ABSTRACT
Thoracic pain is a common symptom in emergency services, and stress radionuclide imaging represents one of the phases of risk stratification in these individuals. However, a group of patients with negative functional exams after physical or pharmacological stress develops myocardial ischemia during this psychological stress. Alterations in vascular tonus as a response to endogenous mechanisms are the physiopathologic basis for such alterations. We report a case that illustrates how mental stress radionuclide imaging has the potential to be used in the assessment of myocardial ischemia non-detected by conventional methods in patients with suspicion of ischemic thoracic pain.
Subject(s)
Chest Pain/diagnostic imaging , Myocardial Ischemia/diagnostic imaging , Radionuclide Imaging/methods , Stress, Psychological/complications , Aged , Female , HumansABSTRACT
A dor torácica é um sintoma comum nos serviços de emergência e a cintilografia de estresse representa uma das etapas da estratificação de risco nesses indivíduos. Entretanto, um grupo de pacientes com exames funcionais negativos após o estresse físico ou farmacológico desenvolve isquemia miocárdica durante estresse mental. As alterações do tônus vascular em resposta a mecanismos endógenos são a base fisiopatológica dessas alterações. Relata-se um caso que ilustra como a cintilografia de estresse mental tem o potencial para ser utilizada na avaliação de isquemia miocárdica, não detectada pelos métodos convencionais, em pacientes com suspeita de dor torácica isquêmica.
Thoracic pain is a common symptom in emergency services, and stress radionuclide imaging represents one of the phases of risk stratification in these individuals. However, a group of patients with negative functional exams after physical or pharmacological stress develops myocardial ischemia during this psychological stress. Alterations in vascular tonus as a response to endogenous mechanisms are the physiopathologic basis for such alterations. We report a case that illustrates how mental stress radionuclide imaging has the potential to be used in the assessment of myocardial ischemia non-detected by conventional methods in patients with suspicion of ischemic thoracic pain.
Subject(s)
Aged , Female , Humans , Chest Pain , Myocardial Ischemia , Radionuclide Imaging/methods , Stress, Psychological/complicationsABSTRACT
OBJECTIVE: This study aimed to assess the true usefulness of the Six-Minute Walk Test as a prognostic indicator and its contribution to clinical practice with heart failure patients. METHODS: In order to investigate the actual value of the Six-Minute Walk Test as an objective measure of mortality probability in patients with heart failure, the test was applied to 179 stable patients (120 men and 59 women, mean age 58.32 +/- 12.7 years, with NYHA class II and III heart failure and an ejection fraction (LVEF) of 34.91 +/- 12.4%). Patients were instructed to walk for 6 minutes and then, four hours later, underwent a conventional exercise stress test (as per Naughton Protocol). Patients were followed for an average of eighteen months. RESULTS: The average distance walked was 521.11 +/- 76.1 meters. During the follow-up period, 66 patients (36.9%) died. There was a significant correlation between the distance walked during the test and mortality (p < 0.0001). The logistic regression model identified the distance walked during the test as the most important independent predictor of mortality (p = 0.0001). A distance shorter than 520 meters identified the patients with an increased probability of death. There was a significant correlation between the number of metabolic equivalents (METs) measured during the conventional exercise stress testing and mortality rate (p = 0.0001). CONCLUSION: The Six-Minute Walk test is a simple, safe and powerful method to assess the prognosis of patients with NYHA class II and III heart failure. It is an objective examination that may replace the conventional ergometric test for the prognostic evaluation of these patients.
Subject(s)
Cardiac Output, Low/diagnosis , Exercise Test , Walking/physiology , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prognosis , Prospective Studies , Ventricular Dysfunction, Left/physiopathologyABSTRACT
OBJETIVOS: Este estudo objetivou avaliar a utilidade do teste de caminhada de seis minutos como indicador prognóstico e sua contribuição na prática clínica diária de pacientes com insuficiência cardíaca. MÉTODOS: O teste de caminhada de seis minutos foi administrado a 179 pacientes (120 homens, 59 mulheres; idade média de 58,32 ± 12,7 anos), portadores insuficiência cardíaca nas classes II e III da New York Heart Association (NYHA), com fração de ejeção do ventrículo esquerdo de 34,91 ± 12,4 por cento. Os pacientes realizaram o teste de caminhada de seis minutos e, 4 horas depois, o teste ergométrico convencional sob o Protocolo de Naughton limitado por sintomas, e foram acompanhados por um período médio de dezoito meses. RESULTADOS: A distância média percorrida no teste de caminhada seis minutos foi de 521,11 ± 76,1 metros. Durante o acompanhamento, 66 pacientes (36,9 por cento) morreram. Houve uma correlação significativa entre a distância percorrida no teste de caminhada de seis minutos e a mortalidade (p < 0,0001). O modelo de regressão logística identificou a distância percorrida durante o teste de caminhada de seis minutos como o mais forte indicador independente de mortalidade (p = 0,0001). A distância caminhada menor que 520 metros identificou os pacientes com maior probabilidade de óbito. O número de equivalentes metabólicos alcançados no teste ergométrico convencional também correlacionou-se significativamente com a mortalidade (p = 0,0001). CONCLUSÃO: O teste de caminhada de seis minutos é um método simples, seguro e potente de avaliação prognóstica de portadores de insuficiência cardíaca nas classes II e III da NYHA. É um exame objetivo, que pode substituir o teste ergométrico convencional na avaliação prognóstica desses pacientes.
Subject(s)
Female , Humans , Male , Middle Aged , Cardiac Output, Low/diagnosis , Exercise Test , Walking/physiology , Predictive Value of Tests , Prognosis , Prospective Studies , Ventricular Dysfunction, Left/physiopathologyABSTRACT
OBJETIVO: Avaliar a função autonômica na cardiomiopatia hipertrófica (CMH) através da variabilidade da freqüência cardíaca (VFC) e correlacioná-la com dados ecocardiográficos. MÉTODOS: Foram estudados 2 grupos pareados por sexo, idade e freqüência cardíaca: A) 10 pacientes com CMH septal (70 por cento não obstrutiva); B) 10 voluntários saudáveis. A VFC foi analisada durante quatro estágios sucessivos: repouso, respiração controlada, teste de inclinação e respiração controlada associada ao teste de inclinação. Compararam-se as médias das variáveis entre os grupos, intragrupos durante os estágios, e no grupo A, correlacionando com as medidas ecocardiográficas (septo interventricular e diâmetro atrial esquerdo). RESULTADOS: Não observamos diferença na VFC entre os grupos nos 3 primeiros estágios. No 4° estágio, constatamos que medidas de atividade vagal apresentaram valores maiores no grupo A [logaritmo da raiz média quadrática das diferenças entre intervalos RR (LogRMSSD) - 1,35±0,14 vs 1,17±0,16; p=0,019; logaritmo do componente alta freqüência (LogAF)-4,89±0,22 vs 4,62±0,26; p=0,032]. Durante os estágios, também verificamos que medidas vagais [proporção de pares de intervalos RR consecutivos cuja diferença > 50ms (pNN50) e LogAF] apresentaram menor redução durante o 3° estágio no grupo A, e o LogAF, um aumento no último estágio (p=0,027), indicando marcante atividade parassimpática neste grupo. A análise da VFC do grupo A não revelou diferença entre pacientes com maior hipertrofia ou diâmetro atrial. CONCLUSÃO: 1) ocorreu predomínio parassimpático durante estimulação autonômica nos pacientes com CMH; 2) não encontramos correlação entre VFC e as medidas ecocardiográficas analisadas.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cardiomyopathy, Hypertrophic/physiopathology , Heart Rate/physiology , Autonomic Nervous System/physiopathology , Algorithms , Case-Control Studies , Echocardiography, Doppler , Electrocardiography, Ambulatory , Statistics, Nonparametric , Parasympathetic Nervous System/physiopathology , Sympathetic Nervous System/physiopathologyABSTRACT
OBJECTIVE: Assess the autonomic function in hypertrophic cardiomyopathy (HCM) through heart rate variability (HRV) and to correlate it to echocardiographic data. METHODS: Two groups were studied, and compared for gender, age and HR: A) Ten (10) patients reporting septal HCM (70% non-obstructive); B) Ten (10) healthy volunteers. HRV was analyzed along four successive stages: at rest, under controlled breathing, while bending, and controlled breathing associated to bending. Variables means were compared between groups and intra-groups in the different stages; in Group A, variables means were correlated to echocardiographic measurements (interventricular septum and left atrial diameter). RESULTS: No HRV difference was reported among groups in the first 3 stages. In the fourth stage vagal activity was shown to be higher in Group A [quadratic mean log between RR intervals (RMSSD) - 1.35+/-0.14 vs 1.17+/-0.16; p=0.019; high frequency component logarithm (LogHF)- 4.89+/-0.22 vs 4.62+/-0.26; p=0.032]. Along the stages, vagal measurements [rate of pairs of consecutive RR intervals whose difference is > or =50 ms (pNN50) and LogHF] also showed lower reduction in the third stage in Group A, while LogHF showed some increase in last stage (p=0.027), thus indicating marked parasympathetic activity in that group. Group A HRV analysis showed no difference among patients reporting larger hypertrophy or atrial diameter. CONCLUSION: 1) Parasympathetic prevalence was shown during autonomic stimulation in HCM patients; 2) No correlation was found between HRV and echocardiographic measurements under analysis.
Subject(s)
Autonomic Nervous System/physiopathology , Cardiomyopathy, Hypertrophic/physiopathology , Heart Rate/physiology , Adult , Algorithms , Case-Control Studies , Echocardiography, Doppler , Electrocardiography, Ambulatory , Female , Humans , Male , Middle Aged , Parasympathetic Nervous System/physiopathology , Statistics, Nonparametric , Sympathetic Nervous System/physiopathologyABSTRACT
A case of women at he twentieth week of pregnancy, with severe mitral stenosis, is reported. She was treated by dilatation through percutaneous valveplasty wíth balloon, by transseptal via, showing relief of the symptomatology and carrying the pregnancy to term.
Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Adult , Catheterization , Mitral Valve Stenosis/therapy , Echocardiography , Mitral Valve StenosisABSTRACT
The authors studied 6,627 patients submitted to cardiac catheterization. These, about 825 had orovalvular disease. Orovalvular disease was more frequent in women in reason of three to two for man. The mitral valve lesion was the most frequent, with 53.78 per cent of cases. In men, the most frequent lesion was aortic. In women, the mitral. In most cases, there was only one valve with lesion, with predominance of mitral stenosis and, after, aortic insuficiency. In cases where there was association of lesions, the predominance was of mitro-aortica lesion. About half of patients who have had isolated lesion had too left ventricular disfunction. In these cases, the aortic insufficiency predominated.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cardiac Catheterization/statistics & numerical data , Heart Valve Diseases/surgery , Heart Valve Diseases/epidemiology , Incidence , Ventricular Dysfunction, LeftSubject(s)
Humans , Male , Female , Adult , Middle Aged , Cineangiography , Coronary Disease/diagnosis , Aged, 80 and over , Ventricular Function, LeftABSTRACT
Foram estudadas 1474 cinecoronariografias das quais 281 (19,1%) foram normais. Tais pacientes apresentavam média de idade de 47 ñ 10 anos, sendo 135 (48%) homens com média de idade de 46 ñ 11 anos e 146 (52%) mulheres com média de idade de 49 ñ 8 anos. Os pacientes foram agrupados: 1) pacientes sem alteraçöes hemodinâmicas: 18,9%; 2) portadores de hipertensäo arterial sistêmica: 48,7%; 3) portadores de agressäo miocárdia: 16,7%; 4) portadores de hipertrofia ventricular esquerda sem causa aparente: 6,4%; 5) portadores de miocardiopatia hipertrófica: 4,6%; 6) portadores de prolapso da valva mitral: 2,5%; 7) portadores de ponte muscular na coronária descendente anterior: 1,8%; 8) portador de microfistulas coronária-ventrículo esquerdo: 0,4%. Os autores concluem que nas situaçöes eletivas, principalmente nas pacientes do sexo feminino, portadores de hipertensäo arterial sistêmica, de hipertrofia ventricular esquerda, de agressäo miocárdia, de prolapso da valva mitral a cinecoronariografia só deve ser realizada após investigaçäo diagnóstica que comprove a isquemia miocárdica, ou que näo possa afastar a possibilidade de sua presença
