RESUMEN
BACKGROUND: Atrioventricular reentrant tachycardias account for approximately one third of cases referred for electrophysiological study (EPS). The anatomical substrate responsible for the reentry is an accessory pathway (AP) able to conduct the electrical stimulus in an anterograde, retrograde or bidirectional manner. OBJECTIVE: To evaluate the correlation of AP location with the male and female genders and AP clinical presentation, whether manifest or concealed. METHODS: Retrospective observational study including 942 consecutive patients, all diagnosed with EPS-confirmed AP from January 1994 to December 2008. APs were classified into eight anatomical groups: left lateral (LL), left posterior (LP), left posteroseptal (LPS), right posteroseptal (RPS), right midseptal (RMS), right anteroseptal (RAS), right lateral (RL), and right posterior (RP). RESULTS: Of the 942 patients, 52.6% were males. The mean age was 31.2±13.8years. As regards gender, APs were more prevalent among men. However, a statistically significant difference was observed only in the LPS (p=0.029) and RL (p=0.003) regions. In relation to the form of presentation of AP, the manifest form was more frequent than the concealed form in six of the eight regions studied, except for the LL and LPS regions. CONCLUSION: AP predominated in males and the manifest form was more frequent than the concealed form in most of the regions studied.
Asunto(s)
Fascículo Atrioventricular Accesorio/epidemiología , Taquicardia Ventricular/epidemiología , Fascículo Atrioventricular Accesorio/fisiopatología , Adulto , Nodo Atrioventricular/fisiopatología , Fascículo Atrioventricular/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Caracteres Sexuales , Taquicardia Ventricular/fisiopatología , Adulto JovenRESUMEN
INTRODUCTION: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk in patients with chronic renal disease (CRD) on hemodialysis (HD). OBJECTIVE: To show the usefulness of chest radiography in the diagnosis of LVH in CRD patients on HD. METHODS: Cross-sectional study including 100 patients (58 men and 42 women), mean age 46.2 ± 14.0 years, with CRD of all causes, for at least six months on HD. Were obtained echocardiogram and chest x-rays of patients, always up to one hour after the end of HD sessions. RESULTS: LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) with eccentric pattern of LVH. Cardiomegaly - defined by cardiothoracic index (CTI) > 0.5 - was present in 61 patients (61%). The following were the sensitivity, specificity and accuracy, respectively, for the variable ICT: 66.2%, 70.5% and 68.0%. The Pearson correlation between ICT and index of left ventricular mass (LVMI) was 0.552 (p < 0.05) and positive likelihood ratio of 2.2. CONCLUSION: Chest radiography is a safe and useful as a diagnostic tool of LVH in CKD patients on HD.
Asunto(s)
Hipertrofia Ventricular Izquierda/etiología , Insuficiencia Renal Crónica/complicaciones , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía Torácica , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Ultrasonografía , Adulto JovenRESUMEN
Atrial fibrillation (AF) is an arrhythmia frequently seen in the postoperative period of cardiac surgery. In this context, it is associated with the presence of comorbidities, longer length of hospital stay, and higher costs related to surgery. The mechanisms involved in the genesis of AF in the postoperative period of cardiac surgery (AFPO) are different from those causing paroxysmal AF. Knowledge of these mechanisms permits the use of efficient measures to reduce the incidence of this arrhythmia. According to recommendations of the literature, treatment is efficient and safe, because the rates of reversion to sinus rhythm are high and complications are reduced, and it is not associated with a high frequency of side effects.
Asunto(s)
Fibrilación Atrial/etiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Posoperatorias/prevención & control , Fibrilación Atrial/terapia , Humanos , Cuidados Posoperatorios , Periodo PosoperatorioRESUMEN
Introdução: A hipertrofia ventricular esquerda (HVE) é um fator preditor independente de risco cardiovascular em pacientes com doença renal crônica (DRC) em hemodiálise (HD). Objetivo: Mostrar a utilidade da radiografia de tórax no diagnóstico de HVE em pacientes com DRC em HD. Métodos: Estudo transversal que incluiu 100 pacientes (58 homens e 42 mulheres), idade média de 46,2 ± 14,0 anos, com DRC de todas as etiologias, há pelo menos seis meses em HD. Foram obtidos ecocardiograma e radiografia de tórax dos pacientes, sempre até uma hora após o término das sessões de HD. Resultados: A HVE foi detectada em 83 pacientes (83%), dos quais 56 (67,4%) apresentavam o padrão concêntrico e 27 (32,6%) a padrão excêntrico de HVE. Cardiomegalia - definida por índice cardiotorácico (ICT) > 0,5 - esteve presente em 61 pacientes (61%). Foram os seguintes os valores de sensibilidade, especificidade e acurácia, respectivamente, para a variável ICT: 66,2%, 70,5% e 68,0%. A correlação de Pearson entre ICT e índice de massa do ventrículo esquerdo (IMVE) foi de 0,552 (p < 0,05) e razão de verossimilhança positivo de 2,2. Conclusão: A radiografia de tórax é um exame seguro e útil como ferramenta diagnóstica de HVE em pacientes com DRC em HD. .
Introduction: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk in patients with chronic renal disease (CRD) on hemodialysis (HD). Objective: To show the usefulness of chest radiography in the diagnosis of LVH in CRD patients on HD. Methods: Cross-sectional study including 100 patients (58 men and 42 women), mean age 46.2 ± 14.0 years, with CRD of all causes, for at least six months on HD. Were obtained echocardiogram and chest x-rays of patients, always up to one hour after the end of HD sessions. Results: LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) with eccentric pattern of LVH. Cardiomegaly - defined by cardiothoracic index (CTI) > 0.5 - was present in 61 patients (61%). The following were the sensitivity, specificity and accuracy, respectively, for the variable ICT: 66.2%, 70.5% and 68.0%. The Pearson correlation between ICT and index of left ventricular mass (LVMI) was 0.552 (p < 0.05) and positive likelihood ratio of 2.2. Conclusion: Chest radiography is a safe and useful as a diagnostic tool of LVH in CKD patients on HD. .
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Hipertrofia Ventricular Izquierda/etiología , Insuficiencia Renal Crónica/complicaciones , Estudios Transversales , Hipertrofia Ventricular Izquierda , Hipertrofia Ventricular Izquierda , Radiografía Torácica , Diálisis Renal , Insuficiencia Renal Crónica/terapiaRESUMEN
OBJECTIVE: To evaluate CAD prevalence in patients with aortic aneurysm, as well as differences related to aneurysm topographies. To describe the primary risk factors for CAD related to this association and their occasional differences according to AA topographies. METHODS: This was an open, prospective, nonrandomized study that evaluated 95 patients (66 men and 33 women, mean age 63 +/- 11.8). All patients, asymptomatic for CAD, had undergone aortic CT and coronary angiography. According to the AA topography, they were classified into three groups: 1) patients with thoracic aortic aneurysm (TAA); 2) thoracoabdominal aortic aneurysm (TAAA); and 3) abdominal aortic aneurysm (AAA). A database was created to store information from clinical data and complementary examinations. Statistical analysis was performed using the Students t test or analysis of variance (ANOVA) for continuous variables and chi-square test for categorical variables. P values < 0.05 were considered statistically significant. RESULTS: CAD prevalence was 63.1%, and AAA was more prevalent than TAA and TAAA (76% vs. 70% vs. 30%, p = 0.001). The comparative analysis of CAD risk factors based on the aortic aneurysm topography revealed that smoking and dyslipidemia were more prevalent among AAA patients (74.5% vs. 42.3% vs. 60%, p = 0.01 and (54.2% vs. 19.9% vs. 60%, p = 0.007, respectively). As for coronary lesion severity in the population of AA patients, 12 (20%) had at least one lesion > or = 70% and 19 (31.6%), > or = 50%. Fifteen patients (25%) had single-vessel disease, 11 (18%) had two-vessel disease, and 34 (57%) had three-vessel disease. CONCLUSION: Asymptomatic CAD is highly prevalent in AA patients, particularly among those with AAA. Study results suggest the need for diagnostic stratification for CAD in patients with AA, especially those with AAA.
Asunto(s)
Aneurisma de la Aorta/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Adulto , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Humanos , Masculino , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
A fibrilação atrial (FA) é uma arritmia frequente no pós-operatório de cirurgia cardíaca. Nesse contexto, está associada à presença de comorbidades, a um maior tempo de hospitalização e a maior custo relacionado à cirurgia. Os mecanismos envolvidos na gênese da FA no pós-operatório de cirurgia cardíaca (FAPO) são diferentes daqueles causadores da FA paroxística. O conhecimento desses mecanismos permite a aplicabilidade de medidas que são eficazes em reduzir a incidência dessa arritmia. O tratamento, segundo recomendações da literatura, é eficaz e seguro, pois as taxas de reversão a ritmo sinusal são elevadas e as complicações reduzidas, e não está associado com a ocorrência elevada de efeitos colaterais.
Atrial fibrillation (AF) is an arrhythmia frequently seen in the postoperative period of cardiac surgery. In this context, it is associated with the presence of comorbidities, longer length of hospital stay, and higher costs related to surgery. The mechanisms involved in the genesis of AF in the postoperative period of cardiac surgery (AFPO) are different from those causing paroxysmal AF. Knowledge of these mechanisms permits the use of efficient measures to reduce the incidence of this arrhythmia. According to recommendations of the literature, treatment is efficient and safe, because the rates of reversion to sinus rhythm are high and complications are reduced, and it is not associated with a high frequency of side effects.
Asunto(s)
Humanos , Fibrilación Atrial/etiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Posoperatorias/prevención & control , Fibrilación Atrial/terapia , Cuidados Posoperatorios , Periodo PosoperatorioRESUMEN
OBJETIVO: Avaliar a prevalência da doença arterial coronariana (DAC) em portadores de aneurisma de aorta (AA), bem como as diferenças relacionadas às diferentes topografias. Descrever os principais fatores de risco para DAC relacionados a esta associação e suas eventuais diferenças de acordo com as diferentes topografias. MÉTODOS: Estudo prospectivo, aberto, não randomizado que avaliou 95 pacientes (62 homens, 33 mulheres, idade 63 ± 11,8 anos) com AA. Todos os pacientes, assintomáticos para DAC, possuíam tomografia computadorizada de aorta e angiografia coronariana. De acordo com a topografia do AA, eles foram divididos em três grupos: 1) pacientes com AA torácica (AAT); 2) com AA toracoabdominal (ATA) e 3) com AA abdominal (AAA). Foi criado um banco de dados com as informações clínicas e de exames complementares. A análise estatística realizada com o teste t de Student ou análise de variância (ANOVA) para as variáveis contínuas e qui-quadrado para as categóricas, sendo considerado p significante quando < 0,05. RESULTADOS: A prevalência de DAC foi de 63,1 por cento, e o AAA apresentou maior prevalência quando comparado ao AAT e ATA (76 por cento vs. 70 por cento vs. 30 por cento, p = 0,001). A análise comparativa dos fatores de risco para DAC de acordo com a topografia do AA revelou que os pacientes com AAA eram mais tabagistas (74,5 por cento vs. 42,3 por cento vs. 60 por cento, p = 0,01) e dislipêmicos (54,2 por cento vs 19,9 por cento vs 60 por cento, p = 0,007). Quanto à gravidade das lesões coronarianas na população de pacientes com AA, 12 (20 por cento) possuíam pelo menos uma lesão coronariana > 70 por cento e 19 (31,6 por cento) > 50 por cento. Quinze pacientes (25 por cento) eram uniarteriais, 11 (18 por cento) biarteriais e 34 (57 por cento) triarteriais. CONCLUSÃO: Em portadores de AA a prevalência de DAC assintomática é elevada, principalmente naqueles com AAA. Os resultados deste estudo sugerem a necessidade de uma estratificação...
OBJECTIVE: To evaluate CAD prevalence in patients with aortic aneurysm, as well as differences related to aneurysm topographies. To describe the primary risk factors for CAD related to this association and their occasional differences according to AA topographies. METHODS: This was an open, prospective, nonrandomized study that evaluated 95 patients (66 men and 33 women, mean age 63 ± 11.8). All patients, asymptomatic for CAD, had undergone aortic CT and coronary angiography. According to the AA topography, they were classified into three groups: 1) patients with thoracic aortic aneurysm (TAA); 2) thoracoabdominal aortic aneurysm (TAAA); and 3) abdominal aortic aneurysm (AAA). A database was created to store information from clinical data and complementary examinations. Statistical analysis was performed using the StudentÆs t test or analysis of variance (ANOVA) for continuous variables and chi-square test for categorical variables. P values < 0.05 were considered statistically significant. RESULTS: CAD prevalence was 63.1 percent, and AAA was more prevalent than TAA and TAAA (76 percent vs. 70 percent vs. 30 percent, p = 0.001). The comparative analysis of CAD risk factors based on the aortic aneurysm topography revealed that smoking and dyslipidemia were more prevalent among AAA patients (74.5 percent vs. 42.3 percent vs. 60 percent, p = 0.01 and (54.2 percent vs. 19.9 percent vs. 60 percent, p = 0.007, respectively). As for coronary lesion severity in the population of AA patients, 12 (20 percent) had at least one lesion > 70 percent and 19 (31.6 percent), > 50 percent. Fifteen patients (25 percent) had single-vessel disease, 11 (18 percent) had two-vessel disease, and 34 (57 percent) had three-vessel disease. CONCLUSION: Asymptomatic CAD is highly prevalent in AA patients, particularly among those with AAA. Study results suggest the need for diagnostic stratification for CAD in patients with AA, especially those with AAA.