2007;88(5) – ABC CARDIOL

ABC

ABC Family | ABC

Artigo Original

Ventricular synchrony in patients with dilated cardiomyopathy and normal individuals: assessment by radionuclide ventriculography

Simone Cristina S. Brandão et al. Maria Clementina P. Giorgi Rodrigo T. de Miche Silvana D'Orio Nishioka … Rafael Willain Lopes Marisa Izaki José Soares Junior Martino Martinelli Filho José Cláudio Meneghetti

OBJECTIVE: To establish the parameters of intra- and interventricular synchrony in normal individuals and to compare them with patients with dilated cardiomyopathy with and without conduction disorders shown in the electrocardiogram (ECG) examination. METHODS: Three groups of patients were included in this study: 18 individuals (G1) with no cardiomyopathy and with a normal ECG (52±12 years, 29% male); 50 patients with dilated cardiomyopathy and severe left ventricular dysfunction, with 20 patients (G2) presenting QRS 120ms (57±12 years, 60% male). All patients underwent RV. Evaluation of left intraventricular dyssynchrony was carried out with the measurement of the phase histogram width and interventricular dyssynchrony was evaluated by the difference of the mean phase angle between the right and left ventricles (RLDif). RESULTS: Left ventricle ejection fractions (LVEF)s were: 62 ± 6% (G1), 27 ± 7% (G2) and 22 ± 8% (G3) and right ventricle ejection fractions were: 46 ± 5% (G1), 41 ± 6%(G2) and 38 ± 8% (G3). Evaluation of the phase histogram width was: 89 ± 18 ms (G1), 203 ± 54 ms (G2) and 312 ± 130 ms (G3), p<0.0001. The measurement of RLDif was: 14 ± 11 ms (G1), 39 ± 40 ms (G2) and 87 ± 49 ms (G3); comparing G1 vs. G2 and G1 vs. G3, p<0.0001 and G2 vs. G3, p=0.0007. CONCLUSION: The parameters analyzed discriminate the three groups of patients according to the ventricular synchrony degree. Patients with dilated cardiomyopathy and withno branch block in ECG (QRS <120 ms) may present dyssynchrony, but at a lower degree than patients with widened QRS.

Read Full Article

Artigo Original

Coronary flow reserve in sickle cell anemia

José Leão de Souza Júnior et al. Ana Clara Tude Rodrigues Paula Cássia Buck Sandra Fátima Menosi Guallandro Charles Mady

BACKGROUND: Patients with sickle cell anemia (SCA) frequently present with episodes of chest pain, alterations in the resting electrocardiogram, and changes in cardiac structure and functions. OBJECTIVE: To evaluate the effect of recurrent episodes of vaso-occlusion on the coronary microcirculation. METHODS: Coronary flow velocity and coronary flow reserve (CFR) of stable patients with SCA (n=10, 5 females, 24.4±5.4 years) were measured in the anterior descending coronary artery with transesophageal echocardiogram at baseline and after intravenous adenosine-induced maximum hyperemia, and compared to those of patients with sickle cell trait (TRA, n=10, 5 females, 27.7±3.2 years), iron deficiency anemia (IRO, n=8, 8 females, 26.6±5.2 years) and control group (NOR, n=10, 5 females, 26.3±6.3 years). RESULTS: The SCA group presented increased diastolic coronary flow velocities (p<0.01) at baseline and during maximum hyperemia (67.3±14.0 and 198.2±37.9 cm/s, respectively) when compared with the other three groups – TRA (34.4±11.9 and 114.7±36.4 cm/s), IRO (42.4±10.4 and 141.0±18.7 cm/s) and NOR (38.1±10.0 and 126.8±24.6 cm/s). However, CFR was normal in the SCA group (3.0±0.7) and comparable (p=0.70) to the other groups – TRA (3.4±0.8), IRO (3.5±1.2), and NOR (3.4±0.8). CONCLUSION: Despite the higher coronary flow velocities already observed at baseline and also during maximum hyperemia, CFR is normal in SCA, which suggests preserved coronary microcirculation. The episodes of vaso-occlusion are not responsible for the cardiologic findings in this disease.

Read Full Article

Case Report

Late coronary thrombosis secondary to implantation of paclitaxel-eluting stent without restenosis of conventional stents

Luciano Maurício de Abreu et al. George César Ximenes Meireles Marcos Kiyoshi Sumita Antonio Artur da Cruz Forte … Jose Del Carmen Solano Aliaga Jorge Hayashi

A male 39 year-old patient with post-infarction angina. The coronary angiography showed total proximal obstruction of right coronary artery (RCA), obstructive lesions of 95% of the anterior descending artery (ADA), 80% of the second left marginal branch (LM2), and 95% of the circumflex artery (CXA). The patient was successfully implanted with a Taxus 3.0 x 24 mm stent and an Express 2.75 x 24 mm stent in the proximal and distal thirds of the RCA, respectively, and with an Infinnium 3.0 x 24 mm stent in the ADA. After seven months, the patient had an anterior acute myocardial infarct (AMI) due to thrombosis of the Infinnium stent and restenosis of the Taxus stent, with no loss of results in the conventional stents.

Read Full Article

Artigo Original

C-reactive protein: an inflammatory marker with prognostic value in patients with decompensated heart failure

Humberto Villacorta et al. Antonio Claudio Masetto Evandro Tinoco Mesquita

BACKGROUND: Inflammation has been implicated in the pathophysiology of a series of cardiovascular diseases. C-reactive protein (CRP) is a marker of inflammation easily obtained in the emergency room. OBJECTIVE: To study the prognostic value of CRP in patients admitted for acute decompensated heart failure (ADHF). METHODS: A prospective cohort of 119 patients with ADHF treated in the emergency room. Mean age was 74±11 years and 76 (64%) of patients were male. All were New York Heart Association Functional Class III or IV. CRP was measured by nephelometry at admission. Patients were followed after hospital discharge for an average of 12±9.7 months and cardiovascular mortality was the outcome analyzed. RESULTS: There were 44 (36.9%) deaths, all from cardiovascular causes. Individuals with CRP > 3 mg/dl had higher mortality than those below this level (p=0.018). In the multivariate analysis using Cox proportional model, CRP proved to be the most important independent prognostic factor (odds ratio 0.0916 [95% CI = 0.0341 – 0.1490] for each one-unit increment in CRP). CONCLUSION: CRP is an independent cardiovascular mortality predictor in patients with ADHF, indicating that inflammation represents an important component in the pathophysiology of the disease.

Read Full Article

Artigo Original

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Edinburgh Claudication Questionnaire

Marcia Makdisse et al. Raimundo Nascimento Neto Antonio Carlos Palandri Chagas David Brasil … Jairo Lins Borges Anderson Oliveira José Gordillo Gisele Balsalobre Luciana Crozariol Miriam Pinho Rafaela Oliveira Ana Fátima Salles

OBJECTIVE: Translation, cultural adaptation and validation of the Brazilian Portuguese version of the Edinburgh Claudication Questionnaire (ECQ) a specific tool to assess intermittent claudication. METHODS: The Brazilian Portuguese version of the ECQ was developed after authorization by the University of Edinburgh. It was applied to 217 individuals: São Paulo Capital District residents with complaints of leg pain. Individuals under research were invited through mass communication media to participate in the I Campaign to Fight Peripheral Arterial Disease (PAD). In stage 1, participants filled out the ECQ and another questionnaire on risk factors and cardiovascular history. In stage 2, participants had anthropometric measures and ankle-brachial index (ABI) at rest measured by vascular Doppler. In case of doubt, vascular treadmill test was applied (VTT). PAD condition was defined by ABI 65 years) and non-elderly subjects. CONCLUSION: The Brazilian Portuguese version of the Edinburgh claudication questionnaire maintained good sensitivity and specificity and can be recommended for screening of PAD in clinical practice and epidemiological research in Brazil.

Read Full Article

Artigo Original

Occurrence rate and clinical predictors of hypertensive pseudocrisis in emergency room care

Silvestre Sobrinho et al. Luís C. L. Correia Constança Cruz Mila Santiago … Ana Catarina Paim Bruno Meireles Mariana Andrade Mariana Kerner Paula Amoedo Carlos Marcílio de Souza

OBJECTIVES: To describe the prevalence of hypertensive pseudocrisis in patients treated in emergency rooms with substantially elevated blood pressure levels. To compare this prevalence in private and public hospitals. To describe the frequency of wrong treatment for this condition. To identify, during triage, independent predictors of pseudocrisis. To evaluate the prognosis of patients with pseudocrisis. METHODS: Patients above the age of 18, admitted to the Emergency Rooms of two hospitals (private and public) during a 6 month timeframe, with diastolic blood pressure > 120 mmHg were included in the study. Hypertensive pseudocrisis was determined when none of the criteria for hypertensive crisis were present (Guidelines of the Brazilian Society of Cardiology¹). RESULTS: In the 110 patients studied, the prevalence of hypertensive pseudocrisis was 48% (95% CI = 39%-58%) and prevailed in the private hospital (59% vs 37%, p=0.02). The frequency of wrong treatment was similar between the two hospitals (94% vs 95%, p=0.87). After multivariate analysis, the presence of headache upon admission (Odds Ratio=5.4; 95% CI = 5.1-13; p< 0.001) and diastolic BP levels (Odds Ratio=0.93; 95% CI = 0.89-0.97; p=0.002) were independent predictors of pseudocrisis. The 5 month mortality rate was lower in the pseudocrisis group than the hypertensive crisis group (0% vs 21%, p=0.0004). CONCLUSIONS: There is a high prevalence of hypertensive pseudocrisis in patients when hypertensive crisis is suspected, particularly in the private hospital. The frequency of wrong treatment was similar for both the private and public hospitals. Headaches and diastolic BP levels are independent predictors for this clinical condition. Hypertensive pseudocrisis has a low rate of lethality.

Read Full Article

Artigo Original

Body mass index and waist circumference as markers of arterial hypertension in adolescents

Maria Luiza Garcia Rosa et al. Evandro Tinoco Mesquita Emanuel Ribeiro Romeiro da Rocha Vânia de Matos Fonseca

OBJECTIVE: To evaluate the sensitivity and specificity of anthropometric measurements of body fat in a sample of Brazilian adolescents for the prediction of hypertension. METHODS: The arterial blood pressure was measured on two visits in a sample of 456 students aged 12 to 17 years, from public and private schools of the Fonseca neighborhood, in Niterói, between 2003 and 2004. A subject was defined as hypertensive if he/she had systolic and diastolic pressures above the 95th percentile for sex, age and height. A questionnaire was applied and Body Mass Index (BMI) and waist circumference (WC) measurements were made. RESULTS: A statistically significant correlation was observed between hypertension and the cutoff points considered unfavorable, both for BMI and WC. The greatest association was with the cutoff point proposed for the Brazilian population. As to the BMI sensitivity used for American Black or White populations or for the Brazilian population, we found 52.4% to 57.1% and 52.4%, respectively. And BMI specificity was 69.3%, 70.0% and 80.88%, respectively. The sensitivity found in our sample, relative to the cutoff points for WC proposed for all American ethnic groups, was also low (45.0%) and specificity was a little higher (77.6% and 74.5%, respectively). CONCLUSION: Existing American WC measurements showed low sensitivity and specificity for hypertension in our population. As to BMI, the available cutoff points also showed a low level of sensitivity. There is a need to establish body fat cutoff points that can provide a better prediction of cardiovascular risk.

Read Full Article

Artigo Original

Morphological basis for the study of the interatrial septum in the human fetus

Hugo Becker Amaral et al. Paulo Zielinsky Aron Ferreira da Silveira Ijoni Costabeber … Luiz Henrique Nicoloso Olmiro Cezimbra de Souza Filho Marcelo Salum João Luiz Manica Juliana Silveira Zanettini Ane Micheli Costabeber

OBJECTIVE: To describe morphological features of the interatrial septum in normal fetuses, especially foramen ovale (FO) and septum primum (SP), in order to compare septum primum excursion with foramen ovale diameter. METHODS: Septum primum excursion (SPE) toward the left atrium (LA) and foramen ovale diameter (FOD) were measured in the hearts of ten formaldehyde-fixed human fetuses ranging from 28 to 36 weeks of gestation. Histological sections were obtained from the foramen ovale (FO), septum primum (SP), septum secundum (SS), left atrium (LA), and right atrium (RA). RESULTS: FOD and SPE measurements were the following: FOD 3.1-3.5 mm and SPE 2.8-3.1 mm in three fetuses with presumed gestational age (GA) of 28 weeks; FOD 3.3-3.5 mm, and SP excursion 4.0-5.0 mm in four fetuses with presumed GA of 34 weeks, plus FOD 3.3-4.5 mm and SPE 6.0-9.0 in three fetuses with presumed GA of 36 weeks. Cardiac muscular fibers were identified in both the septum primum and secundum. CONCLUSION: Based on its muscular components, it may be suggested that SP is active in character, influencing blood flow through the FO, SP mobility, and its excursion into the LA.

Read Full Article

Correlação Clínico-Radiográfica

Case 2/2007: a two-year-old child with ventricular septal defect and right ventricular anomalous muscle bundle

CLINICORADIOLOGICAL SESSION

Case 2/2007 a two-year-old child with ventricular septal defect and right ventricular anomalous muscle bundle

[…]

Read Full Article

Artigo Original

Coronary artery disease treatment in dialysis patients at the Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP

Paula Ferreiro Vieira et al. Paula Dalsoglio Garcia Edson Antonio Bregagnollo Fábio Cardoso Carvalho … Ana Cláudia Kochi Antonio Sérgio Martins Jaqueline Costa Teixeira Caramori Roberto Jorge da Silva Franco Pasqual Barretti Luis Cuadrado Martin

BACKGROUND: Interventional treatment of coronary insufficiency is underemployed among dialysis patients. Studies confirming its efficacy in this set of patients are scarce. OBJECTIVE: To assess the results of interventional treatment of coronary artery disease in patients undergoing dialysis. METHODS: A total of 34 dialysis patients submitted to coronary angiography between September 1995 and October 2004 were divided according to presence or absence of coronary lesion, type of treatment and presence or absence of diabetes mellitus. The groups were compared according to their clinical and survival characteristics. Survival of patients undergoing interventional treatment was compared to overall survival of 146 dialysis patients at the institution in the same period. Interventional treatment was indicated to the same clinical conditions in the general population. RESULTS: Thirteen patients with no angiography coronary lesions presented a survival rate of 100% in 48 months as compared to 35% of 21 patients with coronary artery disease. Diabetic patients had a lower survival rate compared with non-diabetics. Angioplasty had a worse prognosis compared to surgery; however, 80% of patients undergoing angioplasty were diabetic. Seventeen patients submitted to interventional procedures presented a survival rate similar to that of the others 146 hemodialysis patients without clinical evidence of coronary disease. CONCLUSION: This small series shows that myocardial revascularization, whenever indicated, can be performed in dialysis patients. This conclusion is corroborated by similar mortality rates in two groups of patients: coronary patients submitted to revascularization and overall dialysis patients.

Read Full Article

Artigo Original

Patent foramen ovale and ischemic stroke in young people: statistical association or causal relation?

Edson Marcio Negrão et al. Ivar Viana Brandi Simone Vilela Nunes Daniel Gurgel Fernandes Távora … Mauro Nakayama Paulo Sergio Siebra Beraldo

OBJECTIVES: To determine if there are evidences of a causal relation between patent foramen ovale (PFO) x cryptogenic ischemic stroke (IS) in the young population and to analyze this relation in terms of causal criteria. METHODS: A total of 168 young patients with IS was retrospectively evaluated and divided into two groups: cryptogenic and with a defined cause. As a routine procedure, the patients underwent investigation of the PFO by means of transesophageal echocardiogram and/or transcranial Doppler sonography, both of them associated with the bubble test. Multivariate analysis was performed after demonstration of univariate statistical association between PFO x IS. RESULTS: After multivariate analysis, the association between PFO x cryptogenic IS was still statistically significant with odds ratio (adjusted OR = 3.3; 95% CI: 1.5-7.4). The total number of cerebral lesions also presented a significant association with cryptogenic IS (adjusted OR = 0.4; 95% CI: 0.2-0.9). The association between PFO and cryptogenic IS met all the causality criteria. CONCLUSION: The causal relation between PFO and cryptogenic IS in the young population is highly probable. This fact should be considered in the therapeutic decision.

Read Full Article

Artigo Original

Ambulatory blood pressure monitoring and casual blood pressure in hyper-reactive individuals

Lucia Brandão de Oliveira et al. Ademir Batista da Cunha Wolney de Andrade Martins Rosiane Fátima Silveira de Abreu … Luciana Silva Nogueira de Barros Delma Maria Cunha Antonio Cláudio Lucas da Nóbrega Luiz Romeu Martins Filho

BACKGROUND: Developing hypertension is likely to be at least two times greater in individual with exaggerated blood pressure response on exercise testing (ET). Few reports have evaluated the parameters of 24-hour Ambulatory Blood Pressure Monitoring (ABPM) in normotensive individuals with exaggerated blood pressure response to exercise. OBJECTIVE: To evaluate the relationship among the casual blood pressure with hyper-reactive response on ET and to compare Ambulatory Blood Pressure Monitoring (ABPM) data of hyper-reactive individuals with a control group in order to detect early disorders, that allows a preventive action with prognostic implication. METHODS: Casual BP measurement and parameters of ABPM of 26 adult individuals, with mean age of 41.50±11.78 years, normotensive at rest and hyper-reactive on ET was compared to those of 16 adult individuals, with mean age of 41.38±11.55 years, normotensive at rest with normal BP response on exercise. The values <140 x 90 mmHg were considered normal for casual BP. The values 15mmHg diastolic BP on ET for hyper-reactive response diagnosis. RESULTS: Hyper-reactive individuals presented the systolic (p=0.03) and diastolic (p=0.002) casual BP and mean systolic BP (p=0.050), systolic pressure load during the day (p=0.011), and systolic (p=0.017) pressure load higher when compared to the control group. CONCLUSION: Casual high normal BP had a positive correlation with exaggerated BP response. The hyper-reactive individuals showed particular characteristics in casual BP as well as in ABPM parameters, which, although within the range of reference values, differed from those of individuals with normal response to exercise.

Read Full Article

Case Report

Annuloplasty of cryopreserved pulmonary homograft with Delrin stent in pulmonary atresia with ventricular septal defect

Ulisses Alexandre Croti et al. Domingo Marcolino Braile Moacir Fernandes de Godoy Vladimir Ramirez … Lilian Beani Aírton Camacho Moscadini

A six-year-old child was suffering from pulmonary atresia with ventricular septal defect after a total correction at 1 year of age using a bovine pericardial monocusp valve in the reconstruction of the right ventricle outflow tract. The infant evolved with significant pulmonary valve regurgitation (PVR) and right ventricle dysfunction. On reoperation, a cryopreserved pulmonary homograft (CPH) was implanted with annuloplasty utilizing a Delrin ring with the aim of avoiding geometric distortion of the vessel. After two years, an echocardiogram proved a similar state to the immediate postoperative period with slight pulmonary valve regurgitation and normal right ventricular function suggesting that this maneuver may be used as coadjuvant treatment to optimize the result of CPH implantation.

Read Full Article

Case Report

Acute thrombosis of mechanical mitral valve prosthesis successfully treated with thrombolysis

Wilson Coelho Pereira Filho et al. Abrahão Hallack Neto Leandro Caetano Pimentel Glauco Resende Bonato … Felipe de Sousa Possani Moisés Caminatti

A 61-year-old female patient using a mechanical prosthesis for 11 years was admitted to the hospital with sudden dyspnea, pallor and atrial fibrillation. The diagnostic evaluation included transesophageal echocardiogram, which showed a significantly reduced motion of one of the leaflets of the mitral prosthesis and immobility of the other, in addition to a thickened structure compatible with a thrombus adherent to the valve. The patient was diagnosed with thrombosis of mechanical mitral valve prosthesis. Thrombolytic therapy (rtPA) was started successfully. The patient has been followed up for more than one year with a favorable outcome.

Read Full Article

Point of view

Are statins beneficial in heart failure?

Marcio Hiroshi Miname et al. Raul D. Santos Neusa Forti Jayme Diament

POINT OF VIEW

Are statins beneficial in heart failure?

[…]

Read Full Article

Atualização

Clinical use of contrast echocardiography with microbubble-based

Jeane Mike Tsutsui et al. Wilson Mathias Junior

CLINICAL UPDATE

Clinical use of contrast echocardiography with microbubble-based

[…]

Read Full Article

Artigo Original

In comparison to the myocardial perfusion scintigraphy, a treadmill stress test is a viable, efficient and cost effective option to predict cardiovascular events in elderly patients

Luciano Janussi Vacanti et al. Andrei Carvalho Sposito Luciano Séspedes Maíra Sarpi … José Antonio F. Ramires Anna E. Bortnick

OBJECTIVE: To define the prognostic value and cost-effectiveness of the treadmill stress test (TST) in comparison to the dipyridamole myocardial perfusion scintigraphy (DIP), in individuals >75 years of age. METHODS: Consecutive and prospective assessment of 66 patients (40% male) aged 81 ± 5 years of which 57% were hypertensive, 38% had dyslipidemia and 28% were diabetics. The Bruce protocol was adapted for a tilt treadmill and the TST prognostic value was obtained using the Duke treadmill score. RESULTS: The TST duration, recommended maximum heart rate percentage and double product at peak exercise were respectively: 7 ± 3 minutes, 95 ± 9% and 24,946 ± 4,576 (bpm x mmHg). The TST and DIP presented similar positive results for myocardial ischemia (21% vs 15%, respectively). The correlation between the tests was 88% (Kappa 0.63, p<0.01). During 685 ± 120 days of follow-up, nine major events occurred: 6 deaths, 2 acute coronary syndromes and 1 myocardial revascularization. The variables associated with the major events were: age (83 ± 6 vs 80 ± 4 years; p=0.048), male gender (78% vs 33%; p=0.02), ST segment depression (1 ± 1 mm vs 0.25 ± 0.6 mm; p= 0.01), high or intermediate risk determined by the Duke treadmill score – combined in one group (44% vs 2%; p=0.001) and abnormal DIP (44% vs 10%, p= 0.02). CONCLUSION: For this elderly population, the TST was an efficient and viable option with a similar diagnostic value in comparison to the DIP. However, the TST was more accurate in the prediction of major events and offers a lower cost.

Read Full Article

Artigo Original

Quality of life after surgical myocardial revascularization, angioplasty or medical treatment

Myrthes Emy Takiuti et al. Whady Hueb Shirley Borghetti Hiscock Célia Regina Simões da Rocha Nogueira … Priscyla Girardi Fabio Fernandes Desiderio Favarato Neuza Lopes Jorge Chiquie Borges Aécio Flávio Teixeira de Góis José Antonio Franchini Ramires

BACKGROUND: Although the clinical benefits of coronary interventions seem to be confirmed, their effects on quality of life (QoL) are still scarcely studied. OBJECTIVE: To assess the QoL in multivessel coronary disease in patients randomly undergoing surgery, angioplasty or medical treatment. METHODS: The Short-Form Health Survey (SF-36) questionnaire was answered by 483 patients. Of these, 161 underwent surgical revascularization, 166 underwent angioplasty, and 153 were medically treated. RESULTS: At baseline, 86% of the patients referred angina, 34% referred infarction, and 32% were smokers. Medical Treatment: 12 patients (7.7%) had AMI, 24 (15.3%) underwent surgery, and 19 (12.1%) died. In addition, 5 (3.2%) had stroke, and 40 (25.6%) had angina. As regards the mental component, 64.1% and 30.8% had their condition improved and worsened, respectively. As regards the physical component, 70.5% and 27.6% had their condition improved and worsened, respectively. Surgery: 13 patients (8.1%) had AMI, 2 (1.2%) underwent surgery, and 12(7.4%) died. Also, 9 (5.6%) had stroke and 30 (18.6%) had angina. As regards the mental component, 72.7 % and 25.5% had their condition improved and worsened, respectively. As regards the physical component, 82.6% and 16.1% had their condition improved and worsened, respectively. Angioplasty: 18 patients (10.9%) had AMI, 51 (30.7%) underwent interventions, and 18 (19.9%) died. Additionally, six (3.6%) presented stroke and 35 (21%) reported angina. As regards the mental component, 66.9% and 26.5% had their condition improved and worsened, respectively. As regards the physical component, 77.1% and 20.5% had their condition improved and worsened, respectively. CONCLUSION: Improvement was observed in all domains and in the three therapeutic modalities. Comparatively, surgery had provided a better quality of life after a four-year follow-up.

Read Full Article

Artigo Original

Effects of epinephrine in local dental anesthesia in patients with coronary artery disease

Ricardo Simões Neves et al. Itamara Lucia Itagiba Neves Dante Marcelo Artigas Giorgi Cesar José Grupi … Luís Antonio Machado César Whady Hueb Max Grinberg

BACKGROUND: The use of vasoconstrictors for local anesthesia in patients with coronary heart disease is controversial in the literature, and there is concern regarding risk of cardiac decompensation. OBJECTIVE: To evaluate electrocardiographic and blood pressure parameters during restorative dental procedure under local anesthesia with and without a vasoconstrictor in patients with coronary artery disease. METHODS: Sixty-two patients were included in the study, ages ranging from 39 to 80 (mean 58.7 ± 8.8), 51 (83.2%) of whom were male. Thirty patients were randomly assigned to receive 2% lidocaine with epinephrine (epinephrine group), and the remaining patients, 2% lidocaine without epinephrine (non-epinephrine group) for local anesthesia. All patients underwent 24-hour ambulatory blood pressure monitoring and dynamic electrocardiography. Three periods were considered in the study: 1) baseline – recordings obtained during the 60 minutes prior to the procedure; 2) procedure – recordings obtained from the beginning of anesthesia to the end of the procedure and 3) 24 hours. RESULTS: There was an increase in blood pressure in both groups during the procedure, compared with baseline values; but when the two groups were compared no significant difference was detected between them. Heart rate remained unchanged in both groups. No ST-segment depression > 1 mm occurred either at baseline or during the procedure. Seven patients (12.5%) experienced more than ten arrhythmia episodes per hour during the procedure, four (13.8%) in the non-epinephrine group and three (11.1%) in the epinephrine group. CONCLUSION: No difference was observed in blood pressure, heart rate, or evidence of ischemia and arrhythmias in either group. The use of vasoconstrictor has proved to be safe within the range of the present study.

Read Full Article

Case Report

Combined rTPA and aspirin therapy for intracardiac thrombosis in neonates

Fernanda Almeida Tardin et al. Antônio Carlos Avanza Júnior Marcos Rogério Arantes Andião Sônia Maria Alves Andrade Rabello … Emília de Mattos Gouvêa Cristello Edna Cellis Vaccari Baltan Edelweiss Bussinguer Pereira Pegurin Norma Suely Oliveira

We describe a case of a very low birth weight premature female twin with intracardiac thrombosis. Her condition was consistent with neonatal sepsis, and she was treated with advanced life support, antibiotic therapy, parenteral nutrition, blood transfusion, and central venous catheterization. Infective endocarditis was suspected, and a large intracavitary thrombus was detected by two-dimensional Doppler echocardiography. Surgical procedure was not only technically difficult but also highly lethal, being contraindicated in some cases. Consequently, the use of the thrombolytic recombinant tissue-plasminogen activator (rTPA) associated with aspirin was the treatment of choice, and complete dissolution of the thrombus was achieved without adverse effects.

Read Full Article

Artigo Original

Medium term prognostic value of stress myocardial perfusion scintigraphy in a chest pain unit

Jader Cunha de Azevedo et al. Renata Christian Martins Félix Patrícia Lavatori Corrêa Gustavo Borges Barbirato … Hans Fernando da Rocha Dohmann Paulo Roberto Dutra da Silva Evandro Tinoco Mesquita Cláudio Tinoco Mesquita

OBJECTIVE: To evaluate the prognostic value of stress myocardial perfusion scintigraphy (MPS) applied to patients with suspected acute coronary syndrome (ACS). METHODS: Retrospective study. Patients with suspected acute coronary syndrome (ACS) admitted into the chest pain unit (CPU) from December 2002 to April 2004, after exclusion of acute myocardial infarction (AMI) and high risk unstable angina they underwent stress MPS. RESULTS: Selected 301 patients, 65.3 ± 12.5 years and 164 (54.5%) male gender. The test was performed 13 ± 12 hours after admission. Myocardial ischemia (ISQ) was found in 142 patients (47.2%). Male gender (n=94, p=<0.0001), history of diabetes mellitus (n=31, p=0.033), past of AMI (n=52, p=<0.0001), past of surgical myocardial revascularization (n=46, p=<0.0001) and past of percutaneous revascularization (n=68, p=<0.0001) presented correlation with ISQ. The follow-up was 697.7 ± 326.6 days. No MPS variable correlated with the occurrence of primary outcome. Abnormal scintigraphy (n=76, p < 0.0001), ISQ (n=73, p < 0.0001) and post-stress left ventricular ejection fraction below 45% (n=21, p=0.006) correlated with secondary outcome. The presence of ISQ was the major variable in the multivariate analysis for the prediction of secondary outcome (RR = 6.5; CI 95% = 0.009). CONCLUSION: Presence of ISQ was the major independent factor in prediction of adverse events for patients admitted into the CPU.

Read Full Article

Artigo Original

Clinical evaluation and hepatic laboratory assessment in individuals with congestive heart failure

Luiz Antônio Brito Arruda Vasconcelos et al. Eros Antônio de Almeida Luiz Felipe Bachur

OBJECTIVES: To verify the clinical alterations and, in particular, hepatic laboratory alterations in patients in each of the heart failure (HF) functional classes. METHODS: The clinical and laboratory data – alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), bilirubin and coagulogram – of 50 patients admitted in 2002 to a tertiary hospital with the diagnosis of heart failure were researched by means of a cross sectional study. The patients were separated in accordance with their HF class and their data were compared statistically. Patients with hepatopathy of any etiology were excluded. RESULTS: Analysis of the mean transaminase values revealed a significant increase only for the Class IV patients. On the other hand, alkaline phosphatase and GGT presented a progressive increase in accordance with the HF class. CONCLUSION: HF is characterized by a progressive cholestatic profile of laboratory alterations, while transaminase values are only elevated in advanced HF. It is of utmost importance to understand these alterations in order to avoid unnecessary hepatic investigations in individuals with heart failure.

Read Full Article

Case Report

Myocardial revascularization in a patient with situs inversus totalis

Paulo Manuel Pego-Fernandes et al. João Batista de Serro-Azul Fernando Matheus Bruno Shoiti Maehara

We report the case of a patient with dextrocardia and situs inversus totalis associated with obstructive coronariopathy in the anterior and posterior descending arteries, right coronary artery, first diagonal branch and left marginal branch. The patient underwent coronary artery bypass grafting surgery. This surgery has been rarely reported in literature and we found only one similar case in the national medical literature. The myocardial revascularization was carried out with the right mammary artery for the anterior descending artery. The saphenous vein anastomosed the aorta to the right coronary artery, left marginal branch, fist diagonal branch and posterior descending artery. The surgery was performed with extracorporeal circulation.

Read Full Article

Letter to the Editor

What is the BP cutoff value for the diagnosis of hypertension?

LETTERS TO THE EDITOR

What is the BP cutoff value for the diagnosis of hypertension?

[…]

Read Full Article

See all articles