Hemodynamic effects of sildenafil in patients with stable ischemic heart disease.

BACKGROUND: Recently the new specific phosphodiesterase-5 inhibitor sildenafil was introduced into therapy for erectile dysfunction. The hemodynamic effects of sildenafil may be potentially hazardous for patients with cardiac disease. Sildenafil has been reported to augment the hypotensive effects of nitrates. There is sparse information regarding the systemic and pulmonary hemodynamic effects of a single oral dose of sildenafil in patients with stable angina. METHODS: Male patients referred for coronary angiography with diagnosis of chronic stable angina were enrolled in this study to assess the acute hemodynamic effects of sildenafil. Patients receiving long-acting or sublingual nitrates for the last 6 h before the study were excluded. Hemodynamic measurement were taken during right and left heart catheterization in the basal state and 60 min after 50 mg of oral sildenafil. RESULTS: Twelve patients (age 53+/-7 years) were studied. All had stable angina CCS class II or III. Four had previous myocardial infarction. By coronary angiography, seven patients had at least one coronary artery with >70% stenosis, four had at least one with 50-70% stenosis, and one had only intimal irregularities. There were no significant effects of sildenafil on systemic or pulmonary arterial pressure, left ventricle end diastolic pressure, cardiac output, and systemic or pulmonary vascular resistance (P>0.05 for all). No adverse events were observed. CONCLUSION: A single oral dose of sildenafil had no significant hemodynamic effect in supine patients with stable angina. Isolated administration of sildenafil does not appear to be associated to adverse cardiovascular effects.

Acute myocardial infarction: the first manifestation of ischemic heart disease and relation to risk factors.

OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04) and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03). The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

Infarto agudo do miocárdio. Primeira manifestação da cardiopatia isquêmica e relação com fatores de risco / Acute myocardial infarction. The first manifestation of ischemic heart disease and relation to risk factors

OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1 percent were males, 90.4 percent were white, 73.1 percent were older than 55 years, and 53.8 percent were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49 percent of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95 percent CI=0.06-0.59; P=0.04) and left ventricular hypertrophy (RR=0.27; 95 percent CI=0,.8-0.88; P=0.03). The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50 percent. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels

Os recém-nascidos sentem dor quando submetidos à sondagem gástrica? / Do newborn infants feel pain when submitted to gastric suctioning?

Objetivo; avaliar parâmetros fisiológicos e comportamentais para verificar se o recém-nascido sente dor durante a passagem da sonda gástrica. Métodos: 50 recém-nascidos hígidos com idade gestacional superior a 33 semanas e com peso ao nascer superior a 1.999 g foram submetidos a sondagem gástrica e, após, randomizados por sorteio simples em dois grupos: Fricção/Punção e Punção/Fricção. Os recém-nascidos eram avaliados através da escala NIPS - Neonatal Infant Pain Scale- (0-7 pontos, dor >3) por dois observadores independentes em três momentos: um minuto antes, durante e um minuto após a sondagem gástrica, punção e fricção do pécom monitorização simultânea da frequência cardíaca, da frequência respiratoria e da saturação de oxigênio da hemoglobina. Resultados: a frequênciaa respiratória diminuiu somente durante a sondagem gástrica (p=0,004). A frequência cardíaca diminuiu durante a sondagem gástrica (p=0,001), durante a punção no grupo Fricção/Punção (p=0,01) e durante a fricção no grupo Punção/Fricção (p=0,022). A saturação de oxigênio da hemoglobina não se alterou nos três procedimentos. Em relação aos resultados obtidos com a escala NIPS em ambos os grupos. os recém-nascidos sentiram doe durante a sondagem gástrica e a punção, e não na fricção 9Friedman, p<0,0001). Conclusões: durante o procedimento da sondagem gástrica, os recém-nascidos responderam como se esse fosse um estímulo doloroso. As alterações fisiológicas não se mostraram específicas nem sensíveis para avaliação de dor em recém-nascidos