1998;71(5) – ABC CARDIOL

Artigo Original

Use of digoxin in elderly patients admitted to a geriatric unit of a general hospital

Ulisses Gabriel de Vasconcelos Cunha et al. Maira Tonidandel Barbosa Emylucy Martins Paiva Paradela Flávio Gomes Carvalho

PURPOSE: To determine the prevalence of digoxin use as well as its indications in elderly patients at the time of admission to a geriatric unit of a general hospital. METHODS: One hundred and thirty elderly patients aged 65 and over (mean age = 80±9 years), 100 women and 30 men were consecutively investigated. Each patient was submitted to a thorough clinical investigation, laboratory work-up, chest X-ray, electrocardiogram and doppler echocardiogram. The use of digoxin was considered appropriate, questionable or inappropriate. RESULTS: At the time of admission to the geriatric unit 27.6% of the patients were receiving digoxin. The indication was considered appropriate in 36.1%, questionable in 11,1% and inappropriate in 52.7%. CONCLUSION: We found a high prevalence of digoxin use in elderly patients admitted to a geriatric unit of a general hospital. In most cases its indications were considered inappropriate or questionable. Due to the increased risk of digitalis intoxication in this age group the drug should be prescribed under more strict indications.

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Artigo Original

Risk factors for acute myocardial infarction in Brazil (FRICAS study)

Marco Aurélio Dias da Silva et al. Amanda G. M. R. Sousa Hernan Schargodsky

PURPOSE: To determine risk factors related to acute myocardial infarction (AMI) in Brazil. METHODS: Five hundred ninety one patients were selected in 20 medical centers in Brazil, between January/94 and March/95. Two-hundred-ninety-nine patients were cases, and 292 controls with a variety of acute diseases not related to the suspected or known risk factors for acute myocardial infarction. All data were collected through a structured questionnaire filled by the patients. The evaluation of the variables was done through univariate analysis with a significance level of 5%. RESULTS: The factors related to acute myocardial infarction were respectively to cases and controls: Hypercholesterolemia – 210.93±46.74mg/dl and 185.71±45.45mg/dl, (p=0.000); smoking – 41.69% and 27.20% (p=0.000); hypertension – 52.35% and 20.88% (p=0.000); diabetes – 19.70% and 9.93% (p=0.001); family history – related to the patient’s father in 42.14% and 33.22% (p=0.025) and to the mother in 42.14% and 30.82% (p=0.007); socioeconomic level – 88.99% and 60.20% owned house (p=0.002); 44.45% and 33.21% owned car (p=0.010); physical activity – 56.83% and 48.28% had the habit of walking in the year prior to study entry (p=0.029); diet – 38.79% and 28.42% consumed canned food (p=0.013). The mean weight was 72.50±26.89kg and 69±12.26kg (p=0.0271). The mean height was 166.56±8.81cm and 166.66±8.47cm. CONCLUSION: This study confirmed the importance of hypercholesterolemia, hypertension, diabetes mellitus, overweight and family history as risk factors for acute myocardial infarction. There was a significant relation between socioeconomic level and the prevalence of acute myocardial infarction.

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Artigo Original

Association of captopril and hydrochlorothiazide in mild and moderate hypertension

José Luiz Santello et al. Décio Mion Jr

PURPOSE: To evaluate the effectiveness and tolerance of the association of captopril 50mg and hydrochlorithiazide 25mg in hypertensive patients with diastolic pressure between 95 and 115 mmHg. METHODS: An open, multicenter and non-comparative study was performed. After 2 weeks of placebo, the patients received ½ tablet of drug association. Patients were evaluated after 4, 8 and 12 weeks, and those who had diastolic pressure >90mmHg after 8 weeks of therapy received 1 tablet/day. RESULTS: The results of 433 patients were analyzed: 47±10 years old, 30% female, 76% white. Initial systolic and diastolic pressures were 156±16 and 103±11mmHg and after 14 days of placebo were 156±15 and 103±9mmHg (p>0.05). Systolic/diastolic pressure after 4, 8 and 12 weeks of treatment reduced progressively (p<0.05) to 143±14/95±11, 140±13/91±9 and 134±11/86±8mmHg. Blood pressure control was observed in 45, 67 and 88% (p<0.05) of patients after 4, 8 and 12 weeks. Cough was the most important symptom, registered in 7% of patients under placebo and 12% in patients under treatment. The tolerance was considered good for 98% of patients. CONCLUSION: The association of captopril with hydrochlorothiazide is effective with good tolerance, being indicated as a once a day monotherapy for mild and moderate hypertension.

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Artigo Original

Morpho-functional cardiac evaluation in young normotensive children of hypertensive patients. A prospective Doppler-echocardiographic study

Cristina Maria Sousa de Almeida et al. Aristarco Gonçalves de Siqueira-Filho Maurício Bastos de Freitas Rachid Jamil Rachid César Selem Kamel

PURPOSE: Evaluate functional and/or structural cardiac changes in young normotensive subjects with a family history of hypertension. METHODS: Prospective study was performed with 62 normotensive persons, ages 15 to 30 years, divided in 32 children of hypertensive patients (group 1) and 30 children of normotensive persons (group 2) comparable in blood pressure, body surface area, heart rate, age and sex. After clinical examination, all underwent Doppler-echocardiogram to evaluate cardiac structure and left ventricular (LV) systolic and diastolic function. RESULTS: Systolic LV fractional shortening was increased in group 1 when compared with group 2 (38.03±4.95% and 34.7±4.48%, respectively – p<0.01). Mitral deceleration time (DT) ranged from 85 to 160ms – mean values 116.47±16.99ms – in group 1 and from 100 to 220ms – mean values 126.73±26.66ms – in group 2 (p<0.05). A correlation between LV mass and left atrium (LA) diameter was noted in group 1 (r = 0.514, p<0.01). COCLUSION: Children of hypertensive patients show increased LV function, similar to what occurs in early hypertension and in borderline hypertension, even when there is no evidence of LV hypertrophy or high blood pressure. Mitral DT (shorten in group 1) was the only diastolic parameter that differed in the groups. The correlation between LV mass and LA dimension suggests that LA size could be related to functional and hemodynamic LV changes.

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Relato de Caso

Giant left atrial myxoma

Juan Francisco Muñoz Cruz et al. Leniel Bairral Dias João Osório Rodrigues Neto Sérgio Almeida de Oliveira

A 65 year-old man with dilated cardiomiopathy and long history of high blood pressure and a previous cerebral vascular accident had a giant left atrial myxoma as an echocardiographic finding.

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Artigo Original

Trends in cholesterol levels in the adult population of São José do Rio Preto (1991-1997)

José Carlos Nicolau et al. Cristiani Nogueira Lília Nigro Maia José Antonio Franchini Ramires

PURPOSE: To develop a survey about risk factors for atherosclerosis in a > or = 20-year-old population from São José do Rio Preto, and compare the results with those obtained in a similar survey in 1991. METHODS: Quantitative survey with sample stratified by sex and age. The individuals (a total of 646, 303 men) where contacted in outpatient facilities from the Health Secretary and other populated sites, distributed by geographic zone and social class of different neighborhoods. The standard error of the survey was 4%, and the confidence interval was 95%. RESULTS: A) Mean HDL-cholesterol (only in 1997): male gender 43.7±15mg/dL, female gender 49.6±13.5mg/dL (p<0.001, 95% CI 3.7 a 8.1). B) Mean total cholesterol in 1991 vs 1997: for the global population 192.5±48.9mg/dL vs 190.5±42.5mg/dL (p=NS); for men 187.6±53.3mg/dL vs 190.5±42.5mg/dL (p=NS); for women 196.8±40mg/dL vs 187.6±37.8mg/dL (p=0.008, 95% CI 2.4 a 15.9). C) By regression analysis, the variables that correlated significantly with cholesterol levels, in both surveys, were: age (p<0.001), systolic (p<0.001) and diastolic (p<0.001) arterial pressure, diet (p<0.001). Female gender showed correlation only in the 1991 survey (p=0.011), and sedentarism only in 1997 (p=0.014). CONCLUSION: The mean cholesterol levels in the adult population of São José do Rio Preto are very favorable and, in female gender, showed a significant decrease in the 1997 survey, relatively to the 1991 survey.

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Artigo Original

Evaluation of fragmented potentials in the presence of right bundle branch block without structural myocardium abnormalities by using signal-averaged electrocardiogram on time and frequency domain

Paulo Ginefra et al. Eduardo C. Barbosa Luiz A. Christiani Maria de Fátima M. P. Leite … P. R. Benchimol-Barbosa Sílvia H. Boghossian Mônica Scott Isabela M. T. Rangel Rosângela S. Silva Francisco M. Albanesi Fº

PURPOSE: To evaluate if the presence of right bundle branch block (RBBB), without structural myocardial abnormalities (SMA) can generate fragmented potentials (FP) and spectral turbulence on signal-averaged electrocardiogram (SAECG). METHODS: Twelve children with atrial septal defect (ASD) and incomplete right bundle branch block (IRBBB without SMA (group I) were compared to 17 children with post-operative tetralogy of Fallot (TF) with CRBBB, all with SMA, 5 with ventricular premature beats and 2 with sustained ventricular tachycardia (group II). All had SAECG on time (TD) and frequency domain (FD) with 5 variables analysed. RESULTS: All patients of group I had normal variables, in contrast with group II which presented abnormal variables suggesting FP and ST. CONCLUSION: In ASD without SMA, the isolated IRBBB did not generate FP and ST.

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Artigo Original

High blood pressure among bank employees. Life-style and treatment

Dóra Chor

PURPOSE: This study estimates the frequency of treatment of high blood pressure and compares life-styles among hipertensives and non-hipertensives. METHODS: Cross-sectional study in a sistematic sample of 1183 employees in a government-owned bank in the State of Rio de Janeiro, through a self-administered questionnaire. Direct measurements of arterial pressure, weight and height were also taken in a sub-sample. Those who had been informed more than once as having high blood pressure, by a health professional, were classified as hipertensives. RESULTS: There were no important differences among hipertensives and non-hipertensives with respect to the prevalence of smoking, alcohol and physical activities. Dieting was more frequent among overweight/obese hipertensives than overweight/obese non-hipertensives. Only 44,7% were under treatment. Subjects with high level of education were more likely to be treated as were those who quit smoking, presented overweight/obesity or family history of cerebrovascular diseases. CONCLUSION: Access to information and health care was not sufficient to guarantee high blood pressure treatment or a healthy life-style which contributes to hypertension control.

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Artigo Original

Hemodynamic evaluation and clinical outcome of children candidates for heart transplantation with severe dilated cardiomyopathy

Estela Azeka et al. Miguel Barbero Marcial Paulo Roberto Camargo Luiz Kajita … Ana Cristina Aliman José Otávio C. Auler Edmar Atik Munir Ebaid

PURPOSE: To evaluate hemodynamic parameters and clinical outcome of children with severe cardiomyopathy who are candidates for heart transplantation. METHODS: Twenty four children aged from 4 months to 10 years and 8 months (mean 3.7±2.5 years) from February 1992 to May 1996, were submitted to hemodynamic study and the following parameters were measured: cardiac output, mean pulmonary artery pressure (MPAP) and capillary wedge pressure. The pulmonary vascular resistance index (PVRI) and transpulmonary pressure gradient (TGP) were calculated. RESULTS: Ten (41.6%) children were transplanted (group A), 5 (20.8%) are still waiting heart transplantation (group B) and 9 (37.6%) died (group C). The mean age of the B and C group were significantly different. The PVRI, MPAP and TPG were significant lower in group A than group C (p=0.01; p=0.044 and p=0.023 respectively). CONCLUSION: The profile of the hemodynamic parameters of children with severe dilated cardiomyopathy was compatible with the clinical findings. The age was the only difference comparing groups B and C. PVRI, MPAP and TPG were significant factors between group A and C. The older the patient, the worse was the prognosis.

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Artigo Original

Type I atrial flutter radiofrequency ablation. Importance of bidirectional line of block in the inferior vena cava tricuspide annulus isthmus

Mauricio Scanavacca et al. Eduardo Sosa José Luis Velarde André D'Ávila … Denise Hachul Basileu Reolão Osvaldo Sanches Márcio Silva Francisco Darrieux

PURPOSE: To determine the clinical importance of a bi-directional line of block demonstration in the inferior vena cava-tricuspid annulus isthmus as an end-point for radiofrequency (RF) atrial flutter (FL) ablation. METHODS: Forty consecutive patients (51±11 years) with type I FL were divided in 2 groups: GI (30 patients) anatomic, non-electrophysiologic isthmus ablation technique (interruption and non-induction FL criteria); and GII (10 patients) anatomic with electrophysiologic evaluation of bi-directional isthmus conduction. The isthmus activation was analyzed before and after anatomic RF ablation with a cateter exploring each side of the line of block, depending on the conduction evaluation (anterograde or retrograde). RESULTS: FL was interrupted and not reinduced in 26/30 (86.6%) GI patients and in 10 (100%) GII patients (p= 0.5558). During follow-up FL recurred in 30% of the patients in both groups. In GII, 6 patients with bi-directional block remained assymptomatic, whereas 3 patients with unidirectional block presented recurrence (p= 0.012). CONCLUSION: Electrophysiologic demonstration of bi-directional line of block in the isthmus is related to long-term success and should be the criterion for interruption of type I atrial FL RF ablation.

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Artigo Original

Myocardial morphometry of protein-energy malnourished adults

Daniel Ferreira da Cunha et al. Cristiane Helena Pedrini Júlio Cláudio Sousa Marlene Antônia dos Reis … Sidney Gonçalves Ramos Selma Freire de Carvalho da Cunha Vicente de Paula Antunes Teixeira

PURPOSE: To compare cardiac muscle cells width and cardiomyocyte lipofuscin pigment presence between malnourished and non-malnourished necropsied adults. METHODS: Out of 315 necropsy protocols of adults randomly chosen, those with edema, ascitis, systemic arterial hypertension, chronic liver disease, and heart disease were excluded. Malnutrition was defined by body mass index (BMI) <17kg/m². Cardiomyocytes morphometry study and lipofuscin pigment counts were performed. RESULTS: Malnourished (n=8) and controls (n=4), respectively, showed statistical differences in relation to BMI (14.86±1.13 vs 22.02±0.9kg/m²), heart weight/body weight ratio (0.68±0.09 vs 0.54±0.07%), cardiomyocytes width (10.91±0.77 vs 12.90±1.82µm) and lipofuscin pigment presence (39.1 vs 54.4%). CONCLUSION: When compared with controls, necropsied malnourished adults showed decreased myocardial fibers diameters and lower lipofuscin pigment presence. These findings might reflect altered metabolism, and would be associated with harmful clinical effects in terminally ill patients.

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