2001;77(1) – ABC CARDIOL

Original Article

Chagas' heart disease: evolutive evaluation of electrocardiographic and echocardiographic parameters in patients with the indeterminate form

Barbara Maria Ianni et al. Edmundo Arteaga Clovis de Carvalho Frimm Antonio Carlos Pereira Barretto Charles Mady

OBJECTIVE: To identify and associate potential electrocardiographic and echocardiographic changes in patients with the indeterminate form of Chagas’ disease during long-term follow-up. METHODS: One hundred sixty patients underwent standard electrocardiography and two-dimensional guided M-mode echocardiography for left ventricular ejection fraction determination. Patients were followed up for 98.6±30.4 months, undergoing repeat electrocardiographic studies at 6-month intervals and echocardiographic studies at 12-month intervals. RESULTS: Based on the electrocardiographic findings, the patients were divided into group I, 125 patients (78.6%) with normal electrocardiograms throughout follow-up, and group II, 34 patients (21.3%) who developed electrocardiographic changes. Group II was further divided into group IIA (9 patients, 5.6%) with permanent electrocardiographic changes, group IIB (14 patients, 8.8%) with transitory electrocardiographic changes, and group IIC (11 patients, 6.9%) with changes appearing only on the final electrocardiogram. Left ventricular ejection fractions remained normal in the entire population studied and did not differ among groups. CONCLUSION: The indeterminate form of Chagas’ disease clearly represents a benign condition with a favorable long-term prognosis. Although some patients develop electrocardiographic changes, left ventricular systolic function is well preserved.

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Original Article

Do cardiologists at a university hospital adopt the guidelines for the treatment of heart failure?

Antonio Carlos Pereira Barretto et al. Moacyr Roberto Cucê Nobre Inês Lancarotte Airton Roberto Scipioni José Antonio Franchini Ramires

OBJECTIVE: To verify whether the guidelines for the treatment of heart failure have been adopted at a university hospital. The guidelines recommend the following: use of angiotensin-converting enzyme inhibitors for all patients with systolic ventricular dysfunction, use of digitalis and diuretics for symptomatic patients, use of beta-blockers for patients in functional classes II or III, use of spironolactone for patients in functional classes III or IV. METHODS: We analyzed the prescriptions of 199 patients. All these patients had ejection fraction (EF) <=0.50, their ages ranged from 25 to 86 years, and 142 were males. Cardiomyopathy was the most frequent diagnosis: 67 (33.6%) patients had dilated cardiomyopathy, 65 (32.6%) had ischemic cardiomyopathy. RESULTS: Angiotensin-converting enzyme inhibitors were prescribed for 93% of the patients. 71.8% also had a prescription for digitalis, 86.9% for diuretics, 27.6% for spironolactone, 12% for beta-blockers, 37.2% for acetylsalicylic acid, 6.5% for calcium channel antagonists, and 12.5% for anticoagulants. In regard to vasodilators, 71% of the patients were using captopril (85.2mg/day), 20% enalapril (21.4mg/day), 3% hydralazine and nitrates. In 71.8% of the cases, the dosages prescribed were in accordance with those recommended in the large studies. CONCLUSION: Most patients were prescribed the same doses as those recommended in the large studies. Brazilian patients tolerate well the doses recommended in the studies, and that not using these doses may be a consequence of the physician's fear of prescribing them and not of the patient's intolerance.

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Original Article

Prevalence of hypertension in the urban population of Catanduva, in the State of São Paulo, Brazil

Olavo de Carvalho Freitas et al. Fabiano Resende de Carvalho Juliana Marques Neves Paula Karine Veludo … Ricardo Silva Parreira Rodrigo Marafiotti Gonçalves Simone Arenales de Lima Reinaldo Bulgarelli Bestetti

OBJECTIVE: To study the prevalence of systemic hypertension and its control in the population of Catanduva, in the state of São Paulo, Brazil. METHODS: We carried out a randomized cross-sectional population-based study of the urban population of Catanduva with individuals above 18 years of age (688 individuals accounting for 0.9% of the referred population). We interviewed study participants to analyze the major qualitative and quantitative variables that could influence the hypertensive scenario and the risk for systemic hypertension. Blood pressure was measured through the indirect method according to the III Consenso Brasileiro de Hipertensão (III Brazilian Consensus on Hypertension), which established blood pressure levels > or = 140/90 mm Hg as hypertensive. RESULTS: The prevalence of systemic hypertension was higher in individuals with: (1) history of hypertension (p or = 25 kg/m² (p<0.001); (4) low educational level (p<0.0001); (5) familial income ranging from 1 to 5 minimum wages (p<0.05); (6) unmarried status (divorced/separated and widow(er)s) (p<0.0001). Of the interviewed individuals, 27.6% (p=0.05) had blood pressure levels under control. CONCLUSION: Our study showed that the prevalence of systemic hypertension was 31.5%, and that 27.6% of the individuals interviewed had blood pressure levels under control at the time of the interview.

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Case Report

Fibroelastoma of the mitral valve as a cause of transient ischemic stroke

Alexandre Alessi et al. Roberto Gomes de Carvalho Dalton Bertolin Précoma Débora Fontoura … Luciano Rodrigo Oliveira José Zanis Neto Marcello Zapparoli

A 44-year-old woman had a transient ischemic stroke, fibroelastoma of the mitral valve being the source of the embolus. The patient evolved with neutropenia induced by ticlopidine after 10 days of treatment. We report the major clinical features, therapeutical options, and medicamentous toxicity resulting from the use of antiplatelet drugs.

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Case Report

Uhl's anomaly. Differential diagnosis and indication for cardiac transplantation in an infant

Nana Miura Ikari et al. Estela Azeka Vera Demarchi Aiello Edmar Atik … Miguel Barbero-Marcial Munir Ebaid

We report the case of an 8-month-old female infant with Uhl’s anomaly, who underwent successful cardiac transplantation. The clinical findings, complementary laboratory tests, anatomic findings, and differential diagnosis of the anomaly are discussed.

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Original Article

Use of transesophageal echocardiography during implantation of aortic endoprosthesis (stent). Initial experience

Cláudio Henrique Fischer et al. Orlando Campos Fº José Honório de Almeida Palma da Fonseca Cláudia Maria Rodrigues Alves … José Augusto Marcondes Sousa Edgar Bezerra de Lira Fº Antonio Carlos de Camargo Carvalho Ângelo Amato Vicenzo de Paola Ênio Buffolo

OBJECTIVE: To report the role played by transesophageal echocardiography during implantation of self-expanding aortic endoprostheses (stent) at a hemodynamics laboratory. METHODS: Thirteen patients underwent stent implantation in the descending thoracic aorta with the aid of transesophageal echocardiography during the entire procedure. Indications for stenting were as follows: 8 aortic dissections, 2 true aneurysms, 2 penetrating atherosclerotic ulcers, and 1 traumatic pseudoaneurysm. RESULTS: No complications resulting from the use of transesophageal echocardiography were observed. In 12 patients, the initial result was considered appropriate, with total or partial resolution of the major lesion confirmed by a posterior examination. In 1 patient, the procedure was suspended after transesophageal echocardiography and angiography showed that the proximal aortic diameter was inappropriate. Transesophageal echocardiography contributed to clarifying relevant points, such as aortic diameter, anatomic detail of the intimal lesion, and location and size of the communicating orifice. In addition, it facilitated placing the stent in the target lesion, reduced the time of exposure to radiation and the use of contrast medium, and provided rapid identification of intercurrent events, possibly reducing the total duration of the procedure. CONCLUSION: The use of transesophageal echocardiography during placement of aortic stents seems appropriate. The actual advantages of the procedure will be defined in a comparative prospective study.

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Original Article

Is female sex an independent predictor of in-hospital mortality in acute myocardial infarction?

Lúcia Pimenta et al. Roberto Bassan Alfredo Potsch José Francisco Soares Francisco Manes Albanesi Filho

OBJECTIVE: To assess whether female sex is a factor independently related to in-hospital mortality in acute myocardial infarction. METHODS: Of 600 consecutive patients (435 males and 165 females) with acute myocardial infarction, we studied 13 demographic and clinical variables obtained at the time of hospital admission through uni- and multivariate analysis, and analyzed their relation to in-hospital death. RESULTS: Females were older (p<0.001) and had a higher incidence of hypertension (p<0.001). Males were more frequently smokers (p<0.001). The remaining risk factors had a similar incidence among both sexes. All variables underwent uni- and multivariate analysis. Through univariate analysis, the following variables were found to be associated with in-hospital death: female sex (p70 years (p<0.001), the presence of previous coronary artery disease (p=0.0004), previous myocardial infarction (p<0.001), infarction in the anterior wall (p=0.007), presence of left ventricular dysfunction (p<0.001), and the absence of thrombolytic therapy (p=0.04). Through the multivariate analysis of logistic regression, the following variables were associated with in-hospital mortality: female sex (p=0.001), age (p=0.008), the presence of previous myocardial infarction (p=0.02), and left ventricular dysfunction (p<0.001). CONCLUSION: After adjusting for all risk variables, female sex proved to be a variable independently related to in-hospital mortality in acute myocardial infarction.

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Chagas' heart disease: evolutive evaluation of electrocardiographic and echocardiographic parameters in patients with the indeterminate form

Do cardiologists at a university hospital adopt the guidelines for the treatment of heart failure?

Prevalence of hypertension in the urban population of Catanduva, in the State of São Paulo, Brazil

Fibroelastoma of the mitral valve as a cause of transient ischemic stroke

Uhl's anomaly. Differential diagnosis and indication for cardiac transplantation in an infant

Use of transesophageal echocardiography during implantation of aortic endoprosthesis (stent). Initial experience

Is female sex an independent predictor of in-hospital mortality in acute myocardial infarction?

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