RESUMEN
The authors discuss the epidemiology and pathogenesis of Chagas' disease in Brazil, including the use of treatment with a cardioverter-defibrillator in patients with low ejection fraction. Select patients may benefit from resynchronization therapy associated with cardioverter-defibrillator treatment. Electrophysiologic study is indicated in the assessment of the potential utility of an implantable cardioverter-defibrillator.
Asunto(s)
Enfermedad de Chagas/fisiopatología , Enfermedad de Chagas/terapia , Desfibriladores Implantables , Brasil/epidemiología , Cardiomiopatía Chagásica/epidemiología , Cardiomiopatía Chagásica/fisiopatología , Cardiomiopatía Chagásica/terapia , Enfermedad de Chagas/complicaciones , Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/epidemiología , Humanos , Volumen SistólicoRESUMEN
This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted.
RESUMEN
OBJECTIVE: To analyze the in-hospital outcome of elderly patients aged 70 years and older who underwent off-pump coronary artery bypass graft surgery with an intraluminal shunt in urgent, emergent, and elective coronary revascularizations. METHODS: From July 1989 to July 2005, we analyzed 87 patients ranging in age from 70 to 92 years. Of the 87 patients enrolled, 50 (57.5%) patients had unstable angina, with three (3.4%) acute myocardial infarction; thirty-one (35.6%) patients underwent urgent and emergent surgery; thirteen (14.9%) patients had myocardial infarction in less than 30 days, and 34 (39.1%) in more than 30 days. RESULTS: The main postoperative complications were: atrial fibrillation (32.2%), heart failure (12.6%), pneumonia (10.3%), septicemia (3.4%), acute myocardial infarction (2.3%), mediastinitis (1.1%) transient ischemic attack (1.1%), and pneumothorax (1.1%). The mean extubation time was 18.50+/-19.09 hours, the length of stay in the intensive care unit was 2.92+/-2.03 days, and hospital length of stay was 10.55+/-7.16 days. Packed red cells were given to nine (10.34%) patients and none of them was operated due to bleeding. The in-hospital mortality was 4.6%. CONCLUSIONS: In patients over 70 years-old, elective and non-elective off-pump coronary artery bypass grafting with intracoronary shunt showed to be safe and effective, associated with low rates of postoperative complications and mortality in relation to the studied population.
Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/cirugía , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Angina Inestable/etiología , Brasil/epidemiología , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Humanos , Tiempo de Internación , Masculino , Arterias Mamarias/trasplante , Morbilidad , Infarto del Miocardio/etiología , Complicaciones Posoperatorias , Periodo Posoperatorio , Cuidados Preoperatorios , Vena Safena/trasplante , Resultado del TratamientoRESUMEN
OBJETIVO: Analisar a evolução intra-hospitalar de doentes com 70 anos de idade ou mais, submetidos a revascularização do miocárdio sem circulação extracorpórea, com uso de shunt intracoronário, operados na urgência, emergência e eletivamente. MÉTODOS: Foram submetidos à cirurgia 87 doentes com idade entre 70 e 92 anos de julho de 1989 a julho de 2005. Dos 87 doentes, 50 (57,5 por cento) eram portadores de angina instável, sendo três (3,4 por cento) na vigência de infarto agudo do miocárdio. Foram operados em caráter de emergência e urgência 31 (35,6 por cento) doentes. De todo o grupo, havia 13 (14,9 por cento) doentes com infarto ocorrido em até 30 dias e 34 (39,1 por cento) com infarto ocorrido há mais de 30 dias. RESULTADOS: As complicações mais freqüentes foram: fibrilação atrial (32,2 por cento), insuficiência cardíaca congestiva (12,6 por cento), broncopneumonia (10,3 por cento), sepse (3,4 por cento), infarto agudo do miocárdio peri-operatório (2,3 por cento), mediastinite (1,1 por cento), acidente isquêmico transitório (1,1 por cento), pneumotórax (1,1 por cento). O tempo médio de intubação foi de 18,50±19,09 horas; permanência em UTI, 2,92±2,03 dias, e hospitalar, 10,55±7,16 dias. Apenas nove (10,3 por cento) doentes receberam concentrado de hemácias no pós-operatório e nenhum foi reoperado por sangramento. A mortalidade hospitalar foi de 4,6 por cento. CONCLUSÃO: Em doentes acima de 70 anos, operados na emergência, urgência e eletivamente, a revascularização do miocárdio sem extracorpórea com shunt intracoronário apresentou adequada evolução pós-operatória e baixos índices de complicações e mortalidade em relação à população estudada.
OBJECTIVE: To analyze the in-hospital outcome of elderly patients aged 70 years and older who underwent off-pump coronary artery bypass graft surgery with an intraluminal shunt in urgent, emergent, and elective coronary revascularizations. METHODS: From July 1989 to July 2005, we analyzed 87 patients ranging in age from 70 to 92 years. Of the 87 patients enrolled, 50 (57.5 percent) patients had unstable angina, with three (3.4 percent) acute myocardial infarction; thirty-one (35.6 percent) patients underwent urgent and emergent surgery; thirteen (14.9 percent) patients had myocardial infarction in less than 30 days, and 34 (39.1 percent) in more than 30 days. RESULTS: The main postoperative complications were: atrial fibrillation (32.2 percent), heart failure (12.6 percent), pneumonia (10.3 percent), septicemia (3.4 percent), acute myocardial infarction (2.3 percent), mediastinitis (1.1 percent) transient ischemic attack (1.1 percent), and pneumothorax (1.1 percent). The mean extubation time was 18.50±19.09 hours, the length of stay in the intensive care unit was 2.92±2.03 days, and hospital length of stay was 10.55±7.16 days. Packed red cells were given to nine (10.34 percent) patients and none of them was operated due to bleeding. The in-hospital mortality was 4,6 percent. CONCLUSIONS: In patients over 70 years-old, elective and non-elective off-pump coronary artery bypass grafting with intracoronary shunt showed to be safe and effective, associated with low rates of postoperative complications and mortality in relation to the studied population.