RESUMO
Obstructive sleep apnea (OSA) is characterized by upper airway collapse and airflow reduction despite respiratory effort, resulting in intermittent hypoxia and arousals, leading to a cascade of hemodynamic, autonomic, inflammatory, and metabolic effects, responsible for its adverse cardiovascular effect. OSA is an independent risk factor for cardiovascular disease, and its prevalence in patients presenting with acute coronary syndromes is up to 69%. Furthermore, OSA has been associated with increased risk of adverse events after an acute coronary syndrome. Continuous positive airway pressure is considered the mainstay of treatment of OSA and has been shown to reduce the risk of cardiovascular events. However, the proper time to start treatment in the acute setting is unknown. A prospective randomized clinical trial is currently underway to answer this question.
Assuntos
Síndrome Coronariana Aguda/etiologia , Apneia Obstrutiva do Sono/complicações , Síndrome Coronariana Aguda/epidemiologia , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Humanos , Prevalência , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapiaAssuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Índice de Gravidade de Doença , Idoso , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Obesidade/epidemiologia , Estudos Prospectivos , Radiografia , Fatores de TempoRESUMO
Natriuretic peptides such as brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are commonly used in the diagnosis and evaluation of heart failure. However, their utility in patients with chronic kidney disease (CKD) is less clear as renal dysfunction itself can be associated with elevated concentrations of these biomarkers. Given the high prevalence of left ventricular hypertrophy and left ventricular systolic dysfunction in patients with CKD, diagnosis or exclusion of heart failure becomes important in this population. Most studies to date indicate that upward adjustment of diagnostic cut points preserves the usefulness of both BNP and NT-proBNP in the CKD patient, with similar clinical performance of each biomarker. We review the role of natriuretic peptide in heart failure in the setting of chronic renal disease.
Assuntos
Insuficiência Cardíaca/diagnóstico , Nefropatias/complicações , Peptídeos Natriuréticos/metabolismo , Biomarcadores/metabolismo , Doença Crônica , GMP Cíclico/biossíntese , Humanos , Nefropatias/metabolismo , Diálise RenalRESUMO
In a patient with a recently placed stent, a stress echocardiogram clearly indicated ischemia in the territory of the stented vessel. Subsequent coronary angiography, undertaken because of presumed restenosis, showed the stented area to be widely patent. This prompted a review of stress echocardiograms performed in patients within 6 weeks of coronary stenting. Of 21 such cases, 3 additional patients were found to have false-positive results in the territory served by the stented vessel.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Ecocardiografia sob Estresse , Stents , Idoso , Angina Instável/diagnóstico por imagem , Cateterismo/métodos , Doença das Coronárias/fisiopatologia , Doença das Coronárias/terapia , Reestenose Coronária/diagnóstico por imagem , Teste de Esforço , Reações Falso-Positivas , Feminino , Humanos , Masculino , Recidiva , Terapia Trombolítica , Falha de TratamentoRESUMO
A case is reported of acute myocardial infarction (MI) in a previously stented left anterior descending coronary artery, which occurred shortly after uneventful dobutamine stress echocardiography. Myocardial infarction precipitated by dobutamine has been reported only rarely, as has exercise-related MI after stenting. This is the first case of dobutamine-induced MI in a recently stented artery.
