A importância da criação de rede de cuidado para o tratamento do IAM com supra de ST e a experiência da Unidade Coronariana do Hospital das Clínicas / UFMG / The importance of creating a health care network to treat myocardial infarction with ST segment elevation and the experience of the Coronary Unit of UFMG University Hospital

O infarto com supradesnivelamento do segmento ST (IAMCSST) é uma importante causa de morbimortalidade no Brasil. O tratamento ideal para o IAMCSST depende principalmente do diagnóstico precoce e da rápida seleção de estratégia de reperfusão apropriada. A angioplastia coronária percutânea (ICP) primária é a estratégia de escolha em hospitais com serviço de hemodinâmica. Em hospitais sem esse serviço, duas estratégias de reperfusão são possíveis: transferência para ICP primária ou terapia com trombolíticos. A ICP primária apresenta melhores resultados, com redução de eventos cardiovasculares, entretanto, essa vantagem pode ser perdida, dependendo do tempo de atraso para transferência. A criação de rede de cuidado para pacientes com IAMCSST é um desafio para nosso município e pretende possibilitar o acesso à terapia de reperfusão em tempo adequado, levando em consideração as condições clínicas do paciente e do sistema de saúde em que ele é atendido.

Myocardial infarction with ST segment elevation is one of the major causes of morbimortality in Brazil. The ideal treatment for the disease depends mostly on early diagnosis and choice of adequate reperfusion strategy. Primary percutaneous coronary angioplasty (PCI) is a strategywidely adopted in hospitals that provide cardiac services, whereas hospitals without such services usually adopt either transfer for PCI or therapy with thrombolytic drugs. Primary PCI usually provides better results, reducing cardiovascular events, but this may not be effective in the event of significant transference delay. The creation of a health care network for patients with the disease is a challenge in our Municipality that can provide access to reperfusion therapy as soon as possible considering both patients? clinical conditions and health insurance.

Systems of care for ST-segment elevation myocardial infarction: impact of different models on clinical outcomes.

ST-segment elevation myocardial infarction (STEMI) is one of the greatest medical emergencies, for which organization of care has a determinant impact on patient outcomes. The purpose of this paper is to review systems of care for STEMI patients. Although primary percutaneous coronary intervention (PCI) is the preferred option for patients with STEMI, offering easy and emergent access to this procedure often remains difficult because of geographic and diverse structural difficulties. intravenous fibrinolysis, especially when administered early after symptom onset and as part of a pharmacoinvasive strategy (i.e., followed by rapid coronary angiography with PCI when necessary), offers a reasonable therapeutic option in selected cases and has yielded satisfactory clinical results. Network organization is central for optimizing patient care at the acute stage of myocardial infarction. This review describes different clinical experiences with network implementation both in Europe and in North America. In all instances, early recognition of STEMI and, particularly in the pre-hospital setting, shortening time delays is central for the achievement of optimal clinical results. Overall, the encouraging results described in the models presented here, as diverse as they might be, should be an encouragement to promote and implement regional protocols according to the specific local constraints and to monitor their effectiveness by recording simple quality indicators in ongoing registries.

The Watanabe heritable hyperlipidemic (WHHL) rabbit, its characteristics and history of development: a tribute to the late Dr. Yoshio Watanabe.

Professor Yoshio Watanabe, who developed the WHHL rabbit, died on December 13, 2008. He had contributed to studies of lipoprotein metabolism and atherosclerosis, and to the development of hypolipidemic and/or anti-atherosclerotic compounds. WHHL rabbits show hypercholesterolemia due to deficiency of LDL receptors, and very similar lipoprotein metabolism to humans. The incidences of coronary atherosclerosis and myocardial infarction in the original WHHL rabbits were very low. After three rounds of selective breeding, the coronary plaques changed to fibroatheromas with thin fibrous caps and myocardial infarction developed spontaneously. In studies with WHHL rabbits, plaque-stabilizing effects of statins were proved. In this review, we admire his achievements and describe the history of studies using WHHL rabbits.

[Atherosclerosis and ischemic heart disease. Short historical notes]. / Aterosclerosis y cardiopatía isquémica. Notas históricas breves.

A review of some historical accounts in Medicine reveals concepts, clinical descriptions and prognosis of coronary atherosclerosis and ischemic heart disease in the recent past and in remote antiquity. Herein, the historical accounts disclosed include some concepts and terms utilized in reference to atherosclerosis: the oldest documentation of coronary atherosclerosis and myocardial infarction in Egyptian mummies; the clinical syndrome of angor pectoris in the Ebers' papyrus, as well as clinical and prognostic data in the Corpus Hippocraticum regarding possible cases of angina, infarction and sudden death. These reports give a better insight into primitive medicine in the Ancient Western World, revealing the evolving concept of atherosclerosis and the existence of this disease in humanity's remote past.

[Did Emperior Tiberius die from myocardial infarction?]. / Un nouveau diagnostic pour la mort de Tibère.

In Svetonius' Life of the Twelve Cesars, in Tacitus' Annals, and in Dio, Cassius' Roman History, arguments can be found for the diagnosis of myocardial infarction in the case of the Roman emperor Tiberius. After violent and repeated efforts he felt an intense thoracic pain, and from that moment he became very ill and had to be carried in a litter. The course of the disease was marked by several syncopes with apparent death, some of long duration, but with spontaneous total recovery, except for the last one (which occured when getting out of bed). Moreover, we know he had abnormalities of the pulse indicating a lethal prognosis. The most logical explanation is: myocardial infarction complicated with access of ventricular tachycardia, the last one ending in ventricular fibrillation.