2005;85(2) – ABC CARDIOL

Original Article

Comparative study between the therapeutic effects of surgical myocardial revascularization and coronary angioplasty in equivalent ischemic situations: analysis through myocardial scintigraphy with 99mTc-Sestamibi

Anellys E. L. C. Moreira et al. Whady A. Hueb Paulo Rogério Soares José Cláudio Meneghetti … Maria Clementina P. Jorge William A. Chalela Eulogio E. Martinez Filho Sérgio Almeida de Oliveira Fábio Biscegli Jatene José Antônio Franchini Ramires

OBJECTIVE: To assess the myocardial ischemic load to previous and after myocardial revascularization. METHODS: Ninety-six randomized patients, carriers of multivessel coronary artery disease, stable angina, preserved left ventricular function, and exercise-induced myocardial ischemia treated with revascularization (SMR) or coronary angioplasty (TCA). Myocardial scintigraphy with 99mTc-Sestamibi was performed prior to and 6 months after myocardial revascularization. RESULTS: The SMR determined a significant greater index of complete revascularization (p=0.001), an increase in the number of maximum ergometric tests (p=0.001) and reduction in the number of positive ergometric tests with exercise angina (p=0.018). Both procedures provided an important improvement in the functional class of angina (p=0.001), an increase in the average value of double peak product (p=0.009), and the time of exercise tolerance (p<0.001), besides the reduction in the average value of the summed of exercise score (p<0.001) and the difference of the summed of scores (p<0.001) in both groups. CONCLUSION: TCA and SMR did not differ significantly concerning the reduction of myocardial ischemic load 6 months after the procedure. The myocardial revascularization was more complete with the SMR than the TCA, but it did not represent a significant factor for the reduction myocardial ischemic load.

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Correlação Clínico-Radiográfica

Forty days old infant with transposition of the great arteries and ventricular septal defect

Edmar Atik

CLINICAL-RADIOGRAPHIC CORRELATION

Case 2/2005 – Forty days old infant with transposition of the great arteries and ventricular septal defect

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Case Report

Angioedema related to the use of streptokinase

Daniela Camargo de Oliveira et al. Otávio Rizzi Coelho Karen Paraschin Natasha Rebouças Ferraroni Ricardo de Lima Zolner

Angioedema is a rare reaction to streptokinase, acute and potentially fatal, which should be quickly diagnosed and treated to guarantee the best prognosis for the patient. We describe here the case of a 65-year-old man, who displayed an anaphylactic reaction after the beginning of thrombolysis with streptokinase, which was quickly treated, and remained hospitalized for one week in the Intensive Care Unit.

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Case Report

Takotsubo cardiomiopathy: a rare cause of cardiogenic shock simulating acute myocardial infarction

Jayro Thadeu Paiva de Vasconcelos et al. Sebastião Martins João Francisco de Sousa Antenor Portela

Takotsubo Cardiomiopathy is a rare cause of acute left ventricular aneurysm, in the absence of coronariopathy, only recently described in world literature. Symptoms may be similar to those from acute myocardial infarction with typical thoracic pain. The image of dumbbell or Takotsubo (a device used in Japan to capture octopus) suggestive ventricular ballooning is characteristic of that new syndrome and there is usually the disappearing of dyskinetic movement up to the 18th day from the beginning of the symptoms, in average.

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Case Report

Diffuse atherosclerotic disease unmasked by invasive physiologic assessment of coronary flow

Fernando Mendes Sant'Anna et al. Expedito E. Ribeiro da Silva Leonardo Alves Batista Fábio Machado Ventura … Carlos Alberto Mussel Barrozo Nico H.J. Pijls

It is known that coronary atherosclerosis is a diffuse process, very little visible at angiography. This article describes a stable angina patient, three months after acute myocardial infarction (AMI), and a severe lesion in anterior descending artery (ADA), evinced by coronariography. Myocardial fractional flow reserve (FFR), obtained through intracoronary pressure measurements, was 0.37 during maximum hyperemia, clearly showing the presence of ischemia. A stent was implanted in ADA and, despite the excellent angiographic result, post-stent FFR was only 0.75, the minimum limit, below which there is ischemia. When the pressure wire (PW) was slowly drawn back from the distal portion of ADA to its proximal portion, a continuous and gradual increase in intracoronary pressure was noted, which clearly indicates diffuse atherosclerosis and not focal stenosis. A gradient was not observed at the stent place. The patient was kept under medical treatment and has been asymptomatic so far.

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Original Article

Age and psychologic disorders: variables associated to post-infarction sexual dysfunction

Luciano Janussi Vacanti et al. Bruno Caramelli

OBJECTIVE: Data on sexual disfunction (SD) after myocardial infarction (MI) are sketchy, especially in our community and in regard to predictors. Both males and females, with active sexual life and no sexual dysfunction prior to MI were evaluated in order to investigate SD incidence after MI, as well as to identify the possible variables associated. METHODS: Forty-three patients were studied consecutively, through structured questionnaires for SD and psychological disorders (PD) diagnosis. The interference of classic risk factors was analysed for atherosclerosis, for PD and for the use of medications when SD was present up to month 6 after MI. RESULTS: After MI, 91% of patients resumed sexual activity. Twenty-six patients (60%) reported sexual dysfunction up to month 6 from hospital discharge (9 with precocious ejaculation (PE), 15 with erectile dysfunction (ED), and 20 with hypoactive sexual desire disorder (HSDD). PD patients reported sexual dysfunction at higher frequency as compared to those who did not report PD (100%x47%, p=0.001). The sexual dysfunction group was significantly older than the group not reporting sexual dysfunction: 53±8.9 years of age versus 47±8.7 years of age (p=0.04). CONCLUSION: Patients reported significant reduction of sexual activity frequency and high incidence of SD after acute myocardial infarction (AMI). PD and older age were shown to be associated to higher incidence of post-infarction SD.

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Original Article

Systemic hypertension at emergency units: the use of symptomatic drugs as choice for management

Sandro Gonçalves de Lima et al. Luciana Simões do Nascimento Cândido Nobre dos Santos Filho Maria de Fátima P. Militão de Albuquerque Edgar Guimarães Victor

OBJECTIVE: Compare the therapeutic response of symptomatic, hypertensive patients to symptomatic medication or anti-hypertensive drugs at the Emergency Unit. METHODS: A randomized, blind clinical trial involving 100 (one hundred) patients assisted at the Cardiology Emergency Unit at Oswaldo Cruz University Hospital (HUOC). All patients reported symptoms associated to systolic pressure (SBP) between 180 and 200 mmHg and/or diastolic pressure (DBP) between 110 and 120 mmHg. Patients were randomized for treatment with symptomatic (dipirone or diazepan) or anti-hipertensive drug (captopril). Those reporting any associated clinical condition and in need of immediate treatment at the Emergency Unit were excluded from the study. Patients reporting no symptoms, and systolic pressure reduced to levels under 180 mmHg and diastolic pressure under 110 mmHg after the 90-minute period were considered as having met discharge criteria. RESULTS: Mean age of population studied was 54.4 years old, most commonly females. Patients were chronic hypertensive, on irregular pharmacological treatment, with low compliance to non-pharmacologic actions, and classified as overweight and obese grade I. Headache, type D (non-angina) chest pain, and dyspnea were the most frequent complaints. The number of patients treated with symptomatic drug who reached discharge criteria was similar to that of patients treated with anti-hypertensive (p=0.165). No association was found between previous high blood pressure (HBP) diagnosis (p=0.192), pharmacological treatment (p=0.687), and non-pharmacological treatment and discharge criteria. CONCLUSION: Blood pressure (BP) was reduced below levels for discharge criteria for a (non-significant) higher rate of patients treated with symptomatic drug, who were turned into asymptomatic after the observation period.

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Editorial

Should percutaneous coronary intervention and coronary artery bypass graft surgery be considered effective methods to control myocardial ischemia in stable angina?

Paulo Roberto Dutra da Silva et al. Antonio Sérgio Cordeiro da Rocha

EDITORIAL

Should percutaneous coronary intervention and coronary artery bypass graft surgery be considered effective methods to control myocardial ischemia in stable angina?

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Correlação Anatomoclínica

Fatal myocardial infarction in a 88-year-old woman

Ariane Vieira Scarlatelli Macedo et al. Paulo Jorge Moffa Cesar José Grupi Eulógio Emílio Martinez Filho … Petter Libby Paulo Sampaio Gutierrez

ANATOMICOCLINICAL CORRELATION

Case 4/2005 Fatal myocardial infarction in a 88-year-old woman (Instituto do Coração do Hospital das Clínicas – FMUSP, São Paulo, Brasil)

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Case Report

Surgical treatment without extracorporeal circulation of artery disease related to Takayasu's arteritis involving the aorta and great vessels

Rodrigo Milani et al. Paulo Brofman Tayse Sandri Alexandre Varela … José Augusto Souza Luiz Gustavo Emed Stefan da Silveira Marcelo Dantas Maximiliano Guimarães Rafael Pontarolli Francisco Maia

We report the cases of 2 female patients with Takayasu’s arteritis referred to our service with lesions affecting the descending thoracic aorta and great vessels. One of the patients had a critical obstructive lesion in the left coronary ostium. Both patients underwent surgery without extracorporeal circulation, with full heparinization and autotransfusion.

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Editorial

Metabolic syndrome in children and adolescents

Ayrton Pires Brandão et al. Andréa Araújo Brandão Gerald S. Berenson Valentin Fuster

EDITORIAL

Metabolic syndrome in children and adolescents

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Original Article

Comparative study of 18 F-fluorodeoxyglucose imaging with a dual-head coincidence gamma camera with dobutamine stress echocardiography for the assessment of myocardial viability

Pedro Silvio Farsky et al. Leopoldo Soares Piegas Vera Marcia Gimenes Ana Claudia G. Petisco … Paulo S. Duarte Luiz Roberto Martins Mario Issa Paulo Paredes Paulista José Eduardo Moraes Rego Sousa

OBJECTIVE: To compare Dual-Head coincidence gamma camera (DCD-AC) with dobutamine stress echocardiography (DSE) in viability assessment, using functional recovery as the gold standard. METHODS: Twenty-one patients were prospectively studied, with coronary artery disease and severe left ventricular dysfunction undergoing DSE and DCD-AC at baseline and DSE three months after revascularization. RESULTS: Of the 290 segments analyzed, 83% were akinetic, 15% hypokinetic and 2% dyskinetic at rest. DSE identified 68% of these segments as non-viable. DCD-AC identified 56% of these segments as normal (dysfunctional segments with preserved metabolism and perfusion), 30% as viable (preserved metabolism and reduced perfusion) and 14% as non-viable (reduced perfusion and metabolism). Of the DSE non-viable segments, DCD-AC identified 80% as normal or viable and 19.9% as non-viable (p<0.001). In hypokinetic segments viability and normal segments were detected in a higher proportion by both methods (p<0.001). DSE sensibility and specificity were 48.3% and 78.1% respectively. DCD-AC sensibility and specificity was 92.2% and 20.0%. DCD-AC identifies a higher incidence of function improvement in normal segments than in viable and non-viable. CONCLUSION: DCD-AC classified as normal or viable most of the non-viable DSE segments. In assessment of functional recovery segments after three months, DCD-AC showed a high sensibility but low specificity.

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Atualização

Pulmonary arterial hypertension: physiopathology, genetic aspects and response to the chronic use of sildenafil

Alessandra Costa Barreto et al. Sônia Meiken Franchi Alexandre C. Pereira Antonio Augusto Lopes

UPDATE

Pulmonary arterial hypertension. Pathophysiology, genetic aspects and response to the chronic use of sildenafil

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Original Article

Serum lipids in school kids and adolescents from Florianópolis, SC, Brazil: Healthy Floripa 2040 study

Isabela de Carlos Back Giuliano et al. Mário Sérgio Soares de Azeredo Coutinho Sérgio Fernando Torres de Freitas Maria Marlene de Souza Pires … João Nilson Zunino Robespierre Queiroz da Costa Ribeiro

OBJECTIVE: To determine the distribution of serum lipids in children and adolescents of Florianopolis, Santa Catarina State, Brazil. To determine the association between undesirable levels for total cholesterol (>170 mg/dL) and others coronary heart disease risks factors. METHODS: A questionnaire, physical examination and blood analyses were collected from randomized sample from school kids aged range from 7 to 18 years old. RESULTS: 1,053 students participated, aged between 7 and 18 years old. They presented a total cholesterol mean of 162±28 mg/dl, triglyceride mean of 93±47 mg/dl, HDL-cholesterol mean of 53±10 mg/dl, LDL-cholesterol mean of 92±24 mg/dl and non-HDL cholesterol mean of 109±26 mg/dl. The TC/HDL and LDL/HDL mean rates were, respectively, 3.1±0.6 and 1.8±0.5. Findings showed that private school children, 10 years old or less, girls and black children had higher lipids values. Overall findings suggest that the best logistic regression model which explained abnormal total cholesterol levels included: obesity, stroke and heart attack familial history, feminine gender, age of 10 years old or less and overweight body image determined on inspection. CONCLUSION: In comparison to international literature, our results, showed intermediated total cholesterol, lower LDL-cholesterol and non-HDL-cholesterol and higher HDL-cholesterol. Therefore, primary prevention programs are needed to be carrying out, especially among overweight children and adolescents so to prevent ischemic heart disease as adulthood.

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