Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.862
Filtrar
1.
High Blood Press Cardiovasc Prev ; 27(1): 9-17, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31975151

RESUMO

The presence of hypertensive mediated organ damage is related to increased vascular risk and mortality and its prevention should be a therapeutic target and a surrogate marker of in/adequate blood pressure control. In old adult hypertensive patients the therapeutic target should be to prevent major cardiovascular events, but in young hypertensive subjects the focus should be pointed on preventing the development of hypertensive mediated organ damage, since most of the hard events are preceded by functional and structural tissues injury. Hypertension Guidelines of the European Society of Cardiology and European Society of Hypertension recognizes that some variables like electrocardiographic or echocardiographic left ventricle hypertrophy, chronic kidney disease or advance retinopathy, all considered as hypertensive mediated organ damage, may be modifiers of cardiovascular risk estimated by the SCORE system, and for that reason they should be screened in hypertensive patients. It is well known the problem of limited health systems financial resources in many low and even median income countries which precludes the possibilities of generalizing the search for hypertension mediated organ damage in all hypertensive patients. In these scenario the recommendation to perform a detailed screening should be critically evaluated. Some questions remained unanswered: the screening generalization of hypertensive mediated organ damage should modify the cardiovascular risk score of the patients, if its presence could modify the therapeutic approach, and as a consequence, if the treatment adjustment should prolong life expectancy and ameliorate the quality of life.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Cardiopatias/prevenção & controle , Hipertensão/tratamento farmacológico , Nefropatias/prevenção & controle , Doenças Vasculares/prevenção & controle , Anti-Hipertensivos/efeitos adversos , Diagnóstico Precoce , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Cardiopatias/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/mortalidade , Nefropatias/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/diagnóstico , Doenças Vasculares/mortalidade , Doenças Vasculares/fisiopatologia
2.
Rev Med Suisse ; 15(674): 2236-2240, 2019 Dec 04.
Artigo em Francês | MEDLINE | ID: mdl-31804035

RESUMO

Lower extremity arterial disease (LEAD) is a serious and invalidating disease with a relatively high prevalence in the diabetic population. Patients suffering from both conditions have a less favourable prognosis of affected limbs compared to non-diabetic patients, with more frequent adverse limb events such as amputations. Nevertheless, awareness of LEAD remains sub-optimal in the diabetic population. Regular and appropriate screening for this condition is therefore recommended. Affected individuals should receive optimal medical treatment, including intensive management of the various cardiovascular risk factors and strict blood glucose control.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Extremidade Inferior/irrigação sanguínea , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Amputação , Artérias/patologia , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/terapia , Humanos , Fatores de Risco , Doenças Vasculares/patologia , Doenças Vasculares/terapia
3.
Rev Port Cardiol ; 38(8): 609.e1-609.e7, 2019 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31694785

RESUMO

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome that typically occurs in relatively young patients without classical cardiovascular risk factors for coronary artery disease. The etiology appears to be multifactorial and optimal management is not clearly established, so the treatment strategy is often selected based on clinical presentation and coronary anatomy. We present two cases of spontaneous coronary artery dissection with different initial approaches, highlighting the importance of a case-by-case assessment.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Tomada de Decisões , Stents , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Humanos , Masculino , Ultrassonografia de Intervenção , Doenças Vasculares/diagnóstico , Doenças Vasculares/cirurgia
4.
High Blood Press Cardiovasc Prev ; 26(5): 361-373, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31650516

RESUMO

High blood pressure (BP) is becoming a growing health issue even in children and adolescents. Moreover, BP elevation in youth frequently translates into children and adult hypertension contributing to the development of cardiovascular disease. The detection of early markers of vascular damage, potentially leading to overt cardiovascular disease, is important for clinical decisions about if and how to treat hypertension and can be useful in monitoring the effectiveness of the treatment. The purpose of this review is to summarize the actual knowledge about subclinical organ damage (SOD) in hypertensive children and adolescents and its association with cardiovascular disease in children and young adults. Our focus is especially put on left ventricular mass, pulse wave velocity, carotid intima-media thickness and microalbuminuria. We also want to address the scientific evidence about possible regression of SOD and cardiovascular risk with the use of behavioural and specific anti-hypertensive therapy. Indications from current guidelines are critically discussed.


Assuntos
Albuminúria/epidemiologia , Pressão Sanguínea , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Nefropatias/epidemiologia , Doenças Vasculares/epidemiologia , Adolescente , Fatores Etários , Albuminúria/diagnóstico , Albuminúria/fisiopatologia , Doenças Assintomáticas , Criança , Feminino , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Masculino , Fatores de Risco , Doenças Vasculares/diagnóstico , Doenças Vasculares/fisiopatologia , Remodelação Vascular , Rigidez Vascular
6.
Lakartidningen ; 1162019 Sep 13.
Artigo em Sueco | MEDLINE | ID: mdl-31529421

RESUMO

Spontaneous coronary artery dissection can be caused by a tear in the intima or a bleeding in the wall of a coronary artery. It is a possible cause of acute coronary syndrome and should be suspected in patients with few risk factors for coronary artery disease. The condition is overrepresented in women particularly during the peripartum period. We present a case where a 36-year-old woman, three days after delivering her third child, presented with myocardial infarction with nonobstructive coronary arteries. She later presented again with ST-elevation myocardial infarction and coronary angiography with optical coherence tomography revealed coronary dissection that was treated with percutaneous coronary intervention.


Assuntos
Anomalias dos Vasos Coronários , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Eletrocardiografia , Feminino , Humanos , Equipe de Assistência ao Paciente , Intervenção Coronária Percutânea , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/cirurgia , Fatores de Risco , Tomografia de Coerência Óptica , Doenças Vasculares/diagnóstico , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
7.
Diagnosis (Berl) ; 6(3): 227-240, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31535832

RESUMO

Background Diagnostic errors cause substantial preventable harm, but national estimates vary widely from 40,000 to 4 million annually. This cross-sectional analysis of a large medical malpractice claims database was the first phase of a three-phase project to estimate the US burden of serious misdiagnosis-related harms. Methods We sought to identify diseases accounting for the majority of serious misdiagnosis-related harms (morbidity/mortality). Diagnostic error cases were identified from Controlled Risk Insurance Company (CRICO)'s Comparative Benchmarking System (CBS) database (2006-2015), representing 28.7% of all US malpractice claims. Diseases were grouped according to the Agency for Healthcare Research and Quality (AHRQ) Clinical Classifications Software (CCS) that aggregates the International Classification of Diseases diagnostic codes into clinically sensible groupings. We analyzed vascular events, infections, and cancers (the "Big Three"), including frequency, severity, and settings. High-severity (serious) harms were defined by scores of 6-9 (serious, permanent disability, or death) on the National Association of Insurance Commissioners (NAIC) Severity of Injury Scale. Results From 55,377 closed claims, we analyzed 11,592 diagnostic error cases [median age 49, interquartile range (IQR) 36-60; 51.7% female]. These included 7379 with high-severity harms (53.0% death). The Big Three diseases accounted for 74.1% of high-severity cases (vascular events 22.8%, infections 13.5%, and cancers 37.8%). In aggregate, the top five from each category (n = 15 diseases) accounted for 47.1% of high-severity cases. The most frequent disease in each category, respectively, was stroke, sepsis, and lung cancer. Causes were disproportionately clinical judgment factors (85.7%) across categories (range 82.0-88.8%). Conclusions The Big Three diseases account for about three-fourths of serious misdiagnosis-related harms. Initial efforts to improve diagnosis should focus on vascular events, infections, and cancers.


Assuntos
Erros de Diagnóstico/efeitos adversos , Imperícia/legislação & jurisprudência , Neoplasias/diagnóstico , Doenças Vasculares/diagnóstico , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
8.
In Vivo ; 33(5): 1697-1702, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471426

RESUMO

BACKGROUND/AIM: Chemotherapy is often halted due to abnormal liver function resembling hepatitis. But the cause can be extrahepatic portal venous obstruction (EHPVO) with hepatic enzyme elevation rather than being an adverse effect of chemotherapy. We investigated EHPVO with hepatic enzyme elevation in patients with cancer. PATIENTS AND METHODS: Data of these hospitalized patients with solid tumors between January 2013 and September 2017 were collected. The criteria for study inclusion were: (i) Extrahepatic malignancy; (ii) computed tomographic scans showing a tumor with external compression of the extrahepatic portal vein; and (iii) serum aminotransferase (AST) or alanine transaminase (ALT) level three times above the normal value. RESULTS: Thirteen out of 377 (3%) patients developed EHPVO with hepatic enzyme elevation, as demonstrated from computed tomographic scan. Four cases (31%) also had vascular thrombosis (three portal vein and one inferior vena cava). Serum AST increased from 34±11 to 169±94 U/l. ALT increased from 9±38 to 177±104 U/l. There was no relationship of EHPVO with viral markers and cirrhosis. Six cases received chemotherapy with liver function improvement. CONCLUSION: EHPVO occurred in patients with metastatic cancer, leading to hepatic enzyme elevation resembling hepatitis without hepatitis risk factors and cirrhosis. Before withholding chemotherapy due to hepatic enzyme elevation, the possibility of EHPVO should firstly be excluded.


Assuntos
Constrição Patológica/diagnóstico , Hepatite/complicações , Hepatite/diagnóstico , Neoplasias/complicações , Veia Porta/patologia , Doenças Vasculares/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Constrição Patológica/etiologia , Feminino , Hepatite/sangue , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Tomografia Computadorizada por Raios X , Doenças Vasculares/etiologia
10.
J Recept Signal Transduct Res ; 39(3): 187-193, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31429357

RESUMO

The Angiopoietin-1 (Angpt1)/Tie2 signaling pathway is important in regulating vascular function. Angpt1-induced Tie2 activation promotes vascular endothelial cell survival and reduces vascular leakage. Angiopoietin-2 (Angpt2), a weak agonist/antagonist of Tie2, opposes and regulates Angpt1 action. The Tie family of receptor tyrosine kinases, Tie2 and Tie1, exist as either homo-or heterodimers. The molecular complex between the receptors is also crucial in controlling Angpt1 signaling; hence, the molecular balance between Angpt1:Angpt2 and Tie2:Tie1 is important in determining endothelial integrity and vascular stability. This review presents evidence of the change observed in the Angiopoietin/Tie molecules in various pathophysiological conditions and discusses the potential clinical applications of these molecules in vascular complications.


Assuntos
Angiopoietinas/metabolismo , Biomarcadores/metabolismo , Receptores de TIE/metabolismo , Doenças Vasculares/diagnóstico , Doenças Vasculares/metabolismo , Animais , Humanos , Ligantes , Transdução de Sinais , Doenças Vasculares/terapia
11.
J Card Surg ; 34(10): 1137-1139, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389631

RESUMO

Calcific uremic arteriolopathy is a rare, life-threatening syndrome of vascular calcification characterized by occlusion of microvessels that results in extremely painful skin necrosis. We present a case of sarcoidosis-associated hypercalcemia potentiating calcific uremic arteriolopathy in a patient with a left ventricular assist device. The patient's calcific uremic arteriolopathy was successfully treated with sodium thiosulfate. Clinicians should be vigilant in diagnosing calcific uremic arteriolopathy early since it is especially life-threatening in patients with multiple risk factors.


Assuntos
Cálcio/sangue , Coração Auxiliar , Hipercalcemia/complicações , Sarcoidose/complicações , Uremia/complicações , Calcificação Vascular/etiologia , Doenças Vasculares/etiologia , Cardiomiopatias/complicações , Cardiomiopatias/cirurgia , Humanos , Hipercalcemia/sangue , Masculino , Pessoa de Meia-Idade , Sarcoidose/sangue , Uremia/sangue , Uremia/diagnóstico , Calcificação Vascular/sangue , Calcificação Vascular/diagnóstico , Doenças Vasculares/sangue , Doenças Vasculares/diagnóstico
12.
Eur J Dermatol ; 29(3): 274-280, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31389786

RESUMO

BACKGROUND: Skin aging can be classified as either physiological or pathological aging. Pathological aging is most often due to chronic sunlight exposure (photoaging). Age-dependent changes in dermoscopic features of normal skin have not previously been well defined. OBJECTIVES: We compared the dermoscopic features of skin from non-elderly subjects, elderly subjects with physiological aging, and elderly subjects with photoaging. MATERIALS AND METHODS: We enrolled 40 non-elderly subjects aged 20-60 years, 40 elderly subjects aged >60 years with physiological aging, and 40 elderly subjects aged >60 years with photoaging. Skin from the lower legs of subjects was examined by dermoscopy. RESULTS: Compared with non-elderly subjects, dermoscopic examination of elderly subjects with physiological aging and photoaging revealed various degrees of xerosis (mild: scaling limited to skin furrows; moderate: scaling extending beyond skin furrows with accentuation of skin markings; severe: plate-like scaling extending beyond skin furrows with formation of deep skin fissures). In addition, dermoscopic examination of skin from elderly subjects with photoaging showed increased prevalence of uneven pigmentation (small brown globules, reticular pigmentation, and homogeneous pigmentation in a patchy distribution) and vascular telangiectasia (linear and branching vessels). CONCLUSION: This study provides a novel dermoscopic grading system to evaluate the severity of xerosis and demonstrates the application of dermoscopy for the accurate assessment of subtle morphological changes (including pigmentation pattern and vascular structures) associated with physiological aging and photoaging.


Assuntos
Dermoscopia/métodos , Transtornos da Pigmentação/patologia , Envelhecimento da Pele/patologia , Pele/patologia , Doenças Vasculares/patologia , Adulto , Fatores Etários , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Pigmentação/diagnóstico , Prognóstico , Estudos Prospectivos , Valores de Referência , Medição de Risco , Pele/irrigação sanguínea , Pigmentação da Pele/fisiologia , Luz Solar/efeitos adversos , Doenças Vasculares/diagnóstico , Adulto Jovem
13.
S Afr Med J ; 109(7): 477-479, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266572

RESUMO

Spontaneous coronary artery dissection (SCAD) is a relatively rare cause of acute coronary syndrome and sudden cardiac death, which frequently affect young women in the absence of established cardiovascular risk factors. Advancements in cardiovascular imaging account for the increasing recognition of this diagnosis and associated diagnoses, although classic diagnostic modalities such as electrocardiography remain of paramount importance. We present a young woman with recurrent SCAD and briefly discuss her management and its outcome.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/terapia , Eletrocardiografia , Feminino , Humanos , Náusea/etiologia , Recidiva , Sudorese , Troponina T/sangue , Doenças Vasculares/diagnóstico , Doenças Vasculares/terapia
18.
Medicine (Baltimore) ; 98(28): e16391, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305445

RESUMO

RATIONALE: Intravascular papillary endothelial hyperplasia (IPEH; Masson tumor) is a type of vascular lesions composed of reactive proliferation of endothelial cells that occur in organizing thrombus. It commonly occurs on the head, neck, trunk, and upper extremities, but rarely in the foot. PATIENT CONCERNS: A 38-year-old woman visited the hospital with a mass on the dorsum of right foot, which gradually increased in size 3 months ago. DIAGNOSES: Ultrasonographic examination suggested angiomyolipoma or hemangioma. INTERVENTIONS: The patient underwent excision under local anesthesia. OUTCOMES: The lesion was confirmed to be IPEH by histological examination. There were no complications or recurrences after successful surgical excision. LESSONS: IPEH presenting on the dorsum of the foot is vary uncommon. Radiologic diagnosis may be limited for diagnosis, and histologic confirmation should be made after surgical excision. There are some reports suggesting an association between trauma and IPEH occurrence, but this is not yet conclusive.


Assuntos
Doenças Vasculares/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , , Humanos , Doenças Vasculares/patologia , Doenças Vasculares/cirurgia
19.
Expert Rev Cardiovasc Ther ; 17(7): 497-510, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232618

RESUMO

Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly appreciated cause of acute myocardial infarction (AMI) and sudden cardiac death most often affecting young to middle-aged women with few conventional cardiovascular risk factors. Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 04/30/2019). Authors review the key clinical features of SCAD and highlight what is known regarding its pathophysiology and associated factors. The relationship between SCAD and other systemic vasculopathies, notably fibromuscular dysplasia (FMD) is also discussed. Authors also mention the management of acute SCAD along with considerations for long term follow-up such as chest pain syndrome, extracoronary vasculopathy screening, and recurrent SCAD. Expert opinion: Our understanding regarding the association of SCAD and other arteriopathies such as FMD is anticipated to grow. In addition, progress is likely to be made in our efforts to predict recurrent SCAD risk and define potential preventative strategies, possibly through the incorporation of adjunctive imaging.


Assuntos
Anomalias dos Vasos Coronários/etiologia , Doenças Vasculares/congênito , Adulto , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/fisiopatologia , Gerenciamento Clínico , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Recidiva , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia
20.
J Invasive Cardiol ; 31(6): E155-E156, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158813

RESUMO

We present a 48-year-old male patient with extensive lower-limb swelling and chronic kidney disease. Angiography revealed evidence of thrombus in the iliacs and the inferior vena cava was not visualized. Angioplasty of the entire length of the inferior vena cava is a challenging procedure. Surgery is rarely an option. Extensive skill and patience are needed and stenting is usually advised. In many cases, plain angioplasty may be done with favorable results.


Assuntos
Angioplastia com Balão/métodos , Procedimentos Endovasculares/métodos , Veia Ilíaca , Doenças Vasculares/diagnóstico , Veia Cava Inferior , Constrição Patológica , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Doenças Vasculares/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA