Achados ao ecocardiograma transtorácico em pacientes hospitalizados com COVID- 19: resultados do registro brasileiro de ecocardiografia durante a pandemia de COVID-19 (ECOVID) / Transthoracic echocardiography findings of hospitalized patients with COVID-19: results from the brazilian echocardiography registry during the COVID-19 Pandemic (ECOVID)

Fundamento: A ecocardiografia transtorácica (ETT) pode desempenhar um papel crucial na avaliação das manifestações cardíacas da COVID-19. Objetivo: Nosso objetivo foi relatar a prevalência das principais anormalidades ecocardiográficas em pacientes hospitalizados com COVID-19. Métodos: Realizou-se estudo observacional multicêntrico prospectivo com pacientes com COVID-19 submetidos a ETT durante a internação. Pacientes com insuficiência cardíaca prévia, doença arterial coronariana ou fibrilação atrial foram classificados como portadores de doença cardiovascular (DCV) prévia. Foram coletados dados clínicos e ecocardiográficos da estrutura e da função cardíaca. Resultados: Avaliamos 310 pacientes com COVID-19, com 62±16 anos de idade, 61% homens, 53% com hipertensão arterial, 33% com diabetes e 23% com DCV prévia. No total, 65% dos pacientes necessitaram de suporte em unidade de terapia intensiva. As alterações ecocardiográficas mais prevalentes foram hipertrofia do ventrículo esquerdo (VE) (29%), hipertensão pulmonar (25%), disfunção sistólida do VE (16,5%), disfunção sistólica do ventrículo direito (VD) (15,9%), disfunção diastólica do VE grau II/III (11%) e alteração da contratilidade regional do VE (11%). Derrame pericárdico foi incomum (7%). Hipertrofia do VE (25 vs. 45%, p=0,001), disfunção sistólica do VE (11 vs. 36%, p<0,001), alterações da contratilidade regional (6 vs. 29%, p<0,001), disfunção diastólica do VE grau II/III (9 vs. 19%, p=0,03) e hipertensão pulmonar (22 vs. 36%, p=0,019) foram menos comuns nos pacientes sem do que com DCV prévia. A disfunção sistólica do VD mostrou-se semelhante em pacientes sem e com DCV prévia (13 vs. 25%, p=0,07). Conclusões: Entre os pacientes hospitalizados com COVID-19, os achados ecocardiográficos anormais foram comuns, porém menos encontrados naqueles sem DCV. A disfunção sistólica do VD pareceu afetar de forma semelhante pacientes com e sem DCV prévia. (AU)

Background: Transthoracic echocardiography (TTE) may play a crucial role in the evaluation of cardiac manifestations of coronavirus disease 2019 (COVID-19). Objective: We aimed to report the prevalence of the main echocardiographic abnormalities of hospitalized COVID-19 patients. Methods: We performed a prospective multicenter observational study in patients with COVID-19 who underwent TTE during hospitalization. Patients with pre-existing heart failure, coronary artery disease, or atrial fibrillation were categorized as having previous cardiovascular disease (CVD). Clinical and echocardiographic data about cardiac structure and function were collected. Results: We evaluated 310 patients with COVID-19 (mean age, 62±16 years; 61% men; 53% with arterial hypertension; 33% with diabetes; and 23% with previous CVD). Overall, 65% of the patients required intensive care unit support. The most prevalent echocardiographic abnormalities were LV hypertrophy (29%), pulmonary hypertension (25%), left ventricular (LV) systolic dysfunction (16.5%), right ventricular (RV) systolic dysfunction (15.9%), grade II/III LV diastolic dysfunction (11%), and LV regional wall motion abnormality (11%). Pericardial effusion was uncommon (7% of cases). LV hypertrophy (25% vs. 45%, p=0.001), LV systolic dysfunction (11% vs. 36%, p<0.001), regional wall motion abnormalities (6% vs. 29%, p<0.001), grade II/III LV diastolic dysfunction (9% vs. 19%, p=0.03), and pulmonary hypertension (22% vs. 36%, p=0.019) were less common in patients without previous CVD. RV systolic dysfunction occurred at similar frequencies in patients with versus without previous CVD (13% vs. 25%, p=0.07). Conclusions: Among patients hospitalized with COVID-19, abnormal echocardiographic findings were common, but less so among those without previous CVD. RV systolic dysfunction appeared to affect similar proportions of patients with versus without previous CVD. (AU)

A History of Bariatric Surgery: The Maturation of a Medical Discipline.

This article examines the progression of bariatric surgery since its creation more than 60 years ago with a focus on the effect of surgery on weight loss, comorbidity reduction, and safety. The success has been remarkable. It is possible to cure severe obesity, type 2 diabetes, and hyperlipidemia in addition to the many other manifestations of the metabolic syndrome with remarkable safety. Equally important are the opportunities for research afforded by the surgery and its outcomes. Until better treatments become available, bariatric surgery is the therapy of choice for patients with morbid obesity for weight control and comorbidity improvement.

An archaeologic dig: a rice-fruit diet reverses ECG changes in hypertension.

In 1940, a young German refugee physician scientist at Duke University in Durham, North Carolina began to treat patients with accelerated or "malignant" hypertension with a radical diet consisting of only white rice and fruit, with strikingly favorable results. He reported rapid reduction in blood pressure, rapid improvement in renal failure, papilledema, congestive heart failure and other manifestations of this previously fatal illness. This treatment was based on his theory that the kidney had both an excretory and a metabolic function, and that removing most of the sodium and protein burden from this organ enabled it to regain its normal ability to perform its more important metabolic functions. It was also effective in "ordinary" hypertension, in the absence of the dramatic vasculopathy of the accelerated form. The results were so dramatic that many experienced physicians suspected him of falsifying data. Among these results was the normalization of the ECG changes seen with hypertension. This paper reviews his published experience with this radical therapy, its controversial rise to fame, and its decline in popularity with the advent of effective antihypertensive drugs. It features the ECG changes seen in this then fatal disease, and the reversal of these changes by the rice diet. This treatment, though very difficult for the patient, produced effects which make it equal or superior to current multi-drug treatment of hypertension. A poorly known but important observation was that patients who were able to follow the regime, and who were slowly guided through a gradual modification of the diet over many months, were able to transition into a very tolerable low fat, largely vegetarian diet, while leading a normal, active life, without medications, indicating that the disease state had been permanently modified.

Initial approach to hypertension in the hemodynamics unit: review article / Abordagem inicial da hipertensao arterial sistemica em unidade de hemodinamica: artigo de revisao

Correct identification and early management of hypertensive disorders should be a part of the therapeutic repertoire of every professional working in hemodynamics units. Based on recent publications, this study aims to propose a practical approach to the identification and early management of these disorders in this type of service.

O reconhecimento correto e manejo inicial das síndromes hipertensivas devem fazer parte do arsenal terapêutico de todo profissional que trabalhe em unidade de hemodinâmica. Este trabalho tem por objetivo, baseado em publicações recentes, propor uma abordagem prática para identificação e manejo inicial destes agravos nessa unidade.

Isaac Albeniz (1860-1909): Spanish musician who died of chronic renal disease.

Isaac Albéniz was a Spanish musician and pianist who was best known in France and England. One of his last works for piano, the suite Iberia, is well-known and identifies his country of origin. He died with terminal uraemia following longstanding chronic intestinal and kidney symptoms. Suggestions as to pathology include amyloidosis complicated by kidney stones and hypertension that sometimes manifested itself in the form of hypertensive crisis, accompanied by obesity.

Vascular and heart diseases in the incumbent presidents and vice presidents of the United States of america: a medical-historical perspective.

Vascular diseases have been the major cause of death and disability in presidents and vice presidents of the United States. Untreated hypertension and cigarette smoking have contributed greatly to this increased morbidity and mortality risk, which has impacted on historical events, especially in the 20th century. In this article, the medical histories of those incumbent Presidents and Vice Presidents who suffered from coronary artery and cerebrovascular diseases will be reviewed. A discussion of how atrial fibrillation has affected the Presidents is also included.

Physical activity patterns by campus housing status among African American female college students.

Physical activity protects against heart disease, diabetes, high blood pressure, obesity, and cancer. Fewer than 40% of African American women obtain recommended amounts of physical activity. Healthy Campus 2010 identifies physical activity as a top priority for improving the health of college students. However, during college, women tend to reduce their levels of physical activity. This study examines the relationship between campus housing and physical activity behaviors in a sample of African American female college students (N = 138). Participants who lived on campus were significantly more likely to meet the recommended amounts of both moderate and vigorous physical activity than students who lived off campus (44% vs. 19%). The results demonstrate the importance of campus fitness resources in explaining the role that the built environment can play in increased physical activity among this population. Recommendations for the use of the campus's built environment and fitness resources are provided.

Medida da pressão arterial: passado, presente e futuro / Blood pressure measurement: past, present and future

A pressão arterial sempre foi um importante tema de estudo, desde as mais antigas civilizações. Os conhecimentos acerca de sua medida e seu significado clínico foram se aprimorando ao longo do tempo, e atualmente está consolidado o papel da hipertensão arterial na gênese das doenças cardiovasculares. Os estudos em HA têm dado cada vez mais importância ao diagnóstico e tratamento precoces, buscando evitar o acomedimento dos órgãos alvo. Para que isso seja possível, se faz necessário o conhecimento do grande arsenal de métodos de diagnóstico da hipertensão arterial, tanto para avaliar a eficácia terapêutica. Esta monografia pretende fazer uma revisão sistemática sobre a medida da PA, permitindo ao leitor entender como o conhecimento sobre a medida da pressão arterial foi se modificando ao longo dos tempos, as indicações e a impotância da cada método diagnóstico, e como os novos equipamentos poderão revolucionar a medida da pressão arterial na prática clínica. No cenário atual, em que as doenças cardiovasculares representam a principal causa de óbito no mundo, o diagnóstico precoce e o controle dos fatores de risco cardiovasculares, em que se insere a HA, são os únicos meios que temos para aumentar a expectativa de vida da população, com qualidade de vida, que é o mais importante.

[Regional venous hypertension as a factor of compensation for microcirculatory impairments in chronic obliterating diseases of lower-limb arteries (state of the art)].

A thorough analysis of the literature and own data confirmed a lively interest of vascularsurgeons in alterations in venous haemodynamics in patients presenting with chronic obliterating diseases oflower-limb arteries. The presence of close relationships between impaired arterial and venous blood flow and a compensatory pattern of the development of venous hypertension in the ischaemia zone was proved. This should be taken into consideration during conservative therapy of patients sufferingfrom chronic obliterating diseases of lower-limb arteries, and while working out novel types of surgical interventions, as well as for more adequate interpretation of pathophysiological peculiarities of the existing disease.

A cornerstone in the history of hypertension: the seventieth anniversary of the discovery of angiotensin.

In 1939, two independent teams, in Buenos Aires and Indianapolis, identified the polypeptide angiotensin. In 1934, Goldblatt et al. demonstrated that partial occlusion of the renal arteries produces hypertension in dogs, and Houssay in 1936 predicted the presence of a humoral mechanism and, with Fasciolo, demonstrated that the ischemic kidneys released a pressor substance that increased the recipient's blood pressure. Later on, Taquini proved that the rise in blood pressure that follows the re-establishment of circulation in kidneys was also produced by a plasmatic substance from the venous blood of acute ischemic kidneys and it was called 'hypertensin'. Then, they proved that it was the result of an enzymatic reaction in which renin was the enzyme and plasma the substrate. At the same time, in 1939, Page et al. postulated that renin activated by plasma becomes vasoactive and the substance was called 'angiotonin'. Page's group began in 1937, with the purification of renin, studying its renal hemodynamic effects. Later on, Page et al. acknowledged in 1943 the enzymatic nature of the system and renamed their so-called renin-activator as renin substrate. Both groups fused the two original names into 'angiotensin' during a meeting at Michigan in 1958, making the 'adventure of the discovery of angiotensin' a reality.

Desenvolvimento do método indireto de aferição da pressão arterial e dos critérios de diagnóstico da hipertensão / Development of the indirect method of recording blood pressure and hypertension diagnosis criteria / Desarrollo del método indirecto de mensuración de la presión arterial y de los criterios de diagnostico de la hipertensión

INTRODUÇÃO: A hipertensão arterial é um grave problema de saúde pública, estando fortemente associada às doenças cardiovasculares, que são as principais causas de morte no mundo. OBJETIVO: Realizar revisão de literatura sobre o desenvolvimento do método indireto de aferição da pressão arterial, o diagnóstico e a classificação da hipertensão. METODOLOGIA: Levantamento bibliográfico nas bases de dados Lilacs, Scielo e Medline, usando os seguintes descritores: história e determinação da pressão arterial, de acordo com o MeSH e DECs. Foram selecionados 22 artigos científicos. Com relação aos critérios de diagnóstico da hipertensão, foram analisados relatórios sobre a doença, produzidos por organizações nacionais e internacionais de saúde. RESULTADOS: A aferição da pressão arterial iniciou-se com a utilização de aparelhos e técnicas invasivas e rudimentares, evoluindo ao longo dos anos para o desenvolvimento dos modernos esfigmomanômetros de coluna de mercúrio e digitais. Até o final da década de 1950, não havia critérios padronizados para o diagnóstico da hipertensão, os quais vieram a ser estabelecidos em decorrência do aumento do número de casos de morbimortalidade por doenças cardiovasculares. Atualmente, a hipertensão é definida como pressão arterial > 140/90 mmHg. CONCLUSÃO: O desenvolvimento do método indireto de aferição da pressão arterial e dos critérios de diagnóstico da hipertensão foi e permanece sendo um processo contínuo extremamente importante para os estudos sobre a fisiopatologia e os fatores de risco das doenças cardiovasculares.

INTRODUCTION: Hypertension, a serious public health problem, is highly associated to cardiovascular disease, main cause of worldwide death toll. OBJECTIVE: A literature review of the development of the indirect method of recording blood pressure and hypertension diagnosis criteria and classification. METHODS: Data was collected from bibliographic databases Lilacs, Scielo and Medline; key words: history and blood pressure determination, according to MeSH and DECs. 22 scientific articles were selected. Reports published by National and International Health Organizations were evaluated. RESULTS: The recording of blood pressure was first performed by invasive and rudimentary techniques; it evolved throughout the years to the modern mercury column and digital sphygmomanometers. Until the end of fifties there were no standardized criteria for hypertension diagnosis; these were established because of the increasing morbidity and mortality due to cardiovascular disease. Currently, hypertension is defined as blood pressure > 140/90 mmHg. CONCLUSION: The development of the indirect method of recording blood pressure and hypertension diagnosis criteria has been an ongoing process. It has been as well very important for studying the physiopathology and risk factors for cardiovascular disease.

INTRODUCCIÓN: La hipertensión arterial es un grave problema de la salud pública, estando fuertemente asociada a las enfermedades cardiovasculares, que son las principales causas de muerte en el mundo. OBJETIVO: Efectuar una revisión de la literatura sobre el desarrollo del método indirecto de mensuración de la tensión arterial, diagnóstico y clasificación de la hipertensión. METODOLOGÍA: Se realizó una búsqueda bibliográfica en las bases de datos Lilacs, Scielo y Medline, usando los descriptores: historia y determinación de la presión sanguínea, según el MeSH y DECs. Fueron seleccionados 22 artículos científicos. Respecto a los criterios de diagnóstico de la hipertensión, fueron analizados informes deorganizaciones nacionales e internacionales de salud. RESULTADOS: La presión sanguínea comenzó a medirse con aparatos y técnicas invasivas y rudimentarias y, con el tiempo, con los modernos esfigmomanómetros de columna de mercurio y digitales. Hasta los últimos años de la década del 50 del siglo pasado, no había criterios estandarizados para el diagnóstico de la hipertensión, lo cual fue establecido a causa del aumento de la morbi-mortalidad por enfermedades cardiovasculares. Actualmente, la hipertensión se define como presión sanguínea > 140/90 mmHg. CONCLUSIÓN: El desarrollo del método indirecto de mensuración de la presión sanguínea y de los criterios de diagnóstico de la hipertensión fue y sigue siendo un proceso continuo, muy importante para los estudios sobre la fisiopatología y los factores de riesgo de las enfermedades cardiovasculares.

Alterações renais na hipertensão arterial sistêmica / Renal damage in hypertension

A discussão sobre a interação entre hipertensão arterial e lesão renal vem desde o início so século passado. Dados epidemiológicos atuais apontam a hipertensião arterial sistêmica como o fator de risco mais importante para a perda progressiva da função renal em estudos com pacientes acometidos de doença renal crônica terminal. Existem duas formas distintas de apresentação da lesão renal do paciente hipertenso: a nefroesclerose benigna e a nefroesclerose maligna, sendo ambas distintas tanto do ponto de vista clínico como anatomopatológico. O tratamento da hipertensão arterial visa tanto à prevenção de lesões renais no paciente sem doença prévia como à diminuição da deterioração da lesão renal no paciente com doença renal já instalada, sendo as metas terapêuticas baseadas na redução dos valores da pressão arterial, alvo terapêutico < 130/80 mm Hg, preferencialmente com medicamentos que também diminuam a pressão intraglomerular, como inibidores da enzima de conversão da angiotensina e/ou antagonista da angiotensina II.

[Arterial hypertension in extreme situations].

Wartime arterial hypertension (AH) is AH that debuts or changes its character under the influence of specific wartime factors or military labor. The features of wartime AH were determined. They included the following: AH incidence during war grows; AH incidence in the battlefront servicemen is higher than in those who serve on the home front; there is a direct correlation between AH prevalence and how often the person participates in the battles; the patients are relatively young. Acute AH forms usually debuted as a result of extremely strong of lingering stressful factors. Acute AH development was characteristic of subjects having family predisposition to hypertensive reactions. The clinical picture of acute AH had features of a hypertensive crisis, frequent complications of which were acute cardiac insufficiency and/or acute hypertensive encephalopathy, which required urgent medical aid. AH was resistant to pharmacotherapy. Further on, high AH level remained, crises occurred, and lesions of target organs progressed. The features of AH in military operators were characterized by medium, high, and very high risk of complications. II and III degrees of AH prevailed. The main risk factors in patients with workplace arterial hypertension (WAH), in addition to emotional tension, often were smoking, family background, hyperlipidemia, excessive body weight (metabolic syndrome). In 87% of patients with WPAH behavioral type A was revealed, mostly with medium or prominent elevation of the level of personal, reactive, and total anxiety. Persons with prognostically unfavorable 24-hour profiles of BP--non-dippers and night-peakers--prevailed (p < 0.001). Imidazoline receptor agonists (moxonidine) in patients with WAH normalized BP level. Twenty-four-hour BP profiles became normal in 90% of the WAP patients. Positive antihypertensive effects of moxonidine in patients with WAP become clear after 12 weeks of drug application; the psychological status becomes normal too.

The president and the pheochromocytoma.

President Eisenhower experienced an acute heart attack in September 1955 and died of ischemic cardiomyopathy 14 years later. The autopsy revealed, unexpectedly, a 1.5-cm pheochromocytoma in the left adrenal gland. In view of these hitherto unreported findings, the investigators analyzed the blood pressure pattern of the president throughout his life. Although hypertension was documented on and off from 1930 until his death, it is unknown whether the pheochromocytoma was present during his presidency. During the later part of President Eisenhower's life, excessive systolic and diastolic blood pressure spikes were documented, although he concomitantly had severe ischemic cardiomyopathy. In conclusion, most likely, the pheochromocytoma was the underlying cause of this erratic blood pressure pattern and may have worsened the course of the president's ischemic cardiomyopathy.

Blood pressure and hypertension in an American colony (Puerto Rico) and on the USA mainland compared, 1886-1930.

We compare blood pressure and hypertension between adult men on the USA mainland and in Puerto Rico born during 1886-1930 to test hypotheses about the link between cardiovascular health and large socioeconomic and political changes in society: (a) 8853 men surveyed in Puerto Rico in 1965 and (b) 1449 non-Hispanic White men surveyed on the mainland during 1971-1975. Systolic and diastolic blood pressure and hypertension were regressed separately on demographic and socioeconomic variables and cardiovascular risk factors. Mainland men not taking anti-hypertensive medication showed statistically significant improvements in systolic blood pressure and hypertension at the beginning of the century and men in Puerto Rico showed improvements in diastolic blood pressure but only during the last two quinquenniums. An average man born on the mainland during the last birth quinquennium (1926-1930) had 7.4-8.7 mmHg lower systolic blood pressure and was 61% less likely to have systolic hypertension than one born before 1901. On average Puerto Rican men born during 1921-1925 had approximately 1.7 mmHg lower diastolic blood pressure than men born before 1901. Analyses of secular trends in cardiovascular health complements analyses of secular trends in anthropometric indicators and together provide a fuller view of the changing health status of a population.