Prevalence and clinical course of patients with chronic heart failure secondary to chronic Chagas heart disease associated with obstructive coronary artery disease.

BACKGROUND: The prevalence and the outcomes of patients with chronic Chagas heart disease with obstructive coronary artery disease (CCHD-CAD) and chronic heart failure (CHF) with precordial chest pain are unsettled. Accordingly, the aim of this study was to determine the prevalence and clinical course of patients with CHF secondary to CCHD-CAD. METHODS: Patients with positive serology for Chagas disease and systolic CHF were included; those with precordial chest pain and at least two risk factors for CAD underwent coronary arteriogram. RESULTS: In total 262 patients were included in the investigation; 234 (89%) had CHF secondary to CCHD alone, and 28 (11%) with CHF secondary to CCHD-CAD, as observed at coronary arteriogram. The survival probability of patients with CHF secondary to CCHD alone at 12, 24, 36, 48 and 72 mo was 79%, 64%, 54%, 44% and 33%, respectively, whereas survival probability for patients with CHF secondary to CCHD-CAD at 12, 24, 36, 48 and 72 mo was 96%, 80%, 71%, 66% and 57%, respectively (p=0.04). CONCLUSIONS: In patients with CCHD with CHF, the prevalence of CAD of 11% is not neglectable in those with precordial chest pain. The outcome for patients with precordial chest pain with CHF secondary to CCHD-CAD is better than that observed in patients with CHF secondary to CCHD alone.

Outcome of Chagas cardiomyopathy in comparison to ischemic cardiomyopathy.

BACKGROUND: Chagas cardiomyopathy and ischemic heart disease (IHD) are frequent causes of chronic systolic heart failure (CHF) in areas where the former is endemic. Nonetheless, a specific comparison of outcome and role of etiology of CHF failure has not been performed in patients with both conditions. METHODS: Two-hundred twenty two patients with Chagas cardiomyopathy and 79 with IHD with CHF were included in the study. A Cox proportional hazards model was used to establish independent predictors of mortality for the studied population. Survival analysis was performed with the Kaplan-Meir product limit method. RESULTS: In the multivariable model, Beta-Blocker therapy [(hazard ratio (HR)=0.36; 95% confidence interval (CI) 0.24 to 0.52; p<0.005)], Chagas etiology of CHF (HR=3.6; 95% CI 2.0 to 6.5; p<0.005), serum sodium levels (HR=0.95; 95% CI 0.91 to 0.98; p<0.005), digoxin use (HR=2.1; 95% CI 1.19 to 3.80, p=0.01), and spironolactone use (HR=1.7; 95% CI 1.10 to 2.80; p=0.02) were determined independent predictors of all-cause mortality for this cohort. Probability of survival at 12, 24, 36, 48, and 60 months was 92%, 92%, 88%, 81%, and 78%, respectively, in IHD patients, and 79%, 61%, 49%, 41%, and 35%, respectively, in Chagas cardiomyopathy patients (p<0.005). CONCLUSION: Outcome in patients with chronic systolic heart failure secondary to Chagas cardiomyopathy is poorer than that seen in those with IHD.

Criterios para tratamento de taquiarritmias supra ventriculares e ventriculares no infarto agudo do miocardio / Criteria for treatment of tachyarrhythmias in acute myocardial infarction

Nesta revisao, sao abordadas as principais taquiarritmias observadas no infarto agudo do miocardio, com enfase na etiologia, incidencia e manuseio de cada uma, em particular

O ventrículo direito na insuficiência cardíaca congestiva / The right ventricle in heart failure

Durante muitos anos, acreditou-se que o ventrículo-direito representasse um papel secundário na manutençäo de débito cardíaco e na hemodinâmica global. Estudos em modelo canino de tórax e pericárdio abertos falharam em demonstrar piora hemodinâmica após cauterizaçäo da parede livre de ventrículo direito. Hoje, todavia, é clara e definida a participaçäo do ventrículo direito na manutençäo do débito cardíaco, apesar das importantes diferenças anatômicas e fisiológicas em relaçäo ao ventrículo esquerdo. A insuficiência cardíaca direita pode resultar da evoluçäo tardia de um quadro de insuficiência cadíaca esquerda, ou ainda apresentar-se como quadro isolado decorrente de três situaçöes principais: disfunçäo isquêmica no infarto agudo do miocárdio de ventrículo direito, sobrecarga pressórica aguda nos casos de tromboembolismo pulmonar ou crônica nos casos de doença pulmonar obstrutiva crônica, e sobrecarga volumétrica nos casos de comunicaçäo interatrial. A principal causa de insuficiência cardíaca direita é o infarto agudo do miocárdio de ventrículo direito. Discutimos aqui fatores anatômicos, fisiológicos, prognósticos e tratamento da insuficiência cardíaca direita associada a insuficiência cardíaca congestiva e infarto agudo do miocárdio de ventrículo direito.

Uso do ecocardiograma bidimensional para localizaçäo da ponta de cateteres intravenoso / Utilization of two-dimensional echocardiography for localization of intravenous catheters

Mostra-se a utilizaçäo do ecocardiograma bidimensional para determinar a posiçäo da ponta dos cateteres intravenosos centrais. Faz-se uma comparaçäo com o exame radiológico. Apontam-se as vantagens do exame, sua eficácia, limitaçöes e aplicabilidade clínica