Myocardial Reperfusion/methods

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Editorial

Therapeutic Echocardiography

Since its introduction by Edler and Hertz, echocardiography has become the main test of cardiologic propedeutic. Over the last 50 years, its evolution has been remarkable, from A-mode, M-mode, two-dimensional and Doppler images to modern three-dimensional reconstructions and softwares for studying myocardial deformation currently used. For this reason, echocardiography can provide diagnostic data and important prognostic information in virtually all heart diseases.

One of the major advances in echocardiography was the recognition of substances capable of increasing the ultrasound signal for better visualization of cardiac structures, popularly known as “echocardiographic contrasts.” Its beginning dates back to the late 1960s, with the first experience reported on the use of agitated saline solution associated with cardiac ultrasound. This technique (agitation of a saline solution so that it is aerated, allowing an increase in sound reflection) is still used to detect intracardiac communications. Still, it has as drawbacks the poor intravascular stability of the solution and the fact that air bubbles are eliminated from the body during the passage of blood through the lungs, thus preventing its use for visualization of structures of the left heart when the agitated saline solution is administered in a peripheral vein.

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Original Article

Comparative Analysis between Transferred and Self-Referred STEMI Patients Undergoing Primary Angioplasty

Maurício Balk et al. Henrique Basso Gomes Alexandre Schaan de Quadros Marco Aurélio Lumertz Saffi Tiago Luiz Luz Leiria

Abstract

Background:

Studies have shown the benefits of rapid reperfusion therapy in acute myocardial infarction. However, there are still delays during transport of patients to primary angioplasty.

Objective:

To evaluate whether there is a difference in total ischemic time between patients transferred from other hospitals compared to self-referred patients in our institution.

Methods:

Historical cohort study including patients with acute myocardial infarction treated between April 2014 and September 2015. Patients were divided into transferred patients (group A) and self-referred patients (group B). Clinical characteristics of the patients were obtained from our electronic database and the transfer time was estimated based on the time the e-mail requesting patient’s transference was received by the emergency department.

Results:

The sample included 621 patients, 215 in group A and 406 in group B. Population characteristics were similar in both groups. Time from symptom onset to arrival at the emergency department was significantly longer in group A (385 minutes vs. 307 minutes for group B, p < 0.001) with a transfer delay of 147 minutes. There was a significant relationship between the travel distance and increased transport time (R = 0.55, p < 0.001). However, no difference in mortality was found between the groups.

Conclusion:

In patients transferred from other cities for treatment of infarction, transfer time was longer than that recommended, especially in longer travel distances.