RESUMO
Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.
La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).
A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE. Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).
RESUMO
INTRODUCTION: The intricate relationship between Chagas disease and ischemic stroke remains unclear. Limited evidence exists concerning secondary prophylaxis, etiological diagnosis, and stroke-related determinants. This study aims to discern factors linked to stroke in Chagas disease by contrasting patients with and without a history of ischemic stroke. METHODS: Retrospective data from all outpatient Chagas disease patients from two Brazilian hospitals - one Chagas center and one stroke clinic - were examined. Descriptive analyses were conducted to identify stroke-associated factors. Variables were compared between patients with and without ischemic stroke history. RESULTS: Among 678 subjects, 72 had experienced stroke. Univariate associations with stroke included male gender, heart failure, prior or ongoing alcoholism, electrocardiographic features (non-sinus rhythm, left bundle branch, right bundle branch block, left anterosuperior fascicular block, atrial fibrillation), as well as echocardiographic findings indicative of reduced left ventricular ejection fraction and segmental abnormalities. After logistic regression (multivariate analysis), congestive heart failure, right bundle branch block, left anterosuperior divisional block, and atrial fibrillation retained independent associations. CONCLUSION: In this study, cardiac involvement emerged as the predominant factor correlated with stroke in Chagas disease. While atherosclerosis-related risk factors were prevalent, their influence on ischemic stroke in Chagas disease appeared limited.
Assuntos
Fibrilação Atrial , Cardiomiopatia Chagásica , Doença de Chagas , Insuficiência Cardíaca , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Masculino , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/complicações , Estudos de Casos e Controles , Estudos Retrospectivos , Volume Sistólico , Bloqueio de Ramo/complicações , Função Ventricular Esquerda , Doença de Chagas/complicações , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Fatores de Risco , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , AVC Isquêmico/complicações , Eletrocardiografia/efeitos adversosRESUMO
This study aimed to analyze the spatial pattern of natural infection index (NII) for triatomines and the risk of Chagas disease transmission in an endemic area of Northeastern Brazil. An ecological study was conducted, based on 184 municipalities in five mesoregions. The NII for triatomines was evaluated in the Pernambuco State, Brazil, from 2016 to 2018. Spatial autocorrelations were evaluated using Global Moran Index (I) and Local Moran Index (II) and were considered positive when I > 0 and p < 0.05, respectively. In total, 7,302 triatomines belonging to seven different species were detected. Triatoma brasiliensis had the highest frequency (53%; n = 3,844), followed by Triatoma pseudomaculata (25%; n = 1,828) and Panstrongylus lutzi (18.5%; n=1,366). The overall NII was 12%, and the higher NII values were P. lutzi (21%) and Panstrongylus megistus (18%). In the mesoregions of Zona da Mata, Agreste, Sertao, and Sertao do Sao Francisco, 93% of triatomines were detected indoors. The global spatial autocorrelation of I to NII was positive (0.2; p = 0.01), and II values calculated using BoxMap, MoranMap, Lisa Cluster Map were statistically significant for natural infections. With regard to the risk areas for the presence of triatomines, Zone 2 (the Agreste and Sertao regions) presented a relative risk of 3.65 compared to other areas in the state. Our study shows the potential areas of vector transmission of Chagas disease. In this study, the application of different methods of spatial analysis made it possible to locate these areas, which would not have been identified by only applying epidemiological indicators.
Assuntos
Doença de Chagas , Panstrongylus , Triatoma , Trypanosoma cruzi , Animais , Humanos , Brasil/epidemiologia , Insetos Vetores , Análise EspacialRESUMO
ABSTRACT This study aimed to analyze the spatial pattern of natural infection index (NII) for triatomines and the risk of Chagas disease transmission in an endemic area of Northeastern Brazil. An ecological study was conducted, based on 184 municipalities in five mesoregions. The NII for triatomines was evaluated in the Pernambuco State, Brazil, from 2016 to 2018. Spatial autocorrelations were evaluated using Global Moran Index (I) and Local Moran Index (II) and were considered positive when I > 0 and p < 0.05, respectively. In total, 7,302 triatomines belonging to seven different species were detected. Triatoma brasiliensis had the highest frequency (53%; n = 3,844), followed by Triatoma pseudomaculata (25%; n = 1,828) and Panstrongylus lutzi (18.5%; n=1,366). The overall NII was 12%, and the higher NII values were P. lutzi (21%) and Panstrongylus megistus (18%). In the mesoregions of Zona da Mata, Agreste, Sertao, and Sertao do Sao Francisco, 93% of triatomines were detected indoors. The global spatial autocorrelation of I to NII was positive (0.2; p = 0.01), and II values calculated using BoxMap, MoranMap, Lisa Cluster Map were statistically significant for natural infections. With regard to the risk areas for the presence of triatomines, Zone 2 (the Agreste and Sertao regions) presented a relative risk of 3.65 compared to other areas in the state. Our study shows the potential areas of vector transmission of Chagas disease. In this study, the application of different methods of spatial analysis made it possible to locate these areas, which would not have been identified by only applying epidemiological indicators.
Assuntos
Cardiologia , Sistema Cardiovascular , Miocardite , Brasil , Humanos , Miocardite/diagnóstico , Miocardite/terapia , Sociedades MédicasRESUMO
Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.
Assuntos
Doença de Chagas , Doença Aguda , Brasil/epidemiologia , Doença de Chagas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Doenças NegligenciadasRESUMO
ABSTRACT Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.
RESUMO
Objetivo: O objetivo desse trabalho é descrever as estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com Insuficiência Cardíaca de etiologia Chagásica. Método: Trata-se de um estudo descritivo, com olhar qualitativo, desenhado a partir de métodos descritivos e observacionais sobre estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com Insuficiência Cardíaca de etiologia chagásica em um ambulatório referência do Estado de Pernambuco, Brasil. Resultados: através da anamnese e do exame físico, são utilizadas estratégias de intervenções relacionadas ao uso correto das medicações, dieta alimentar, atividade física e vacinação. Realizam-se orientações sobre a doença e hábitos saudáveis, a fim de fortalecer o autocuidado e melhorar a adesão terapêutica. Conclusão: sabe-se que o tratamento a esses pacientes deve ser similar ao de IC de outras etiologias, porém a etiologia chagásica exige uma coleta de dados minuciosa, para que o cuidado seja mais individualizado e integral, considerando o contexto complexo e negligenciado desta doença. (AU).
Objective: This study aims to describe the therapeutic strategies used in nursing appointments given to patients with heart failure of Chagas etiology. Method: This is a descriptive study, with a qualitative perspective, designed from descriptive and observational methods on therapeutic strategies used in the nursing appointments of patients with Heart Failure of Chagas etiology in a reference clinic in the State of Pernambuco, Brazil. Results: Through anamnesis and physical examination, intervention strategies related to the correct use of medications, diet, physical activity and vaccination are used. There are given orientations about the disease and healthy habits in order to strengthen self-care and improve therapeutic adherence. Conclusion: It is known that the treatment of these patients must be similar to the ones of Heart Failure of other etiologies, but the Chagasic etiology requires detailed data collection, so that care is more individualized and comprehensive, considering the complexity and neglected context of this disease. (AU).
El objetivo de este trabajo es describir las estrategias terapéuticas utilizadas en las consultas de enfermería de pacientes con insuficiencia cardíaca de etiología chagásica. Se trata de un estudio descriptivo, con perspectiva cualitativa, diseñado a partir de métodos descriptivos y observacionales sobre las estrategias terapéuticas utilizadas en las consultas de enfermería de pacientes con Insuficiencia Cardíaca de etiología chagásica en un servicio ambulatorio de referencia en el Estado de Pernambuco, Brasil. A través de la anamnesis y la exploración física se implementan estrategias de intervención relacionadas con el correcto uso de medicamentos, dieta, actividad física y vacunación. Se dan orientaciones sobre la enfermedad y los hábitos saludables con el fin de fortalecer el autocuidado y mejorar la adherencia terapéutica. Se sabe que el tratamiento de estos pacientes debe ser similar al de la IC de otras etiologías, pero la etiología chagásica requiere que se realice una recolección de datos detallada, para que la atención sea más individual e integral, considerando el contexto complejo y lo desatendida que está dicha enfermedad. (AU).
Assuntos
Humanos , Masculino , Feminino , Doença de Chagas , Enfermagem Cardiovascular , Insuficiência Cardíaca , Cooperação e Adesão ao TratamentoRESUMO
Recent evidence suggests cardiac amyloidosis (CA) is a mostly underdiagnosed condition, particularly in the transthyretin-mediated form, and is a frequent cause of heart failure with preserved ejection fraction (HFpEF) in the elderly. New paradigms about CA also involve the development of disease-modifying specific therapies. This article summarizes these new concepts.
Evidências recentes sugerem que a amiloidose cardíaca é uma doença amplamente subdiagnosticada, particularmente na sua forma ligada à transtirretina, podendo ser uma causa comum de insuficiência cardíaca com fração de ejeção preservada (ICFEP) no idoso. Os novos paradigmas sobre a doença incluem o desenvolvimento de novas terapias específicas que modificam a história natural da doença. Este artigo traz uma síntese destes novos conceitos.
Assuntos
Amiloidose , Insuficiência Cardíaca , Idoso , Insuficiência Cardíaca/etiologia , Humanos , Pré-Albumina , Volume SistólicoRESUMO
Resumo Evidências recentes sugerem que a amiloidose cardíaca é uma doença amplamente subdiagnosticada, particularmente na sua forma ligada à transtirretina, podendo ser uma causa comum de insuficiência cardíaca com fração de ejeção preservada (ICFEP) no idoso. Os novos paradigmas sobre a doença incluem o desenvolvimento de novas terapias específicas que modificam a história natural da doença. Este artigo traz uma síntese destes novos conceitos.
Abstract Recent evidence suggests cardiac amyloidosis (CA) is a mostly underdiagnosed condition, particularly in the transthyretin-mediated form, and is a frequent cause of heart failure with preserved ejection fraction (HFpEF) in the elderly. New paradigms about CA also involve the development of disease-modifying specific therapies. This article summarizes these new concepts.
Assuntos
Humanos , Idoso , Insuficiência Cardíaca/etiologia , Amiloidose , Volume Sistólico , Pré-AlbuminaRESUMO
INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.
