1998;70(2) – ABC CARDIOL

Artigo Original

Exercise duration determines the magnitude and duration of post-exercise hypotension

Cláudia Lúcia de Moraes Forjaz et al. Danilo Forghieri Santaella Liliane Onda Rezende Antonio Carlos Pereira Barretto Carlos Eduardo Negrão

PURPOSE: Considering that exercise duration may play a role in post-exercise hypotension, we tested the hypothesis that a prolonged submaximal exercise would lead to a greater and longer blood pressure fall after exercise than a shorter exercise bout. METHODS: Experimental protocol – 10 subjects were submitted to two cycle ergometer exercise trials (25 and 45min) at 50% of VO2 peak. Control protocol – 12 subjects rested in the sitting position for 45min. Blood pressure (BP) was measured before (20min) and after (90min) rest or exercise bouts. RESULTS: Systolic BP decreased significantly after exercise and this reduction was greater and lasted longer after 45min of exercise. Mean and diastolic BP decreased after exercise and they were significantly lower during the 45min session. Control protocol – no change in BP was observed after resting condition. CONCLUSION: A longer exercise bout leads to a greater and longer post-exercise hypotension.

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Artigo Original

Acute myocardial infarction diagnosis. The value of serum myoglobin levels, compared with creatine kinase and MB fraction

Alexandre Biasi Cavalcanti et al. Roberto Henrique Heinisch Evandro de Campos Albino João Nilson Zunino

PURPOSE: To compare the diagnostic performance of two traditional plasma markers of myocardial infarction (MI), creatine kinase (CK) and its MB fraction (CK-MB), with plasma myoglobin (Mgb) levels, for the diagnosis of MI. METHODS: From September of 94 to February of 95, in an observational, prospective, and non-controlled fashion, 64 patients admitted to a cardiology emergency room (ER), with non-traumatic chest pain were studied. Patients presenting with more than 6h after the onset of symptoms, muscular trauma, cardiopulmonary resuscitation and renal insufficiency were not included. Definitive MI diagnosis was established if the patient had at least two of the three classic MI findings: ischemic chest discomfort longer than 20min, electrocardiogram with necrosis (Q waves) and elevated CK and CK-MB levels. RESULTS: There were 18 patients with MI. The sensitivity for CK, CK-MB and Mgb were respectively 33%, 22% and 61%. The specificity was 85%, for CK ,95% for CK-MB and 97% for Mgb. The difference between Mgb and CK sensitivities was 28%, with a 95% confidence interval (CI) from -4% to 59%, the difference between Mgb and CK-MB sensitivities was 39%, (CI 9% to 69%). The difference between Mgb and CK especificities was 13%, (CI 12% to 14%) and the difference between Mgb and CK-MB specificities was 2%, (CI -5% to 9%). CONCLUSION: In the studied population, Mgb was more sensitive than CK-MB for the diagnosis of MI with similar specificity and Mgb was more specific than CK for this diagnosis.

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Artigo Original

Stereology of the myocytes in young and aged rats

Márcia Barbosa Águila et al. Carlos Alberto Mandarim-de-Lacerda Mara Ibis Rodrigues Apfel

PURPOSE: To determine the myocardial quantitative changes comparing young and aged animals by using the stereology. METHODS: Thirty rat hearts were studied (15 rats aged 3 months and 15 other rats aging 15 months). The hearts were removed, weighed, fixed in 10% buffered formaldehyde solution, embedded in paraffin, cut in 7µm thick slices and stained with HE and picro-sirius stains. In each group we counted 15 random microscopic fields. The following parameters were studied: Vv(myocyte) and Vv(interstitium)(%) (the volume densities of the cardiac myocyte and interstitium, determined by the point-counting method), and Nv(myocyte) (1/mm³) (the numerical density of the cardiac myocytes, determined with the disector method). The total number of myocytes (N[myocyte]) and the mean volume of the myocytes (V[myocytes]) were also determined. The differences were tested by the Mann-Whitney test.RESULTS: Cardiac weight increased from 1.1 to 1.7g, the Vv(myocyte) decreased from 76.7 to 72.2%, the Vv(interstitium) increased from 23.3 to 27.8%. The Nv(myocyte) and the N(myocyte) decreased from 14.76×10(4) to 6.19×10(4)/mm³ and 15.64×10(4) to 10.72×10(4) myocytes, respectively. Simultaneously, the V(myocyte) increased from 5.42×10³ to 13.26×10³mm³. These differences were statistically significant (p<0.05). CONCLUSION: Myocardial changes, comparing young rats with aged ones suggest loss of myocytes (increased apoptosis?) with simultaneous myocyte hypertrophy.

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Atualização

Resumos dos Temas-Livres apresentados ao IV Congresso Brasileiro de Ergometria e Reabilitação Cardiovascular – 30/10 a 1/11/97 – Ribeirão Preto-SP

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Artigo Original

Effect of eggplant on plasma lipid levels, lipidic peroxidation and reversion of endothelial dysfunction in experimental hypercholesterolemia

Paulo Afonso Ribeiro Jorge et al. Lidia C. Neyra Regina M. Osaki Eros de Almeida Neura Bragagnolo

PURPOSE: To study the effect of egg plant on endothelium-dependent relaxation, and plasma lipids in hypercholesterolemic rabbits, and to assess influence of this plant on the malondialdehyde (MDA) content of LDL particles and the arterial wall. METHODS: Thirteen male rabbits were randomly assigned to control (C), hypercholesterolemic (H) and egg plant (E) treated groups (n=10 each). The H and E rabbits were fed a diet supplemented with cholesterol (0.5%) and coconut oil (10%) for 4 weeks. In addition, group E received 10mL of the fruit juice/day during the last 2 weeks.The animals were killed and the aorta removed to measure MDA content and the endothelium dependent relaxation responses. Total plasma cholesterol, VLDL, LDL, HDL and triglyceride levels were determined using commercial kits. MDA was quantified in native and oxidized LDL and in the arterial wall. RESULTS: After 4 weeks, the E group rabbits had a significantly lower weight , plasma cholesterol, LDL, triglyceride and aortic cholesterol contentthan group H(p<0.05). The MDA content that was significantly increased in the LDL particles and in the arterial wall of H rabbits was reduced in the E group (p<0.05). Endothelium-dependent relaxation were significantly higher in the E group compared H group rabbits (p<0.05). CONCLUSION: In hypercholesterolemic rabbits egg plant juice significantly reduced weight, plasma cholesterol levels, aortic cholesterol content and the MDA concentrations in native-oxidized LDL and in the arterial wall and increased the endothelium-dependent relaxations.

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Artigo Original

Early and late physiological effects of balloon mitral valvuloplasty

Japy Angelini Oliveira Fº et al. Marcelo Regazzini Orlando Campos Fº Ana Fátima Salles … Turíbio Leite Barros Neto Neil Ferreira Novo José Bocanegra Eulógio Martinez Fº Dirceu Vieira Santos Fº

PURPOSE: To evaluate the early and late cardiorespiratory responses after balloon mitral valvuloplasty. METHODS: Nine female patients aged 35±9 years, with mitral stenosis, in class II or III (NYHA) underwent upright ergoespirometric test, resting electrocardiogram and echocardiogram before, 3 to 5 days (early evaluation) and 8 to 12 months (late evaluation) after mitral valvuloplasty. All patients were treated with digitalis and diuretics. RESULTS: During late evaluation, 44% patients were in class II and 56% were in class I (NYHA). The resting heart rate decreased (87±11bpm vs 85±7bpm vs 75±9bpm) and the number of steps increased (4±1 steps vs 5±2 steps vs 6±1 steps); the peak oxygen uptake improved only in the late evaluation (16±3mL/kg/min vs 18±4mL/kg/min vs 22±7mL/kg/min). The anaerobic threshold, minute ventilation (VE) and ventilatory equivalent for oxygen showed no change. The heart rate (1st step: 124±18bpm vs 112±13bpm vs 87±15bpm), O2 uptake (1st step: 10±2mL/kg/min vs 8±2mL/kg/min vs 8±2mL/kg/min) and VE decreased during submaximal exercise in early and late phases. The mitral valve area decreased in the late evaluation (0.94cm² vs 1.66cm² vs 1.20cm²). CONCLUSION: Although partial restenosis tended to occur in these patients, they improved the functional class and cardiorespiratory performance and cardiocirculatory load during submaximal exercise.

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Artigo Original

Body fat distribution, blood pressure and plasma lipids and lipoprotein levels

Dartagnan Pinto Guedes et al. Joana Elisabete Ribeiro Pinto Guedes

PURPOSE: To study associations between FAT distribution and blood pressure levels and concentrations of lipids and lipoproteins, irrespective of body fat content and physical activity. METHODS: A sample of 62 subjects of both genders aging 20-45 years-old was used in the study. The adipose tissue distribution was based on the waist-to-hip ratio (WHR). Body fat content was estimated by the body mass index (BMI), and physical activity was assessed by maximal oxygen uptake (VO2max). Partial correlation analyses were used to determine the strength of the associations. RESULTS: After correction for BMI there was a significant partial correlation between centripetal adipose tissue distribution and serum triglyceride, LDL-cholesterol levels, and blood pressure. However, controlling for VO2max, there was no significant association between WHR and any serum variable and blood pressure. CONCLUSION: The centripetal adipose tissue distribution, independent of body fat content, was related to lipid and lipoprotein plasma concentrations and to blood pressure levels in both sexes. Physical activity seems to be an important modifier of this relationship, emphasizing its role in the control of cardiovascular risk factors.

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Relato de Caso

Meningococcemia complicated by myocarditis

Francisco Manes Albanesi Fº et al. Ricardo Mourilhe Rocha Rui Alves Barros

We report a case of a 26-year old man with meningococcemia complicated with myocarditis (ventricular dysfunction and myocardial ischemia), that required treatment for heart failure. Regression of myocardial dysfunction was observed six months after the infection.

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Artigo Original

Partial sternotomy in H. A new approach for cardiac surgery

Danton R. Loures et al. Leonardo A. Mulinari André L. Tyszka Edison Ribeiro … Roberto G. Carvalho Rui Almeida

PURPOSE: To present our results with the minimally invasive thoracotomy (MIT) in patients with valve disease and to describe a new type of thoracotomy. METHODS: Twenty-five patients with valve disease as the major cardiac problem were operated during a five month period. Two types of incisions were used: one in an inverted-T fashion and another in a H fashion. Fourteen patients were submitted to an inverted-T incision and eleven to a H incision. In 24% of the patients reoperation was being performed. RESULTS: The incisions ranged from 7.5 to 11cm (mean 9.1cm), mean ICU stay was 31h and hospital stay 4.8 days. In all but one patient the operation could be adequately in performed through the MIT, in only one patient total sternotomy had to be performed. CONCLUSION: The MIT may have some advantages such as, better aesthetic results, less pain and more sternal stability. These factors may improve early extubation and decrease hospital stay. The H type incision allows an adequate exposition of the most central part of the chest and all heart valves with adequate exposure. This technique led to no complications during reoperations and we believe it to be as safe as the total sternotomy.

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Artigo Original

The association between different measurements of obesity and the prevalence of hypertension

Miguel Gus et al. Leila B. Moreira Maurício Pimentel Ana Luiza M. Gleisener … Renan S. Moraes Flávio D. Fuchs

PURPOSE: To evaluate the association between body mass index (BMI), waist-hip ratio and waist circumference with the prevalence of hypertension in a representative sample of 1088 adults of Porto Alegre (RS), Brazil. METHODS: In this cross-sectional survey, subjects were considered as having hypertension if they had systolic blood pressure > or = 160mmHg or diastolic > or = 90mmHg, and were considered obese if they had BMI > or = 27kg/m², or had a waist-hip-ratio > or = 0.95cm (men) or 0.80 (women) or had a waist circumference > or = 96 (men) or 92 (women). RESULTS: Obesity defined by the BMI was associated with hypertension in both genders (RR 1.9, CI 1.0 – 3.2 in men; RR 2.2, CI 1.3 – 3.8 in women). The other indices were significantly associated with hypertension just in women. CONCLUSION: BMI > or = 27.0kg/m² was strongly associated with increased odds to have hypertension. Similar magnitude of the association with the other indices indicate their utility to estimate the risk of hypertension.

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Relato de Caso

Heart disease and systemic amyloidosis. In vivo diagnosis

Rosana G. G. Mendes et al. Paulo Roberto B. Evora José Antonio Mansur Mendes Jorge Haddad Simone Carvalho

This is the case of a 42year-old male with systemic amyloidosis, probably primary, and heart involvement. Physiopathological and clinical aspects are described as well as the rarity of the diagnosis in vivo. The limited aspects of therapy are also described.

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