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1.
Clin Hemorheol Microcirc ; 60(3): 297-307, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24787628

RESUMO

OBJECTIVE: Heparin-induced Extracorporeal Low Density Lipoprotein Precipitation (HELP) Apheresis gives beneficial reductions in Low Density Lipoprotein (LDL) cholesterol levels; otherwise, extracorporeal circulation settings might elicit inflammation and platelet aggregation. The net effect of these variations on carotid hemodynamic has not been established. Aim of the present study was to investigate periprocedural variations of common carotid artery wall shear stress, circumferential wall tension, and Peterson's elastic modulus. METHODS: Measurements were sequentially performed on 22 procedures: immediately before apheresis (T1), within one hour after (T2), after 24 (T3) and 48 hours (T4). In order to confirm acute effects, in additional 30 procedures measurements were performed at T1 and T2. RESULTS: Mean shear stress was decreased at T2, with an improvement at T4. Mean circumferential wall tension showed an improvement at T4; arterial stiffness showed the same trend, but only close to statistical significance. The following 30 procedures, where measurements were performed at T1 and T2 only, confirmed previous results, showing a deep wall shear stress decrease at T2 (-21%). CONCLUSION: LDL apheresis seems to have a biphasic effect on common carotid hemodynamics: the acute worsening of shear stress, probably mediated by extracorporeal circulation, was followed by its improvement, possibly driven by LDL cholesterol reduction.


Assuntos
Remoção de Componentes Sanguíneos/métodos , Doenças Cardiovasculares/etiologia , Artéria Carótida Primitiva/metabolismo , Hipercolesterolemia/complicações , Circulação Extracorpórea , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade
2.
J Heart Lung Transplant ; 23(11): 1238-44, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15539121

RESUMO

BACKGROUND: Cardiac allograft vasculopathy (CAV) remains the major cause of death after cardiac transplantation during long-term follow-up. Nevertheless, annual angiographic evaluation is difficult to perform routinely. We evaluated the value of clinical risk factors and non-invasive testing for cardiac allograft vasculopathy in predicting cardiac events or death in asymptomatic patients with normal ventricular function during long-term follow-up after heart transplantation. METHODS: We studied 39 patients, mean aged 48 +/- 13 years, at 86 +/- 31 months after heart transplantation. Patients underwent thallium scintigraphy, treadmill stress testing, dobutamine stress echocardiography, and angiography to detect CAV. We prospectively observed all patients an additional 4 years for acute myocardial infarction, congestive heart failure, or death. RESULTS: Angiography detected CAV in 15 patients (38%). Three patients had acute myocardial infarction and another 7 had congestive heart failure, representing 25% of cardiac events during the study period. Nine deaths (23%) occurred during the same observation time. Univariate analysis showed that increased body mass index, positive dobutamine stress echocardiography results, and positive angiography results were associated significantly with cardiac events or death during follow-up. In the absence of coronary angiography, stepwise logistic regression identified positive dobutamine echocardiography results as the unique independent predictor of cardiac events (p = 0.001) or death (p = 0.002). CONCLUSION: Cardiac events and death after heart transplantation increased during long-term follow-up of this population. However, dobutamine stress echocardiography is well tolerated and, in the absence of routine angiographic evaluation, may be a strong predictor of these events.


Assuntos
Doença das Coronárias/mortalidade , Dobutamina , Ecocardiografia sob Estresse , Transplante de Coração/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Tempo
3.
Ann Thorac Surg ; 76(2): 607-10, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12902116

RESUMO

Humoral response emerges as an important component in acute graft rejection and a new challenge to clinicians in posttransplant care. Management of recurrent episodes and persistent activation of the humoral component of the immune system, despite the usual therapeutic approach to rejection, remains unknown. This article describes the successful use of methotrexate as an option for rescuing a graft in this worrisome situation.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Rejeição de Enxerto/prevenção & controle , Transplante de Coração/imunologia , Metotrexato/administração & dosagem , Doença Aguda , Adulto , Formação de Anticorpos/fisiologia , Cardiomiopatia Dilatada/diagnóstico , Relação Dose-Resposta a Droga , Esquema de Medicação , Sobrevivência de Enxerto , Transplante de Coração/efeitos adversos , Transplante de Coração/métodos , Humanos , Masculino , Prognóstico , Imunologia de Transplantes , Resultado do Tratamento
4.
Arq Bras Cardiol ; 78(6): 553-60, 2002 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-12185855

RESUMO

OBJECTIVE: The 6-minute walk test is an way of assessing exercise capacity and predicting survival in heart failure. The 6-minute walk test was suggested to be similar to that of daily activities. We investigated the effect of motivation during the 6-minute walk test in heart failure. METHODS: We studied 12 males, age 45 +/- 12 years, ejection fraction 23 +/- 7%, and functional class III. Patients underwent the following tests: maximal cardiopulmonary exercise test on the treadmill (max), cardiopulmonary 6-minute walk test with the walking rhythm maintained between relatively easy and slightly tiring (levels 11 and 13 on the Borg scale) (6EB), and cardiopulmonary 6-minute walk test using the usual recommendations (6RU). The 6EB and 6RU tests were performed on a treadmill with zero inclination and control of the velocity by the patient. RESULTS: The values obtained in the max, 6EB, and 6RU tests were, respectively, as follows: O2 consumption (ml.kg-1.min-1) 15.4 +/- 1.8, 9.8 +/- 1.9 (60 +/- 10%), and 13.3 +/- 2.2 (90 +/- 10%); heart rate (bpm) 142 +/- 12, 110 +/- 13 (77 +/- 9%), and 126 +/- 11 (89 +/- 7%); distance walked (m) 733 +/- 147, 332 +/- 66, and 470 +/- 48; and respiratory exchange ratio (R) 1.13 +/- 0.06, 0.9 +/- 0.06, and 1.06 +/- 0.12. Significant differences were observed in the values of the variables cited between the max and 6EB tests, the max and 6RU tests, and the 6EB and 6RU tests (p < 0.05). CONCLUSION: Patients, who undergo the cardiopulmonary 6-minute walk test and are motivated to walk as much as they possibly can, usually walk almost to their maximum capacity, which may not correspond to that of their daily activities. The use of the Borg scale during the cardiopulmonary 6-minute walk test seems to better correspond to the metabolic demand of the usual activities in this group of patients.


Assuntos
Baixo Débito Cardíaco , Teste de Esforço/métodos , Atividades Cotidianas , Adulto , Análise de Variância , Tolerância ao Exercício , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Caminhada
5.
Circulation ; 106(9): 1097-103, 2002 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-12196335

RESUMO

BACKGROUND: Erectile dysfunction (ED) is common in patients with congestive heart failure (CHF). ED reduces quality of life, and it may affect compliance, thereby impairing the success of CHF treatment. METHODS AND RESULTS: In the first phase (fixed-dose double-blind, randomized, placebo-controlled, two-way crossover study), we studied in 23 men with CHF the effects of 50 mg sildenafil on exercise and neurohormonal activation. Patients underwent a treadmill 6-minute cardiopulmonary walking (6'WT) test followed by a maximal cardiopulmonary exercise test (ET). In the second phase, patients received sildenafil, taken as required for ED. Sildenafil reduced the heart rate (HR) (bpm) before the 6'WT (from 75+/-15 to 71+/-14, P=0.02) and ET (from 75+/-15 to 71+/-15, P=0.02); the systolic blood pressure (mm Hg) before the 6'WT (from 116+/-18 to 108+/-18, P=0.004) and ET (from 116+/-15 to 108+/-17, P=0.001); the diastolic blood pressure before the 6'WT (from 69+/-9 to 63+/-11, P=0.01) and ET (from 70+/-8 to 65+/-10, P=0.004); and the Ve/VCO2 slope during the 6'WT (from 32+/-7 to 31+/-6, P=0.04) and ET (from 33+/-8 to 31+/-5, P=0.03). Sildenafil attenuated the HR increment during the 6'WT (P=0.003) and ET (P=0.000). Sildenafil increased the peak *O2 from 16.6+/-3.4 to 17.7+/-3.4 mL/kg per min (P=0.025) and the exercise time from 12.3+/-3.4 to 13.7+/-3.2 minutes (P=0.003). Sildenafil improved most scores of International Index of Erectile Function. CONCLUSIONS: Sildenafil was tolerated and effective for ED treatment in CHF, and improved the exercise capacity. The reduction of HR during exercise with sildenafil could theoretically decrease the myocardial oxygen consumption during sexual activity.


Assuntos
Disfunção Erétil/tratamento farmacológico , Tolerância ao Exercício/efeitos dos fármacos , Insuficiência Cardíaca/tratamento farmacológico , Norepinefrina/sangue , Piperazinas/administração & dosagem , Vasodilatadores/administração & dosagem , Administração Oral , Pressão Sanguínea/efeitos dos fármacos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Disfunção Erétil/sangue , Disfunção Erétil/complicações , Teste de Esforço/efeitos dos fármacos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/efeitos dos fármacos , Satisfação do Paciente/estatística & dados numéricos , Piperazinas/efeitos adversos , Estudos Prospectivos , Purinas , Citrato de Sildenafila , Sulfonas , Resultado do Tratamento , Vasodilatadores/efeitos adversos
6.
Arq. bras. cardiol ; 78(6): 553-560, June 2002. graf
Artigo em Português, Inglês | LILACS | ID: lil-316151

RESUMO

OBJECTIVE: The 6-minute walk test is an way of assessing exercise capacity and predicting survival in heart failure. The 6-minute walk test was suggested to be similar to that of daily activities. We investigated the effect of motivation during the 6-minute walk test in heart failure. METHODS: We studied 12 males, age 45±12 years, ejection fraction 23±7 percent, and functional class III. Patients underwent the following tests: maximal cardiopulmonary exercise test on the treadmill (max), cardiopulmonary 6-minute walk test with the walking rhythm maintained between relatively easy and slightly tiring (levels 11 and 13 on the Borg scale) (6EB), and cardiopulmonary 6-minute walk test using the usual recommendations (6RU). The 6EB and 6RU tests were performed on a treadmill with zero inclination and control of the velocity by the patient. RESULTS: The values obtained in the max, 6EB, and 6RU tests were, respectively, as follows: O2 consumption (ml.kg-1.min-1) 15.4±1.8, 9.8±1.9 (60±10 percent), and 13.3±2.2 (90±10 percent); heart rate (bpm) 142±12, 110±13 (77±9 percent), and 126±11 (89±7 percent); distance walked (m) 733±147, 332±66, and 470±48; and respiratory exchange ratio (R) 1.13±0.06, 0.9±0.06, and 1.06±0.12. Significant differences were observed in the values of the variables cited between the max and 6EB tests, the max and 6RU tests, and the 6EB and 6RU tests (p<0.05). CONCLUSION: Patients, who undergo the cardiopulmonary 6-minute walk test and are motivated to walk as much as they possibly can, usually walk almost to their maximum capacity, which may not correspond to that of their daily activities. The use of the Borg scale during the cardiopulmonary 6-minute walk test seems to better correspond to the metabolic demand of the usual activities in this group of patients


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Baixo Débito Cardíaco , Teste de Esforço , Atividades Cotidianas , Análise de Variância , Tolerância ao Exercício , Fatores de Tempo , Caminhada
7.
Arq Bras Cardiol ; 78(2): 224-9, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11887198

RESUMO

OBJECTIVE: This study evaluated the effects of a new method of mitral valve replacement on left ventricular (LV) remodeling and heart failure functional class. METHODS: Eight patients (6 men) with severe mitral regurgitation from end-stage dilated cardiomyopathy underwent surgery. Five patients were in functional class (FC) IV, 2 were in FC III and 1 was in FC III/IV. Age ranged from 33 to 63 years. Both the anterior and posterior leaflets of the mitral valve were divided into hemileaflets. The resultant 4 pedicles were displaced under traction toward the left atrium and anchored between the mitral annulus and an implanted valvular prosthesis. The beating heart facilitated ideal chordae tendineae positioning. RESULTS: All patients survived and were discharged from the hospital. After a mean follow-up period of 6.5 months (1-12 m), 5 patients were in FC I; 2 in FC I/II; and 1 in FC II. The preoperative ejection fraction ranged from 19% to 30% (mean: 25.7 +/- 3.4 %), and the postoperative ejection fraction ranged from 21% to 40% (mean: 31.1 +/- 5.8%). Doppler echocardiography showed evidence of LV remodeling in 4 patients, including lateral wall changes and a tendency of the LV cavity to return to its elliptical shape. CONCLUSION: This technique of mitral valve replacement, involving new positioning of the chordae tendineae, allowed LV remodeling and improvement in FC during this brief follow-up period.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Remodelação Ventricular , Adulto , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Estudos Prospectivos , Ultrassonografia
8.
Arq. bras. cardiol ; 78(2): 224-229, Feb. 2002. ilus, tab
Artigo em Inglês | LILACS | ID: lil-303907

RESUMO

OBJECTIVE: This study evaluated the effects of a new method of mitral valve replacement on left ventricular (LV) remodeling and heart failure functional class. METHODS: Eight patients (6 men) with severe mitral regurgitation from end-stage dilated cardiomyopathy underwent surgery. Five patients were in functional class (FC) IV, 2 were in FC III and 1 was in FC III/IV. Age ranged from 33 to 63 years. Both the anterior and posterior leaflets of the mitral valve were divided into hemileaflets. The resultant 4 pedicles were displaced under traction toward the left atrium and anchored between the mitral annulus and an implanted valvular prosthesis. The beating heart facilitated ideal chordae tendineae positioning. RESULTS: All patients survived and were discharged from the hospital. After a mean follow-up period of 6.5 months (1-12 m), 5 patients were in FC I; 2 in FC I/II; and 1 in FC II. The preoperative ejection fraction ranged from 19 percent to 30 percent (mean: 25.7±3.4 percent), and the postoperative ejection fraction ranged from 21 percent to 40 percent (mean: 31.1± 5.8 percent). Doppler echocardiography showed evidence of LV remodeling in 4 patients, including lateral wall changes and a tendency of the LV cavity to return to its elliptical shape. CONCLUSION: This technique of mitral valve replacement, involving new positioning of the chordae tendineae, allowed LV remodeling and improvement in FC during this brief follow-up period


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cardiomiopatia Dilatada , Implante de Prótese de Valva Cardíaca , Valva Mitral , Insuficiência da Valva Mitral , Remodelação Ventricular , Cardiomiopatia Dilatada , Ventrículos do Coração , Valva Mitral , Insuficiência da Valva Mitral , Estudos Prospectivos
9.
Arq. bras. cardiol ; 76(5): 403-408, May 2001. ilus
Artigo em Português, Inglês | LILACS | ID: lil-288790

RESUMO

Infectious complications following heart transplantation are an important cause of morbidity and mortality. Generally, bacterial infections are predominant; however, fungal infections can be responsible for up to 25 percent of infectious events. We report the case of a patient who presented with histoplasmosis as an infectious complication five years after heart transplantation due to a chagasic cardiopathy. This association has rarely been reported in the international literature


Assuntos
Humanos , Masculino , Adulto , Cardiomiopatia Chagásica/cirurgia , Transplante de Coração/efeitos adversos , Histoplasmose/diagnóstico , Histoplasmose/etiologia
10.
Arq. bras. cardiol ; 76(1): 29-42, jan. 2001. tab, graf
Artigo em Português, Inglês | LILACS | ID: lil-279896

RESUMO

OBJECTIVE: To determine the predictive values of noninvasive tests for the detection of allograft vascular disease. METHODS: We studied 39 patients with mean ages of 48Ý13 years and a follow-up period of 86Ý13 months. The diagnosis of allograft vascular disease was made by cine-coronary arteriography, and it was considered as positive if lesions existed that caused > or = 50 percent obstruction of the lumen. Patients underwent 24h Holter monitoring, thallium scintigraphy, a treadmill stress test, and dobutamine stress echocardiography. Sensitivity, specificity, and positive and negative predictive values were determined in percentages for each method, as compared with the cine-coronary arteriography results. RESULTS: Allograft vascular disease was found in 15 (38 percent) patients. The Holter test showed 15.4 percent sensitivity, 95.5 percent specificity...


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Doença das Coronárias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Transplante de Coração
11.
Arq. bras. cardiol ; 75(5): 413-28, Nov. 2000.
Artigo em Português, Inglês | LILACS | ID: lil-273497

RESUMO

OBJECTIVE: To study the influence of immune and nonimmune risk factors on the development of allograft vasculopathy after cardiac transplantation. METHODS: We studied 39 patients with a mean age of 46 + or - 12 years. The following variables were analyzed: weight (kg), body mass index (kg/m²), donor's age and sex, rejection episodes in the first and second years after transplantation, systolic and diastolic blood pressures (mmHg), total cholesterol and fractions (mg/dL), triglycerides (mg/dL), diabetes, and cytomegalovirus infection. The presence of allograft vasculopathy was established through coronary angiography. RESULTS: Allograft vasculopathy was observed in 15 (38 percent) patients. No statistically significant difference was observed between the two groups in regard to hypertension, cytomegalovirus infection, diabetes, donor's sex and age, rejection episodes in the first and second years after transplantation, and cholesterol levels. We observed a tendency toward higher levels of triglycerides in the group with disease. Univariate and multivariate analyses showed statistically significant differences between the two groups when we analyzed the body mass index (24.53 + or - 4.3 versus 28.11 + or - 4.6; p=0.019). CONCLUSION: Body mass index was an important marker of allograft vasculopathy in the population studied


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Criança , Adolescente , Adulto , Doença das Coronárias/etiologia , Rejeição de Enxerto/imunologia , Transplante de Coração/efeitos adversos , Transplante de Coração/imunologia , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Brasil/epidemiologia , Cineangiografia , Seguimentos , Rejeição de Enxerto/epidemiologia , Modelos Logísticos , Fatores de Risco
12.
Arq. bras. cardiol ; 74(1): 5-12, Jan. 2000. tab, graf
Artigo em Português, Inglês | LILACS | ID: lil-262250

RESUMO

PURPOSE:To determine the indication for and incidence and evolution of temporary and permanent pacemaker implantation in cardiac transplant recipients. METHODS: A retrospective review of 114 patients who underwent orthotopic heart transplantation InCor (Heart Institute USP BR) between March 1985 and May 1993. We studied the incidence of and indication for temporary pacing, the relationship between pacing and rejection, the need for pemanent pacing and the clinical follow-up. RESULTS: Fourteen of 114 (12 per cent) heart transplant recipients required temporary pacing and 4 of 114 (3.5 per cent) patients required permanent pacing. The indication for temporary pacing was sinus node dysfunction in 11 patients (78.5 per cent) and atrioventricular (AV) block in 3 patients (21.4 per cent). The indication for permanent pacemaker implantation was sinus node dysfunction in 3 patients (75 per cent) and atrioventricular (AV) block in 1 patient (25 per cent). We observed rejection in 3 patients (21.4 per cent) who required temporary pacing and in 2 patients (50 per cent) who required permanent pacing. The previous use of amiodarone was observed in 10 patients (71.4 per cent) with temporary pacing. Seven of the 14 patients (50 per cent) died during follow-up. CONCLUSION: Sinus node dysfunction was the principal indication for temporary and permanent pacemaker implantation in cardiac transplant recipients. The need for pacing was related to worse prognosis after cardiac transplantation.


Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Bloqueio Cardíaco/terapia , Transplante de Coração/métodos , Marca-Passo Artificial , Nó Sinoatrial/fisiopatologia , Bloqueio Cardíaco/mortalidade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
13.
Arq. bras. cardiol ; 74(2): 141-8, Jan. 2000. tab, graf
Artigo em Português, Inglês | LILACS | ID: lil-262347

RESUMO

OBJECTIVE:To evaluate the use of methotrexate for the treatment of recurrent rejection in heart transplant recipients. METHODS: We studied 6 patients submitted to heart transplantation that showed rejection grade ü 3A (ISHLT) in two consecutives endomyocardial biopsy specimens. The dose was 11.26ñ3.75mg/week. The evaluated data were: ventricular function, endomyocardial biopsy, white cell count and number of rejection episodes before and after methotrexate administration. RESULTS: There was a reduction in the number of rejection episodes (5.17ñ1.47 before methotrexate; 2.33ñ1.75 after 6 months and 3.17ñ2.99 after 12 months of treatment, p=0.0193). The ventricular function was normal with ejection fraction of 76.5ñ4.80 before and 75.6ñ4.59 after methotrexate (p=0.4859). One patient did not finish the treatment because he showed signs of rejection associated with severe pericardial effusion. Five patients had a reduction in the white cell count (8,108ñ23.72 before and 5650ñ1350 after methotrexate, p=0.0961). One pulmonary infection with complete resolution after antibiotic treatment was observed. CONCLUSION: Methotrexate in low doses is an effective adjunct therapy in the treatment of recurrent rejection after heart transplantation.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adolescente , Pessoa de Meia-Idade , Assistência Ambulatorial , Rejeição de Enxerto/tratamento farmacológico , Transplante de Coração/imunologia , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Biópsia , Rejeição de Enxerto/sangue , Rejeição de Enxerto/patologia , Imunossupressores/administração & dosagem , Contagem de Leucócitos , Metotrexato/administração & dosagem , Resultado do Tratamento
14.
Arq. bras. cardiol ; 73(4): 339-48, out. 1999. tab, graf
Artigo em Português, Inglês | LILACS | ID: lil-255031

RESUMO

OBJECTIVE - To identify, the anaerobic threshold and respiratory compensation point in patients with heart failure. METHODS - The study comprised 42 Men,divided according to the functional class (FC) as follows: group I (GI) - 15 patients in FC I; group II (GII) - 15 patients in FC II; and group III (GIII) - 12 patients in FC III. Patients underwent a treadmill cardiopulmonary exercise test, where the expired gases were analyzed. RESULTS - The values for the heart rate (in bpm) at the anaerobic threshold were the following: GI, 122_27; GII, 117_17; GIII, 114_22. At the respiratory compensation point, the heart rates (in bpm) were as follows: GI, 145_33; GII, 133_14; GIII 123_22. The values for the heart rates at the respiratory compensation point in GI and GIII showed statistical difference. The values of oxygen consumption (VO2) at the anaerobic threshold were the following (in ml/kg/min): GI, 13.6_3.25; GII, 10.77_1.89; GIII, 8.7_1.44 and, at the respiratory compensation point, they were as follows: GI, 19.1_2.2; GII, 14.22_2.63; GIII, 10.27_1.85. CONCLUSION - Patients with stable functional class I, II, and III heart failure reached the anaerobic threshold and the respiratory compensation point at different levels of oxygen consumption and heart rate. The role played by these thresholds in physical activity for this group of patients needs to be better clarified


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Limiar Anaeróbio/fisiologia , Baixo Débito Cardíaco/fisiopatologia , Exercício/psicologia , Índice de Gravidade de Doença , Ergometria , Tolerância ao Exercício , Frequência Cardíaca/fisiologia , Consumo de Oxigênio/fisiologia , Espirometria
15.
Arq. bras. cardiol ; 73(4): 391-8, out. 1999. tab
Artigo em Português, Inglês | LILACS | ID: lil-255036

RESUMO

It has been reported that growth hormone may benefit selected patients with congestive heart failure. A 63-year-old man with refractory congestive heart failure waiting for heart transplantation, depending on intravenous drugs (dobutamine) and presenting with progressive worsening of the clinical status and cachexia, despite standard treatment, received growth hormone replacement (8 units per day) for optimization of congestive heart failure management. Increase in both serum growth hormone levels (from 0.3 to 0.8 mg/l) and serum IGF-1 levels (from 130 to 300ng/ml) was noted, in association with clinical status improvement, better optimization of heart failure treatment and discontinuation of dobutamine infusion. Left ventricular ejection fraction (by MUGA) increased from 13 percent to 18 percent and to 28 percent later, in association with reduction of pulmonary pressures and increase in exercise capacity (rise in peak VO2to 13.4 and to 16.2ml/kg/min later). The patient was"de-listed" for heart transplantation. Growth hormone may benefit selected patients with refractory heart failure


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Cardíaca/tratamento farmacológico , Hormônio do Crescimento Humano/uso terapêutico , Caquexia/etiologia , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Hormônio do Crescimento Humano/sangue , Resultado do Tratamento
16.
Arq. bras. cardiol ; 71(2): 169-73, ago. 1998. graf
Artigo em Português | LILACS | ID: lil-241756

RESUMO

Objetivo - Os efeitos dos Beta-bloqueadores n insuficiência cardiaca (IC) refratária näo tem sido adequadamente estudados. Investigamos os efeitos do caverdilol (Bloqueador Beta1, Beta2, Alfa) nos sintomas e na funçäo ventricular de portadores de IC refratária. Métodos - Foram estudados 21 pacientes, idade média de 56/10 anos, 9 em classe funcional (CF) IV, e 12 em CF III intermitente com IV. A dose inicial de carvedilol foi de 6,25mg e, se tolerada, aumentada progressivamente. A dose média final foi 42/11mg. Os pacientes foram submetidos a avaliaçöes clínicas e eletrocardiográficas seriadas. realizaram-se, antes e com 196/60 dias de evoluçäo, ecocardiograma e ventriculografia radioisotópica. Resultados - O medicamento foi tolerado em (76 por cento ) pacientes. Um paciente está em fase de titulaçäo em CF II. Com 196/60dias de evoluçäo observaram-se 8 pacientes em CF I e 7 em II; reduçäo da frequencia cardiaca de 96/15 para 67/10bpm (p<0,001); reduçäo do diametro diastólicofinal do ventrículo esquerdo (VE) de 73/13 para 66/12mm (ecocardiograma) (p<0,009); e aumento da fraçäo de ejeçäo de VE de 0,21/0,06 para 0,34/0,12 (p<0,003). Conclusäo - O carvedilol aos seus efeitos beneficos na funçäo ventricular ; remodelamento do CF é, se tolerado, uma potencial alternativa terapêutica no tratamento medicamentoso da IC refratária. Entretanto, estudos adicionais säo necessários para definiçäo do efeito a longo prazo neste específico subgrupo de pacientes.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Antagonistas Adrenérgicos beta/farmacologia , Carbazóis/farmacologia , Insuficiência Cardíaca/tratamento farmacológico , Função Ventricular/efeitos dos fármacos , Antagonistas Adrenérgicos beta/uso terapêutico , Carbazóis/uso terapêutico , Tolerância a Medicamentos
17.
Arq. bras. cardiol ; 68(4): 293-296, Abr. 1997.
Artigo em Português | LILACS | ID: lil-320333

RESUMO

We report the case of a 69 year-old male who developed congestive heart failure functional class IV (NYHA). The admission electrocardiogram (EKG) revealed sinus rhythm, PR interval of 240 ms, QRS interval of 110 ms, the QRS vector of 0 degree, Q waves from V1 to V6, tall R waves from V1 to V4 that decreased to V5 and V6. The vectocardiogram had anteriorization of the electrical forces of QRS, with vector half area in the horizontal plane at +60 degrees. After two years the patient had a myocardial infarction, the EKG at the admission had the same pattern and after two days developed important changes: enlargement of QRS interval with length of 160 ms, QRS vector of +100 degrees, R waves at D2, D3 e AVF that increase from D2 to D3, QS at D1, AVL, AVR and V1, rS at V2 and V3, R wave is notched and thickened+ at V5 and V6, that return to the initial pattern after one day. The patient progressed to death in the eighth day after infarction. This case reported a intermitent pattern of EKG that is an uncontestable proof to the existence of the left middle fascicular block.


Assuntos
Humanos , Masculino , Idoso , Bloqueio de Ramo , Insuficiência Cardíaca/fisiopatologia , Bloqueio de Ramo , Eletrocardiografia , Insuficiência Cardíaca/complicações , Vetorcardiografia
18.
Arq. bras. cardiol ; 68(4): 269-272, Abr. 1997.
Artigo em Português | LILACS | ID: lil-320339

RESUMO

PURPOSE: To determine through conventional radiology the type of ventricular involvement in endomyocardial fibrosis (EMF). METHODS: We analyzed 56 cases with EMF confirmed by angiocardiography and 9 by postmortem study, aged between 16 and 56 years (mean 32); there were 42 females. Only one radiologist analyzed X-rays without any knowledge of the cineangiography findings. RESULTS: The right side of the heart was primarily involved in 9 patients and the cardiac silhouette was characteristically globular and had oligemic pulmonary fields (66.66). The cardiothoracic ratio was 0.62 +/- 0.11. Out of 9 patients, 8 were female. The left side of the heart was established as being primarily involved in 11 cases and simulated rheumatic mitral disease. The cardiothoracic ratio was 0.51 +/- 0.09 and there were increased pulmonary fields in 63.6. The biventricular disease occurred in 36 cases. There were radiologic findings of right and left side. The cardiothoracic ratio was 0.63 +/- 0.06 and there was oligemic pulmonary fields in 38.8, increased pulmonary fields in 33.3and was normal in 27.7. There were 4:1 females. CONCLUSION: The radiological study is fundamental in the initial diagnosis of EMF. The type of involvement could be done in 66.07of all cases by chest X-ray.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Fibrose Endomiocárdica , Cineangiografia , Ventrículos do Coração
19.
Arq. bras. cardiol ; 68(2): 103-106, Fev. 1997.
Artigo em Português | LILACS | ID: lil-320369

RESUMO

PURPOSE: The aim of this study was to determine prevalence and the underlying mechanism of persistent palpitations after successful radiofrequency ablation of reentrant nodal tachycardia and atrioventricular tachycardia. METHODS: One hundred twenty consecutive patients (mean age of 36 +/- 16 years) who underwent radiofrequency catheter ablation of atrioventricular or reentrant nodal tachycardia constituted the analyzed group. Prevalence of palpitations was investigated during out-clinic visits and telephone interviews. Patients complaining of palpitations were divided in 2 groups: 1) those in whom palpitations lasted more than 30 seconds, and 2) those in whom the paroxysms lasted < 30 seconds (group II). All patients underwent clinical evaluation, ECG and Holter monitoring. Transesophageal atrial pacing and electrophysiologic stimulation were carried out when judged necessary. RESULTS: During a follow up period of 9 +/- 4 months, 52 patients complained of palpitations. In 31 group I patients, palpitations were related to ventricular and atrial premature beats as shown during Holter monitoring. In group II patients, eight had recurrence, five presented a new arrhythmia not recognized previously to the ablative procedure and two patients had their symptoms related to arrhythmias recognized before ablation but taken as asymptomatic. The mechanism of palpitations was not identified in six patients. CONCLUSION: Palpitations may persist in 43of patients who undergo radiofrequency ablation to treat reentrant nodal tachycardia and atrioventricular tachycardia. Recurrence and treatment are more likely when palpitations last longer than 30 seconds.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Ablação por Cateter/efeitos adversos , Arritmias Cardíacas , Taquicardia por Reentrada no Nó Atrioventricular , Idoso de 80 Anos ou mais , Arritmias Cardíacas , Ecocardiografia Transesofagiana , Eletrocardiografia Ambulatorial , Seguimentos , Prevalência , Recidiva
20.
Arq. bras. cardiol ; 67(6): 395-400, Dez. 1996.
Artigo em Português | LILACS | ID: lil-319223

RESUMO

PURPOSE: To investigate the short-term effects of the partial ventriculectomy (resection of lateral wall associated to mitral annuloplasty) on cardiac mechanics, contractility, shape and geometry of the left ventricle (LV). METHODS: Eleven male patients with severe congestive heart failure due to dilated cardiomyopathy were studied. The mean age was 51 +/- 7 years and the functional class was III (five patients) or IV (six patients) before the surgery. Patients were evaluated before and at 17 +/- 4 days after the surgery by simultaneous LV pressure and echocardiographic data. End-diastolic pressure (EDP-mmHg), wall stress (EDS-g/cm2) and diameter (EDD-cm); endsystolic wall stress (ESS) and diameter (ESD), fractional shortening (FS-) and maximal elastance (Emax-mmHg/ cm/s); the diastolic slope of the pressure-diameter (Kp-mmHg/cm) and stress-strain (Km-g/cm2) loops; shape (L/ EDD, adimensional, where L is the LV long axis) and geometry (Th/EDD, adimensional, where TH is the LV diastolic thickness) were obtained. RESULTS: 1) The ressected muscle fragments (diamond shape) were 10.8 +/- 1.3 cm in length and 5 +/- 0.6 cm in width; 2) all patients were discharged from hospital (15-29 days) in class I (eight cases), II (two), and III (one); 3) it was observed a decrease in EDP (24.3 +/- 7.7 x 17.5 +/- 3.2, p = 0.016); in EDD (8.0 +/- 0.7 x 7.2 +/- 0.8, p = 0.002); in EDS (57.9 +/- 26.8 x 37.4 +/- 19.2, p = 0.005); in ESS (199 +/- 46.9 x 102.8 +/- 33.1, p = 0.004); in ESD (7.1 +/- 0.7 x 5.7 +/- 0.8, p < 0.001); in Kp (22.3 +/- 15.9 x 11.5 +/- 6.9, p = 0.014); and in K(m) (467.4 +/- 212 x 214.6 +/- 87.4, p = 0.01); and, 4) it was noted an increase in FS (11.5 +/- 1.8 x 19.8 +/- 3.9, p < 0.001); in Emax (13.8 +/- 2.2 x 18.6 +/- 3.2, p < 0.001); and in L/EDD (1.32 +/- 0.1 x 1.47 +/- 0.13, p < 0.007) and Th/Dd (0.11 +/- 0.04 x 0.17 +/- 0.08, p < 0.038). CONCLUSION: The partial ventriculectomy showed multiple significant beneficial effects in these dilated myopathic hearts.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Cardiomiopatia Dilatada , Ventrículos do Coração/cirurgia , Procedimentos Cirúrgicos Cardíacos , Elasticidade , Eletrocardiografia , Hemodinâmica , Contração Miocárdica , Período Pós-Operatório , Função Ventricular
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