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Purpose: This study aimed to evaluate whether there is a correlation between the maximum strength of upper limb when performing a multijoint exercise and peak oxygen uptake (V'O2peak) in Chronic Heart Failure (CHF) subjects. Method: This cross-sectional study involved CHF subjects with a left ventricular ejection fraction (LVEF) less than 50%, who underwent a cardiopulmonary exercise test (CPET) on a treadmill and 1-repetition maximum (1-RM) test for upper limb strength using a bench press exercise. Results: The sample consisted of 16 individuals aged 54 ± 12 years with a LVEF of 37 ± 7%. The V'O2peak was 14.98 ± 5.4 ml·min-1·kg-1 and mean maximum load in the 1-RM test was 38 ± 16 kg. There was strong correlation of V'O2peak with the load in the 1-RM test (r = 0.70; p = .037; r2 = 0.48). Conclusion: There is a strong correlation between the load in 1-RM test for upper limb with V'O2peak in CHF individuals. It is a safe, inexpensive and reproducible way to assess the muscle strength in this population.
Subject(s)
Heart Failure , Ventricular Function, Left , Humans , Stroke Volume , Cross-Sectional Studies , Exercise Test , Chronic Disease , Upper Extremity , Oxygen ConsumptionABSTRACT
Abstract Timothy Syndrome is a rare autosomal dominant multisystem genetic condition. The CACNA1C gene, codifier of the CaV1.2 calcium channel, is affected, resulting in the loss of voltage-dependent calcium channel inactivation. Relevant clinical characteristics: (1) corrected QT interval greater than 480ms; (2) syndactyly. Death often occurs during childhood, and results from ventricular tachyarrhythmias. This study presents the case of a female newborn who suffered a cardiorespiratory arrest, secondary to ventricular arrhythmia. A prolonged QT interval, combined with 2:1 AV block, was also identified, requiring a definitive cardiac pacemaker implant that, during inpatient care, developed pulmonary sepsis, followed by death.
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PURPOSE: We report the results of low back pain treatment using a combination of nucleotides, uridine (UTP), cytidine (CMP) and vitamin B12, vs a combination of vitamins B1, B6, and B12. PATIENTS AND METHODS: Randomized, double-blind, controlled trial, of a 60-day oral treatment: Group A (n=317) receiving nucleotides+B12 and Group B (n=317) receiving B vitamins. The primary endpoint was the percentage of subjects in each group presenting adverse events (AEs). Secondary endpoints were visual analog scale (VAS) pain scores at Visit 2 (day 30) and Visit 3 (day 60) in relation to pretreatment values, Roland-Morris Questionnaire (RMQ) scores and finger-to-floor distance (FFD) (percentage of subjects per group presenting improvement ≥5 points and ≥3cm, respectively). RESULTS: Seventy-five (24%) and 105 (33%) subjects (P=0.21) presented 133 and 241 AEs, with 3159% of subjects presenting ≥2 AEs (P=0.0019) in Group A and Group B, respectively. Twenty-four subjects in Group B were discontinued due to AEs, while no AE-related discontinuations occurred in Group A (P<0.0001). VAS score reduction after 30 and 60 days of treatment was statistically significant (P<0.0001) in both groups, with Group A showing greater reduction at Visit 2 (P<0.0001). RMQ score improvement ≥5 points occurred in 99% of subjects from each group, and FFD improvement ≥3 cm occurred in all subjects. CONCLUSION: Treatment with nucleotides+B12 was associated with a lower number of total AEs, fewer AEs per subject, and no AE-related treatment discontinuation. Pain intensity (VAS) reduction was superior at 30 days of treatment in the nucleotides+B12 group and equivalent between groups at 60 days of treatment. Improvements in efficacy measures RMQ and FFD were observed in both groups at treatment days 30 and 60.
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BACKGROUND: Motion sickness can be triggered in a variety of situations and is characterized primarily by nausea and vomiting. Ginger is widely used in treating conditions including chemotherapy-associated gastrointestinal symptoms, morning sickness, postoperative nausea, and motion sickness. OBJECTIVES: The primary study objective was to evaluate Zingiber officinale extract in the treatment of motion sickness. Secondary objectives were to evaluate treatment effect on Motion Sickness Assessment Questionnaire (MSAQ) score and subscores before and after treatment, and to evaluate treatment tolerability. METHODS: Open-label, single-arm study assessing motion sickness outcomes with and without pre-travel oral treatment with Zingiber officinale 160 mg extract (containing 8 mg gingerols). All patients answered the MSAQ on 4 separate occasions following a trip of at least 15 minutes in duration: Trip 1 (pretreatment) and Trips 2, 3, and 4 (after oral treatment with study medication). The primary end point was percentage of patients presenting improvement ≥20 score points on the MSAQ during Trip 2, Trip 3, and Trip 4 in comparison to pretreatment score (Trip 1). Secondary end points included percentage of patients presenting improvement in MSAQ subscores during Trips 2, 3, and 4; percentage of patients presenting treatment-related adverse events; and pre- and posttreatment physician assessment scores. RESULTS: One hundred eighty-four patients were included and 174 completed treatment. A reduction of ≥20 points in total MSAQ score points occurred in 26.52%, 29.89%, and 29.31% of patients from Trips 2, 3, and 4, respectively. There was no significant difference at Trips 2, 3, and 4 in number of patients presenting improvement ≥20 score points (Pâ¯=â¯0.9579). There was a significant reduction in total MSAQ scores from Trips 2, 3, and 4 (P < 0.0001) compared with Trip 1. Total MSAQ scores did not vary at each trip taken under treatment (Pâ¯=â¯0.28). There were significant (P < .001) improvements in all domain subscores from Trips 2, 3, and 4 in relation to scores from Trip 1. There was a significant improvement in physician assessment scores at Visit 2 (P < .0001). Adverse events were reported among 31 patients, mainly affecting the gastrointestinal system. Twenty-four patients (13.04%) reported 39 adverse events considered related to treatment. No significant change in physical exam was noted at Visit 2 in relation to Visit 1. CONCLUSIONS: These open label, historically controlled study results suggest the need for randomized, blinded, placebo and active substance controlled clinical trials. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX).
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BACKGROUND: Phlebotonics have beneficial effects on some symptoms related to chronic venous disease (CVD) of the lower limbs. The most commonly used one is diosmin, available in a pure semisynthetic form or as a micronized purified flavonoid fraction. Patients and Methods. The primary objective of this single-blind, randomized, parallel-group, prospective study was to assess the clinical noninferiority of nonmicronized diosmin 600 mg once daily (D-group) compared to micronized diosmin 900 mg plus hesperidin 100 mg once daily (D/H-group) over a 6-month treatment period. Adult patients with a symptomatic CVD of the lower limbs (C0-C3 grade; 20-60 mm on a 100 mm visual analog scale (VAS)) were included. The primary endpoint was the change (from baseline to last postbaseline value) of the intensity of the lower-limb symptoms on VAS. RESULTS: 114 patients (mean age, 44.4 years; women, 90.4%) were randomized in the per-protocol analysis (D-group, n = 57; D/H-group, n = 57; D/H-group, p < 0.0001) in the D-group and -22.8 mm (p < 0.0001) in the D-group and -22.8 mm (p < 0.0001) in the D-group and -22.8 mm (. CONCLUSION: Nonmicronized diosmin 600 mg was proven to have a noninferior efficacy compared to micronized diosmin 900 mg plus hesperidin 100 mg, associated with greater ease in swallowing the tablet.
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Fundamento: A doença arterial coronariana é a principal causa de morte no mundo, e a idade é fator de risco independente de mortalidade em pacientes submetidos à revascularização cirúrgica. Objetivo: Avaliar os fatores preditores de risco de óbito em pacientes submetidos à revascularização miocárdica com mais de 70 anos. Métodos: Trata-se de uma coorte retrospectiva de banco de dados de cirurgia cardíaca. Foi utilizada a regressão logística para avaliar os preditores independentes de óbito. Resultados: Foram 372 pacientes submetidos à revascularização cirúrgica de 2004 a 2012. O principal fator de risco cardiovascular foi a hipertensão arterial sistêmica, seguida do diabetes melito. A mortalidade em 30 dias foi de 19,35%. A presença de doença vascular periférica (OR: 2,47), cirurgia de emergência (OR: 4,86) e procedimento valvular combinado (OR: 3,86) foram os preditores independentes de óbito. Conclusão: O procedimento cirúrgico em pacientes idosos apresentou mortalidade maior que da população geral. Doença vascular periférica, cirurgia de emergência e procedimento valvular combinado aumentaram o risco de óbito nesses pacientes
Background: Coronary artery disease is the leading cause of death worldwide, with age being an independent risk factor for mortality in patients submitted to surgical revascularization. Objective: To evaluate the mortality risk predictors in patients older than 70 years submitted to myocardial revascularization. Methods: This is a retrospective cohort study of a cardiac surgery database. Logistic regression was used to assess independent death predictors. Results: A total of 372 patients submitted to surgical revascularization from 2004 to 2012 were assessed. The main cardiovascular risk factor was hypertension, followed by diabetes mellitus. Mortality at 30 days was 19.35%. The presence of peripheral vascular disease (OR: 2,47), emergency surgery (OR: 4,86) and combined valve procedure (OR: 3,86) were independent predictors of death. Conclusion: The surgical procedure in elderly patients showed a higher mortality than in the general population. Peripheral vascular disease, emergency surgery and combined valve procedures increased the risk of death in these patients
Subject(s)
Humans , Male , Female , Aged , Aged , Epidemiologic Methods , Epidemiology , Age Factors , Myocardial Revascularization/methods , Coronary Artery Disease/surgery , Cardiovascular Diseases/epidemiology , Data Interpretation, Statistical , Multivariate Analysis , Predictive Value of Tests , Retrospective Studies , Risk Factors , Diabetes Mellitus , Hospitals, Special , HypertensionABSTRACT
A insuficiência cardíaca (IC) é a via final de todas as cardiopatias. Com o avanço tecnológico, asobrevida do cardiopata vem aumentando. Paralelamente observa-se o aumento da incidência da IC. Há poucosdados em relação à evolução tecnológica e seu real impacto na mortalidade desses pacientes. Objetivo: Avaliar a evolução dos índices de internações hospitalares em pacientes adultos com insuficiência cardíaca, taxa de permanência e mortalidade no Sistema Único de Saúde. Métodos: Os dados foram obtidos no DATASUS, referentes ao período de 2001 a 2012. Foram avaliados: a incidência de internações hospitalares gerais e por IC, a média de permanência, a mortalidade e o custo hospitalar, estratificados por sexo, faixa etária e local de internação hospitalar.Resultados: No período estudado ocorreram 91272037 internações hospitalares, sendo 3,96% por IC. Pacientes do sexo masculino corresponderam a 50,76%. O número absoluto de internações por IC diminuiu de 379463 em 2001 para 240 280 em 2012. A média de permanência global foi 5,8 dias em 2001 e 6,6 dias em 2012. A taxa de mortalidade esteve em ascensão, iniciando com 6,58% em 2001 e chegando a 9,5% em 2012 (aumento de 46,1%). O custo da AIH média aumentou de R$ 519,54 em 2001 para R$ 1209,56 em 2012 (aumento de 132,8%). Conclusão: Mesmo com a diminuição das internações hospitalares, a IC é uma síndrome de elevado custo para o Sistema Único de Saúde, com elevados índices de mortalidade que paradoxalmente aumentaram ao longo do tempo apesar do avanço tecnológico ocorrido...
Heart failure (HF) is the final common event of all cardiac diseases. Technological advances have allowed for significant improvement to survival rates in cardiac patients. Correspondingly, an increase in the HF incidence has been observed. Few dataare available on technological advances and their actual impact on the mortality rate of these patients. Objective: To assess the progress of hospital admission rates of adult patients with heart failure, average length of stay and mortality rate in the Brazilian SUS (Unified Health System). Methods: DATASUS data for the 2001-2012 period were obtained. An assessment was performed of data such as all-cause hospital admissions and heart failure-related admissions, average length of stay in hospital, mortality rate and hospital costs, after being stratified by sex, age and place of hospitalization. Results: Over the study period, there have been 91,272,037 hospital admissions, of which 3.96% were due to HF. Male patients accounted for 50.76%. The absolute number of HF-related hospital admissions decreased from 379,463, in 2001, to 240,280, in 2012. The average overall stay in hospital was 5.8 days, in 2001, and 6.6 days, in 2012. The mortality rate was on the rise, from 6.58%, in 2001, to 9.5%, in 2012 (a 46.1% increase). The average cost of AH increased from R$ 519.54, in 2001, to R$ 1,209.56, in 2012 (a 132.8% increase). Conclusion: Despite the decline in hospital admissions, HF is a highly costly syndrome for the Brazilian Unified Health System, with high mortality rates, which paradoxically increased over time, despite technological advances...
Subject(s)
Humans , Male , Female , Adult , Brazil/epidemiology , Death , Hospitalization , Heart Failure/epidemiology , Unified Health System/statistics & numerical data , Age Factors , Drug Therapy , Evidence-Based Medicine , Randomized Controlled Trials as Topic/methods , Sex Factors , Treatment OutcomeABSTRACT
Chronic Venous Disorder (CVD) is a term used to represent all abnormal clinical changes that result from venous disease of the lower extremities, and that have a chronic pattern. This disease has a documented socioeconomic impact, involving a significant part of the western populations, and consuming 2-3% or more of societies? health budgets. This review of the literature focuses on diosmin, a benzopyrone phlebotonic, specifically mechanisms of action as well as preclinical and clinical evidence.
Subject(s)
Humans , Diosmin , Venous InsufficiencyABSTRACT
Fundamentos: A doença arterial coronariana (DAC) é uma das principais causas de internação no SUS e importante fator de risco para a disfunção ventricular. Os pacientes portadores de DAC são classificados como de alto risco cardiovascular, apresentando metas terapêuticas cada vez mais rigorosas.Objetivo: Avaliar o controle dos fatores de risco tradicionais e metas terapêuticas em pacientes com DAC.Métodos: Foi realizada análise retrospectiva de prontuários de pacientes atendidos no ambulatório da residência médica de uma unidade terciária de saúde, hospital referência em cardiologia na rede pública, no período de abril de 2013 a abril de 2014. Preencheram os critérios de inclusão 110 pacientes.Resultados: Dentre os pacientes incluídos, 68,1% eram do sexo masculino. A média de idade foi 60,1±9,2 anos. Tinham diagnóstico de HAS, 90,9% dos pacientes; 42,7% de DM, 81,8% de dislipidemia (DLP), 25,4% eram tabagistas e 32,7% apresentavam história familiar positiva para DAC. A maior parte (61%) recebeu tratamento clínico mais cirúrgico, seguindo-se o tratamento clínico mais percutâneo (20,9%) e por último o tratamento clínico exclusivo (18,1%). Em relação ao controle de metas, 78,1% estavam com pressão arterial controlada (PAS <140 mmHg e PAD <90 mmHg), 65,4% com TG <150 mg/dL; 87,2% com CT <200 mg/dL; 29,1% com HDL >45 mg/dL; 65,4% com LDL <100 mg/dL; e 27,2% com LDL <70 mg/dL.Conclusão: Apesar de serem pacientes de alta complexidade e alto risco, obteve-se boa resposta no controle pressórico, enquanto no controle da dislipidemia os resultados foram insatisfatórios, o que pode em parte ser explicado pelas opções terapêuticas disponíveis na rede pública de saúde.
Background: Coronary artery disease (CAD) is a major cause of hospitalization in Brazils Unified National Health System (SUS) and an important risk factor for ventricular dysfunction. CAD patients are rated as high cardiovascular risks, with increasingly tighter treatment targets.Objective: To assess traditional CAD risk factor controls and treatment targets among CAD patients.Methods: A retrospective analysis was conducted of the medical records of patients seen at the residency outpatient clinic at a tertiary healthcare facility that is a cardiology reference center in the SUS from April 2013 to April 2014. The inclusion criteria were met by 110 patients.Results: Among the included patients, 68.1% were male, with an average age of 60.1±9.2 years; 90.9% were diagnosed with hypertension; 42.7% with DM, 81.8% with dyslipidemia (DLP), 25.4% were smokers and 32.7% had positive family histories of CAD. Most (61%) received surgical and clinical treatment, followed by clinical and percutaneous treatment (20.9%) and finally clinical treatment only (18.1%). Regarding target controls, 78.1% had controlled blood pressure (SBP <140 mmHg and DBP <90 mmHg), 65.4% with TG <150 mg/dL; 87.2% with TC <200 mg/dL; HDL with 29.1%> 45 mg/dL; 65.4% with LDL <100 mg/dL; LDL and 27.2% with <70 mg/dL.Conclusion: Despite being high-complexity and high-risk patients, a good response was obtained only for blood pressure control, while the dyslipidemia control findings were unsatisfactory, which may be partly explained by the treatment options available in the SUS.
Subject(s)
Humans , Male , Female , Middle Aged , Coronary Artery Disease/complications , Coronary Artery Disease/therapy , Risk Factors , Therapeutics/methods , Coronary Angiography/methods , Diabetes Mellitus/therapy , Dyslipidemias/therapy , Epidemiologic Factors , Hypertension/therapy , Observational Study , Tertiary Care CentersABSTRACT
Homem de 43 anos de idade procurou o ambulatório com queixa de dor precordial em queimação, iniciada há cinco anos, aos médios esforços. Não apresentava fatores de risco para doença arterial coronariana. O eletrocardiograma apresentou ondas T negativas e com amplitude superior a 10 mm. A cintilografia miocárdica evidenciou no mapa polar o sinal solar polar map. A ressonância magnética cardíaca revelou importante hipertrofia do ventrículo esquerdo com predomínio do segmento apical, com maior espessura parietal de 22 mm e realce tardio mostrando exuberante captação tardia do contraste com distribuição mesocárdica difusa, confirmando a hipótese de doença de Yamaguchi.
A 43 year-old man with no risk factors for coronary artery disease visited the out-patient clinic complaining of burning chest pain that began five years ago with average effort. The electrocardiogram showed negative T waves wider than 10mm. Myocardial scintigraphy showed the solar polar sign in the polar map. Cardiac magnetic resonance imaging disclosed significant left ventricular hypertrophy with predominance of the apical segment with greater wall thickness of 22mm and delayed enhancement, showing ample delayed contrast uptake with diffuse mesocardial distribution, confirming the hypothesis of Yamaguchi disease.
Subject(s)
Humans , Adult , Cardiomyopathy, Hypertrophic , Cardiomyopathy, Hypertrophic/diagnosis , Cardiomyopathy, Hypertrophic/therapy , Chest Pain , Echocardiography, Doppler , Electrocardiography , Magnetic Resonance Spectroscopy , PrevalenceABSTRACT
Fundamentos: O controle dos fatores de risco cardiovascular em pacientes com doença arterial coronariana (DAC) é um grande desafio, principalmente nos pacientes mais graves nos quais as metas terapêuticas são mais rigorosas.Objetivo: Analisar a obtenção das metas terapêuticas e a prescrição das medicações nos pacientes portadores deDAC após revascularização miocárdica (CRM). Métodos: Analisados os prontuários de 68 pacientes submetidos à CRM, com pelo menos um ano deacompanhamento após a cirurgia. Pacientes submetidos à troca valvar associada foram excluídos da análise.Resultados: Quarenta e cinco (66,2%) pacientes eram do sexo masculino com média de idade de 60,3±9,1 anos. Aprincipal indicação para CRM foi angina instável (62%). Noventa e quatro por cento dos pacientes eram hipertensos, 28% diabéticos, 50% dislipidêmicos e 50% tinham história prévia de infarto agudo do miocárdio. A média da fração de ejeção foi 60±13%. A lesão do troncoda coronária esquerda ocorreu em 29% dos pacientes e o número médio de enxertos foi 2,7±0,75. Após um ano de pós-operatório, 73,0% dos pacientes usavam IECA, 86,6% betabloqueador, 83,0% AAS e 96,6% estatina. No pós-operatório, o controle dos fatores de risco foi obtido nas proporções: PAS<140mmHg (55,9%), PAD<90mmHg (62,7%), glicose<100mg% (41,1%), colesteroltotal<200mg% (70,9%),LDL<100mg% (57,7%) ou LDL<70mg% (28,8%), HDL>45mg% (32,0%) etriglicerídeos<150mg% (47,8%).Conclusão: Os pacientes após um ano de CRM apresentam índices de controle pressórico, glicêmico e lipídico inadequados. O uso das medicações para DAC foi considerado adequado, exceto para o uso de IECA que poderia ser mais utilizada.
Subject(s)
Humans , Male , Female , Middle Aged , Coronary Disease/surgery , Coronary Disease/therapy , Risk Factors , Secondary Prevention/methods , Myocardial Revascularization/methods , Myocardial RevascularizationABSTRACT
Fundamentos: A doença arterial coronariana é a principal causa de óbito no mundo e os pacientes submetidos àcirurgia de revascularização miocárdica (CRVM) constituem o grupo de maior risco. Objetivo: Analisar aspectos epidemiológicos na CRVM em hospital especializado em cirurgia cardíaca no Rio de Janeiro, entre agosto 2004 e junho 2009. Método: Estudo retrospectivo, realizado entre agosto2004 e junho 2009, em que se analisou a primeira CRVM em 1.029 pacientes consecutivos maiores de 18 anos.Foram analisados dados do pré-operatório e considerado o tipo de evolução hospitalar (alta versus óbito).Resultados: Média de idade 61,2±10,3 anos e 67,3% do sexo masculino, peso 72,0±13,6kg, altura 1,63±0,09m, índice de massa corporal 26,9±4,3kg/m2 e superfície corporal1,77±0,19m2. Cor da pele por autoclassificação observada: 75,8% brancos, 16,5% pardos e 7,7% pretos, versus a esperada segundo o IBGE 2008): branca=54,3%,parda=33,8%, preta=11,5% e amarela ou indígena=0,3% (p<0,0001). Fatores de risco cardiovascular: hipertensãoarterial sistêmica 88,3%, dislipidemia 66,4%, colesterol sérico 173±50,2mg/dl, história familiar 50,4%, diabetes mellitus 32,9% e tabagismo prévio 56,6%. EuroSCORE4,91±6,81% (quartis 1,40% e 5,26%). A mortalidade observada (8,89%) foi superior à esperada (4,91%)(p<0,0001). Conclusão: Conhecer os fatores de risco permite a prevenção, auxilia a decisão do médico e facilita a alocação de recursos. Houve predomínio inesperado e desproporcionados pacientes de cor da pele branca e elevada prevalência dos fatores de risco cardiovascular, além de mortalidadeacima do esperado neste grupo de pacientes.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Coronary Disease/surgery , Coronary Disease/mortality , Epidemiology , Hospitals, Special , Risk Assessment/methods , Risk Assessment , Myocardial Revascularization/mortality , Survival Analysis , Risk FactorsABSTRACT
Fundamentos: Nota-se crescente utilização da angiotomografia de arterias coronárias, encontrando-se na literatura grande variabilidade na dose de radiação empregada. Há preocupação mundial em relação à exposição à radiação ionizante em procedimentos médicos, sendo que estratégias para minimização da dose são fortemente encorajadas. Objetivos: Determinar a dose de radiação utilizada em clínica privada no Rio de Janeiro e fatores associados à redução da dose. Métodos: Estudos retrospectivo e observacional, envolvendo 232 pacientes consecutivos submetidos à angiotomografia de artérias coronárias de 64 detectores por indicação clínica, utilizando-se técnicas visando à redução da dose de radiação. Resultados: A dose média geral de radiação empregada foi 7,6mSv, sem diferença na dose aplicada em homens e mulheres (7,9mSv vs. 7,0mSv, respectivamente, p=0,15). A utilização de modulação de dose pelo eletrocardiograma (ECG) e tensão do tubo de 100kV estão ambas associadas à queda de aproximadamente 50 por cento cada na dose. Fatores como idade avançada e presença de stents estão associados à maior exposição. Conclusões: A dose de radiação utilizada rotineiramente...
Background: In parallel to an upsurge in the use of computed tomography coronary angiography (CTCA), the literature varies widely in terms of radiation doses, prompting worldwide concern about radiation exposure in medical procedures, with strong supportfor strategies aimed at reducing these doses. Objectives: To determine the radiation dose employed in CTCA studies in a private clinic at Rio de Janeiro, Brazil, and the factors associated with lower radiation doses. Methods: Retrospective observational study of 232consecutive patients clinically referred for 64-slice CTCA with radiation dose r eduction techniques. Results: The mean radiation dose was 7.6mSv, with no difference between men and women (7.9mSv vs. 7.0mSv, respectively, p=0,15). Electrocardiogram (ECG) dose modulation and reduced 100kV tubevoltage are associated with dose reductions of approximately 50% each. Factors such as increasing age and the presence of coronary stents are associated with higher exposure. Conclusions: The routine radiation dose used with exposure minimization techniques...
Subject(s)
Humans , Male , Female , Middle Aged , Coronary Disease/complications , Radiation/classification , Risk FactorsABSTRACT
Fundamentos: O tratamento da doença arterial coronariana (DAC) tem como base o controle dos seus fatores de risco. Com a divulgação de diretrizes para o manejo desses fatores, supõe-se que pacientes encaminhados para a cirurgia de revascularização do miocárdio (CRM), após otimização do tratamento clínico, encontrem-se de acordo com as metas estabelecidas. Objetivo: Avaliar, em pacientes internados para CRM, colesterol, glicemia, pressão arterial (PA) e índice de massa corporal (IMC), a fim de conhecer a adesão a metas estabelecidas para controle de hipercolesterolemia, diabetes, hipertensão arterial e obesidade. Métodos: Foram estudados 331 pacientes. Adesão a metas de controle foi considerada presente se colesterol total <200mg/dl, glicemia de jejum <110mg/dl, PA<140/90mmHg em não diabéticos e <130/80mmHg em diabéticos, e IMC <25kg/m². Resultados: Controle da hipercolesterolemia foi encontrado em 84 por cento dos pacientes e controle do diabetes, em 67 por cento. A PA encontrava-se dentro das metas...
Subject(s)
Humans , Male , Female , Diabetes Mellitus/diagnosis , Coronary Disease/complications , Coronary Disease/diagnosis , Guidelines as Topic/standards , Hypertension/complications , Hypertension/diagnosis , Risk FactorsABSTRACT
Introduction: Congestive heart failure (CHF) is defined by a cardiac deficit in supplying normal oxygen and nutrient demands to the body. Among the many drug therapies for relief of CHF symptoms are diuretics in the treatment of edemas associated with this condition, which prevent fluid accumulation in tissues, and relieve the symptoms. Furosemide is a loop diuretic that is commonly used to this end, whose most common side effect is electrolyte imbalance, particularly hypokalemia. Potassium supplementation during treatment is recommended at a preventive measure. Objectives: To evaluate the clinical response to the use of the combination of furosemide and potassium chloride in patients presenting non-acute CHF, with respect to: 1) Signs and symptoms of CHF 2) Serum sodium and potassium levels registered in the patient chart 3) Incidence of laboratory alterations 4) Incidence of adverse events.Materials and Methods: This was a descriptive, analytic, retrospective study performed at Hospital Universitário Constantino Otaviano, UNIFESO, evaluating medical charts of patients presenting non-acute CHF who were treated with the combination of furosemide and potassium chloride. Only patients presenting laboratory data from before and after treatment were included. For each patient, the hospital chart was analyzed in order to complete the Clinical Research Form (CRF). The CRFs were filled, stored, coded, and the data were analyzed using GraphPad Prism 5.0 software. Results: There was a clinically significant decrease from pretreatment in the number of patients presenting all signs and symptoms of CHF, with the exception of nausea. Vital signs improved significantly in relation to pretreatment values. Sodium and potassium levels decreased, but remained within reference range, as did other laboratory evaluations performed. In addition to the furosemide + potassium chloride treatment, 59/60 patients were prescribed additional medications. A total of 35 adverse events were...
Subject(s)
Humans , Potassium Chloride , Furosemide , Heart FailureABSTRACT
We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.
Subject(s)
Coronary Disease/complications , Heart Neoplasms/complications , Myxoma/complications , Aged , Coronary Angiography , Coronary Artery Bypass/methods , Coronary Disease/surgery , Echocardiography , Heart Atria , Heart Neoplasms/diagnosis , Heart Neoplasms/surgery , Humans , Incidental Findings , Male , Myxoma/diagnosis , Myxoma/surgery , Severity of Illness IndexABSTRACT
Descrevemos o caso de um paciente de 67 anos, portador de doença arterial coronariana obstrutiva, o qual, em avaliação pré-operatória para cirurgia de herniorrafia inguinal, realizou ecocardiograma demonstrando um volumoso tumor em átrio esquerdo, móvel, não-obstrutivo, com pedículo proveniente da veia pulmonar superior direita. O paciente realizou cineangiocoronariografia com ventriculografia esquerda, evidenciando lesão obstrutiva grave em terço médio da artéria descendente anterior, moderada em terço proximal da artéria circunflexa, no local de saída do primeiro ramo marginal, e coronária direita com lesão não-obstrutiva em terço distal. Havia, ainda, disfunção ventricular esquerda moderada. O paciente foi então submetido a cirurgia para retirada do tumor e revascularização do miocárdio. O exame histopatológico mostrou tratar-se de um mixoma.
We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.
Subject(s)
Aged , Humans , Male , Coronary Disease/complications , Heart Neoplasms/complications , Myxoma/complications , Coronary Angiography , Coronary Artery Bypass/methods , Coronary Disease/surgery , Echocardiography , Heart Atria , Heart Neoplasms/diagnosis , Heart Neoplasms/surgery , Incidental Findings , Myxoma/diagnosis , Myxoma/surgery , Severity of Illness IndexABSTRACT
Objetivo: Analisar o perfil clínico-cirúrgico de pacientes internados com diagnóstico definitivo de endocardite infecciosa (EI)(critérios de Duke) no ano de 2004. Métodos: Foram estudados, retrospectivamente, 22 pacientes consecutivos, admitidos no período de janeiro a dezembro de 2004 com diagnóstico de endocardite infecciosa. Resultados: 59 por cento eram do sexo masculino e o tempo médio de internação foi de 55,6 dias. A febre foi sintoma inicial mais frqüente. A valvulopatia reumática foi o fator predisponente cardíaco mais encontrado. 64 por cento das hemoculturas foram positivas e a válvula mitral foi a mais acomedida por vegetação. Todos os pacientes analisados apresentaram complicações da EI e, portanto, foram tratados com cirurgia cardíaca. O implante de prótese metálica mitral foi o procedimento mais realizado (11 casos). A taxa de óbito hospitalar foi de 13,6 por cento e o grau de concordância dos achados da ecocardiografia, cirurgia e anatomia patológica foi 81 por cento. Conclusão: O perfil clínico dos pacientes, a alta prevalência de complicações e a indicação cirúrgica em 100 por cento dos casos provavelmente se deveram ao perfil da Instituição (hospital de referência). Tal fato confirma a evidência de que a EI é doença de elevada complexidade e mortalidade