenta, Lúcia; Volschan, André; Araujo, Mônica; Clare, Cristina; Fabrício, Marcelo; Sanmartin, Carlos Henrique; Mohallem, Kalil; Gaspar, Sergio; Macaciel, Renato. Chest pain in the emergency room. Importance of a systematic approach. Arquivos Brasileiros de Cardiologia, v. 74, n. 1, p. 22-29, set. 2000.

Formato de Documento Eletrônico (APA)

Bassan, R., Scofano, M., Gamarski, R., Dohmann, H. F., Pimenta, L., Volschan, A., Araujo, M., Clare, C., Fabrício, M., Sanmartin, C. H., Mohallem, K., Gaspar, S., & Macaciel, R. (2000). Chest pain in the emergency room. Importance of a systematic approach. Arquivos Brasileiros de Cardiologia, 74(1), 22-29.

Formato de Documento Eletrônico (ISO)

Bassan, Roberto and Scofano, Marcelo and Gamarski, Roberto and Dohmann, Hans Fernando and Pimenta, Lúcia and Volschan, André and Araujo, Mônica and Clare, Cristina and Fabrício, Marcelo and Sanmartin, Carlos Henrique and Mohallem, Kalil and Gaspar, Sergio and Macaciel, Renato. Chest pain in the emergency room. Importance of a systematic approach. Arquivos Brasileiros de Cardiologia [online]. 2000, vol. 74, n. 1, [citado 2026-10-14], pp. 22-29. Disponível em: <https://journals.cardiol.br/article/chest-pain-in-the-emergency-room-importance-of-a-systematic-approach-2/>. ISSN 0066-782X

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