2005;84(1) – ABC CARDIOL

Artigo Original

Effect of estradiol on cardiopulmonary and metabolic responses of postmenopausal normotensive women undergoing cardiopulmonary exercise testing

Roberto Calvoso Júnior et al. José Mendes Aldrighi Carlos Eduardo Negrão Ivani Credidio Trombetta José Antonio F. Ramires

OBJECTIVE: To assess the cardiopulmonary and metabolic responses of 30 postmenopausal women using estrogen during maximum physical activity during cardiopulmonary exercise testing. Twenty-five women completed the test. METHODS: A prospective, double-blind, randomized, placebo-controlled study was carried out to assess 2 groups of women: estradiol group – comprising 14 postmenopausal women (57.6±4.8 years) receiving oral estradiol at the dosage of 2 mg/day for 90 days; and placebo group – comprising 11 women (55.8±6.7 years) receiving placebo during the same period. Both groups underwent cardiopulmonary exercise testing on a cycloergometer, during which the following variables were assessed: volume of oxygen consumption per kilogram per minute during peak exercise (VO2peak); anaerobic threshold (AT); volume of oxygen consumption per kilogram per minute in the anaerobic threshold (VO2 in AT); point of respiratory decompensation (PRD); duration of exercise (DE); maximum load achieved (ML); maximum heart rate (HR); systolic blood pressure (SBP); and diastolic blood pressure (DBP) before and after drug administration. RESULTS: The following variables showed statistically significant reductions only in the group of women receiving estradiol: VO2peak (P=0.002); AT (P=0.01); VO2 in AT (P=0.001); and DE (P=0.05). The other variables did not change. CONCLUSION: Estradiol did not improve the cardiopulmonary and metabolic responses when compared with placebo.

Read Full Article

Artigo Original

Postischemic stunned myocardium does not alter cardiac response to an elevation in contractile frequency

Orlando Sant'Ana Jr et al. Roberto J. Nogueira Neif Murad Antonio Carlos Lopes Paulo J. F. Tucci

OBJECTIVE:To assess the influence of the postischemia/reperfusion stunned myocardium (PIRSM) on the inotropic and lusitropic effects of heart rate (HR). METHODS: Nine preparations of isolated dog hearts in isovolumic contraction and nourished by the arterial blood of another dog underwent heart rate elevation from 60 bpm to 200 bpm, in 20-bpm stages. The following variables were assessed before (B) and after (A) ischemia (15 min) and reperfusion (30 min): the pressure developed during contraction (PD), its first positive (+dP/dt) and negative (-dP/dt) derivative, the time of maximum pressure (TMP), the pressure at rest (Pr), and the time necessary for the developed pressure to decrease by 90% of its maximum value (time for relaxation – TR90%). RESULTS: The stimulating effects of HR elevation on inotropism and relaxation were similar before and after ischemia/reperfusion as follows: +dP/dt values increased, TMP decreased, -dP/dt values were intensified, and TR90% decreased. The values of PD did not change, and Pr increased. CONCLUSION: The results confirmed the positive inotropic effect of HR elevation (Bowditch effect) and the depressive action of ischemia/reperfusion. They also evidenced that PIRSM does not alter the stimulating action of the Bowditch effect, in accordance with the current concept that PIRSM does not impair calcium myocardial kinetics, favoring the prevalent hypothesis that the decrease in the contractile capacity after ischemia/reperfusion depends on the reduction of the myofilament responsiveness to calcium.

Read Full Article

Relato de Caso

Acute myocardial infarction and documented sudden death

Gustavo Carvalho et al. Maurício de Nassau Machado Lília Nigro Maia

A sexagenarian man sought the emergency unit complaining of dubious chest pain and lipothymia. He was investigated and stratified. His serial electrocardiograms and serum markers for myocardial injury were negative for myocardial ischemia, as was his exercise test. However, the patient died suddenly inside the hospital while under continuous electrocardiographic Holter monitoring, which evidenced acute myocardial infarction complicated by complex ventricular arrhythmia (ventricular tachycardia and fibrillation), which culminated in death refractory to the cardiopulmonary resuscitation maneuvers.

Read Full Article

Artigo Original

Myocardial remodeling after experimental acute myocardial infarction in rats: effect of renin-angiotensin-aldosterone system blockade

Hindalis Ballesteros Epifanio et al. Leonardo Antonio Mamede Zornoff Beatriz Bojikian Matsubara Sergio Alberto Rupp de Paiva … Roberto Minoru Tani Inoue Luiz Shiguero Matsubara

OBJECTIVE: To assess the effect of lisinopril and losartan on myocardial remodeling in experimental infarction in rats. METHODS: Male Wistar rats underwent myocardial infarction and were either treated with lisinopril [20 mg/kg/day (LIS, n=13)] or losartan [20 mg/kg/day (LOS, n=11)], or kept without any treatment (NT, n=11) for 3 months. Their results were compared with those of a control group (CONT, n=11) comprising noninfarcted rats. After euthanasia, the left ventricle was isolated and weighed. The following measurements were taken: the sectional area of myocytes (AC), interstitial collagen fraction (CVF), and myocardial hydroxyproline (HOP). The variables were compared by using 1-way ANOVA, with a significance level of P<0.05. RESULTS: Acute myocardial infarction caused left ventricular hypertrophy. The treatments with lisinopril or losartan could prevent hypertrophy, which was quantified by use of left ventricular weight (LOS=1.06±0.12g, LIS=0.97±0.18g, NT=1.26±0.17g, CONT=1.02±0.09g; P<0.05), of left ventricular weight-to-body weight ratio LV/BW (LOS=2.37± 0.21mg/g, LIS=2.41±0.38mg/g, NT=2.82±0.37mg/g, CONT=2.27± 0.15mg/g), and of left ventricular AC measure-ment (LOS=210±39µ², LIS=217±35µ², NT=256±35µ², CONT=158±06 µ²; P<0.05). The CVF was significantly greater in the left ventricle of the infarcted group, and its increase was prevented with treatment (LOS=1.16±0.4%, LIS=1.27±0.5%, NT=1.8± 0.4%, CONT=0.7±0.5%). Myocardial hydroxyproline was greater in the infarcted group (NT=6.91±2.98mg/g vs. CONT=2.81± 1.21mg/g) and did not change with treatment. CONCLUSION: Myocardial remodeling after infarction is characterized by an increase in the remaining ventricular mass and in interstitial collagen. The angiotensin-converting-enzyme blockers and the selective angiotensin II AT1 antagonist prevent hypertrophy of the myocyte and interstitial fibrosis.

Read Full Article

Relato de Caso

Heart transplantation in a patient with endomyocardial fibrosis

Humberto F.G. de Freitas et al. Pedro Paulo Neves de Castro Paulo Roberto Chizzola Edimar Alcides Bocchi

Endomyocardial fibrosis is a common disease in tropical countries, particularly Uganda and Nigeria. It may affect the right and left ventricles, creating restrictive heart failure, which, in addition to the classical symptoms, manifests as ascites disproportional to peripheral edema. We report the case of a female patient with endomyocardial fibrosis refractory to clinical treatment, who underwent surgical treatment with clinical improvement for a short period. Three months after the surgery for resection of the endomyocardial fibrosis and tricuspid valvuloplasty, the disabling symptoms reappeared. Then the patient underwent bicaval orthotopic heart transplantation, which had a good clinical outcome. This was the first case of heart transplantation for the treatment of endomyocardial fibrosis, which proved to be a promising alternative.

Read Full Article

Artigo Original

Myocardial revascularization without extracorporeal circulation in patients over 75 years of age: analysis of immediate results

Rodrigo Milani et al. Paulo Brofman Alexandre Varela Jose Augusto Souza … Maximiliano Guimarães Rafael Pantarolli Alexandre Barbosa Laura Barbosa Thaise Sandri Luiz Gustavo Emed Fernanda Ceccon Francisco Maia

OBJECTIVE: To assess the immediate results of myocardial revascularization surgery without extracorporeal circulation in a group of patients over 75 years of age. METHODS: From January 2001 to December 2003, 193 (121 men and 72 women) patients with ages ranging from 75 to 94 years, corresponding to 100% of the coronary surgeries performed in patients over the age of 75 years, underwent myocardial revascularization without extracorporeal circulation. Their hospitalization data were retrospectively analyzed. RESULTS: Arterial hypertension was present in 174 (90%), dyslipidemia in 115 (59%), smoking in 89 (46%), and diabetes in 57 (29%). Ninety-six (49.7%) patients had had a previous myocardial infarction, 53 of whom (27.4%) had experienced an acute ischemic event in a period < 30 days after surgery. Critical obstructive lesions in 3 or more coronary vessels were present in 156 (80.95%) patients, while 30 (15%) patients had an important obstruction of the left main coronary artery, and 30 (15%) patients had an ejection fraction < 30%. The score obtained according to the EUROSCORE ranged from 3 to 18, with an expected mortality rate for the group of 7.54±2.69%. The total number of distal anastomoses was 639. Seven (3.62%) patients died, 3 due to bronchopneumonia, 1 due to mediastinitis, 1 due to metabolic causes, 1 due to cardiogenic shock, and another died suddenly after refixation of a sternal dehiscence. Reoperation due to bleeding, orotracheal reintubation, and prolonged mechanical ventilation were factors associated with an increase in mortality. CONCLUSION: The surgery adopted for myocardial revascularization was associated with a low mortality rate, a low complication index, and a short length of stay at the hospital.

Read Full Article

Relato de Caso

Single coronary artery: angioplasty with stent implantation

Ian C. D. Teixeira et al. Alexandre X. Brant Alexandre Ares Bruno Sarbi … Isaac Moscoso Adnan A. Salman Salvador A. B. Cristóvão João B. Oliveira Neto Maria Fernanda Z. Mauro José A. Mangione

We report the case of a rare anomaly of the right coronary artery originated from the middle third of the left anterior descending (LAD) coronary artery with a proximal atheromatous obstructive lesion immediately before the emergence of the right coronary artery (RCA). The patient underwent successful angioplasty with stent implantation in the left anterior descending coronary artery. Only 7 cases of this anomaly of distribution have been reported in the literature, but none of them was treated with percutaneous revascularization.

Read Full Article

Artigo Original

Assessment of the pulmonary vascular blood supply in patients with pulmonary atresia, ventricular septal defect, and aortopulmonary collateral arteries

Ulisses Alexandre Croti et al. Miguel Lorenzo Barbero Marcial Carla Tanamati Marcelo Biscegli Jatene … Domingo Marcolino Braile Sergio Almeida de Oliveira

OBJECTIVE: To study the morphometric characteristics of the central pulmonary arteries and aortopulmonary collateral arteries by assessing the morphology of the pulmonary vascular blood supply, to determine their significance in surgical treatment. METHOD: From January 1990 to June 2001, 40 patients were studied. Those who had the complete cineangiocardiographic study prior to the first surgical intervention were included in the study. The morphometric characteristics of the central pulmonary arteries (PPAA) and aortopulmonary collateral arteries (APCA) were analyzed, as was the distribution of blood irrigation to the lungs. The following indices were calculated: pulmonary arterial index (PPAAI), aortopulmonary collateral arterial index (APCAI), and total neopulmonary arterial index (TNPAI = PPAAI + APCAI). The surgical treatment was considered palliative (PT), palliative definitive (PDT), and definitive (DT). RESULTS: The palliative treatment predominated. No statistically significant differences were observed in the patients undergoing PT, PDT, and DT, in regard to PPAAI, APCAI, and TNPAI. Comparing PPAAI and APCAI, no difference was observed for DT (P=0.4309); APCAI was greater than PPAAI for PT (P=0.0176); and APCAI was descriptively greater for PDT. The TNPAI of patients undergoing DT was greater than that of patients undergoing PT (P=0.0959). Five morphologically similar subgroups were identified and designated as B1, B2, B3, B4, and B5. Overall mortality was 17.5%. CONCLUSION: The morphometric characteristics are important, but the morphology of the pulmonary vascular blood supply of the PPAA and APCA proved to be better for guiding the surgical treatment. Independently of the didactical division into subgroups, PT predominated. Mortality was not correlated with the morphometric characteristics.

Read Full Article

Artigo Original

Prevalence of excessive weight and hypertension in a low-income urban population

Adelina Maria Melo Feijão et al. Francisco Vieira Gadelha Antonio Alberto Bezerra Antonio Maurício de Oliveira … Maria do Socorro Sombra Silva José Wellington de Oliveira Lima

OBJECTIVE: To study the relation between body mass and blood pressure in a low-income urban population. METHODS: From July to December 1998, a cross-sectional study was carried out in a representative sample of a low-income urban community with individuals of both sexes, aged > 30 years and living in 67 (30%) blocks selected out of 224. Blood pressure, weight, and height were measured, and completion of a questionnaire provided information on sex, age, familial income, educational level, and occupation. Body mass index was obtained by dividing weight (kilogram) by height squared (square meter), and the following values were considered: BMI BMI 30, obesity. In addition, excessive weight was defined as BMI > 25, and arterial hypertension was defined as systolic blood pressure > 140 mm Hg and diastolic blood pressure > 90 mm Hg. RESULTS: In 1078 dwellings, 1137 eligible individuals resided, and complete information was obtained from 1032 (91%) individuals. The prevalences of arterial hypertension and excessive weight were 22.58% and 51.26%, respectively. Before adjustment, the OR for arterial hypertension for overweight individuals was 1.85 (95% CI: 1.52-2.25) and, for obese individuals, 3.7 (95% CI: 3.04-4.50); after adjustment, the ORs were 2.04 (95% CI: 1.65-2.54) and 4.08 (95% CI: 3.30-5.08), respectively. CONCLUSION: A strong association between body mass and blood pressure exists, independently of sex, age, familial income, educational level, and occupation.

Read Full Article

Artigo Original

Acute coronary syndromes in the absence of significant coronary artery disease

Maria das Graças Viana Pinheiro et al. Alvaro Rabelo Jr. Rogerio Santos de Jesus Luciana Cunha Nascimento Ursula Maria Moreira Costa

OBJECTIVE: To assess the clinical characteristics, evolution, and in-hospital complications of patients with acute coronary syndromes (ACS) in the absence of significant obstructive coronary artery disease (CAD). METHODS: Cross-sectional study of patients hospitalized from August 1996 to March 2002 with acute coronary syndrome, with or without an elevation in the ST segment, and with (= 50%) or without (<50%) significant coronary stenosis. Their clinical and demographic characteristics and their in-hospital complications were analyzed. RESULTS: Of the 1351 patients admitted with acute coronary syndrome, 28% had an elevation in the ST segment and 72% had no elevation. The patients with acute coronary syndrome with no elevation in the ST segment and no significant coronary obstruction were younger, predominantly females, and had a lower frequency of dyslipidemia, previous coronary arterial disease, diabetes mellitus, smoking, and systemic arterial hypertension, when compared with those with significant obstructive lesion. Among the individuals with acute coronary syndrome and an elevation in the ST segment, smoking was the most prevalent risk factor in patients with nonsignificant obstructive lesion. In regard to complications, recurring ischemia, congestive heart failure, and arrhythmias were more frequent in patients with acute coronary syndrome with no elevation in the ST segment and no significant obstructive coronary lesion. CONCLUSION: Patients with acute coronary syndrome with no elevation in the ST segment and with nonsignificant obstructive coronary lesions are younger, predominantly females, have a greater frequency of risk factors for coronary arterial disease, and a lower incidence of complications as compared with patients with significant obstructive coronary lesion.

Read Full Article