Estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com insuficiência cardíaca de etiologia chagásica / Therapeutic strategies used in the nursing appointmentofpatients with heart failure of chagasical etiology / Experiencias de profesionales de enfermería sobre el (ir)respeto a los derechos humanos en el cuidado de personas hospitalizadas

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).

Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease.

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.

Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease

Abstract 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.

I Latin American Guidelines for the diagnosis and treatment of Chagas' heart disease: executive summary.

Much has been achieved in one century after Carlos Chagas' discovery. However, there is surely much to be done in the next decades. At present, we are witnessing many remarkable efforts to monitor the epidemiology of the disease, to better understand the biology of the T. cruzi and its interaction with human beings as well as the pathogenesis and pathophysiology of the complications in the chronic phase, and deal more appropriately and effectively with late cardiac and digestive manifestations. Although the vector and transfusion-derived transmission of the disease has been controlled in many countries, there remains a pressing need for sustained surveillance of the measures that led to this achievement. It is also necessary to adopt initiatives that enable appropriate management of social and medical conditions resulting from the migration of infected individuals to countries where the disease formerly did not exist. It's also necessary to standardize the most reliable methods of detection of infection with T. cruzi, not only for diagnosis purposes, but more crucially, as a cure criterion. The etiological treatment of millions of patients in the chronic stage of the disease is also to be unraveled. A renewed interest in this area is observed, including prospects of studies focusing on the association of drugs with benznidazole. We also wait for full evidence of the actual effectiveness of the etiological treatment to impact favorably on the natural history of the disease in its chronic phase. Eventually, cardiologists are primarily responsible for improving the clinical management of their patients with Chagas' disease, judiciously prescribing drugs and interventions that respect, as much as possible, the peculiar pathophysiology of the disease, wasting no plausible therapeutic opportunities.

Miocardiopatia periparto / Peripartum cardiomyopathy

Faz-se um relato das informaçöes obtidas no manuseio de 13 pacientes portadoras de miocardiopatia periparto e em associaçäo com revisäo efetuada na literatura mundial. Chama-se a atençäo para os aspectos mais atuais desta forma de miocardiopatia. Realiza-se, no transcorrer do trabalho, abordagem dos mais variados elementos envolvidos com a doença em foco, bem como sua incidência, etiopatogenia, quadro clínico, diagnóstico, tratamento e prognóstico

Aspectos especiais do teste ergométrico em pacientes portadores da síndrome de Wolf-Parkinson-White / Special aspects of the ergometric test in patients with Wolff-Parkinson-White syndrome

Realizou-se teste cicloergométrico em 51 pacientes, sendo 37 do sexo masculino e 14 do feminino, com idade média de 33,8 anos, todos portadores da síndrome de Wolff-Parkinson-White (WPW) e sem outras patologias associadas. Durante os exames näo foram observados sinais de comprometimento da funçäo cardíaca, nem diferença significativa da tolerância ao esforço físico, em relaçäo àquela observada na populaçäo considerada normal. Os principais objetivos foram a análise dos diferentes comportamentos do padräo de WPW diante do esforço físico, a freqüência de alteraçöes do segmento ST do tipo isquêmico, bem como a prevalência de arritmia cardíaca com o exercício. Acrescenta-se ainda uma revisäo da literatura referente à fisiopatologia das alteraçöes eletrocardiográficas durante o teste ergométrico e sua importância atual na identificaçäo do sub-grupo chamado de alto risco

Prolapso da valva mitral / Mitral valve prolapse

A freqüência com que se encontra o prolapso da valva mitral no cotidiano do cardiologista tem justificado os inúmeros trabalhos publicados sobre a síndrome, desde a sua descriçäo, na tentativa de esclarecer os aspectos controvertidos que ainda persistem. Tendo em vista a atualidade do tema, realizou-se a presente revisäo, enfatizando em especial os aspectos práticos do manuseio desses pacientes

Endomiocardiofibrose / Endomyocardial fibrosis

Revisa-se a literatura no que se relaciona aos aspectos clínicos, diagnósticos e terapêuticos da endomiocardiofibrose, ralatando em paralelo sua experiência. Discutem-se pontos controversos como a etiologia da doença e enfatiza-se no tratamento a abordagem cirúrgica que vem se revelando promissora nos casos selecionados

A lesäo apical na miocardiopatia chagásica / Apical lesion in chagasic myocardiopathy

Os autores realizam revisäo, assim como relatam sua experiência, com o estudo de nove casos, da chamada Lesäo Apical na Miocardiopatia Chagásica. Salientam a frequência, patogenia, aspectos clínicos, diagnóstico e tratamento dessa entidade, de ocorrência comum em nosso meio

HLA e doenças cardíacas / HLA and cardiac diseases

Realiza-se trabalho de revisäo com o objetivo de estudar a associaçäo de algumas doenças cardíacas com antígenos do sistema HLA. Para isto, säo revistos conceitos básicos da imunogenética e abordados alguns dos recentes progressos nessa área. Embora os informes sobre uma possível associaçäo entre HLA e doenças cardíacas ainda sejam bastante fragmentados e algumas vezes controversos, esses fatos, no entanto, näo invalidam a possibilidade desta associaçäo. As doenças cardíacas enfocadas säo: Cardiopatias Congênitas, Febre Reumática, Prolapso da Valva Mitral, Hipertensäo Arterial, Miocardiopatia Hipertrófica e Doenças Coronarianas