2005;84(6) – ABC CARDIOL

ABC

ABC Family | ABC

Artigo Original

Analysis of the intra-hospital attending of ventricular fibrilation/ventricular taquicardia simulated events

Miguel Antônio Moretti et al. André Moreira Bento Ana Paula Quilici Márcia Martins … Luís Francisco Cardoso Sérgio Timerman

OBJECTIVE: To analyze the time intervals between the beginning of the Ventricular Fibrilation/Ventricular Taquicardia (VF/VT) and the main procedures made. METHODS: Twenty VF/VT simulations were performed and filmed in a hospital environment, using a static mannequin, on random days at random times. All teams had the same level of skills. The times (in sec.) related to basic life support (BLS) – arrival of the team (AT), confirmation of the arrest (CAT), beginning of the CPR (IT) and the times related to the advanced life support (ALS) – 1st defibrillation (DT), 1st dose of adrenalin (AT) and orotracheal intubation (OTIT). The variables were analyzed and compared in two groups: intensive care unit (ICU) and wards with telemetry (TLW). RESULTS:The results in both groups was in that order (GW x ICU ) – AT (70.2+38.7 x 38.6+49.2); CCA (89.4+57.1 x 71+63.9); SC (166.8+81.1 x 142+66.2); FD (282.5+142.8 x 108.4+52.5); FE (401.4+161.7 x 263.3+122.8) e OI (470.3+150.6×278.8+98.8). Shows the comparison of the average times between the two groups. CONCLUSION: The differences noted in relation to DT, AT and OTIT favorable to ICU are associated to the facility of performance of the ALS maneuvers in such environment. The BLS-related times were similar in both groups, which reinforce the need for the use of semi-automatic defibrillators, even in a hospital environment.

Read Full Article

Relato de Caso

Dyspnea through compression of mediastinal structures due to pericardial cyst

Jeanine Eggers Caramori et al. Luciane Miozzo Maurice Formigheri Cristiano Barcellos … Muriel Grando Tiago Trentin

A case of a 65-year-old patient, showing dyspnea to strains and right side pain as main symptoms of an approximately 8 cm cyst in the pericardium. The physical, biochemical and electrocardiographic examinations did not evince any changes. The results from the thoracic radiography, CT scan and echocardiogram suggested pericardial cyst. Based on those clinical evidences, the patient was submitted to a thoracotomy in the right side thoracic region and a complete excision of the mediastinal mass was performed, with complete remission of the symptoms.

Read Full Article

Artigo Original

Nutritional repercussion in advanced heart failure and its value in prognostic assessment

Luís Guilherme Veloso et al. Mucio Tavares de Oliveira Junior Robson Tadeu Munhoz Paulo Cesar Morgado … José Antonio Franchini Ramires Antonio Carlos Pereira Barretto

OBJECTIVE: To analyze the nutritional repercussion in heart failure and its relations with left ventricular dysfunction and mortality. METHODS: A series of nutritional parameters in a group of 95 patients with advanced chronic heart failure, arising out of dilated cardiomyopathy and age < 65 years old, without concomitant diseases was studied. The duration of symptons, final diastolic diameter and left ventricular ejection fraction were verified. The nutritional assessment, included the ideal percentage of weight the triceps skin fold thickness, percentiles of circumference of muscular mass of the arm, the albumin serum levels and the lymphocytes global count. RESULTS: The nutritional situation was alterated in 45.3% to 94.7% of the patients in accordance to the assessment parameter used. There was neither correlation between the nutritional parameters and the length of symptoms, nor with the ventricular dysfunction level. That group of patients had a homogenous evolution, and 75.8% of them died in an average time of 21.86 weeks. The left ventricular diastolic diameter and ejection fraction did not allow for the prediction of survival. A diminished body mass identified a group with higher risk of death. The ideal percentage of the body mass was predictive of survival (p=0.0352), the patients with less than 80% of ideal weight had a higher relative risk of death of 1.99 (1.12-3.02) (p=0.0132). CONCLUSION: Malnutrition is frequent in patients with advanced heart failure and dilated cardiomyopathy. The reduced body mass was a better predictor of survival than the left ventricular ejection fraction in patients under advanced stage of myocardial compromising.

Read Full Article

Artigo Original

Diastolic dysfunction in diabetic normotensive patients, regardless of the presence of microangiopathy

João Carlos Ferreira Braga et al. Fábio Villaça Guimarães Filho Carlos Roberto Padovani Beatriz B. Matsubara

OBJECTIVE: To assess the Doppler-echocardiographic changes in normotensive patients with type II diabetes mellitus, in the presence or absence of signs of microangiopathy. METHODS: Patients with type II diabetes mellitus were submitted to funduscopy contrasted with fluorescein and dosage of microalbuminuria for diagnose of microangiopathy and divided into two groups: DMII (patients without microangiopathy, n=19) and DM+A (patients with microangiopathy, n=13). All of them were submitted to a Doppler-echocardiography and the results were compared with normotensive patients of same sex and age (group C, n=20), by using the ANOVA, followed by the test of Tukey. In all comparisons the significance level p<0.05 was adopted. RESULTS: There were no differences among the groups regarding the systolic function indicators or left ventricular mass. Differences compatible with diastolic dysfunction in the two groups of diabetic were observed, regardless of the presence of microangiopathy, which showed significantly higher values of the times of isovolumetric relaxation of the left ventricle (TIRLV, ms): (DMII= 97±22.2; DM+A= 107±28.2 and C= 80±10.7; p<0.05), and lower values of the maximum speeds of the wave of fast ventricular filling (E, cm/s): (DMII= 69±17.5; DM+A= 75±19.7 and C= 84±14.5, p<0.05 between DMII and C). There was no difference among the groups concerning the E/A rate. CONCLUSION: Normotensive patients with type II diabetes mellitus and without clinical signs of cardiovascular compromising showed signs of diastolic dysfunction, non-associated to the presence of microangiopathy.

Read Full Article

Editorial

"Time is life": a duty of awareness on sudden death

Manoel Fernandes Canesin et al. Sergio Timermam Flávio Rocha Brito Marques Dario Ferreira Irani Ribeiro de Moura

EDITORIAL

“Time is life” – A duty of awareness on sudden death

[…]

Read Full Article

Artigo Original

Home exercise program: short term effects on physical aptitude and blood pressure in hypertensive individuals

Paulo de Tarso Veras Farinatti et al. Ricardo Brandão de Oliveira Vivian Liane Mattos Pinto Walace David Monteiro Emílio Francischetti

OBJECTIVE: To observe the influence of a four-month-unsupervised-exercise program performed at home on the blood pressure (BP) and physical performance in hypertensive adults. METHODS: A target group with 26 men and 52 women, and a control group with 9 men and 7 women were observed, with ages ranging from 25 to 77 years old. The target group underwent a home exercise program, basically with aerobic activity (60-80% of the estimated maximum heart rate for the age, 30min of walking at least 3 times a week), in addition to the flexibility exercises. Guidelines on the control chart and variables that could influence the treatment were given at each assessment. Patients were followed-up for four months, with assessments every 2 months observing: BP at rest; body weight, waist-hip ratio (W/HR), body fat percentage (%F), sum of skinfold measurements (SM) and central-peripheral skinfold ratio (C/P); trunk flexibility (TF); heart rate and workload ratio during submaximal test in cycle ergometer (HR/W), represented by the regression curve inclination between both (a). RESULTS: The target group demonstrated significant alterations in weight (-3.7 kg), WHR (-0.03), SM (-12 mm), %F (-4.4%), TF (+2.3 cm), HR/W (-0.02) and BP (-6 and -9 mmHg for systolic and diastolic pressure respectively). The control group presented small weight alterations (+1.3 Kg) and %F (+1.7%). CONCLUSION: Unsupervised exercise home programs, even in short term, may present positive effects on the blood pressure and physical performance in hypertensive individuals.

Read Full Article

Correlação Anatomoclínica

Cardiac arrest in pulseless electric activity in a 49 year-old man in the 23th day post acute myocardial infarction

Desidério Favarato et al. Paulo Sampaio Gutierrez

Read Full Article

Point of view

Do angiotesin II blockers increase the incidence of myocardial infarction?

Jorge Ilha Guimarães

POINT OF VIEW

Do angiotesin II blockers increase the incidence of myocardial infarction?

[…]

Read Full Article

Artigo Original

Chlamydia pneumoniae and Mycoplasma pneumoniae in calcified nodes of stenosed aortic valves

Marilia Harumi Higuchi-dos-Santos et al. Humberto Pierri Maria de Lourdes Higuchi Amit Nussbacher … Sueli Palomino Nadia Vieira Sambiase José Antonio Franchini Ramires Maurício Wajngarten

OBJECTIVE: We investigated whether Chlamydia pneumoniae (CP) and Mycoplasma pneumoniae (MP) are present in aortic valve stenosis (AS). METHODS: Immunohistochemistry was utilized to identify CP antigens, in situ hybridization to identify MP DNA, and electron microscopy was used to evaluate the following three groups: Normal – 11 normal autopsy valves; Atherosclerosis – 10 autopsy valves from patients with systemic atherosclerosis and no AS; and AS – 14 surgical specimens of AS analyzed in 3 sub-regions: AS-Preserved – peripheral, preserved regions; AS-Fibrosis – peri-calcified fibrotic tissue; and AS-Calcification – calcified nodules. RESULTS: The positive area fraction of CP antigen median values were 0.09, 0.30, 0.18, 1.33, and 3.3 in groups Normal, Atherosclerosis, AS-Preserved, AS-Fibrosis, and AS-Calcification, respectively. CP density was significantly greater in Atherosclerosis and AS-Calcification than in Normal (P<0.05). Within the AS group, the amount of CP was greater in the Calcification and Fibrosis regions (P<0.05). MP-DNA positive area fraction (median values) were 0.12, 0.44, 0.07, 0.36, and 1.52 in groups Normal, Atherosclerosis, AS-Preserved, AS-Fibrosis, and AS-Calcification, respectively. The amount of MP-DNA was greater in AS-Calcification than in Normal (P<0.05). Within the AS group, MP-DNA was in larger quantity in the Calcification and Fibrosis regions (P<0.05). CONCLUSION: AS Calcified nodes present higher concentration of CP and MP suggesting that these bacteria may be associated with the development of calcification and inflammation. This adds novel similarities between AS and the atherosclerosis process, which may have infection mechanisms involved.

Read Full Article

Point of view

Expanding the use of reperfusion therapy: from GISSI to DANAMI

Antonio Luiz da Silva Brasileiro

POINT OF VIEW

Expanding the use of reperfusion therapy. From GISSI to DANAMI

[…]

Read Full Article

Relato de Caso

Left ventricular pseudoaneurysm associated to severe mitral insufficiency, complicating inferolaterodorsal acute myocardial infarction

João Luiz de A. A. Falcão et al. Sandra Nívea R. S. Falcão Maria Fernanda M. A. Garcia Ana Lúcia M. Arruda … Alexadre C. Hueb Fábio B. Jatene Paulo S. Gutierrez José Carlos Nicolau José Antônio F. Ramires Roberto Rocha C. V. Giraldez

We described a case of left ventricular pseudoaneurysm associated to a severe mitral regurgitation, complicating a inferolaterodorsal acute myocardial infarction. The lesion was found in a routine echocardiogram during the in-hospital follow-up. The well-succeeded surgical strategy and the good clinical evolution of the patient were distinguished.

Read Full Article

Artigo Original

Functional assessment of the left atrial appendage at transesophageal echocardiography before and after percutaneous valvotomy in the mitral stenosis

Solange Bernardes Tatani et al. Orlando Campos Filho Claudio Henrique Fischer Valdir Ambrósio Moisés … José Augusto Marcondes de Souza Cláudia Maria Rodrigues Alves Angelo Amato Vincenzo de Paola Antonio Carlos C. Carvalho

OBJECTIVE: To assess the effects of the relief of the mitral stenosis by percutaneous ballon valvotomy in the function of the left atrial appendage. METHODS: Twelve patients with symptomatic mitral stenosis, in sinus rhythm, were studied. They were submitted to the transesophageal echocardiogram before and after effective percutaneous ballon valvotomy. Concerning the left atrial appendage, the peak flow velocities and the respective integral of the anterograde and retrograde flow, in addition to the ejection fraction calculated through the planimetry of the area of that structure, were analyzed at the pulsatile Doppler. RESULTS: There was a significant increase of the anterograde flow velocity of the left atrial appendage after percutaneous ballon valvotomy (pre: mean of 0.30 m/s; post: mean of 0.47 m/s; p<0.05) and their respective integrals. The same happened with the retrograde flow velocity (pre: mean of 0.35 m/s, post: mean of 0.53 m/s; p<0.05). There was a tendency of increase of the ejection fraction of the left atrial appendage after the procedure (pre: mean of 20%, post: mean of 31%; p=0.08). CONCLUSION: The effective opening of the stenosed mitral orifice resulting from the percutaneous ballon valvotomy determined an improvement of the flow pattern of the left atrial appendage, which can potentially contribute for the reduction of the embolic risk.

Read Full Article

Atualização

Echocardiographic assessment of cardiac resynchronization therapy

Carlos Eduardo Suaide Silva et al. Antonio Carlos Pereira Barretto

UPDATE

Echocardiographic assessment of cardiac resynchronization therapy

[…]

Read Full Article

Artigo Original

Research of markers for the genes of the heavy chain of cardiac beta-myosin and myosin binding protein C in relatives of patients with hypertrophic cardiomyopathy

Adriana Paula Tirone et al. Edmundo Arteaga Alexandre da Costa Pereira José Eduardo Krieger … Paula de Cássia Buck Barbara Maria Ianni Charles Mady

OBJECTIVE: To study the molecular markers for the genes of the heavy chain of cardiac beta-myosin and the myosin binding protein C in relatives of carriers of hypertrophic cardiomyopathy. METHODS: Twelve families who had anamnesis, physical exam, electrocardiogram, echocardiogram and blood collection for the genetic study through the chain reaction of polymerase. RESULTS: From the 227 relatives, 25% were ill-taken, with 51% men, with an average age of 35±19 (2 to 95) years old. The genetic analysis showed a connection with the gene of the cardiac b-myosin in a family and, in another, a connection with the gene of the myosin-binding protein C. In five families, the connections with the two genes were excluded; in two, the connection with the gene of the myosin-binding protein C, but for the b-myosin gene the results were non-conclusive; in two families, the results were non-conclusive for both genes and in one the connection for the b-myosin gene was excluded. The results were non-conclusive for the gene of the myosin-binding protein C. CONCLUSION: In our environment, other genes, different from those described in the literature, may prevail, or there are other genetic differences related to the origin of our population and/or environmental factors.

Read Full Article

Point of view

Do angiotensin II receptor blockers (ARB-II) increase the incidence of myocardial infarction?

Mário Sérgio Soares de Azeredo Coutinho

POINT OF VIEW

Do angiotensin II receptor blockers (ARB-II) increase the incidence of myocardial infarction?

[…]

Read Full Article

Artigo Original

Function of the left atrium in the Chagas' cardiomyopathy

Maria do Carmo Pereira Nunes et al. Márcia de Melo Barbosa Édson Siqueira da Rocha Manoel Otávio da Costa Rocha

OBJECTIVE: To study the function of the left atrium in carriers of dilated cardiomyopathy of chagasic etiology and relate it to the diastolic function and to the functional class. METHODS: We studied 75 chagasic with cardiomyopathy patients from July to 1999 to May to 2001, submitted to clinical exams, electrocardiogram and transesophageal echocardiogram. The left atrium function was assessed by means of the velocities in the left atrial appendix and the atrial reverse in the pulmonary vein. The control group consisted of 20 normal patients. RESULTS: The age was 48±13 years old and 69% were men. Most of patients (88%) were in functional classes I and II, under a conventional treatment for cardiac insufficiency. The fraction of ejection of the left ventricle was 39±13%. The indicators of diastolic function associate to those of systolic function and the functional class. Patients with pseudonormal or restrictive pattern of diastolic dysfunction presented a larger diameter of the left atrium, lower flow velocities in the left atrial appendix and a longer duration of the atrial reverse. There was no difference among the patients with normal pattern and abnormal diastolic relaxation in relation to the control group. CONCLUSION: The left atrial function is an important parameter in the assessment of patients with chagasic myocardiopathy and it is related to the systolic and diastolic functions of the left ventricle.

Read Full Article