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1.
Arq Bras Cardiol ; 103(1): 76-84, 2014 Jul.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25120086

RESUMO

The chemical structure of lipoprotein (a) is similar to that of LDL, from which it differs due to the presence of apolipoprotein (a) bound to apo B100 via one disulfide bridge. Lipoprotein (a) is synthesized in the liver and its plasma concentration, which can be determined by use of monoclonal antibody-based methods, ranges from < 1 mg to > 1,000 mg/dL. Lipoprotein (a) levels over 20-30 mg/dL are associated with a two-fold risk of developing coronary artery disease. Usually, black subjects have higher lipoprotein (a) levels that, differently from Caucasians and Orientals, are not related to coronary artery disease. However, the risk of black subjects must be considered. Sex and age have little influence on lipoprotein (a) levels. Lipoprotein (a) homology with plasminogen might lead to interference with the fibrinolytic cascade, accounting for an atherogenic mechanism of that lipoprotein. Nevertheless, direct deposition of lipoprotein (a) on arterial wall is also a possible mechanism, lipoprotein (a) being more prone to oxidation than LDL. Most prospective studies have confirmed lipoprotein (a) as a predisposing factor to atherosclerosis. Statin treatment does not lower lipoprotein (a) levels, differently from niacin and ezetimibe, which tend to reduce lipoprotein (a), although confirmation of ezetimibe effects is pending. The reduction in lipoprotein (a) concentrations has not been demonstrated to reduce the risk for coronary artery disease. Whenever higher lipoprotein (a) concentrations are found, and in the absence of more effective and well-tolerated drugs, a more strict and vigorous control of the other coronary artery disease risk factors should be sought.


Assuntos
Lipoproteína(a)/fisiologia , Apolipoproteínas A/química , Apolipoproteínas A/genética , Humanos , Lipoproteína(a)/análise , Lipoproteína(a)/metabolismo , Fatores de Risco
2.
Arq. bras. cardiol ; 103(1): 76-84, 07/2014. tab
Artigo em Inglês | LILACS | ID: lil-718102

RESUMO

The chemical structure of lipoprotein (a) is similar to that of LDL, from which it differs due to the presence of apolipoprotein (a) bound to apo B100 via one disulfide bridge. Lipoprotein (a) is synthesized in the liver and its plasma concentration, which can be determined by use of monoclonal antibody-based methods, ranges from < 1 mg to > 1,000 mg/dL. Lipoprotein (a) levels over 20-30 mg/dL are associated with a two-fold risk of developing coronary artery disease. Usually, black subjects have higher lipoprotein (a) levels that, differently from Caucasians and Orientals, are not related to coronary artery disease. However, the risk of black subjects must be considered. Sex and age have little influence on lipoprotein (a) levels. Lipoprotein (a) homology with plasminogen might lead to interference with the fibrinolytic cascade, accounting for an atherogenic mechanism of that lipoprotein. Nevertheless, direct deposition of lipoprotein (a) on arterial wall is also a possible mechanism, lipoprotein (a) being more prone to oxidation than LDL. Most prospective studies have confirmed lipoprotein (a) as a predisposing factor to atherosclerosis. Statin treatment does not lower lipoprotein (a) levels, differently from niacin and ezetimibe, which tend to reduce lipoprotein (a), although confirmation of ezetimibe effects is pending. The reduction in lipoprotein (a) concentrations has not been demonstrated to reduce the risk for coronary artery disease. Whenever higher lipoprotein (a) concentrations are found, and in the absence of more effective and well-tolerated drugs, a more strict and vigorous control of the other coronary artery disease risk factors should be sought.


A partícula de lipoproteína (a) apresenta estrutura semelhante à da LDL, diferenciando-se pela presença da apolipoproteína (a) ligada por uma ponte dissulfeto à apolipoproteína B. Sua síntese ocorre no fígado e sua concentração plasmática varia de < 1 mg a > 1.000 mg/dL, podendo ser dosada de rotina em laboratório clínico por método baseado em anticorpos monoclonais. Acima de 20 a 30 mg/dL o risco de desenvolvimento de doença cardiovascular aumenta em cerca de duas vezes, o que não é válido para os afrodescendentes, que já apresentam normalmente níveis mais altos dessa lipoproteína, do que caucasianos e orientais. Entretanto, o risco para indivíduos negros também deve ser levado em conta. Gênero e idade exercem pouca influência na concentração de lipoproteína (a). A homologia com o plasminogênio, que interfere na cascata fibrinolítica, pode ser um mecanismo da aterogenicidade da lipoproteína (a). Entretanto, a deposição direta na parede da artéria também é um dos mecanismos possíveis, sendo a lipoprotrína (a) mais oxidável do que a LDL. De forma geral estudos prospectivos confirmam a lipoproteína (a) como fator predisponente à aterosclerose. O uso de estatinas não interfere no nível da lipoproteína (a), diferentemente da niacina e da ezetimiba, que promovem sua diminuição, embora essa última dependa de confirmação. Não está demonstrado que a redução de lipoproteína (a) resulte em diminuição de risco de doença arterial coronária. Diante de concentrações mais elevadas de lipoproteína (a) e na falta de medicações mais efetivas e de boa tolerabilidade, deve-se, pelo menos, procurar controlar, de forma mais rigorosa, os outros fatores de risco de doença arterial coronária.


Assuntos
Humanos , Lipoproteína(a)/fisiologia , Apolipoproteínas A/química , Apolipoproteínas A/genética , Lipoproteína(a)/análise , Lipoproteína(a)/metabolismo , Fatores de Risco
3.
Arq. bras. cardiol ; 75(3): 235-42, set. 2000. ilus
Artigo em Português, Inglês | LILACS | ID: lil-274144

RESUMO

We report the case of a 72-year-old female with pure autonomic failure, a rare entity, whose diagnosis of autonomic dysfunction was determined with a series of complementary tests. For approximately 2 years, the patient has been experiencing dizziness and a tendency to fall, a significant weight loss, generalized weakness, dysphagia, intestinal constipation, blurred vision, dry mouth, and changes in her voice. She underwent clinical assessment and laboratory tests (biochemical tests, chest X-ray, digestive endoscopy, colonoscopy, chest computed tomography, abdomen and pelvis computed tomography, abdominal ultrasound, and ambulatory blood pressure monitoring). Measurements of catecholamine and plasmatic renin activity were performed at rest and after physical exercise. Finally the patient underwent physiological and pharmacological autonomic tests that better diagnosed dysautonomia.


Assuntos
Humanos , Feminino , Idoso , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Barorreflexo/fisiologia , Sistema Cardiovascular/fisiopatologia , Agonistas Adrenérgicos beta/farmacologia , Aldosterona/análise , Aldosterona/metabolismo , Doenças do Sistema Nervoso Autônomo/diagnóstico , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea/fisiologia , Bradicardia/induzido quimicamente , Catecolaminas/sangue , Catecolaminas/metabolismo , Frequência Cardíaca/fisiologia , Postura , Sistema Renina-Angiotensina/fisiologia , Renina/sangue , Renina/metabolismo , Teste da Mesa Inclinada , Manobra de Valsalva/fisiologia
4.
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
5.
Arq. bras. cardiol ; 68(4): 257-260, Abr. 1997.
Artigo em Português | LILACS | ID: lil-320341

RESUMO

PURPOSE: To compare the effects of gemfibrozil and lovastatin in patients with hypercholesterolemia and increased lipoprotein(a) [Lp(a)] levels. METHODS: Twenty-seven subjects with total cholesterol (TC) > 240 mg/dL, LDL-C > 160 mg/dL and Lp(a) > 25 mg/dL were studied. Patients were randomized to receive gemfibrozil 1200 mg/day, (n = 14, 54 +/- 7 years) or lovastatin 40-80 mg at night (n = 13, 55 +/- 9 years) for 12 weeks. Lipid profile and Lp(a) were determined at 4 and 12 weeks of treatment. RESULTS: Gemfibrozil reduced TC (-21), LDL-C (-26), triglycerides (TG)(-48) and Lp(a) (-25), increased HDL-C (+48)(p < 0.001). Lovastatin reduced TC (-29), LDL-C (-37) and TG (-25) (p < 0.001) however, it did not affect Lp(a). CONCLUSION: Besides reducing plasma LDL-C, TG and increasing HDL-C, gemfibrozil effectively lowers Lp(a) levels. Lovastatin did not affect Lp(a) levels.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Anticolesterolemiantes/uso terapêutico , Hipolipemiantes/uso terapêutico , Genfibrozila , Hipercolesterolemia , Lipoproteína(a)/sangue , Lovastatina , Análise de Variância , Distribuição de Qui-Quadrado , Hipercolesterolemia
6.
Arq. bras. cardiol ; 68(3): 163-166, Mar. 1997.
Artigo em Português | LILACS | ID: lil-320353

RESUMO

PURPOSE: To evaluate the sensitivity and specificity of myocardial perfusion scintigraphy in the detection of coronary artery disease in patients with right bundle branch block (RBBB). METHODS: Thirty one patients (24 male, 62.3 +/- 10.5 years) with RBBB, submitted to myocardial perfusion scintigraphy associated with exercise (n = 7) or dipyridamole (n = 24) and previous cinecoronariography were studied retrospectively. Left ventricle scintigraphic image was divided in three segments corresponding to the three main epicardic coronary territories in a total of 93 segments. Cineangiographic and scintigraphic data were then compared according to the different artery territories. RESULTS: Twenty three patients had significant lesions (> or = 60) in one or more coronary arteries and eight had no obstruction. Forty nine segments were irrigated by normal coronary arteries and 44 were related to arteries that had significant lesions. Twenty out of twenty three patients showed alterations in perfusion (sensitivity = 87). All patients without coronary obstructions showed normal perfusion scintigraphy (specificity = 100). One of the segments perfused by normal coronaries showed abnormal scintigraphy. Scintigraphy showed perfusion defects in 29 out of 44 segments with coronary obstructions. Sensitivity and specificity of the method for each arterial territory were 72and 100(left descending coronary artery), 67and 94(right coronary artery), 55and 100(circunflex coronary artery), respectively. CONCLUSION: The presence of RBBB does not modify the sensitivity and specificity of the method in the detection of coronary artery disease.


Assuntos
Humanos , Masculino , Feminino , Bloqueio de Ramo , Doença das Coronárias , Bloqueio de Ramo , Angiografia Coronária , Doença das Coronárias , Teste de Esforço , Análise por Pareamento , Estudos Retrospectivos , Sensibilidade e Especificidade
7.
Rev. bras. cir. cardiovasc ; 12(1): 1-9, jan.-mar. 1997. tab, graf
Artigo em Português | LILACS | ID: lil-193711

RESUMO

Objetivo: Estudar aspectos ainda näo esclarecidos relacionados a parâmetros clínicos pré-operatórios de prognóstico, risco cirúrgico, benefício funcional e sobrevida a longo prazo. Métodos: Foram analisados 71 pacientes com diagnóstico de cardiomiopatia isquêmica, com fraçäo de ejeçäo ventricular esquerda <30 por cento e perfusäo miocárdica pela cintilografia TL-201 antes e após a revascularizaçäo do miocárdio no período hospitalar e após a alta, com seguimento médio de 48 meses. Resultados: A mortalidade imediata foi de 2,8 por cento e a sobrevida tardia em seguimento de 5 anos foi de 62,8 por cento. Analisando todos os pacientes em relaçäo à curva de sobrevida, näo se verificou correlaçäo da presença ou ausência da onda Q no ECG, com a presença de isquemia na cintilografia TI-201, com o grau de fraçäo de ejeçäo do ventrículo esquerdo e com a intensidade de insuficiência cardíaca (ICC) ou de angina. Comparando-se os pacientes sobreviventes com os que faleceram, verificou-se diferença estatisticamente significante em relaçäo à maior presença de ICC classe funcional IV e de bloqueio de ramo esquerdo nos pacientes que faleceram. Conclusäo: As presenças de insuficiência cardíaca classe funcional IV e de bloqueio de ramo esquerdo relacionaram-se a pior prognóstico. Devido ao mecanismo de morte ser multifatorial e a miocardiopatia isquêmica apresentar padräo miocárdico e arterial heterogêneos, é dificil estabelecer índices pré-operatórios de prognóstico para a revascularizaçäo do miocárdio. Os resultados cirúrgicos obtidos a curto e longo prazos demonstram a segurança do procedimento cirúrgico e o seu benefício em aumentar a sobrevida e a qualidade de vida dos pacientes com cardiomiopatia isquêmica.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/cirurgia , Isquemia Miocárdica/cirurgia , Revascularização Miocárdica , Análise de Sobrevida , Disfunção Ventricular Esquerda/mortalidade , Seguimentos , Isquemia Miocárdica/mortalidade , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Arq. bras. cardiol ; 68(2): 107-111, Fev. 1997.
Artigo em Português | LILACS | ID: lil-320368

RESUMO

PURPOSE: In order to associate the major benefits of the coronary artery bypass graft (CABG) with a less aggressive procedure minimally invasive coronary artery bypass graft (MICABG) has been utilized. The aim of the work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation. METHODS: Twenty-six patients, 19 males with ages from 44 to 83 years old, and having isolated lesion of the anterior descending artery were operated upon. Left anterior minithoracotomy of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate was decreased with the use of intravenous betablockers. For LIMA--anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered. RESULTS: All patients presented satisfactory postoperative evolution, being discharged from the hospital at 72 h after surgery in the majority of the cases. There were delay in two patients healing of incisions and 25 patients have remained asymptomatic, with a mean in postoperative follow-up of four months. One patient died in the second postoperative month due to stroke. CONCLUSION: MICABG makes the surgery possible with better esthetic effect, lower cost and enables faster recovery than the conventional one. The use of VATS through the thoracotomy itself, allows the LIMA dissection without other incisions. It also permitted more ample dissection of the LIMA when compared to minithoracotomy without VATS.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doença das Coronárias , Revascularização Miocárdica/métodos , Toracoscopia , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Angiografia Coronária , Seguimentos , Período Pós-Operatório , Resultado do Tratamento
9.
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
10.
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
11.
Arq. bras. cardiol ; 67(6): 375-378, Dez. 1996.
Artigo em Português | LILACS | ID: lil-319227

RESUMO

PURPOSE: To study the short and long term clinical course of patients with severe aortic stenosis after surgical treatment of the valvular lesion. METHODS: Thirty survivors among 31 consecutive patients with severe left ventricular dysfunction (LVD) due to aortic stenosis (AS) were submitted to clinical and echocardiographic follow-up during a mean of 30 months after surgical treatment of the valvular lesion. Twenty five (83.3) patients were male with a mean age of 50 years (25 to 74). Before operation the following parameters were obtained: diastolic left ventricular diameter (DLVD), shortening fraction (SF), left ventricular ejection fraction (LVEF), aortic valve area (AVA), left ventricular-aortic pressure gradient (PG) and NYHA functional class (FC). During the follow up, after the surgical procedure, FC, DLVD, LVEF and SF could be analysed and compared with previous data. RESULTS: A significant rise in SF (p = 0.001) and LVEF (p = 0.0001), as well as a decrease in DLVD (p = 0.001) were observed in the follow up. Symptoms lessened in severity in the majority of patients. Three of our patients died with progressive LVD and heart failure, after at least 36 months of follow-up. These results indicate that when operation is carried out in patients with AS and left ventricular failure, a significant improvement in left ventricular function and in symptoms takes place. Although the risk of surgical treatment is increased in this group of patients, LVD should not be considered a contraindication to the procedure. CONCLUSION: The left ventricular dysfunction is not a contraindiction for the surgical treatment of the aortic stenosis.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Bioprótese , Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Disfunção Ventricular Esquerda , Valva Aórtica , Ecocardiografia Doppler , Seguimentos , Período Pós-Operatório , Índice de Gravidade de Doença
12.
Arq. bras. cardiol ; 67(5): 339-342, Nov. 1996.
Artigo em Português | LILACS | ID: lil-319236

RESUMO

PURPOSE: The decision of stopping cardiopulmonary resuscitation (CPR) in patients brought to emergency room in arrest remains a challenge. Such decision is even more difficult when someone is brought by bystanders, after an acute loss of consciousness without any out-of-hospital care. To evaluate the probability of survival of these patients we reviewed retrospectively charts in our institution, during a period of five years. METHODS: One hundred and one patients that fulfilled these characteristics came to our emergency in arrest. The time to arrival since symptoms started, cardiac rhythm at first electrocardiogram (EKG), age, gender, initial CPR success, late outcomes and previous diseases were obtained. Patients were divided in two groups regarding which cardiac rhythms they had at first EKG: A-patients arriving in asystole; and VF-patients arriving in ventricular fibrillation. To evaluate time to arrival, we arbitrarily choose 15 min as a reference point. RESULTS: In these 101 subjects the mean age was 62 +/- 13.7 years and 63 (62.3) were men. Previous heart disease was documented in 74 [dilated cardiomyopathy in 22 (21.7), coronary heart disease in 41 (40.6), arterial hypertension in 25 (24.7) and others in 6 (5.6)]. In 66 episodes we were sure of the time patients spent before arrival (mean 2.5 +/- 11 min). Only in 63 subjects we had no doubts about the rhythm at entrance: VF in 37 (58.7), A in 22 (34.9) and an accelerated idioventricular rhythm (AIR) in four (6.3). Time to arrival was 18.6 +/- 10.6 in VF vs 32.5 +/- 11.7 min in A (p = 0.012). Fourteen (13.8) subjects resumed a supraventricular rhythm with systolic pressure > or = 90 mmHg after CPR and all of them were in VF (13) or AIR (one). Nine patients (8.9) evolved in coma. Only five (4.9) were discharged from the hospital without any neurological disturbance and their time to arrival ranged from one to 15 (9 +/- 5.8) min. CONCLUSION: Delayed arrival to the emergency room (> 15 min) associated with asystole were predictors of unsuccessful CPR, and both data are helpful in deciding when to stop CPR in subjects arriving at the emergency department with no out-of-hospital care.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Parada Cardíaca/terapia , Reanimação Cardiopulmonar/normas , Ordens quanto à Conduta (Ética Médica) , Serviços Médicos de Emergência/normas , Eletrocardiografia , Estudos Retrospectivos , Fatores de Tempo
15.
Arq. bras. cardiol ; 67(2): 87-91, ago. 1996. tab
Artigo em Português | LILACS | ID: lil-199319

RESUMO

OBJETIVO - Avaliar os efeitos agudos da ibopamina (IBO) sobre a mecânica e a contrabilidade miocárdica em pacientes com insuficiência cardíaca congestiva (ICC)refratária secundária à cardiomiopatia dilatada idiopática.MÉTODOS- Foram estudados 10 pacientes (idade= 43+-7anos) do sexo masculino, em ritmo sinusal, com cardiomiopatia dilatada idiopática e ICC refratária.Foram realizados estudos ecocardiográficos e hemodinâmicos (cateter micro-tip) simultâneos, antes (basal) e após (20,40 e 60min) à administraçäo de um comprimido de 200mg de IBO.Para cada fase obtidas as relaçöes pressäo/diâmetro e esforço/de formaçäo do ventrículo esquerdo (VE).A partir destas relaçöes foram analisados:frequência cardíaca (FC-bpm), débito cardíaco (DC-L/m), pressäo diastólica final (PDF-mmHg); fraçäo de encurtamento (D por cento); elastância máxima (E máx - mmHg/cm/s);esforços sistólico final (ESF-g/cm2) e diastólito final (EDF-g/cm2); rididez da cavidade (Kp-mmHg/cm) e do músculo cardíaco (Km-g/cm2);e tempo da constante de relaxamento (Tau-ms).RESULTADOS- Na condiçäo basal e aos 20,40 e 60min após a administraçäo da IBO, näo houve variaçäo significante na FC (99+-7;99+-8e99+-10), e foram observados aumentos signifacantes do DC (4,13+-1,28;4,95+-1,38;5,13+-1,86;5,18+-1,57), do D por cento (13,7+-2,4;15,4+-2,8;15,9+-1,8;16,1+-2,0), e da E máx (14,8+-3,2;16+-3,6;17,7+-4,2;17,6+-4,2).Houve mudanças significativas, com aumento transitório inicial seguido de diminuiçäo da PDF ( 26,3+-4,2;30,6+-6,4;24,6+-5,6;22,3+-4,6) do EDF (79,7+-22,8;91,7+-29,6;79+-31;63+-17,3) e do Kp (27,2+-12,6;60+-26,7;27,9+-11,7;28+-11).CONCLUSAO - A IBO produziu efeito benéfico na funçäo sistólica e diastólica do VE, bem como aumentou a contratilidade em pacientes com insuficiência cardíaca severa devido à cardiomiopatia dilatada idiopática.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Cardiomiopatias , Insuficiência Cardíaca , Contração Miocárdica , Função Ventricular
16.
Arq. bras. cardiol ; 67(2): 93-8, ago. 1996. tab
Artigo em Português | LILACS | ID: lil-199320

RESUMO

OBJETIVO- avaliar a influência da idade sobre a conduta e a resposta para terapêutica com pravastina, em pacientes seguidos por médicos da comunidade.MÉTODOS- Conforme a faixa etária, 873 pacientes foram divididos em três grupos:grupo A com idades entre 45e 59 anos(n=544), grupo B com idades entre 60 e 64 anos (n=182) e grupo C com idades entre 65 e 70 anos (n=147).Após quatro semanas recebendo apenas orientaçäo dietética, os pacientes receberam 10mg/dia de pravastatina por período de 12 semanas.RESULTADOS- Observou-se prevalência maio em faixas etárias mais idosas de fatores de risco, como hipertensäo arterial (45,7 por cento, 54,1 por cento nos grupos A, B e C, respctivamente, p=0,0165), diabetes mellitus (9,3 por cento, 17,6 por cento e 25,8 por cento grupos A,B,C, respectivamente, p<0,0001), e doenças cardíacas prévia (23,1 por cento, 34,3 por cento e 34,7,Grupos A,B e C, respectivamente, p<0,001).Durante o período de orientaçäo dietética houve reduçäo nos níveis de colesterol total em cerca de 10 por cento e de LDL colesterol de 10,5 por cento, resposta semelhante nos três grupos.Com a administraçäo de pravastina, a reduçäo foi mais importante, atingindo percentual médio de 30,0 por cento, o mesmo sendo obeservado com o LDL colesterol com níveis de 31,7 por cento, sem diferenças entre os grupos.Os níveis de colesterol de alta densidade (HDL) aumentaram, significativamente, com a introduçäo da pravastatina (12,7 por cento).Com a introduçäo da terapêutica, o aumento percentural nos níveis de HDL colesterol foi maior nos pacientes com HDL prévio baixo (_<35mg/dL) nos três grupos.A intervençäo terapêutica foi bem tolerada nos três grupos.CONCLUSAO- Em Pacientes selecionados por médicos da comunidade para terapêutica hipolipemiante, o aumento da idade relacionou-se com frequência a fatores de risco e cardiopatia.Independentemente da idade, houve boa resposta à terapêutica com pravastatina.


Assuntos
Humanos , Pessoa de Meia-Idade , Hiperlipidemias , Pravastatina/uso terapêutico
17.
Arq. bras. cardiol ; 67(1): 1-4, jul. 1996. ilus
Artigo em Português | LILACS | ID: lil-199307

RESUMO

OBJETIVO: Comparar portadores de miocardiopatia chagásica com insuficiência cardíaca congestiva (ICC) e consumo máximo de oxigênio (VO2 max) acima de 20mL/kg-1/min-1 com grupo normal, e rediscutir o conceito de normalidade do método.MÉTODOS: Foram estudados 104 pacientes com ICC. O grupo controle (G2) constituiu-se de 23 indvíduos normais sedentários. Analisamos os pacientes pela VO2max e fraçäo de ejeçäo (FE) de ventrículo esquerdo. As médias foram comparadas utilizando o teste t. RESULTADOS: Dos 104 pacientes, 37 (35,6por cento) apresentaram VO2max acima de 20 mL/kg-1/min-1(GI), com valores entre 20,5 e 30,5 (24,5+/-2,9) e FE entre 19 e 63 (42+/-11,7). G2 apresentou VO2max entre 21 e 42 mL/kg-1/min-1 (33,3+/-5,6) e FE entre 70 e 82 (75,1+/-3,2). Näo houve diferença significante (p=0,1136) entre as idades. Houve diferença entre as médias de VO2max e FE (p<0,0001).CONCLUSAO: Estes pacientes atingiram VO2max acima de 20mL/kg-1/min-1, e apresentaram

Assuntos
Humanos , Insuficiência Cardíaca/epidemiologia , Cardiomiopatia Chagásica/epidemiologia , Consumo de Oxigênio , Estudos de Casos e Controles
18.
Arq. bras. cardiol ; 67(1): 5-9, jul. 1996. tab
Artigo em Português | LILACS | ID: lil-199308

RESUMO

OBJETIVO- Testar a hipótese de que a rejeiçäo após transplante cardíaco poderia diminuir a reserva de contralidade do ventrículo esquerdo (VE).MÉTODOS - Foram estudados 11 pacientes utilizando-se metodologia näo invasiva (ecocardiografia e pressäo arterial sistêmicca). Os parämetros ecocardiográficos epressóricos (pressäo sistólica final (PSF), frequência cardíaca (FC)volumes diastólico final (VDF) e sistólico final (VSF), fraçäo de ejeçäo (FE), esforço sistólico final (ESF) e a relaçäo de final de sístole entre o esforço e o volume (ESF/VSF) do VE foram obtidos em 68 estudos realizados sete dias-12 meses após o transplante.De acordo com o resultado das biopsias, os pacientes foram divididos em dois grupos:grup A- sem rejeiçäo (53 estudos) e grupos B - com rejeiçäo (15 estudos).RESULTADOS - A infusäo de nitroprussiato provocou mudanças significativas e semelhantes nos dois grupos em todos os parâmetros, com exeçäo da relaçäo ESF/VSF.(A=68ñ12mL), o VSF(A=12ñ5 e B=18ñ12mL) e o ESF(A=59ñ13 e B=82ñ20g/cm²); aumentou a FC(A=94ñ9eB=93ñ16bpm) e a FE(A=83ñ5eB=79ñ8 por cento) e näo provocou modificaçäo na relaçäo ESF/VSF (A=5,5ñ1,7 e B=4,8ñ1,5g/cm²/mL) A infusäo de dobutamina provocou mudanças distintas nos 2 grupos, com exeçäo da PSF que aumentou de forma similar (A=156ñ26eB149ñ26mmHg). Os aumentos na FC na FE e na relaçäo ESF/vsf foram significamente maiores no grupo A do que no grupo B (FC-A=117ñ19 e B=102ñ25bpm; Fe- A=91ñ4e B=78ñ11 por cento, ESF/VSf - A=13,1ñ6 e B=6,1ñ3,1g/cm²/mL), bem como foram significativamente menores no grupo A o VDF (57ñ18x94ñ35mL),o VSF (5ñ3x24ñ20mL) e o ESF (57ñ21x102ñ40g/cm²).CONCLUSAO- A rejeiçäo pode näo alterar a funçäo contrátil de repouso do VE mas deprime sua reserva de contralidade.


Assuntos
Humanos , Transplante de Coração , Rejeição de Enxerto/epidemiologia , Função Ventricular , Testes de Hipótese
19.
Arq. bras. cardiol ; 66(5): 263-266, Mai .1996.
Artigo em Português | LILACS | ID: lil-319281

RESUMO

PURPOSE: The aim of this study was to determine the lipid profile after heart transplantation. METHODS: We performed sequential analyses in serum (in mg/dL) of total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol and triglycerides in patients who underwent orthotopic heart transplantation. These analyses were performed at one month (33 patients), six months (32), one year (26), two years (22) and three years (19) after the transplantation. RESULTS: After the heart transplantation there was a progressive elevation in the serum levels of total cholesterol (215 +/- 53 at the 1st month, 229 +/- 57 at the 6th month, 239 +/- 52 at the 1st year, 250 +/- 53 at the 2nd year and 278 +/- 63 at the 3rd year, p = 0.0006). LDL-cholesterol (137 +/- 46 at the 1st month, 152 +/- 47 at the 6th month, 156 +/- 45 at the 1st year, 164 +/- 43 at the 2nd year and 180 +/- 58 at the 3rd year, p = 0.03). VLDL-cholesterol (35 +/- 15 at the 1st month, 37 +/- 14 at the 6th month, 42 +/- 14 at the 1st year, 42 +/- 15 at the 2nd year and 45 +/- 17 at the 3rd year, p = 0.01) and triglycerides (169 +/- 75 at the 1st month, 188 +/- 75 at the 6th month, 216 +/- 70 at the 1st year, 218 +/- 89 at the 2nd year and 255 +/- 103 at the 3rd year, p = 0.001). There were no changes in HDL-cholesterol levels (44 +/- 15 at the 1st month, 41 +/- 12 at the 6th month, 40 +/- 12 at the 1st year, 44 +/- 14 at the 2nd year and 45 +/- 15 at the 3rd year, p = ns). CONCLUSION: We observed a progressive elevation in the levels of total cholesterol, LDL, VLDL and triglicerides during the 1st three years after heart transplantation.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Colesterol , HDL-Colesterol , LDL-Colesterol , VLDL-Colesterol , Transplante de Coração , Triglicerídeos/sangue , Análise de Variância , Seguimentos , Período Pós-Operatório , Fatores de Tempo
20.
Arq. bras. cardiol ; 66(5): 253-256, Mai .1996.
Artigo em Português | LILACS | ID: lil-319283

RESUMO

PURPOSE: To compare the correlation between the departure areas (DA), negative or positive, in patients whose electrocardiogram showed left bundle branch block (LBBB) and association with left ventricular hipertrophy (LVH) and myocardial infarction (MI), to the electrocardiographic (ECG) and vectocardiographic (VCG) classic criteria. METHODS: The study was carried out with 46 patients (27 males) with LBBB. These patients had hypertension (19.5), coronary heart disease (34.7) and 21 patients with no heart disease (45.8). RESULTS: The statistic analysis using the Cluster method divided the patients in two groups. Group I (22 patients) showed an average rate for the DA (-2 SD) of 1091 for QRS and of 640 for ST-T. For the DA (+2 SD), the average rate was 618 for QRS and 881 for ST-T; group II (24 patients) showed an averaged for the DA (-2 SD) of 1063 for QRS and of 225 for ST-T. For the DA (+2 SD), the averaged rate was 428 for QRS and 600 for ST-T. CONCLUSION: In general the current ECG/VCG findings, can not differentiate the presence of the association of LBBB to LVH and MI. The DA of ST-T, mainly negative was the most efficient to separate the two groups and help in the differential diagnosis.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Mapeamento Potencial de Superfície Corporal , Bloqueio de Ramo , Eletrocardiografia , Vetorcardiografia , Função Ventricular Esquerda , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Diagnóstico Diferencial , Sensibilidade e Especificidade
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