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2.
Open Heart ; 7(2)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33020258

RESUMO

BACKGROUND: Cardiac involvement with COVID-19 is increasingly being recognised. Clinical characteristics and outcomes of patients with COVID-19 complicated by secondary Takotsubo cardiomyopathy (TC) is poorly understood. METHODS: This retrospective case series was conducted between March and April 2020 at four hospitals of Steward Health Care Network of Massachusetts, USA. Seven patients out of 169 who had echocardiogram were identified to have features of TC. Demographic, clinical, laboratory, management and outcome were gathered from their electronic medical records. We also reviewed all the published cases of COVID-19 and TC in the literature to recognise their common clinical characteristics, risk factors and outcomes. RESULTS: In our series of seven patients, three typical, two inverted, one biventricular and one global TC were recognised. Three were females and four were males. The mean age was 71±11 years. In-hospital death was observed in 57% of patients. Patients who belonged to the high-risk group and had high-risk echocardiographic features in our series had a 100% mortality rate. CONCLUSIONS: COVID-19 complicated by TC has a high mortality rate. Early identification of patients with COVID-19 who are at higher risk for developing secondary TC is important for the prevention of complications, and thus improved outcomes.


Assuntos
Causas de Morte , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/epidemiologia , Distribuição por Idade , Idoso , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Coração Auxiliar , Mortalidade Hospitalar/tendências , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Cardiomiopatia de Takotsubo/terapia
4.
Nat Commun ; 11(1): 4683, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943621

RESUMO

Wearable dry electrodes are needed for long-term biopotential recordings but are limited by their imperfect compliance with the skin, especially during body movements and sweat secretions, resulting in high interfacial impedance and motion artifacts. Herein, we report an intrinsically conductive polymer dry electrode with excellent self-adhesiveness, stretchability, and conductivity. It shows much lower skin-contact impedance and noise in static and dynamic measurement than the current dry electrodes and standard gel electrodes, enabling to acquire high-quality electrocardiogram (ECG), electromyogram (EMG) and electroencephalogram (EEG) signals in various conditions such as dry and wet skin and during body movement. Hence, this dry electrode can be used for long-term healthcare monitoring in complex daily conditions. We further investigated the capabilities of this electrode in a clinical setting and realized its ability to detect the arrhythmia features of atrial fibrillation accurately, and quantify muscle activity during deep tendon reflex testing and contraction against resistance.


Assuntos
Condutividade Elétrica , Epiderme , Monitorização Fisiológica/instrumentação , Movimento (Física) , Pele , Artefatos , Impedância Elétrica , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrodos , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Eletromiografia/instrumentação , Eletromiografia/métodos , Desenho de Equipamento , Humanos , Monitorização Fisiológica/métodos , Polímeros/química , Sorbitol
5.
N Z Med J ; 133(1520): 73-82, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994595

RESUMO

AIM: Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS: We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS: Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION: In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Mortalidade Hospitalar/tendências , Hospitais Urbanos/estatística & dados numéricos , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Angiografia Coronária/métodos , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Nova Zelândia/etnologia , Alta do Paciente/tendências , Estudos Prospectivos , Recidiva , Estresse Psicológico/epidemiologia , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Centros de Atenção Terciária/estatística & dados numéricos
7.
Medicine (Baltimore) ; 99(39): e22326, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991443

RESUMO

RATIONALE: The most common cardiac involvement of Fabry disease (FD) is left ventricular hypertrophy (LVH), which usually occurs in male patients over the age of 30. In rare cases, it can progress to ventricular dilation in the late stage of the disease. PATIENT CONCERNS: A 16-year-old boy presenting with recurrent extremity pain and chest distress was admitted to our hospital. Imaging examinations revealed ventricular dilation. DIAGNOSIS: α-Galactosidase A enzyme assay and GLA gene sequencing confirmed the diagnosis of FD and revealed a novel mutation c.76_77insT. INTERVENTIONS: The patient was treated using metoprolol (23.75 mg qd) and angiotensin-converting enzyme inhibitor (fosinopril sodium 5 mg qd). He refused enzyme replacement therapy for financial reasons. OUTCOMES: The echocardiography, electrocardiography, renal function, and routine blood and urine tests performed 20 months after the patients discharge from hospital showed no significant changes. The patient reported a slow and gradual decrease in the frequency and degree of pain and chest distress, starting approximately 24 months after discharge. LESSONS: Cardiac involvement of FD can progress rapidly in some cases. Screening for FD should be considered in patients with unexplained ventricular dilation, especially in those with a history of typical FD manifestations.


Assuntos
Dilatação Patológica/diagnóstico por imagem , Doença de Fabry/complicações , Doença de Fabry/genética , Hipertrofia Ventricular Esquerda/etiologia , alfa-Galactosidase/genética , Adolescente , Assistência ao Convalescente , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Ecocardiografia/métodos , Eletrocardiografia/métodos , Terapia de Reposição de Enzimas/economia , Doença de Fabry/tratamento farmacológico , Fosinopril/uso terapêutico , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Metoprolol/uso terapêutico , Mutação , Simpatolíticos/uso terapêutico , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(37): e22093, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925751

RESUMO

RATIONALE: Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers infection and inflammation. As a result, pericarditis and pericardial effusion may occur with or without COVID-19 related respiratory signs. Due to limitations in sensitivity and specificity of current COVID-19 diagnostic studies, cases that trigger high clinical intuition, even with negative serologic and polymerase chain reaction testing results, may necessitate further diagnostic workup to discover the underlying etiology. PATIENT CONCERNS: Here we present a rare case of pericardial effusion in the setting of asymptomatic COVID-19 infection manifesting with the chief complaint of chest pain. DIAGNOSIS: While undergoing diagnostic workup, the patients first 2 sets of COVID 19 reverse transcription-polymerase chain reaction (RT-PCR) were negative while a latter RT-PCR test, as well as serology, were positive, leading to the diagnosis of COVID-19 reinfection or subacute presentation of viral infection with pericardial effusion. Echocardiogram depicted large circumferential pericardial effusion with mildly thickened pericardium. INTERVENTIONS: The patient underwent pericardial window placement followed by ibuprofen administration and discharged from the hospital. OUTCOMES: During the follow-up visit patient had no symptoms and echocardiogram demonstrated complete resolution of the effusion. LESSONS: Due to the possible establishment of pericardial effusions and consecutively tamponade even without any COVID-19 related clinical presentation, it is crucial for clinicians to trust their intuition, conduct the appropriate diagnostic tests, find the underlying diagnosis and prevent the devastating consequences.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Ecocardiografia/métodos , Pandemias , Derrame Pericárdico , Pericardiocentese/métodos , Pneumonia Viral , Infecções Assintomáticas , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/fisiopatologia , Derrame Pericárdico/cirurgia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Resultado do Tratamento
10.
Fisioterapia (Madr., Ed. impr.) ; 42(4): 170-176, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193504

RESUMO

INTRODUCCIÓN: Las tecnologías para la rehabilitación son instrumentos, equipos, sistemas o dispositivos, que aportan a los procesos de recuperación de las capacidades humanas. La 4.ª revolución industrial ha hecho que se utilice la realidad virtual en procesos de rehabilitación, por lo cual es necesario conocer sus efectos fisiológicos en las personas. OBJETIVO: Determinar el efecto de la exposición a la RV sobre los signos vitales en 7 adultos mayores aparentemente sanos. MÉTODO: Se presenta un estudio epidemiológico descriptivo de una serie de 7 casos que permitió evaluar el comportamiento de los signos vitales. Los participantes fueron adultos mayores con edades entre 50 a 75 años, sin ningún tipo de patología osteomuscular y neuromuscular que impidan la ejecución de programa. Se contó con 4 tipos de ambientes virtuales programados progresivamente desde un ambiente de adaptación hasta el ambiente virtual de demandas reales. RESULTADOS: En la recolección de los signos vitales se evidenció un aumento significativo en FC, FR, TAM y SaO2 (P < 0,05), no se encontraron diferencias significativas de los signos vitales tomados previos a la exposición y 10 minutos posterior (P < 0,05). CONCLUSIÓN: Los cambios hemodinámicos antes de la exposición a RV no son permanentes en el tiempo. Los signos vitales 10 minutos posterior a la exposición regresan a los valores iniciales; lo cual permite aplicar la RV en personas mayores aparentemente sanas como estrategia terapéutica sin riesgo de presentar cambios fisiológicos concurrentes y nocivos, de acuerdo a la muestra de este estudio


INTRODUCTION: The technologies for rehabilitation are instruments, equipment, systems or devices, which contribute to the processes of recovery of human capabilities. The 4.th industrial revolution has brought about the use of virtual reality in rehabilitation processes, and therefore it is necessary to be aware of its physiological effects on people. OBJECTIVE: To determine the effect of VR exposure on vital signs in 7 apparently healthy older adults. METHOD: We present a descriptive epidemiological study of a series of 7 cases that allowed us to evaluate the behaviour of vital signs. The participants were older adults aged between 50 and 75 years, without any musculoskeletal or neuromuscular pathology to prevent them undertaking the programme. There were 4 types of virtual environments programmed progressively from an adaptation environment to the virtual environment of real demands. RESULTS: In the collection of vital signs, a significant increase in HR, FR, TAM and SaO2 (P < .05) was evidenced, no significant differences were found in the vital signs taken before and 10minutes after exposure (P < .05). CONCLUSION: Haemodynamic changes before exposure to RV are not permanent over time. Vital signs 10minutes after exposure return to initial values, which allows the application of RV in apparently healthy older people as a therapeutic strategy without risk of presenting concurrent and harmful physiological changes, according to the sample of this study


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Realidade Virtual , Sinais Vitais/fisiologia , Terapia por Exercício , 24960 , Hemodinâmica , Técnicas de Exercício e de Movimento/instrumentação , Eletrocardiografia/métodos , Arritmias Cardíacas/diagnóstico por imagem
11.
Medicine (Baltimore) ; 99(32): e21602, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769916

RESUMO

INTRODUCTION: Recent studies have shown that His-bundle pacing could be an alternative in patients requiring cardiac resynchronization therapy as it is comparable or better in terms of amelioration of ventricular activation, narrowing of the QRS complex, or clinical outcomes. However, in case of high threshold at the level of His-bundle or inability to correct conduction through a diseased His-Purkinje system other option should be searched like left bundle pacing. PATIENT CONCERNS: A 77-year-old man presented to the Emergency Department for dizziness and dizziness and lightheadedness due to an intermittent 2:1 atrioventricular block with a QRS complex morphology of a major left branch block. DIAGNOSIS: Given the documented symptomatic 2:1 AV block, according to the European Guideliness the patient was considered to have a class 1 indication of permanent double chamber cardiostimulation. INTERVENTIONS: A lead delivery system with a C315 His catheter and a Select Secure 3830 69 cm pacing lead were placed at the His bundle area with important narrowing of the QRS complex but with an unacceptable high threshold. The delivery system was moved towards the apex 1,5 cm and the lead screwed deep into the septum until capture of the left bundle branch was achieved with complete normalization of the conduction troubles. OUTCOMES: At 3 month follow-up the patient was asymptomatic and the pacing and sensing thresholds remained at same values as during implantation: 0.75/0.4 ms and 14 mV respectively. CONCLUSION: Left bundle-pacing represents the next step of His-Purkinje system pacing to overcome all difficulties related to His-bundle pacing.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Idoso , Bloqueio Atrioventricular/terapia , Fascículo Atrioventricular/anormalidades , Estimulação Cardíaca Artificial/normas , Eletrocardiografia/métodos , Feminino , Fluoroscopia/métodos , Humanos
12.
Medicine (Baltimore) ; 99(32): e21633, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769928

RESUMO

INTRODUCTION: Pacing of the His bundle and conduction system seems an attractive site for pacing. Lead placement in His-pacing might be technically challenging due to surrounding structures and particular anatomic location. PATIENT CONCERNS: A 62-years old male patient was admitted for recurrent syncope. Electrocardiographic monitoring revealed periods of complete atrioventricular block with left branch block morphology and a QRS duration of 160 ms. DIAGNOSIS: A diagnosis of intermittent complete atrioventricular block was made with a Class I indication of permanent dual-chamber cardiac pacing. INTERVENTIONS: A lead delivery system with a C315 His catheter and a Select Secure 3830 69 cm pacing lead was placed at the septal area of the atrioventricular junction with good pacing and sensing thresholds. An important narowing of the QRS was observed. OUTCOMES: After the procedure, good pacing and sensing parameters were observed.Echocardiography revealed disappearance of the previously recorded ventricular dyssynchronism.Device follow-up at 1 month and 3 months showed stable pacing and sensing parameters. CONCLUSION: Pacing the distal His bundle normalized the QRS complex, therefore "curing" both the atrioventricular and the left bundle branch conduction abnormalities. As such, the technique can be used as an alternative to cardiac electrical resynchronization therapy with acceptable pacing and detection thresholds and better ventricular activation pattern.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Fascículo Atrioventricular/cirurgia , Eletrocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Síncope/terapia
13.
Medicine (Baltimore) ; 99(32): e21570, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769902

RESUMO

RATIONALE: Macrophage activation syndrome (MAS) is a rare life-threatening condition characterized by cytokine-mediated tissue injury and multiorgan dysfunction. PATIENT CONCERNS: We describe the unique case of young man who developed MAS as the sole manifestation of an otherwise paucisymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DIAGNOSES: Clinical and biological criteria led to the diagnosis of MAS; cytokine profile was highly suggestive reverse transcription polymerase chain reaction for SARS-CoV-2 in nasopharyngeal swabs was negative, but serum anti-SARS-CoV-2 immunoglobulin A and immunoglobulin G resulted positive leading to the diagnosis of SARS-CoV-2 infection. INTERVENTIONS: The patient was treated with empiric antibiotic and hydroxychloroquine. OUTCOMES: Clinical improvement ensued. At follow-up, the patient is well. LESSON: SARS-CoV-2 infection may trigger develop life-threatening complications, like MAS. This can be independent from coronavirus disease 2019 gravity.


Assuntos
Ceftriaxona/administração & dosagem , Infecções por Coronavirus/diagnóstico , Hospitalização , Hidroxicloroquina/administração & dosagem , Síndrome de Ativação Macrofágica/diagnóstico , Pneumonia Viral/diagnóstico , Adolescente , Análise Química do Sangue , China , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/tratamento farmacológico , DNA Viral/análise , Diagnóstico Diferencial , Progressão da Doença , Quimioterapia Combinada , Eletrocardiografia/métodos , Seguimentos , Humanos , Síndrome de Ativação Macrofágica/terapia , Masculino , Pandemias , Alta do Paciente , Pneumonia Viral/tratamento farmacológico , Radiografia Torácica/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
BMC Cardiovasc Disord ; 20(1): 314, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32611362

RESUMO

BACKGROUND: Coronary artery aneurysm (CAA) is a potential cause of infarction. During the outbreak of coronavirus disease 2019 (COVID-19), home isolation and activity reduction can lead to hypercoagulability. Here, we report a case of sudden acute myocardial infarction caused by large CAA during the home isolation. CASE PRESENTATION: During the outbreak of coronavirus disease 2019 (COVID-19),a 16-year-old man with no cardiac history was admitted to CCU of Tang du hospital because of severe chest pain for 8 h. The patient reached the hospital its own, his electrocardiogram showed typical features of anterior wall infarction, echocardiography was performed and revealed local anterior wall dysfunction, but left ventricle ejection fraction was normal, initial high-sensitivity troponin level was 7.51 ng/mL (<1.0 ng/mL). The patient received loading dose of aspirin and clopidogrel bisulfate and a total occlusion of the LAD was observed in the emergency coronary angiography (CAG). After repeated aspiration of the thrombus, TIMI blood flow reached level 3. Coronary artery aneurysm was visualized in the last angiography. No stent was implanted. Intravascular ultrasound (IVUS) was performed and the diagnosis of coronary artery aneurysm was further confirmed. The patient was discharged with a better health condition. CONCLUSIONS: Coronary artery aneurysm is a potential reason of infarction, CAG and IVUS are valuable tools in diagnosis in such cases, during the outbreak of coronavirus disease 2019 (COVID-19), home isolation and activity reduction can lead to hypercoagulability, and activities at home should be increased in the high-risk patients.


Assuntos
Infarto Miocárdico de Parede Anterior , Aneurisma Coronário , Angiografia Coronária/métodos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Trombectomia/métodos , Ultrassonografia de Intervenção/métodos , Adolescente , Infarto Miocárdico de Parede Anterior/diagnóstico , Infarto Miocárdico de Parede Anterior/etiologia , Infarto Miocárdico de Parede Anterior/fisiopatologia , Infarto Miocárdico de Parede Anterior/cirurgia , Betacoronavirus/isolamento & purificação , China/epidemiologia , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Ecocardiografia/métodos , Eletrocardiografia/métodos , Humanos , Masculino , Pandemias , Medição de Risco , Fatores de Risco , Resultado do Tratamento
15.
Int Heart J ; 61(4): 831-837, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32728002

RESUMO

Ventricular septal rupture (VSR) is one of the fatal complications of myocardial infarction in the percutaneous coronary intervention era. A rapid diagnosis, medical and mechanical support, and surgical intervention are required for recovery and survival. In such a situation, the risk of complications associated with surgery is very high, especially in very elderly patients, in which any therapeutic strategy should be carefully discussed by the heart team. Herein, we describe two cases of VSRs after recent myocardial infarction (RMI) in very elderly patients that required debate regarding whether to perform surgery. The patients included a 93-year-old man and 89-year-old man, both of which were not highly frail before the RMI occurred. In the former case, a conservative strategy was adopted because the risk of surgery was considered, but he did not survive. On the other hand, the latter patient underwent surgery and his life was ultimately saved. Based on these two cases, we concluded that even if the patients are very old, if possible, surgical intervention should be fully considered.


Assuntos
Tratamento Conservador/métodos , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/efeitos adversos , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Idoso de 80 Anos ou mais , Ecocardiografia/métodos , Eletrocardiografia/métodos , Evolução Fatal , Idoso Fragilizado , Humanos , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/fisiopatologia
16.
Cardiol Young ; 30(9): 1346-1349, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32600496

RESUMO

We present our recent experience with a 6-month-old infant with a personal history of short bowel syndrome that presented with fever, cyanosis, and cardiogenic shock secondary to severe pulmonary hypertension and right ventricular failure without pulmonary thromboembolism. He did not present signs of toxin-mediated disease or Kawasaki disease. He was finally diagnosed with SARS-CoV-2 infection. If this presentation is confirmed in future research, the severe cardiovascular impairment in children with COVID-19 could be also attributable to the primary pulmonary infection, not only to a multisystem inflammatory syndrome but also in children without heart disease.


Assuntos
Angiografia por Tomografia Computadorizada , Infecções por Coronavirus , Insuficiência Cardíaca , Hipertensão Pulmonar , Pandemias , Pneumonia Viral , Choque Cardiogênico , Síndrome de Resposta Inflamatória Sistêmica , Betacoronavirus/isolamento & purificação , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Lactente , Masculino , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Radiografia Torácica , Respiração Artificial/métodos , Índice de Gravidade de Doença , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Resultado do Tratamento
19.
Radiol Med ; 125(9): 838-850, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32671554

RESUMO

4D Flow is an emerging MR technique enabling three-dimensional and cardiac phase-resolved flowmetry with ECG-gated phase-contrast MRI that increased the speed of data acquisitions, accuracy and robustness. The method is promoting researches in areas that have not been fully addressed before in the cardiovascular system, such as flowmetry of the bloodstream across the valves, within the heart chambers, complexed flow dynamics such as vortex, helical or retrograde. Wall shear stress and other potential biomarkers derived from 4D Flow are known to be related to vascular wall diseases such as atherosclerosis. In this review, fundamental concepts of 4D Flow technique and post-processing, benefits and limitations as well as its clinical applications are discussed, and the importance of quality control and validation of the method is emphasized. New ideas inspired by 4D Flow can help clinicians and MR scientists further understand the role of flow dynamics in health sciences, diseases and various aspects of cardiovascular physiology.


Assuntos
Circulação Coronária/fisiologia , Imagem Cinética por Ressonância Magnética/métodos , Velocidade do Fluxo Sanguíneo , Eletrocardiografia/métodos , Humanos , Hidrodinâmica , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Fluxo Sanguíneo Regional/fisiologia , Resistência ao Cisalhamento/fisiologia
20.
JAMA ; 324(3): 279-290, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32692391

RESUMO

Importance: Perioperative cardiovascular complications occur in 3% of hospitalizations for noncardiac surgery in the US. This review summarizes evidence regarding cardiovascular risk assessment prior to noncardiac surgery. Observations: Preoperative cardiovascular risk assessment requires a focused history and physical examination to identify signs and symptoms of ischemic heart disease, heart failure, and severe valvular disease. Risk calculators, such as the Revised Cardiac Risk Index, identify individuals with low risk (<1%) and higher risk (≥1%) for perioperative major adverse cardiovascular events during the surgical hospital admission or within 30 days of surgery. Cardiovascular testing is rarely indicated in patients at low risk for major adverse cardiovascular events. Stress testing may be considered in patients at higher risk (determined by the inability to climb ≥2 flights of stairs, which is <4 metabolic equivalent tasks) if the results from the testing would change the perioperative medical, anesthesia, or surgical approaches. Routine coronary revascularization does not reduce perioperative risk and should not be performed without specific indications independent of planned surgery. Routine perioperative use of low-dose aspirin (100 mg/d) does not decrease cardiovascular events but does increase surgical bleeding. Statins are associated with fewer postoperative cardiovascular complications and lower mortality (1.8% vs 2.3% without statin use; P < .001) in observational studies, and should be considered preoperatively in patients with atherosclerotic cardiovascular disease undergoing vascular surgery. High-dose ß-blockers (eg, 100 mg of metoprolol succinate) administered 2 to 4 hours prior to surgery are associated with a higher risk of stroke (1.0% vs 0.5% without ß-blocker use; P = .005) and mortality (3.1% vs 2.3% without ß-blocker use; P = .03) and should not be routinely used. There is a greater risk of perioperative myocardial infarction and major adverse cardiovascular events in adults aged 75 years or older (9.5% vs 4.8% for younger adults; P < .001) and in patients with coronary stents (8.9% vs 1.5% for those without stents; P < .001) and these patients warrant careful preoperative consideration. Conclusions and Relevance: Comprehensive history, physical examination, and assessment of functional capacity during daily life should be performed prior to noncardiac surgery to assess cardiovascular risk. Cardiovascular testing is rarely indicated in patients with a low risk of major adverse cardiovascular events, but may be useful in patients with poor functional capacity (<4 metabolic equivalent tasks) undergoing high-risk surgery if test results would change therapy independent of the planned surgery. Perioperative medical therapy should be prescribed based on patient-specific risk.


Assuntos
Doenças Cardiovasculares/etiologia , Complicações Pós-Operatórias/etiologia , Medição de Risco/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Fatores Etários , Idoso , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Biomarcadores/sangue , Angiografia Coronária , Ecocardiografia Transesofagiana , Eletrocardiografia/métodos , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Insuficiência Cardíaca/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Isquemia Miocárdica/diagnóstico , Revascularização Miocárdica , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Stents/efeitos adversos , Acidente Vascular Cerebral/induzido quimicamente , Fatores de Tempo , Estados Unidos/epidemiologia
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