Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 20
Filtrar
1.
Arq Bras Cardiol ; 116(1): 77-86, 2021 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33566969

RESUMO

BACKGROUND: The physical examination enables prognostic evaluation of patients with decompensated heart failure (HF), but lacks reliability and relies on the professional's clinical experience. Considering hemodynamic responses to "fight or flight" situations, such as the moment of admission to the emergency room, we proposed the calculation of the acute hemodynamic index (AHI) from values of heart rate and pulse pressure. OBJECTIVE: To evaluate the in-hospital prognostic ability of AHI in decompensated HF. METHODS: A prospective, multicenter, registry-based observational study including data from the BREATHE registry, with information from public and private hospitals in Brazil. The prognostic ability of the AHI was tested by receiver-operating characteristic (ROC) analyses, C-statistics, Akaike's information criteria, and multivariate regression analyses. p-values < 0.05 were considered statistically significant. RESULTS: We analyzed data from 463 patients with heart failure with low ejection fraction. In-hospital mortality was 9%. The median AHI value was used as cut-off (4 mmHg⋅bpm). A low AHI (≤ 4 mmHg⋅bpm) was found in 80% of deceased patients. The risk of in-hospital mortality in patients with low AHI was 2.5 times that in patients with AHI > 4 mmHg⋅bpm. AHI independently predicted in-hospital mortality in acute decompensated HF (sensitivity: 0.786; specificity: 0.429; AUC: 0.607 [0.540-0.674]; p = 0.010) even after adjusting for comorbidities and medication use [OR: 0.061 (0.007-0.114); p = 0.025). CONCLUSIONS: The AHI independently predicts in-hospital mortality in acute decompensated HF. This simple bed-side index could be useful in an emergency setting. (Arq Bras Cardiol. 2021; 116(1):77-86).


Assuntos
Insuficiência Cardíaca , Brasil , Insuficiência Cardíaca/diagnóstico , Hemodinâmica , Mortalidade Hospitalar , Humanos , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes
7.
Clin Cardiol ; 42(12): 1181-1188, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31571248

RESUMO

BACKGROUND: Patient limitations guide selection of heart failure therapies, for which indications often specify New York Heart Association Class. OBJECTIVES: To determine the extent of patient-reported limitations during daily activities and compare to New York Heart Association class assigned by providers during the same visit, and to left ventricular ejection fraction (LVEF) group. METHODS AND RESULTS: While waiting for their appointment, 948 patients on return visits to an ambulatory HF clinic completed a written questionnaire assessing specific activity limitations, which were compared to physician-assigned NYHA class during the same visit. Patient-reported limitation to perform daily activity ranged from 25% for bathing to 61% for yardwork or housework and 71% for jogging or hurrying. Most patients who did not report limitations to perform daily life activities were correctly classified as NYHA I by the physicians (76%), but 12% of the 376 patients classified as NYHA I reported limitations to showering or bathing and 73% reported limitations while doing yardwork or house work. Limitation to walking was reported by 172 patients (50%) classified as class II. Limitations to walking one block were most common in patients with LVEF ≥40% compared to patients with LVEF <40%, and least commonly, in HF with better EF (improved from 31 ± 13 to 52 ± 7). CONCLUSIONS: Activity limitations are commonly reported by ambulatory HF patients, but underestimated by physicians. It is not clear how this should guide therapy validated for NYHA class but focused activity questions may merit wider use to track limitations and improvement in ambulatory HF.


Assuntos
Atividades Cotidianas , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Volume Sistólico , Inquéritos e Questionários , Função Ventricular Esquerda
9.
10.
Cardiovasc Ther ; 35(5)2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28715142

RESUMO

INTRODUCTION: Parasympathetic dysfunction may play a role in the genesis of arrhythmias in Chagas disease. AIM: This study evaluates the acute effects of pyridostigmine (PYR), a reversible cholinesterase inhibitor, on the occurrence of arrhythmias in patients with Chagas cardiac disease. METHOD: Following a double-blind, randomized, placebo-controlled, cross-over protocol, 17 patients (age 50±2 years) with Chagas cardiac disease type B underwent 24-hour Holter recordings after oral administration of either pyridostigmine bromide (45 mg, 3 times/day) or placebo (PLA). RESULTS: Pyridostigmine reduced the 24-hours incidence (median [25%-75%]) of premature ventricular beats-PLA: 2998 (1920-4870), PYR: 2359 (940-3253), P=.044; ventricular couplets-PLA: 84 (15-159), PYR: 33 (6-94), P=.046. Although the total number of nonsustained ventricular tachycardia in the entire group was not different (P=.19) between PLA (1 [0-8]) and PYR (0 [0-4]), there were fewer episodes under PYR in 72% of the patients presenting this type of arrhythmia (P=.033). CONCLUSION: Acute administration of pyridostigmine reduced the incidence of nonsustained ventricular arrhythmias in patients with Chagas cardiac disease. Further studies that address the use of pyridostigmine by patients with Chagas cardiac disease under a more prolonged follow-up are warranted.


Assuntos
Antiarrítmicos/administração & dosagem , Cardiomiopatia Chagásica/tratamento farmacológico , Inibidores da Colinesterase/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Brometo de Piridostigmina/administração & dosagem , Taquicardia Ventricular/prevenção & controle , Complexos Ventriculares Prematuros/prevenção & controle , Administração Oral , Antiarrítmicos/efeitos adversos , Doenças Assintomáticas , Brasil , Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/parasitologia , Inibidores da Colinesterase/efeitos adversos , Estudos Cross-Over , Método Duplo-Cego , Esquema de Medicação , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Brometo de Piridostigmina/efeitos adversos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/parasitologia , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/parasitologia , Complexos Ventriculares Prematuros/fisiopatologia
11.
J Strength Cond Res ; 31(6): 1525-1535, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28538301

RESUMO

The objective of this study is to evaluate the cardiorespiratory variables of Taekwondo athletes while performing incremental exercise test on an ergometer using a ramp protocol and to propose a specific protocol for assessing these physiological variables during Taekwondo practice. Fourteen athletes participated in 2 incremental exercise tests: a treadmill exercise test (TREADtest) and a Taekwondo-specific exercise test (TKDtest). The TKDtest consists in 1-minute stages of kicks with an incremental load between then. The subjects perform kicks each time a sound signal was heard. Heart rate (HR), oxygen uptake (V[Combining Dot Above]O2), and their reserve correspondents (V[Combining Dot Above]O2R and reserve heart rate [HRR]) were divided into quartiles to verify their kinetics along the tests. Significant difference between 2 tests was found only for V[Combining Dot Above]O2R (p = 0.03). Regarding the quartiles, significant differences were found for HR in the first (p = 0.030) and second (p = 0.003). Analyzing the regression curves, significant differences were found for HR for intercept (p = 0.01) and slope (p = 0.05) and HRR for slope (p = 0.02). Analysis showed that significant reliability, with intraclass correlation coefficient (ICC), was found for the V[Combining Dot Above]O2peak (ICC = 0.855, p = 0.003), V[Combining Dot Above]O2 in ventilatory thresholds 1 (ICC = 0.709, p = 0.03) and 2 (ICC = 0.848, p = 0.003). Bland-Altman analyses reported a mean difference ± the 95% limits of agreement of 2.2 ± 8.4 ml·kg·min to V[Combining Dot Above]O2peak. The TKDtest is reliable for measurement of cardiorespiratory variables, and the behavior of these variables differs mainly from TREADtest, probably because of the motor task performed.


Assuntos
Atletas , Aptidão Cardiorrespiratória/fisiologia , Teste de Esforço/métodos , Teste de Esforço/normas , Artes Marciais/fisiologia , Adolescente , Adulto , Ergometria , Tolerância ao Exercício/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Reprodutibilidade dos Testes , Adulto Jovem
12.
Eur J Appl Physiol ; 112(9): 3369-78, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22270484

RESUMO

Despite mortality from heart disease has been decreasing, the decline in death in women remains lower than in men. Hypertension (HT) is a major risk factor for cardiovascular disease. Therefore, approaches to prevent or delay the onset of HT would be valuable in women. Given this background, we investigated the effect of diet and exercise training on blood pressure (BP) and autonomic modulation in women with prehypertension (PHT). Ten women with PHT (39 ± 6 years, mean ± standard deviation) and ten with normotension (NT) (35 ± 11 years) underwent diet and exercise training for 12 weeks. Autonomic modulation was assessed through heart rate (HR) and systolic BP (SBP) variability, using time and frequency domain analyses. At preintervention, women with PHT had higher SBP (PHT: 128 ± 7 vs. NT: 111 ± 6 mmHg, p < 0.05) and lower HR variability [standard deviation of normal-to-normal beats (SDNN), PHT: 41 ± 18 vs. NT: 60 ± 19 ms, p < 0.05]. At post-intervention, peak oxygen consumption and muscular strength increased (p < 0.05), while body mass index decreased in both groups (p < 0.05). However, SBP decreased (118 ± 8 mmHg, p < 0.05 vs. preintervention) and total HR variability tended to increase (total power: 1,397 ± 570 vs. 2,137 ± 1,110 ms(2), p = 0.08) only in the group with PHT; consequently, HR variability became similar between groups at post-intervention (p > 0.05). Moreover, reduction in SBP was associated with augmentation in SDNN (r = -0.46, p < 0.05) and reduction in low-frequency power [LF (n.u.); r = 0.46, p < 0.05]. In conclusion, diet and exercise training reduced SBP in women with PHT, and this was associated with augmentation in parasympathetic and probably reduction in sympathetic cardiac modulation.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea/fisiologia , Dieta , Exercício Físico/fisiologia , Pré-Hipertensão/fisiopatologia , Adolescente , Adulto , Dieta/métodos , Regulação para Baixo , Terapia por Exercício , Feminino , Frequência Cardíaca/fisiologia , Humanos , Pessoa de Meia-Idade , Educação Física e Treinamento/métodos , Pré-Hipertensão/dietoterapia , Pré-Hipertensão/terapia , Adulto Jovem
13.
Clinics (Sao Paulo) ; 66(7): 1137-42, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21876964

RESUMO

OBJECTIVE: This study aimed to compare respiratory responses, focusing on the time-domain variability of ventilatory components during progressive cardiopulmonary exercise tests performed on cycle or arm ergometers. METHODS: The cardiopulmonary exercise tests were conducted on twelve healthy volunteers on either a cycle ergometer or an arm ergometer following a ramp protocol. The time-domain variabilities (the standard deviations and root mean squares of the successive differences) of the minute ventilation, tidal volume and respiratory rate were calculated and normalized to the number of breaths. RESULTS: There were no significant differences in the timing of breathing throughout the exercise when the cycle and arm ergometer measurements were compared. However, the arm exercise time-domain variabilities for the minute ventilation, tidal volume and respiratory rate were significantly greater than the equivalent values obtained during leg exercise. CONCLUSION: Although the type of exercise does not influence the timing of breathing when dynamic arm and leg exercises are compared, it does influence time-domain ventilatory variability of young, healthy individuals. The mechanisms that influence ventilatory variability during exercise remain to be studied.


Assuntos
Braço , Teste de Esforço/métodos , Perna (Membro) , Ventilação Pulmonar/fisiologia , Respiração , Adulto , Análise de Variância , Dióxido de Carbono/metabolismo , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Testes de Função Respiratória , Estatísticas não Paramétricas , Fatores de Tempo
14.
J Cardiothorac Surg ; 6: 62, 2011 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-21524298

RESUMO

BACKGROUND: The treatment of coronary artery disease (CAD) seeks to reduce or prevent its complications and decrease morbidity and mortality. For certain subgroups of patients, coronary artery bypass graft surgery (CABG) may accomplish these goals. The objective of this study was to assess the pulmonary function in the CABG postoperative period of patients treated with a physiotherapy protocol. METHODS: Forty-two volunteers with an average age of 63 ± 2 years were included and separated into three groups: healthy volunteers (n = 09), patients with CAD (n = 9) and patients who underwent CABG (n = 20). Patients from the CABG group received preoperative and postoperative evaluations on days 3, 6, 15 and 30. Patients from the CAD group had evaluations on days 1 and 30 of the study, and the healthy volunteers were evaluated on day 1. Pulmonary function was evaluated by measuring forced vital capacity (FVC), maximum expiratory pressure (MEP) and Maximum inspiratory pressure (MIP). RESULTS: After CABG, there was a significant decrease in pulmonary function (p < 0.05), which was the worst on postoperative day 3 and returned to the preoperative baseline on postoperative day 30. CONCLUSION: Pulmonary function decreased after CABG. Pulmonary function was the worst on postoperative day 3 and began to improve on postoperative day 15. Pulmonary function returned to the preoperative baseline on postoperative day 30.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Modalidades de Fisioterapia , Cuidados Pós-Operatórios/métodos , Insuficiência Respiratória/reabilitação , Mecânica Respiratória/fisiologia , Capacidade Vital/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Testes de Função Respiratória , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Fatores de Risco
15.
Clinics ; 66(7): 1137-1142, 2011. ilus, tab
Artigo em Inglês | LILACS | ID: lil-596898

RESUMO

OBJECTIVE: This study aimed to compare respiratory responses, focusing on the time-domain variability of ventilatory components during progressive cardiopulmonary exercise tests performed on cycle or arm ergometers. METHODS: The cardiopulmonary exercise tests were conducted on twelve healthy volunteers on either a cycle ergometer or an arm ergometer following a ramp protocol. The time-domain variabilities (the standard deviations and root mean squares of the successive differences) of the minute ventilation, tidal volume and respiratory rate were calculated and normalized to the number of breaths. RESULTS: There were no significant differences in the timing of breathing throughout the exercise when the cycle and arm ergometer measurements were compared. However, the arm exercise time-domain variabilities for the minute ventilation, tidal volume and respiratory rate were significantly greater than the equivalent values obtained during leg exercise. CONCLUSION: Although the type of exercise does not influence the timing of breathing when dynamic arm and leg exercises are compared, it does influence time-domain ventilatory variability of young, healthy individuals. The mechanisms that influence ventilatory variability during exercise remain to be studied.


Assuntos
Adulto , Humanos , Masculino , Braço , Teste de Esforço/métodos , Perna (Membro) , Ventilação Pulmonar/fisiologia , Respiração , Análise de Variância , Dióxido de Carbono/metabolismo , Consumo de Oxigênio/fisiologia , Testes de Função Respiratória , Estatísticas não Paramétricas , Fatores de Tempo
16.
Clin Physiol Funct Imaging ; 30(6): 420-5, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20718807

RESUMO

The influence of a very fast ramp rate on cardiopulmonary variables at ventilatory threshold and peak exercise during a maximal arm crank exercise test has not been extensively studied. Considering that short arm crank tests could be sufficient to achieve maximal oxygen consumption (VO2), it would be of practical interest to explore this possibility. Thus, this study aimed to analyse the influence of a fast ramp rate (20 W min⁻¹) on the cardiopulmonary responses of healthy individuals during a maximal arm crank ergometry test. Seventeen healthy individuals performed maximal cardiopulmonary exercise tests (Ultima CardiO2; Medical Graphics Corporation, St Louis, USA) in arm ergometer (Angio, LODE, Groningen, The Netherlands) following two protocols in random order: fast protocol (increment: 2 w/6 s) and slow protocol (increment: 1 w/6 s). The fast protocol was repeated 60-90 days after the 1st test to evaluate protocol reproducibility. Both protocols elicited the same peak VO2 (fast: 23.51 ± 6.00 versus slow: 23.28 ± 7.77 ml kg⁻¹ min⁻¹; P = 0.12) but peak power load in the fast ramp protocol was higher than the one in the slow ramp protocol (119 ± 43 versus. 102 ± 39 W, P < 0.001). There was no other difference in ventilatory threshold and peak exercise variables when 1st and 2nd fast protocols were compared. Fast protocol seems to be useful when healthy young individuals perform arm cardiopulmonary exercise test. The usefulness of this protocol in other populations remains to be evaluated.


Assuntos
Teste de Esforço , Frequência Cardíaca , Contração Muscular , Músculo Esquelético/fisiologia , Consumo de Oxigênio , Ventilação Pulmonar , Mecânica Respiratória , Adulto , Limiar Anaeróbio , Braço , Brasil , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Fatores de Tempo , Adulto Jovem
18.
Clinics (Sao Paulo) ; 64(4): 351-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19488594

RESUMO

INTRODUCTION: There are no available data addressing the potential clinical risks of open-water swimming competitions. OBJECTIVE: Address the risks of hypothermia and hypoglycemia during a 10-km open-water swimming competition in order to alert physicians to the potential dangers of this recently-introduced Olympic event. METHODS: This was an observational cross-sectional study, conducted during a 10-km open-water event (water temperature 21 degrees C). The highest ranked elite open-water swimmers in Brazil (7 men, 5 women; ages 21+/-7 years old) were submitted to anthropometrical measurements on the day before competition. All but one athlete took maltodextrine ad libitum during the competition. Core temperature and capillary glycemia data were obtained before and immediately after the race. RESULTS: Most athletes (83%) finished the race with mild to moderate hypothermia (core temperature <35 degrees C). The body temperature drop was more pronounced in female athletes (4.2+/-0.7 degrees C vs. male: 2.7+/-0.8 degrees C; p=0.040). When data from the athlete who did not take maltodextrine was excluded, capillary glycemia increased among athletes (pre 86.6+/-8.9 mg/dL; post 105.5+/-26.9 mg/dL; p=0.014). Time to complete the race was inversely related to pre- competition body temperature in men (r=-0.802; p=0.030), while it was inversely correlated with the change in capillary glycemia in women (r=-0.898; p=0.038). CONCLUSION: Hypothermia may occur during open-water swimming events even in elite athletes competing in relatively warm water. Thus, core temperature must be a chief concern of any physician during an open-water swim event. Capillary glycemia may have positive effects on performance. Further studies that include more athletes in a controlled setting are warranted.


Assuntos
Hipotermia/fisiopatologia , Natação/fisiologia , Adulto , Glicemia/metabolismo , Regulação da Temperatura Corporal/fisiologia , Estudos Transversais , Feminino , Humanos , Hipotermia/sangue , Masculino , Resistência Física , Fatores de Risco , Adulto Jovem
19.
Clinics ; 64(4): 351-356, 2009. graf, tab
Artigo em Inglês | LILACS | ID: lil-511938

RESUMO

INTRODUCTION: There are no available data addressing the potential clinical risks of open-water swimming competitions. OBJECTIVE: Address the risks of hypothermia and hypoglycemia during a 10-km open-water swimming competition in order to alert physicians to the potential dangers of this recently-introduced Olympic event. METHODS: This was an observational cross-sectional study, conducted during a 10-km open-water event (water temperature 21ºC). The highest ranked elite open-water swimmers in Brazil (7 men, 5 women; ages 21±7 years old) were submitted to anthropometrical measurements on the day before competition. All but one athlete took maltodextrine ad libitum during the competition. Core temperature and capillary glycemia data were obtained before and immediately after the race. RESULTS: Most athletes (83 percent) finished the race with mild to moderate hypothermia (core temperature <35ºC). The body temperature drop was more pronounced in female athletes (4.2±0.7ºC vs. male: 2.7±0.8ºC; p=0.040). When data from the athlete who did not take maltodextrine was excluded, capillary glycemia increased among athletes (pre 86.6±8.9 mg/dL; post 105.5±26.9 mg/dL; p=0.014). Time to complete the race was inversely related to pre- competition body temperature in men (r=-0.802; p=0.030), while it was inversely correlated with the change in capillary glycemia in women (r=-0.898; p=0.038). CONCLUSION: Hypothermia may occur during open-water swimming events even in elite athletes competing in relatively warm water. Thus, core temperature must be a chief concern of any physician during an open-water swim event. Capillary glycemia may have positive effects on performance. Further studies that include more athletes in a controlled setting are warranted.


Assuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Hipotermia/fisiopatologia , Natação/fisiologia , Glicemia/metabolismo , Regulação da Temperatura Corporal/fisiologia , Estudos Transversais , Hipotermia/sangue , Resistência Física , Fatores de Risco , Adulto Jovem
20.
Int J Cardiol ; 107(1): 138-9, 2006 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-16337518

RESUMO

Following a randomized, cross-over, and double-blind design, 14 patients with coronary heart disease were submitted, to maximal cardiopulmonary exercise tests on a treadmill, 2 h after the oral administration of either placebo or pyridostigmine bromide (45 mg), a reversible cholinesterase inhibitor. One observer, who was blind to the experimental condition, measured RR and QT intervals over the 12 electrocardiographic leads in the first and third minute of active recovery from exercise. Paired t test was used to compare each variable measured in the same moment after placebo and pyridostigmine. Pyridostigmine reduced the QTc interval in the first minute of active recovery when compared to placebo (P=0.004). Two patients, whose heart rate recovery (1st minute) was below normal values (patient 1=4 bpm; patient 2=7 bpm; i.e. <12 bpm) presented with correction of this variable after pyridostigmine ingestion (patient 1=22 bpm; patient 2=36 bpm). Prospective trials should evaluate the impact of cholinergic stimulation with pyridostigmine on mortality.


Assuntos
Inibidores da Colinesterase/uso terapêutico , Tolerância ao Exercício/efeitos dos fármacos , Exercício Físico/fisiologia , Sistema de Condução Cardíaco/efeitos dos fármacos , Isquemia Miocárdica/tratamento farmacológico , Brometo de Piridostigmina/uso terapêutico , Administração Oral , Idoso , Inibidores da Colinesterase/administração & dosagem , Teste de Esforço , Tolerância ao Exercício/fisiologia , Feminino , Humanos , Masculino , Brometo de Piridostigmina/administração & dosagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...