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2.
Artigo em Inglês | MEDLINE | ID: mdl-33656833

RESUMO

INTRODUCTION: The presence of mild to moderate pericardial effusion after cardiac surgery is common and oral medical therapy is usually able to treat it. Larger effusions are less frequent and surgical intervention is usually necessary. However, there are some rare cases of large effusions that are recurrent even after intervention and become challenging to treat. METHODS: We describe the case of a patient submitted to coronary artery bypass grafting (CABG) without any intraoperative complications, who was regularly discharged from the hospital. She was referred to our emergency department twice after surgery with large pericardial effusion that was drained. Even after those two interventions and with adequate oral medication, the large effusion recurred. RESULTS: During follow-up, the patient had her symptoms resolved, with no need for further hospital admission. Her echocardiograms after the last intervention showed no pericardial effusion. The present surgical technique demonstrated to be easy to perform, thus it should be considered as a treatment option for these rare cases of large and repetitive effusions, which do not respond to the traditional methods. CONCLUSIONS: In challenging cases of recurrent and large pericardial effusions, the pericardial-peritoneal window is an alternative surgical technique that brings clinical improvement and diminishes the risk of cardiac tamponade.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32981855

RESUMO

INTRODUCTION: A volumetric approach to measure stent expansion derived from optical coherence tomography (OCT) is superior in regards to clinical outcomes when compared to the conventional method. The current software already performs a semi-automatic assessment and it is available as a clinical tool, however data is still scarce. We evaluated the stent expansion analysis that uses a volumetric vessel model, called minimum expansion index - MEI and compared to the conventional model, which utilizes the minimum stent area expansion (MSAx) indexed to the references, and its potential impact on procedural decision-making strategy in percutaneous coronary intervention. METHODS: This was a prospective, all-comers single center study, from all patients undergoing OCT-guided PCI between September 2018 and May 2019. We utilized the APTIVUE™ OPTIS 5.2 software (Abbott, Santa Clara, CA) to evaluate MEI and MSAx measurements after reference adjustments. RESULTS: We included 100 patients with mean age of 64 ± 12.5 years, 68% were men, and the main arteries analyzed through OCT were LAD (48%), RCA (31%) and LCx (21%). The mean MEI was 77.6% ± 16.7% and the mean MSAx was 71.6% ± 16.9%. MEI location differed from MSAx in 70% of cases, and in those cases the mean distance between MEI and MSAx was 15.3 mm ± 12.4 mm. In 53% of the times, the stent underexpansion based on MEI was located proximally to the MSAx by 18.1 mm ± 11.8 mm. Furthermore, in 42% of the total cases, MEI would change the intervention strategy based on the stent underexpansion being in a different location ≥10 mm in comparison to MSAx (34%) associated with the discrepancy between expansion indexes for MEI and MSAx (22%). CONCLUSION: We concluded that MEI location did not correlate to the conventional MSAx in two thirds of the cases. Moreover, compared to MEI, the MSAx assessment yielded lower expansion values in different stent positions, potentially changing the appropriate post-stent optimization, which thus would impact the decision-making strategy in almost half of the patients.

5.
Artigo em Inglês | MEDLINE | ID: mdl-32552523

RESUMO

Endovascular Therapeutic hypothermia (ETH) reduces the damage caused by postischemia reperfusion injury syndrome in cardiopulmonary arrest and has already established its role in patients with sudden death; however, its role in ST-segment elevation myocardial infarction (STEMI) remains controversial. The objectives of this study were to investigate the safety, feasibility, and 30-day efficacy of rapid induction of therapeutic hypothermia as adjunctive therapy to percutaneous coronary intervention (PCI) in patients with anterior and inferior STEMIs. This was a prospective, controlled, randomized, two-arm, prospective, interventional study of patients admitted to the emergency department within 6 hours of angina onset, with anterior or inferior STEMI eligible for PCI. Subjects were randomized to the hypothermia group (primary PCI+ETH) or to the control group (primary PCI) at a 4:1 ratio. The ETH was induced by 1 L cold saline (1-4°C) associated with the Proteus™ System, by cooling for at least 18 minutes before coronary reperfusion with a target temperature of 32°C ± 1°C. Maintenance of ETH was conducted for 1-3 hours, and active reheating was done at a rate of 1°C/h for 4 hours. Primary safety outcomes were the feasibility of ETH in the absence of (1) door-to-balloon (DTB) delay; (2) major adverse cardiac events (MACE) within 30 days after randomization. The primary outcomes of effectiveness were infarct size (IS) and left ventricular ejection fraction (LVEF) at 30 days. An as-treated statistical analysis was performed. Fifty patients were included: 35 (70%) randomized to the hypothermia group and 15 (30%) to the control group. The mean age was 58 ± 12 years; 78% were men; and associated diseases were 60% hypertension, 42% diabetes, and 72% dyslipidemia. The compromised myocardial wall was anterior in 38% and inferior in 62%, and the culprit vessels were left anterior descending artery (LAD) (40%), right coronary artery (38%), and left circumflex (18%). All 35 patients who attempted ETH (100%) had successful cooling, with a mean endovascular coronary reperfusion temperature of 33.1°C ± 0.9°C. The mean ischemic time was 375 ± 89.4 minutes in the hypothermia group and 359.5 ± 99.4 minutes in the control group. The mean DTB was 92.1 ± 20.5 minutes in the hypothermia group and 87 ± 24.4 minutes in the control group. The absolute difference of 5.1 minutes was not statistically significant (p = 0.509). The MACE rates were similar between both groups (21.7% vs. 20% respectively, p = 0.237). In the comparison between the hypothermia and control groups, no statistically significant differences were observed at 30 days between mean IS (13.9% ± 8% vs. 13.8% ± 10.8%, respectively, p = 0.801) and mean final LVEF (43.3% ± 11.2% vs. 48.3 ± 10.9%, respectively; p = 0.194). Hypothermia as an adjunctive therapy to primary PCI in STEMI is feasible and can be implemented without delay in coronary reperfusion. Hypothermia was safe regarding the incidence of MACE at 30 days. However, there was a higher incidence of arrhythmia and in-hospital infection in the hypothermia group, with no increase in mortality. Regarding efficacy, there was no difference in IS or LVEF at 30 days that would suggest additional myocardial protection with ETH. ClinicalTrials.gov: NCT02664194.

6.
Bernoche, Claudia; Timerman, Sergio; Polastri, Thatiane Facholi; Giannetti, Natali Schiavo; Siqueira, Adailson Wagner da Silva; Piscopo, Agnaldo; Soeiro, Alexandre de Matos; Reis, Amélia Gorete Afonso da Costa; Tanaka, Ana Cristina Sayuri; Thomaz, Ana Maria; Quilici, Ana Paula; Catarino, Andrei Hilário; Ribeiro, Anna Christina de Lima; Barreto, Antonio Carlos Pereira; Azevedo, Antonio Fernando Barros de Filho; Pazin, Antonio Filho; Timerman, Ari; Scarpa, Bruna Romanelli; Timerman, Bruno; Tavares, Caio de Assis Moura; Martins, Cantidio Soares Lemos; Serrano, Carlos Vicente Junior; Malaque, Ceila Maria Sant'Ana; Pisani, Cristiano Faria; Batista, Daniel Valente; Leandro, Daniela Luana Fernandes; Szpilman, David; Gonçalves, Diego Manoel; Paiva, Edison Ferreira de; Osawa, Eduardo Atsushi; Lima, Eduardo Gomes; Adam, Eduardo Leal; Peixoto, Elaine; Evaristo, Eli Faria; Azeka, Estela; Silva, Fabio Bruno da; Wen, Fan Hui; Ferreira, Fatima Gil; Lima, Felipe Gallego; Fernandes, Felipe Lourenço; Ganem, Fernando; Galas, Filomena Regina Barbosa Gomes; Tarasoutchi, Flavio; Souza, Germano Emilio Conceição; Feitosa, Gilson Soares Filho; Foronda, Gustavo; Guimarães, Helio Penna; Abud, Isabela Cristina Kirnew; Leite, Ivanhoé Stuart Lima; Linhares, Jaime Paula Pessoa Filho; Moraes, Junior João Batista de Moura Xavier; Falcão, João Luiz Alencar de Araripe; Ramires, Jose Antônio Franchini; Cavalini, José Fernando; Saraiva, José Francisco Kerr; Abrão, Karen Cristine; Pinto, Lecio Figueira; Bianchi, Leonardo Luís Torres; Lopes, Leonardo Nícolau Geisler Daud; Piegas, Leopoldo Soares; Kopel, Liliane; Godoy, Lucas Colombo; Tobase, Lucia; Hajjar, Ludhmila Abrahão; Dallan, Luís Augusto Palma; Caneo, Luiz Fernando; Cardoso, Luiz Francisco; Canesin, Manoel Fernandes; Park, Marcelo; Rabelo, Marcia Maria Noya; Malachias, Marcus Vinícius Bolívar; Gonçalves, Maria Aparecida Batistão; Almeida, Maria Fernanda Branco de; Souza, Maria Francilene Silva; Favarato, Maria Helena Sampaio; Carrion, Maria Julia Machline; Gonzalez, Maria Margarita; Bortolotto, Maria Rita de Figueiredo Lemos; Macatrão-Costa, Milena Frota; Shimoda, Mônica Satsuki; Oliveira-Junior, Mucio Tavares de; Ikari, Nana Miura; Dutra, Oscar Pereira; Berwanger, Otávio; Pinheiro, Patricia Ana Paiva Corrêa; Reis, Patrícia Feitosa Frota dos; Cellia, Pedro Henrique Moraes; Santos Filho, Raul Dias dos; Gianotto-Oliveira, Renan; Kalil Filho, Roberto; Guinsburg, Ruth; Managini, Sandrigo; Lage, Silvia Helena Gelas; Yeu, So Pei; Franchi, Sonia Meiken; Shimoda-Sakano, Tania; Accorsi, Tarso Duenhas; Leal, Tatiana de Carvalho Andreucci; Guimarães, Vanessa; Sallai, Vanessa Santos; Ávila, Walkiria Samuel; Sako, Yara Kimiko.
Arq. bras. cardiol ; 113(3): 449-663, Sept. 2019. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1038561
7.
Artigo em Inglês | MEDLINE | ID: mdl-30975579

RESUMO

We describe an interesting case of a 71 years old fragile female, with progressive shortness of breath on exertion and ankle swelling, cardiac failure NYHA class III. She also had chest irradiation due to Hodgkin's disease many years before, previous surgical aortic valve replacement using bioprosthetic stent-less Freestyle #25 mm valve (Medtronic, Inc) in 2000 for severe aortic stenosis, history of cardiac arrest in 2012 and angioplasty to ostial RCA, PCI to ostial RCA in 2014, CABG (RA graft to RCA) in 2014 (RCA intra-stent restenosis with refractory ischemia), anemia requiring regular transfusions, bronchiectasis and chronic kidney disease. Because of the great comorbidities, STS 4.9% and worsening of the symptoms due to severe aortic valve regurgitation, heart team decided to perform "valve-in-valve" Transcatheter Aortic Valve Replacement (VIV-TAVR), but we already predicted coronary occlusion while performing this procedure because of the low left main coronary ostium and short aortic valve sinus. So regarding the probable left main coronary occlusion during the valve implantation, we decided to perform the placement of a not deployed stent inside the left main prior to the valve procedure, and to deploy it in case the predicted left main occlusion occurred. So just after the VIV-TAVR procedure, we observed left main coronary occlusion and the patient got ischemic cardiogenic shock and cardiac arrest, so we performed immediate PCI and deployed the bailout stent. After some minutes of chest compressions, an Impella mechanical circulatory support system (Abiomed, Danvers, MA) had to be installed. Patient recovered spontaneous circulation, and after hemodynamic stabilization, she was sent to the Intensive Coronary Unit, without further complications. She was discharged successfully without neurological or cardiac sequelae after 1 week.

8.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.590-603.
Monografia em Português | LILACS | ID: biblio-1009128
9.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.655-664.
Monografia em Português | LILACS | ID: biblio-971559
10.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 23(3): 55-60, jul.-set.2013.
Artigo em Português | LILACS | ID: lil-754417

RESUMO

A educação continuada constitui um critério de avaliaçãode qualidade do ensino das instituições, sendo uma das ferramentasmais importantes na capacitação dos profissionaisda saúde, na atualização profissional e no aprimoramentoda equipe multidisciplinar. A simulação diminui a distânciaexistente entre o que se ensina na teoria e sua aplicabilidadena prática profissional. O treinamento com cenários é dividido,didaticamente, em três momentos: elaboração, execuçãoe debriefing. O debriefing é o momento utilizado para análisee reflexão do que foi vivido durante a simulação, para que sedescubra o que foi aprendido e sua aplicabilidade a partir deexperiências vividas em situações reais. A simulação clínicatambém permite que os profissionais estejam mais aptos a anteversituações clínicas adversas, possam cometer erros e, atémesmo, tirar suas dúvidas antes de lidar com situações reais,sempre em ambientes controlados e sob constante supervisão...


Continuing education is a major criterion for the evaluationof the quality of teaching institutions, so it is one of the mostimportant tools in the training of health professionals in professionalupdating and improving the multidisciplinary team.Simulation decreases the gap between what is taught in theoryand its applicability in practice. The training scenario is divideddidactically in three stages: preparation, execution anddebriefing. The debriefing is the time required for analysis andreflection of what was experienced during the simulation, sothat they disco ver what they have leamed and their applicabilityfrom experiences in real situations. Simulation also allowsclinical professionals to be more able to predict adverse clinicalsituations, so that they can make mistakes or even get therequestions solved before dealing with real situations, alwaysin controlled environments and under constant supervision...


Assuntos
Humanos , Capacitação em Serviço/ética , Tutoria/ética , Educação Médica Continuada/métodos , Simulação de Doença/diagnóstico
11.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 23(3): 61-64, jul.-set.2013.
Artigo em Português | LILACS | ID: lil-754418

RESUMO

A construção de um centro de simulação necessita deplanejamento cuidadoso. Ele deve ser funcional, prático,representar o ambiente real proposto e fornecer otimizaçãodas salas a fim de criar rotatividade e a possibilidade depraticar diferentes cenários com diferentes ambientes em ummesmo espaço físico. Sendo assim, algumas perguntas devemser respondidas antes da aquisição de qualquer equipamento...


Simulation Center provides diverse leaming opportunities in a safeand supportive environrnent to promote communication, collaboration,and integration of Cardiology and healthcare partnerswith a focus on preparing leamers to be competent, confident, andcompassionate health professionals. The simulation labs providean environrnent where the users may practice their proper clientassessment, critical thinking, intervention skills, and procedures...


Assuntos
Humanos , Capacitação em Serviço/classificação , Tutoria/métodos , Educação Médica Continuada/ética , Simulação/políticas
12.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 23(3): 66-71, jul.-set.2013.
Artigo em Português | LILACS | ID: lil-754419

RESUMO

Um exame clínico objetivamente estruturado é ummoderno tipo de exame frequentemente usado em ciênciasda saúde e em cardiologia. Ele é projetado para testaro desempenho da habilidade clínica ecompetência emhabilidades como comunicação, atuação no pré-hospitalar,na sala de emergência, exame clínico, procedimentosmédicos/prescrição, prescrição de exercícios, técnicasde mobilização, avaliação de imagens radiográficas elaboratórios e interpretação dos resultados...


Changes in medical practice that lirnit instruction time andpatient availability, the expanding options for diagnosis andmanagement, and advances in technology are contributing togreater use of simulation technology in medical education.High-technology simulations currently being used a cardiovasculardisease simulator, which can be used to simulate cardiacconditions; multimedia computer systems, which includespatient-centered, case-based programs that constitute a generalistcurriculum in cardiology. Some benefits of simulationtechnology include improvements in certain surgical technicalskills, in cardiovascular examination skills, and in acquisitionand retention ofknowledge compared with traditionallectures.These systems help to address the problem of poor skills trainingand proficiency and may provide a method for physiciansto beco me self-directed lifelong leamers...


Assuntos
Humanos , Competência Clínica , Capacitação em Serviço/classificação , Tutoria/métodos , Educação Médica Continuada/métodos , Competência Profissional , Simulação de Doença/diagnóstico
13.
Arq Bras Cardiol ; 100(2): 105-13, 2013 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23503818

RESUMO

Despite advances related to the prevention and treatment in the past few years, many lives are lost to cardiac arrest and cardiovascular events in general in Brazil every year. Basic Life Support involves cardiovascular emergency treatment mainly in the pre-hospital environment, with emphasis on the early recognition and delivery of cardiopulmonary resuscitation maneuvers focused on high-quality thoracic compressions and rapid defibrillation by means of the implementation of public access-to-defibrillation programs. These aspects are of the utmost importance and may make the difference on the patient's outcomes, such as on hospital survival with no permanent neurological damage. Early initiation of the Advanced Cardiology Life Support also plays an essential role by keeping the quality of thoracic compressions; adequate airway management; specific treatment for the different arrest rhythms; defibrillation; and assessment and treatment of the possible causes during all the assistance. More recently, emphasis has been given to post-resuscitation care, with the purpose of reducing mortality by means of early recognition and treatment of the post-cardiac arrest syndrome. Therapeutic hypothermia has provided significant improvement of neurological damage and should be performed in comatose individuals post-cardiac arrest. For physicians working in the emergency department or intensive care unit, it is extremely important to improve the treatment given to these patients by means of specific training, thus giving them the chance of higher success and of better survival rates.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Adulto , Brasil , Desfibriladores , Serviços Médicos de Emergência , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Respiração Artificial/métodos , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia
14.
Arq. bras. cardiol ; 100(2): 105-113, fev. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-667950

RESUMO

Apesar de avanços nos últimos anos relacionados à prevenção e a tratamento, muitas são as vidas perdidas anualmente no Brasil relacionado à parada cardíaca e a eventos cardiovasculares em geral. O Suporte Básico de Vida envolve o atendimento às emergências cardiovasculares principalmente em ambiente pré-hospitalar, enfatizando reconhecimento e realização precoces das manobras de ressuscitação cardiopulmonar com foco na realização de compressões torácicas de boa qualidade, assim como na rápida desfibrilação, por meio da implementação dos programas de acesso público à desfibrilação. Esses aspectos são de fundamental importância e podem fazer diferença no desfecho dos casos como sobrevida hospitalar sem sequelas neurológicas. O início precoce do Suporte Avançado de Vida em Cardiologia também possui papel essencial, mantendo, durante todo o atendimento, a qualidade das compressões torácicas, adequado manejo da via aérea, tratamento específico dos diferentes ritmos de parada, desfibrilação, avaliação e tratamento das possíveis causas. Mais recentemente dá-se ênfase a cuidados pós-ressuscitação, visando reduzir a mortalidade por meio do reconhecimento precoce e tratamento da síndrome pós-parada cardíaca. A hipotermia terapêutica tem demonstrado melhora significativa da lesão neurológica e deve ser realizada em indivíduos comatosos pós-parada cardíaca. Para os médicos que trabalham na emergência ou unidade de terapia intensiva é de grande importância o aperfeiçoamento no tratamento desses pacientes por meio de treinamentos específicos, possibilitando maiores chances de sucesso e maior sobrevida.


Despite advances related to the prevention and treatment in the past few years, many lives are lost to cardiac arrest and cardiovascular events in general in Brazil every year. Basic Life Support involves cardiovascular emergency treatment mainly in the pre-hospital environment, with emphasis on the early recognition and delivery of cardiopulmonary resuscitation maneuvers focused on high-quality thoracic compressions and rapid defibrillation by means of the implementation of public access-to-defibrillation programs. These aspects are of the utmost importance and may make the difference on the patient's outcomes, such as on hospital survival with no permanent neurological damage. Early initiation of the Advanced Cardiology Life Support also plays an essential role by keeping the quality of thoracic compressions; adequate airway management; specific treatment for the different arrest rhythms; defibrillation; and assessment and treatment of the possible causes during all the assistance. More recently, emphasis has been given to post-resuscitation care, with the purpose of reducing mortality by means of early recognition and treatment of the post-cardiac arrest syndrome. Therapeutic hypothermia has provided significant improvement of neurological damage and should be performed in comatose individuals post-cardiac arrest. For physicians working in the emergency department or intensive care unit, it is extremely important to improve the treatment given to these patients by means of specific training, thus giving them the chance of higher success and of better survival rates.


Assuntos
Adulto , Humanos , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Brasil , Desfibriladores , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar/terapia , Respiração Artificial/métodos , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia
16.
In. Timerman, Sergio; Dallan, Luís Augusto Palma; Geovanini, Glaucylara reis. Síndromes coronárias agudas e emergências cardiovasculares / Acute coronary syndromes and cardiovascular emergencies. São Paulo, Atheneu, 2013. p.265-281.
Monografia em Português | LILACS | ID: lil-719904
17.
Rev. bras. cardiol. invasiva ; 20(2): 204-207, abr.-jun. 2012. ilus
Artigo em Português | LILACS | ID: lil-649574

RESUMO

Os autores apresentam a experiência inicial do uso de dispositivo mecânico de reanimação AutoPulse®. O dispositivo foi utilizado em caso de parada cardiorrespiratória em sala dehemodinâmica, permitindo a continuidade do procedimentopercutâneo concomitantemente à ressuscitação cardiopulmonar. O dispositivo proporcionou compressões torácicas ininterruptas e efetivas, bem como liberou um médico da equipe paraoutras funções durante o procedimento. Houve dificuldades quanto à rapidez na instalação do dispositivo no momento daemergência e em relação à radiopacidade dos componenteseletrônicos, que impediram algumas projeções angiográficas.O uso de dispositivos mecânicos de compressões torácicasdurante parada cardiorrespiratória é factível, porém ainda nãohá comprovação de seus benefícios em relação à ressuscitaçãocardiopulmonar com compressões manuais.


Assuntos
Humanos , Masculino , Idoso , Angioplastia/métodos , Angioplastia , Parada Cardíaca/complicações , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar , Eletrocardiografia/métodos , Eletrocardiografia
18.
Rev. bras. cardiol. invasiva ; 18(3): 321-326, set. 2010. tab, graf
Artigo em Português | LILACS | ID: lil-566809

RESUMO

Introdução: A técnica de ecocardiografia tridimensional em tempo real (eco-3D) para avaliação da área valvar mitral (AVM) é uma técnica inovadora, que deve ser validada na compração com técnicas de cálculos de AVM já consagrados. O cálculo da AVM pelo método de Gorlin já foi bem estabelecido e correlaciona-se de forma adequada com a verdadeira AVM. Nosso objetivo foi comparar as medidas de AVM obtidas pelos métodos hemodinâmicos e ecocardiográfico, a partir de parâmetros hemodinâmicos invasivos (fórmula de Gorlin) e de eco-3D após valvoplastia mitral percutânea por cateter-balão (VCB). Método: Estudo prospectivo, realizado entre fevereiro de 2009 e fevereiro de 2010, em que foram selecionados 24 indivíduos (dos quais 22 mulheres, na faixa etária de 39 + ou - 12 anos) portadores de estenose mitral sintomática submetidos a VCB. Foi feita análise ecocardiográfica transtorácica bidimensonal e tridimensional antes e após VCB, em que foram aferidos a AVM (eco-3D/medida invasiva) e o gradiente...


Assuntos
Humanos , Feminino , Cateterismo , Ecocardiografia Tridimensional/métodos , Ecocardiografia Tridimensional , Ecocardiografia/métodos , Ecocardiografia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico
19.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 20(2): 251-272, abr.-jun. 2010. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP | ID: lil-570211

RESUMO

O infarto do miocárdio configura-se como uma das maiores causas de morte no mundo ocidental. Nas últimas décadas, o uso da terapia trombolítica modificou drasticamente o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST. Esse fato decorreu principalmente da redução significante da mortalidade e da disfunção ventricular proporcionadas pela terapia trombolítica A arritmia mais frequentemente relacionada à parada cardiorrespiratória nas primeiras horas de infarto é a fibrilação ventricular, e sua abordagem precoce e adequada é de extrema relevância, sendo até mesmo mais eficaz que a terapia trombolítica no salvamento de vidas. Cada vez mais tem sido salientada a importância da identificação rápida e eficiente de pacientes com isquemia miocárdica aguda nos serviços de emergência. O exame eletrocardiográfico deve ser realizado idealmente em menos de 10 minutos da apresentação à emergência e é o centro do processo decisório inicial em pacientes com suspeita de infarto agudo do miocárdio. É importante que seja feita a estratificação de risco inicial de acordo com a probabilidade de o doente desenvolver eventos e complicações cardíacas isquêmicas no futuro para que a estratégia de tratamento mais adequada possa ser instituída, objetivando uma terapêutica mais potente e precoce quando se identificam os riscos intermediários e alto, com a intenção de reduzir eventos...


Acute myocardial infarction is one of the major causes of death in the Western world. In recent decades, the use of thrombolytic therapy dramatically changed the prognosis of patients with ST segment elevation acute myocardial infarction. This occurred mainly due to a significant reduction of mortality and ventricular dysfunction provided by thrombolytic therapy. Ventricular fibrillation is the type of arrhythmia most frequently related to cardiopulmonary arrest in the early hours of infarction, and an early and appropriate approach is extremely important and even more effective than thrombolytic therapy in saving lives. The importance of a prompt and efficient identification of patients with acute myocardial ischemia has been increasingly highlighted. Electrocardiographic examination must be carried out within less than 10 minutes of presentation to the emergency room and is the core of the early decision-making process in patients with suspected acute myocardial infarction. Risk stratification should be done as soon as possible according to the probability of developing ischemic cardiac events and complications in the future so that the most appropriate treatment strategy is established, aiming at a more potent and early therapy when intermediate and high risk groups are identified, aiming at reducing adverse events such as (re)infarction or death. Currently, the use of troponins T and I and CK-MB mass is suggested as markers of myocardial injury. CK-MB activity measurement should be replaced as soon as possible. In large centers, the use of fibrinolytics combined with other drugs reduced hospital mortality rates to below 6.5%. However there has been little progress in understanding the epidemiology and treatment in the prehospital phase.


Assuntos
Humanos , Angina Instável/complicações , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia/métodos , Eletrocardiografia , Teste de Esforço/métodos
20.
Rev Bras Cir Cardiovasc ; 24(1): 38-43, 2009.
Artigo em Inglês, Português | MEDLINE | ID: mdl-19504017

RESUMO

OBJECTIVE: To determine whether the proximal anastomosis interferes or not in mid- and long-term patency of these grafts. METHODS: One hundred twenty-three out of 481 patients who had undergone surgery using radial artery (RA) were restudied. The mean age was 58.8 + 10.4 years. In 96 (78.05%) patients the cardiopulmonary bypass (CPB) was used. Considering all surgical grafts, 382 coronary branches were grafted (mean, 3.1 + 0.8 arteries per patient). 150 of them used radial artery (RA), and the left marginal branches (LOM) were the most prevalent (48.67%). The proximal anastomosis was performed in the aorta in 50 (40.65%) patients and as an artificial 'Y' composite graft with the left or right internal thoracic artery (LIMA/RITA) in 73 (59.35%). Postoperatively, coronary angiography studies were performed within a mean period of 5.36 + 3.21 years. The obtained data was divided into two categories: proximal anastomosis (aorta/composite) and patency (occluded/patent). A chi-square test was used to compare both proportions, within a 95% confidence interval (CI). RESULTS: From the 50 aorta-anastomosed grafts, 42 (84%) were patent and eight (16%) occluded. Regarding the 73 'Y' composite grafts, 59 (80.82%) were patent and 14 (19.18%) occluded. Comparing these proportions in both techniques, there was no statistically significant difference between them (P=0.651, CI=95%). CONCLUSION: The site of proximal anastomosis of the RA coronary grafts does not interfere in mid- and long-term graft occlusion and patency.


Assuntos
Aorta/cirurgia , Ponte de Artéria Coronária/métodos , Oclusão de Enxerto Vascular/etiologia , Artéria Torácica Interna/cirurgia , Artéria Radial/transplante , Grau de Desobstrução Vascular/fisiologia , Anastomose Cirúrgica/métodos , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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