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1.
Texto & contexto enferm ; 29: e20180399, Jan.-Dec. 2020. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1101980

RESUMO

ABSTRACT Objective: to evaluate the effectiveness of educational interventions in improving the quality of life of people with arterial hypertension. Method: an integrative literature review which included studies that conducted educational interventions aimed at the hypertensive public to improve quality of life. The search was performed in the following databases: MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO and CINAHL, without restriction of language, date and sample size. For this, the following descriptors were crossed: "hipertensão" (hypertension), "educação em saúde" (health education) and "qualidade de vida" (quality of life). 619 articles were retrieved and after the selection and analysis process, a total of 10 made up this review. Data extraction and analysis were performed with the help of validated instruments and the result summarized. Results: Most studies were developed on a quasi-experimental basis, using generic instruments to measure quality of life with significant improvement after educational interventions, with group technology being the most used educational strategy. Just one study used a specific instrument to evaluate hypertensive patients. Conclusion: these results may direct the interventions to be implemented by health professionals in managing arterial hypertension. Further investigations are needed to identify and verify the most effective interventions for hypertensive patients, considering heterogeneous profiles and aiming at improving quality of life.


RESUMO Objetivo: evaluar la eficacia de las intervenciones educativas en el mejoramiento de la calidad de vida de personas con hipertensión arterial. Método: revisión integradora de la literatura que incluyó estudios que han realizado intervenciones educativas direccionadas al público hipertenso con el objetivo de mejorar su calidad de vida. La búsqueda se realizó en las bases de datos MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO e CINAHL, sin restricción de idioma, fecha ni tamaño de muestra. A tal efecto, se utilizaron los descriptores "hipertensión", "educación en salud" y "calidad de vida". Se tomaron 619 artículos y luego de un proceso de selección y análisis esta revisión se compone de un total de 10. La extracción y el análisis de datos se realizaron con el auxilio de instrumentos validados e se procedió a la síntesis de los resultados. Resultados: la mayor parte de los estudios se desarrolló con carácter casi experimental mediante el uso instrumentos genéricos para medir la calidad de vida, con significativa mejoría después de realizadas las intervenciones educativas, siendo la tecnología grupal la estrategia educacional más utilizada. Apenas un estudio utilizó un instrumento específico para la evaluación de hipertensos. Conclusión: estos resultados pueden direccionar las intervenciones que deben llevarse a cabo por profesionales de la salud en el manejo de la presión arterial. Es necesario profundizar las investigaciones para identificar y verificar las intervenciones más eficientes en pacientes hipertensos, considerando perfiles heterogéneos a fin de mejorar su calidad de vida.


RESUMO Objetivo: avaliar a efetividade de intervenções educativas na melhora da qualidade de vida de pessoas com hipertensão arterial. Método: revisão integrativa da literatura que incluiu estudos que realizaram intervenções educacionais direcionadas ao público hipertenso com vistas à melhora da qualidade de vida. Busca realizada nas bases de dados: MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO e CINAHL, sem restrição de idioma, data e tamanho amostral. Para tal, cruzaram-se os descritores: "hipertensão", "educação em saúde" e "qualidade de vida". Foram resgatados 619 artigos e após o processo de seleção e análise, um total de 10 compuseram esta revisão. A extração e análise dos dados foram realizadas com auxílio de instrumentos validados e o resultado sumarizado. Resultados: a maioria dos estudos foi desenvolvida em caráter quase experimental, utilizando-se de instrumentos genéricos para mensuração da qualidade de vida com melhora significativa após a realização de intervenções educativas, sendo a tecnologia grupal a estratégia educacional mais utilizada. Apenas um estudo utilizou instrumento específico para avaliação em hipertensos. Conclusão: estes resultados podem direcionar as intervenções a serem implementadas por profissionais de saúde no manejo da hipertensão arterial. Futuras investigações são necessárias para identificar e verificar as intervenções mais eficazes aos pacientes hipertensos, considerando perfis heterogêneos e visando à melhora da qualidade de vida.


Assuntos
Qualidade de Vida , Doença Crônica , Hipertensão , Saúde , Educação em Saúde , Revisão , Pressão Arterial , Análise de Dados
2.
Hipertens. riesgo vasc ; 37(3): 133-136, jul.-sept. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-193522

RESUMO

La disfunción autonómica es una enfermedad muy frecuente en las alfa-sinucleoinopatías (enfermedad de Parkinson, demencia por cuerpos de Lewy, atrofia multisistémica). A nivel cardiovascular puede producir síntomas como hipotensión ortostática, hipertensión supina o disminución de la respuesta de la frecuencia cardiaca a estímulos. Para el diagnóstico es fundamental una sospecha clínica y una exploración física minuciosa, tomando la presión arterial tanto en posición de decúbito supino como en bipedestación. El electrocardiograma puede mostrar un alargamiento de los intervalos PR y QT, mientras que la monitorización ambulatoria de presión arterial de 24 h aporta información sobre los patrones de presión arterial. La confirmación de la disfunción simpática cardiaca puede realizarse con una gammagrafía miocárdica de inervación con 123-I-metilbencilguanidina (123-I-MIBG), ya que refleja la captación noradrenérgica neuronal específica. A continuación presentamos el caso de un varón con enfermedad de Parkinson que tras un completo estudio fue diagnosticado de disfunción autonómica cardiovascular


Autonomic dysfunction is a common condition in the alpha-synucleinopathies (Parkinson's disease, dementia with Lewy bodies, multiple system atrophy). Cardiovascular symptoms may include orthostatic hypotension, supine hypertension or decreased heart rate response. A clinical suspicion and physical examination are essential for diagnosis, taking blood pressure in supine and standing positions. The electrocardiogram may show a prolongation of the PR and QT intervals, while 24-hour ambulatory blood pressure monitoring provides information on blood pressure patterns. Cardiac sympathetic dysfunction can be confirmed by an innervation myocardial scintigraphy with 123-I-methylbenzylguanidine (123-I-MIBG). This can reflect specific neuronal noradrenergic uptake.We present the case of a man with Parkinson's disease who was diagnosed with cardiovascular autonomic dysfunction after a complete study


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Doenças do Sistema Nervoso Autônomo/complicações , Doenças do Sistema Nervoso Autônomo/diagnóstico por imagem , Doenças Neurodegenerativas/complicações , Pressão Arterial/efeitos dos fármacos , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Índice de Gravidade de Doença , Eletrocardiografia , Frequência Cardíaca , Captopril , Síndrome do QT Longo/diagnóstico
3.
Cardiovasc Ther ; 2020: 4349612, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32983258

RESUMO

Background: Central aortic blood pressure (CABP) indices, central hemodynamics, and arterial stiffness are better predictors of cardiovascular events as compared with brachial cuff pressure measurements alone. The present study is aimed at assessing the effects of different antihypertensive drug combination regimens involving renin-angiotensin-aldosterone system (RAAS) inhibitors on CABP indices in Indian patients with hypertension. Methods: This was a cross-sectional, single-center study conducted in patients treated for hypertension for >6 weeks using different treatment regimens involving the combination of RAAS inhibitors with drugs from other classes. CABP indices, vascular age, arterial stiffness, and central hemodynamics were measured in patients using the noninvasive Agedio B900 device (IEM, Stolberg, Germany) and compared between different treatment regimens. Results: A total of 199 patients with a mean age of 54.22 ± 10.15 years were enrolled, where 68.8% had hypertension for over three years and 50.25% had their systolic blood pressure (SBP) < 140 mmHg. Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively. The mean vascular age was higher than the actual age (58.13 ± 12.43 vs. 54.22 ± 10.15, p = 0.001). The SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were lower than those in patients treated with ARB-based combinations (p < 0.05). The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments (p = 0.001). In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments (p < 0.05). A total of 6.5% patients experienced any side effects. Conclusion: The majority of central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs. Our results indicate a gap between routine clinical practice and evidence-based guidelines in Indian settings and identify a need to reevaluate the current antihypertensive prescription strategy.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Adulto , Idoso , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Estudos Transversais , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Índia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(36): e21864, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899016

RESUMO

Spinal anesthesia (SpA) for elective caesarean section (CS) is often accompanied by clinically relevant arterial hypotension. The Bezold-Jarisch reflex, causing postspinal hypotension, has been shown to be antagonized by serotonin type 3 (5-HT3) blockade. Our aim was to assess if routine prophylactic administration of the 5-HT3 antagonist ondansetron (ODS) attenuates postspinal change in maternal blood pressure.Elective CS under SpA were retrospectively analyzed. Eighty parturients having routinely received 8 mg ODS prior to SpA were compared with 80 patients having not (control group).Mean arterial blood pressure significantly decreased from baseline to the postspinal period (P < .0001) without differences in blood pressure decreases between the 2 groups. This also applied to the heart rate. Overall use of cafedrine/theodrenaline was higher in the ODS group (0.8 (0.4-1.6) mL vs 0.8 (0-1.0) mL in the control group, P = .01). APGAR values showed a presumably clinically irrelevant decrease in control group compared with the ODS group.Our results suggest that routine administration of ODS in a dosage of 8 mg does not effectively attenuate postspinal change in maternal blood pressure during CS in our setting. Given the wide variability of anesthetic techniques, only large prospective and randomized multicenter trials will ultimately serve to elucidate this issue.


Assuntos
Anestesia Obstétrica/métodos , Raquianestesia/métodos , Cesárea/métodos , Ondansetron/administração & dosagem , Antagonistas do Receptor 5-HT3 de Serotonina/administração & dosagem , Adulto , Índice de Apgar , Pressão Arterial/efeitos dos fármacos , Estudos de Casos e Controles , Cesárea/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
5.
Georgian Med News ; (304-305): 127-134, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965263

RESUMO

The aim of the study was elaboration of an approach for monitoring of cardiac output (CO) and systemic arterial pressure (SAP) using data obtained via measurements of the pulse waveform in peripheral arteries under steady-state and transitive conditions. CO and SAP were simultaneously recorded in common carotid and femoral arteries in narcotized (urethane, 1 mg/g) rats continuously and after infusions of sodium nitroprusside, adrenaline hydrochloride, dextran solution or acute experimental hemorrhage. Fourier analysis has been employed for estimating the generalized transfer functions (GTFs) and generalized vascular input impedance (GVI) along with individualized transfer functions (ITFs) for the states in the aftermath of infusions of vasoactive pharmacological agents, dextran solution or acute experimental hemorrhage. The results of pulse waveform analysis in the femoral artery were used for reconstruction of the pulse curves in carotid arteries and aortic blood flow. A comparison of directly measured and predicted pressure and flow values revealed the absence of significant differences under steady-state conditions. Short-term shifts of haemodynamics that follow various transitory influences on the cardiovascular system inevitably evoke changes in the mechanical properties of the blood vessels. Since both GTF and ITF express the mechanical properties of the vascular bed, their values also change under these conditions. This causes control of vascular stiffness and rigidity by estimation of the pulse wave velocities before and after administration of vasoactive agents and/or changes of the circulation blood volume.


Assuntos
Pressão Arterial , Hemodinâmica , Animais , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Artérias Carótidas , Frequência Cardíaca , Ratos
6.
PLoS One ; 15(8): e0237736, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817703

RESUMO

AIMS: To assess the impact of two different respiratory rates in hemodynamic, perfusion and ventilation parameters in a pediatric animal model of cardiac arrest (CA). METHODS: An experimental randomized controlled trial was carried out in 50 piglets under asphyxial CA. After ROSC, they were randomized into two groups: 20 and 30 respirations per minute (rpm). Hemodynamic, perfusion and ventilation parameters were measured 10 minutes after asphyxia, just before ROSC and at 5, 15, 30 and 60 minutes after ROSC. Independent medians test, Kruskal-Wallis test and χ2 test, were used to compare continuous and categorical variables, respectively. Spearman's Rho was used to assess correlation between continuous variables. A p-value <0.05 was considered significant. RESULTS: Arterial partial pressure of carbon dioxide (PaCO2) was significantly lower in the 30 rpm group after 15 minutes (41 vs. 54.5 mmHg, p <0.01), 30 minutes (39.5 vs. 51 mmHg, p < 0.01) and 60 minutes (36.5 vs. 48 mmHg, p = 0.02) of ROSC. The percentage of normoventilated subjects (PaCO2 30-50 mmHg) was significantly higher in the 30 rpm group throughout the experiment. pH normalization occurred faster in the 30 rpm group with significant differences at 60 minutes (7.40 vs. 7.34, p = 0.02). Lactic acid levels were high immediately after ROSC in both groups, but were significantly lower in the 20 rpm group at 30 (3.7 vs. 4.7 p = 0.04) and 60 minutes (2.6 vs. 3.6 p = 0.03). CONCLUSIONS: This animal model of asphyxial CA shows that a respiratory rate of 30 rpm is more effective to reach normoventilation than 20 rpm in piglets after ROSC. This ventilation strategy seems to be safe, as it does not cause hyperventilation and does not affect hemodynamics or cerebral tissue perfusion.


Assuntos
Asfixia/terapia , Parada Cardíaca/terapia , Taxa Respiratória/fisiologia , Ventilação/normas , Animais , Pressão Arterial/fisiologia , Asfixia/fisiopatologia , Dióxido de Carbono/metabolismo , Modelos Animais de Doenças , Parada Cardíaca/fisiopatologia , Humanos , Ácido Láctico/metabolismo , Pediatria , Estatísticas não Paramétricas , Suínos/fisiologia
7.
Ecotoxicol Environ Saf ; 204: 111036, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32784013

RESUMO

Human exposure to methylmercury (MeHg) due to contaminated fish intake as part of a high-fat (HFD), high-carbohydrate diets is a reality today for many populations. HFD is associated with hypertension and hyperlipidemia, primary cardiovascular disease (CVD) risk factors. Some studies suggest that MeHg induces those risk factors. We evaluated the effect of MeHg exposure in mice fed with HFD or control diet for eight weeks. In the last experimental 15 days, the half group received a MeHg solution (20 mg/L) replacing water. Blood pressure (BP), heart rate, lipoprotein concentrations, and paraoxonase activity were evaluated. Liver cholesterol, triacylglycerol, and IBA-1+ cells, as well as transcriptional levels of genes related to lipid metabolism and inflammatory response, were also assessed. HFD and both MeHg groups presented increased BP and total cholesterol (TC). In the liver, HFD but not MeHg was related to an increase in TC. Also, MeHg intoxication reduced paraoxonase activity regardless of diet. MeHg intoxication and HFD increased steatosis and the number of IBA-1+ cells and modified some gene transcripts associated with lipid metabolism. In conclusion, we demonstrated that MeHg effects on CVD risk factors resemble those caused by HFD.


Assuntos
Pressão Arterial/efeitos dos fármacos , Aterosclerose/epidemiologia , Dieta Hiperlipídica/efeitos adversos , Poluentes Ambientais/efeitos adversos , Fígado/efeitos dos fármacos , Compostos de Metilmercúrio/efeitos adversos , Estado Nutricional , Animais , Aterosclerose/induzido quimicamente , Fígado Gorduroso/metabolismo , Feminino , Inflamação/induzido quimicamente , Inflamação/fisiopatologia , Lipoproteínas/metabolismo , Fígado/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Fatores de Risco
8.
Br J Anaesth ; 125(4): 622-628, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32739045

RESUMO

BACKGROUND: Arterial pressure lability is common during the process of replacing syringes used for norepinephrine infusions in critically ill patients. It is unclear if there is an optimal approach to minimise arterial pressure instability during this procedures. We investigated whether 'double pumping' changeover (DPC) or automated changeover (AC) reduced blood pressure lability in critically ill adults compared with quick syringe changeover (QC). METHODS: Patients requiring a norepinephrine infusion syringe change were randomised in a non-blinded trial undertaken in six ICUs. Randomisation was minimised by norepinephrine flow rate at inclusion and centre. The primary outcome was the frequency of increased/decreased mean arterial pressure (defined by 15 mm Hg from baseline measurements) within 15 min of switching the syringe compared with QC. RESULTS: Patients (mean age: 64 (range:18-88)) yr were randomly assigned to QC (n=95), DPC (n=95), or AC (n=96). Increased MAP was the commonest consequence of syringe changeovers. MAP variability was most frequent after DPC (89/224 changeovers; 39.7%) compared with 57/223 (25.6%) changeovers after quick syringe switch and 46/181 (25.4%) in patients randomised to receive automated changeover (P=0.001). Fewer events occurred with QC compared with DPC (P=0.002). Sensitivity analysis based on mixed models showed that performing several changeovers on a single patient had no impact. Both type of changeover and norepinephrine dose before syringe changeover were independently associated with MAP variations >15 mm Hg. CONCLUSIONS: Quick changeover of norepinephrine syringes was associated with less blood pressure lability compared with DPC. The prevalence of MAP variations was the same between AC and QC. CLINICAL TRIAL REGISTRATION: NCT02304939.


Assuntos
Pressão Arterial/efeitos dos fármacos , Cuidados Críticos , Norepinefrina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Seringas , Adulto Jovem
9.
Arch. med ; 20(2): 428-436, 20200703.
Artigo em Espanhol | LILACS | ID: biblio-1118898

RESUMO

Objetivo: el propósito de este estudio fue determinar la relación entre el índice de masa corporal, el índice de masa grasa y la tensión arterial en un grupo de cadetes con sobrepeso. El índice de masa corporal no estima la adiposidad como sí sucede con el índice de masa grasa; a su vez, el exceso de adiposidad predispone el desarrollo de enfermedades cardiovasculares. Materiales y métodos: estudio observacional retrospectivo. Se aplicaron estadísticos descriptivos y correlación de Pearson. Resultados: 90 cadetes con edad promedio 22 ± 3años y con índice de masa corporal de 27,3 ± 2 kg/m2, hicieron parte del estudio. El índice de masa grasa no presentó diferencias significativas entre hombres y mujeres: 7,62 ± 2,37 kg/m2 y 7,8 ± 2,3kg/m2 respectivamente (p: 0,38). En hombres, la tensión arterial sistólica y diastólica fue normal y sin diferencias significativas (p > 0,05). En los hombres, la tensión arterial diastólica se relacionó con valor absoluto de la masa grasa (r= 0,420 p 0,00) y con el índice de masa grasa (r=0,386 p: 0,00). En las mujeres, el índice de masa grasa se relacionó con el índice de masa corporal (r= 0,516 p= 0,00) y la tensión arterial sistólica se relacionó con la circunferencia de la cintura (r= 0,357 p: 0,03). Conclusiones: en jóvenes militares el índice de masa corporal ≥ 25 kg/m2, no se relaciona con la tensión arterial y el índice de masa grasa, no sugiere sobrepeso por adiposidad..Au


Objective: the purpose of this study was to determine the relationship between body mass index, body mass index and blood pressure in a group of overweight cadets. The body mass index does not estimate adiposity as if it happens with the fat mass index.In turn, excess adiposity predisposes the development of cardiovascular diseases Materials and methods: retrospective observational study. Descriptive statistics and Pearson's correlation were applied. Results: 90 cadets with an average age of 22 ± 3 years and a body mass index of 27.3 ± 2 kg / m2 were part of the study. The fat mass index did not show significant differences between men and women: 7.62 ± 2.37 kg / m2 and 7.8 ± 2.3kg / m2 respectively (p: 0.38). In men, systolic and diastolic blood pressure was normal and without significant differences (p> 0.05). In men, diastolic blood pressure was related to absolute value of fat mass (r = 0.420 p 0.00) and to the fat mass index (r = 0.386 p: 0.00). In women, the fat mass index was related to the body mass index (r = 0.516 p = 0.00) and the systolic blood pressure was related to the waist circumference (r = 0.357 p: 0.03). Conclusions: in young military the body mass index ≥ 25 kg / m2, is not related to blood pressure and fat mass index, does not suggest overweight due to adiposity..Au


Assuntos
Adulto , Índice de Massa Corporal , Pressão Arterial
10.
Am J Vet Res ; 81(8): 635-641, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32701000

RESUMO

OBJECTIVE: To compare noninvasive blood pressure (NIBP) measurements with invasive blood pressure (IBP) measurements of arterial blood pressure (ABP) in anesthetized dogs as obtained with a veterinary-specific multiparameter monitor. ANIMALS: 21 client-owned healthy female dogs anesthetized for routine ovariohysterectomy. PROCEDURES: ABP measurements were obtained with a single veterinary-specific multiparameter monitor via a pneumatic cuff placed over the medial dorsal metatarsal artery (NIBP) and a transducer connected to a catheter placed in the contralateral artery (IBP). The 224 paired ABP measurements (complete data set) were categorized into 3 subsets-hypotension, normotension, and hypertension-on the basis of invasive measurements of mean arterial blood pressure (MAP). The NIBP and IBP measurements of systolic and diastolic arterial blood pressure (SAP and DAP, respectively) and MAP were compared. RESULTS: NIBP measurements were frequently lower than IBP measurements. The greatest underestimation was for the hypertension subset of NIBP measurements, with biases for SAP of 15.7 mm Hg, DAP of 14.1 mm Hg, and MAP of 12.0 mm Hg. Considering the complete data set, precision was acceptable (SD of the differences between paired measurements ≤ 15 mm Hg for DAP [9.0 mm Hg] and MAP [12.1 mm Hg]); however, precision was not acceptable for SAP (SD, 18.6 mm Hg). CONCLUSIONS AND CLINICAL RELEVANCE: NIBP measurements with the studied veterinary-specific multiparameter monitor generally agreed with IBP measurements during hypotensive and normotensive periods for anesthetized healthy female dogs undergoing routine ovariohysterectomy. However, inaccuracies, frequently underestimations, were observed during periods of hypertension, and therefore, NIBP measurements should be interpreted cautiously.


Assuntos
Anestesia/veterinária , Pressão Arterial , Animais , Pressão Sanguínea , Determinação da Pressão Arterial , Monitores de Pressão Arterial , Cães , Feminino
11.
Vasc Endovascular Surg ; 54(7): 592-597, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32643584

RESUMO

BACKGROUND: Hemodynamics, dissection morphology, and aortic wall elasticity have a major influence on the pressure in the false lumen. In contrast to aortic wall elasticity, the influence of hemodynamics and dissection morphology have been investigated often in multiple in vitro and ex vivo studies. The purpose of this study was to evaluate the influence of aortic wall elasticity on the diameter and pressure of the false lumen in aortic dissection. METHODS: An artificial dissection was created in 3 ex vivo porcine aortas. The aorta models were consecutively positioned in a validated in vitro circulatory system with physiological pulsatile flow. Each model was imaged with ultrasound on 4 positions along the aorta and the dissection. At these 4 locations, pressure measurement was also performed in the true and false lumen with an arterial catheter. After baseline experiments, the aortic wall elasticity was adjusted with silicon and the experiments were repeated. RESULTS: The aortic wall elasticity was decreased in all 3 models after siliconizing. In all 3 siliconized models, the diameters of the true and false lumen increased at proximal, mid, and distal location, while the mean arterial pressure did not significantly change. CONCLUSIONS: In this in vitro study, we showed that aortic wall elasticity is an important parameter altering the false lumen. An aortic wall with reduced elasticity results in an increased false lumen diameter in the mid and distal part of the false lumen. These results can only be transferred to corresponding clinical situations to a limited extent.


Assuntos
Aneurisma Dissecante/fisiopatologia , Aneurisma Aórtico/fisiopatologia , Pressão Arterial , Rigidez Vascular , Animais , Elasticidade , Modelos Animais , Modelos Cardiovasculares , Estresse Mecânico , Sus scrofa
12.
J Cardiovasc Magn Reson ; 22(1): 50, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32698897

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) associated with pulmonary hypertension (PH) is a significant source of morbidity and mortality in premature infants. Recent advances have allowed the use of cardiovascular magnetic resonance (CMR) in the assessment of respiratory and cardiac disease in infants with BPD. In adults and older pediatric patients, decreased CMR interventricular septal curvature correlates with increased mean pulmonary artery pressure and pulmonary vascular resistance. The current study sought to determine the relationship of CMR derived septal curvature in neonates with BPD and BPD-PH with a need for PH therapy. METHODS: Forty moderate or severe BPD and 12 mild BPD or control infants were imaged without contrast between 38 and 47 weeks post-menstrual age on a neonatal-sized, neonatal intensive care unit-sited 1.5 T CMR scanner. CMR indices including eccentricity index (CMR-EI) and septal curvature were measured and compared to BPD severity and clinical outcomes including hospital length of stay (LOS), duration of respiratory support, respiratory support level at discharge and PH therapy. RESULTS: CMR-EI was directly associated and septal curvature was inversely associated with BPD severity. In a univariate analysis, CMR-EI and septal curvature were associated with increased hospital LOS, duration of respiratory support, respiratory support at hospital discharge, and need for PH therapy. In multivariable analysis CMR-EI was associated with hospital LOS and duration of respiratory support and septal curvature was associated with respiratory support at hospital discharge. Septal curvature was the only clinical or CMR variable associated with need for PH therapy (R2 = 0.66, p = 0.0014) in multivariable analysis demonstrating improved discrimination beyond CMR-EI. CONCLUSIONS: CMR derived septal curvature correlates significantly with clinical outcomes including hospital LOS, duration of respiratory support, respiratory support level at hospital discharge, and PH therapy in neonates with BPD and BPD-PH. Further, CMR derived septal curvature demonstrated improved discrimination of need for PH therapy and respiratory support at discharge compared to clinical variables and other CMR indices, supporting septal curvature as a non-invasive marker of PH in this population with potential to guide management strategies.


Assuntos
Pressão Arterial , Displasia Broncopulmonar/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Artéria Pulmonar/fisiopatologia , Resistência Vascular , Septo Interventricular/diagnóstico por imagem , Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/terapia , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Recém-Nascido , Tempo de Internação , Masculino , Valor Preditivo dos Testes , Artéria Pulmonar/efeitos dos fármacos , Terapia Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Resistência Vascular/efeitos dos fármacos , Septo Interventricular/efeitos dos fármacos , Septo Interventricular/fisiopatologia
14.
Rev Cardiovasc Med ; 21(2): 163-179, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32706206

RESUMO

Pulmonary arterial hypertension (PAH) is a progressive and fatal lung disease of multifactorial etiology. Most of the available drugs and FDA-approved therapies for treating pulmonary hypertension attempt to overcome the imbalance between vasoactive and vasodilator mediators, and restore the endothelial cell function. Traditional medications for treating PAH include the prostacyclin analogs and receptor agonists, phosphodiesterase 5 inhibitors, endothelin-receptor antagonists, and cGMP activators. While the current FDA-approved drugs showed improvements in quality of life and hemodynamic parameters, they have shown only very limited beneficial effects on survival and disease progression. None of them offers a cure against PAH, and the median survival rate remains less than three years from diagnosis. Extensive research efforts have led to the emergence of innovative therapeutic approaches in the area of PAH. In this review, we provide an overview of the current FDA-approved therapies in PAH and discuss the associated clinical trials and reported-side effects. As recent studies have led to the emergence of innovative therapeutic approaches in the area of PAH, we also focus on the latest promising therapies in preclinical studies such as stem cell-based therapies, gene transfer, and epigenetic therapies.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Hipertensão Arterial Pulmonar/terapia , Artéria Pulmonar/efeitos dos fármacos , Animais , Terapia Genética , Humanos , Hipertensão Arterial Pulmonar/genética , Hipertensão Arterial Pulmonar/mortalidade , Hipertensão Arterial Pulmonar/fisiopatologia , Artéria Pulmonar/fisiopatologia , Transplante de Células-Tronco , Resultado do Tratamento
15.
PLoS One ; 15(7): e0235635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614897

RESUMO

BACKGROUND: Normothermic ex vivo liver perfusion (NEVLP) is a promising strategy to increase the donor pool in liver transplantation. Small animal models are essential to further investigate questions regarding organ preservation and reconditioning by NEVLP. A dual vessel small animal NEVLP (dNEVLP) model was developed using metamizole as a vasodilator and compared to conventional portovenous single vessel NEVLP (sNEVLP). METHODS: Livers of male Wistar rats were perfused with erythrocyte-supplemented culture medium for six hours by either dNEVLP via hepatic artery and portal vein or portovenous sNEVLP. dNEVLP was performed either with or without metamizole treatment. Perfusion pressure and flow rates were constantly monitored. Transaminase levels were determined in the perfusate at the start and after three and six hours of perfusion. Bile secretion was monitored and bile LDH and GGT levels were measured hourly. Histopathological analysis was performed using liver and bile duct tissue samples after perfusion. RESULTS: Hepatic artery pressure was significantly lower in dNEVLP with metamizole administration. Compared to sNEVLP, dNEVLP with metamizole treatment showed higher bile production, lower levels of transaminases during and after perfusion as well as significantly lower necrosis in liver and bile duct tissue. Biochemical markers of bile duct injury showed the same trend. CONCLUSION: Our miniaturized dNEVLP system enables normothermic dual vessel rat liver perfusion. The administration of metamizole effectively ameliorates arterial vasospasm allowing for six hours of dNEVLP, with superior outcome compared to sNEVLP.


Assuntos
Dipirona/farmacologia , Transplante de Fígado , Preservação de Órgãos/métodos , Vasodilatação/efeitos dos fármacos , Animais , Pressão Arterial/efeitos dos fármacos , Bile/metabolismo , Ductos Biliares/patologia , Artéria Hepática/patologia , Fígado/irrigação sanguínea , Fígado/patologia , Testes de Função Hepática , Masculino , Ratos , Ratos Wistar
16.
PLoS One ; 15(7): e0235933, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32640004

RESUMO

BACKGROUND: Non-Invasive Venous waveform Analysis (NIVA) is novel technology that captures and analyzes changes in venous waveforms from a piezoelectric sensor on the wrist for hemodynamic volume assessment. Complex cranial vault reconstruction is performed in children with craniosynostosis and is associated with extensive blood loss, potential life-threatening risks, and significant morbidity. In this preliminary study, we hypothesized that NIVA will provide a reliable, non-invasive, quantitative assessment of intravascular volume changes in children undergoing complex cranial vault reconstruction. OBJECTIVE: To present proof-of-concept results of a novel technology in the pediatric population. METHODS: The NIVA prototype was placed on each subject's wrist, and venous waveforms were collected intraoperatively. Estimated blood loss and fluid/blood product administration were recorded in real time. Venous waveforms were analyzed into a NIVA value and then correlated, along with mean arterial pressure (MAP), to volume changes. Concordance was quantified to determine if the direction of change in volume was similar to the direction of change in MAP or change in NIVA. RESULTS: Of 18 patients enrolled, 14 had usable venous waveforms, and there was a significant correlation between change in NIVA value and change in volume. Change in MAP did not correlate with change in volume. The concordance between change in MAP and change in volume was less than the concordance between change in NIVA and change in volume. CONCLUSION: NIVA values correlate more closely to intravascular volume changes in pediatric craniofacial patients than MAP. This initial study suggests that NIVA is a potential safe, reliable, non-invasive quantitative method of measuring intravascular volume changes for children undergoing surgery.


Assuntos
Craniossinostoses/cirurgia , Veias/fisiologia , Pressão Arterial/fisiologia , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Craniossinostoses/terapia , Feminino , Hidratação , Hemodinâmica , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Reconstrutivos
17.
Cardiovasc Pathol ; 49: 107257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32674046

RESUMO

BACKGROUND: Chronic Chagas disease (CCHD) associated with Systemic Arterial Hypertension (SAH) is frequently found in areas where the disease is endemic. The pathogenesis of patients with both pathologies (CCHD-SAH) is unsettled. Nitric Oxide (NO) and Kinins are important players in the myocardial inflammation process in experimental CCHD. No previous study has addressed this question in patients with CCHD, particularly in those with CCHD-SAH. Accordingly, this study was undertaken in an attempt to contribute to the understanding of the pathogenesis of patients with CCHD-SAH. METHODS: Thirty-seven patients with a positive serology for Chagas disease were enrolled; 15 had CCHD alone, 22 had CCHD-SAH (abnormal ECG/Doppler echocardiogram plus a systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg on admission), and 11 had SAH alone. Thirty healthy individuals matched by age and sex served as controls. Plasma High-molecular (Hkg) and low-molecular weight (LKg) kininogens, plasma kallikrein levels (Pkal and Tcal), Kininase II, and plasma NO were measured. RESULTS: HKg and LKg were lower in CCHD-SAH patients in comparison with other groups (P < .0001). Pkal and Tcal were higher in CCHD-SAH patients in comparison with the other groups (P< .0001). Kininase II levels were similar in SAH, CCHD, and CCHD-SAH patients, but lower in comparison with controls (P< .0001). NO levels were similar in CCHD and CCHD-SAH patients, but higher in comparison with SAH patients and controls (P > .0001). CONCLUSION: Such findings suggest increased Kinin and NO activity in patients with CCHD-SAH, thus contributing to the understanding of the pathogenesis of this condition.


Assuntos
Pressão Arterial , Doença de Chagas/sangue , Hipertensão/sangue , Cininas/sangue , Óxido Nítrico/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Brasil/epidemiologia , Estudos de Casos e Controles , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Doença de Chagas/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Regulação para Cima
18.
Am J Physiol Heart Circ Physiol ; 319(2): H370-H376, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32648822

RESUMO

Changes in the arterial baroreflex arc contribute to elevated sympathetic outflow and altered reflex control of blood pressure with human aging. Using ultrasound and sympathetic microneurography (muscle sympathetic nerve activity, MSNA) we investigated the relationships between aortic and carotid artery wall tension (indices of baroreceptor activation) and the vascular sympathetic baroreflex operating point (OP; MSNA burst incidence) in healthy, normotensive young (n = 27, 23 ± 3 yr) and middle-aged men (n = 22, 55 ± 4 yr). In young men, the OP was positively related to the magnitude and rate of unloading and time spent unloaded in the aortic artery (r = 0.56, 0.65, and 0.51, P = 0.02, 0.003, and 0.03), but not related to the magnitude or rate of unloading or time spent unloaded in the carotid artery (r = -0.32, -0.07, and 0.06, P = 0.25, 0.81, and 0.85). In contrast, in middle-aged men, the OP was not related to either the magnitude or rate of unloading or time spent unloaded in the aortic (r = 0.22, 0.21, and 0.27, P = 0.41, 0.43, and 0.31) or carotid artery (r = 0.06, 0.28, and -0.01; P = 0.48, 0.25, and 0.98). In conclusion, in young men, aortic unloading mechanics may play a role in determining the vascular sympathetic baroreflex OP. In contrast, in middle-aged men, barosensory vessel unloading mechanics do not appear to determine the vascular sympathetic baroreflex OP and, therefore, do not contribute to age-related arterial baroreflex resetting and increased resting MSNA.NEW & NOTEWORTHY We assessed the influence of barosensory vessel mechanics (magnitude and rate of unloading and time spent unloaded) as a surrogate for baroreceptor unloading. In young men, aortic unloading mechanics are important in regulating the operating point of the vascular sympathetic baroreflex, whereas in middle-aged men, these arterial mechanics do not influence this operating point. The age-related increase in resting muscle sympathetic nerve activity does not appear to be driven by altered baroreceptor input from stiffer barosensory vessels.


Assuntos
Envelhecimento , Aorta/inervação , Pressão Arterial , Barorreflexo , Artérias Carótidas/inervação , Músculo Esquelético/inervação , Pressorreceptores/fisiologia , Adulto , Fatores Etários , Aorta/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Frequência Cardíaca , Homeostase , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Ultrassonografia , Adulto Jovem
19.
Am J Physiol Heart Circ Physiol ; 319(2): H468-H480, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32648821

RESUMO

Prolonged sitting, which is known to impair peripheral vascular function, often occurs in spaces (e.g., offices) with mild hypercapnic atmospheres. However, the effects of prolonged sitting in hypercapnic conditions on vascular function are unknown. Therefore, the purpose of this study was to investigate the effects of prolonged sitting in mild hypercapnic conditions on vascular and autonomic function in humans. Twelve healthy young adults participated in two experimental visits that consisted of sitting for 2.5 h in a control condition [normal atmospheric conditions sitting (PSIT)] or a mild hypercapnic condition (HCAP; CO2 = 1,500 ppm). During each visit, heart rate variability (HRV), blood pressure (BP), pulse wave velocity (PWV), augmentation index (AIx), brachial and popliteal artery flow-mediated dilation (FMD), and near-infrared spectroscopy (NIRS) were assessed before and after prolonged sitting. Sitting significantly decreased AIx in both groups (P < 0.05). Brachial and popliteal FMD were reduced with sitting (P < 0.05), and the reduction in popliteal FMD was amplified by HCAP (P < 0.05). Baseline microvascular oxygenation was decreased following sitting in both groups (P < 0.05). However, microvascular reoxygenation upon cuff release was slower only in HCAP (P < 0.05). HRV, HR, BP, and PWV did not significantly change with sitting in either group (P > 0.05). We conclude that prolonged sitting attenuated both brachial and popliteal endothelial function and was associated with perturbed microcirculation. Additionally, mild hypercapnic conditions further impaired peripheral endothelial and microvascular function. Together, these findings suggest that prolonged sitting is accompanied by a host of deleterious effects on the vasculature, which are exacerbated by mild hypercapnia.NEW & NOTEWORTHY The results of this study reveal that prolonged sitting attenuates endothelial function and microvascular function. Additionally, prolonged sitting with mild hypercapnia, which is similar to everyday environments, further exacerbates peripheral endothelial function and microvascular function.


Assuntos
Artéria Braquial/inervação , Hemodinâmica , Hipercapnia/fisiopatologia , Artéria Poplítea/inervação , Postura Sentada , Sistema Nervoso Simpático/fisiopatologia , Adulto , Pressão Arterial , Artéria Braquial/diagnóstico por imagem , Feminino , Frequência Cardíaca , Hemoglobinas/metabolismo , Humanos , Hipercapnia/sangue , Hipercapnia/diagnóstico por imagem , Masculino , Microcirculação , Oxiemoglobinas/metabolismo , Artéria Poplítea/diagnóstico por imagem , Fatores de Tempo , Rigidez Vascular , Adulto Jovem
20.
Am J Physiol Heart Circ Physiol ; 319(2): H360-H369, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32678708

RESUMO

Proper inlet boundary conditions are essential for accurate computational fluid dynamics (CFD) modeling. We developed methodology to derive noninvasive FFRB using CFD and computed tomography coronary angiography (CTCA) images. This study aims to assess the influence of brachial mean blood pressure (MBP) and total coronary inflow on FFRB computation. Twenty-two patients underwent both CTCA and FFR measurements. Total coronary flow was computed from left ventricular mass (LVM) measured from CTCA. A total of 286 CFD simulations were run by varying MBP and LVM at 70, 80, 90, 100, 110, 120, and 130% of the measured values. FFRB increased with incrementally higher input values of MBP: 0.78 ± 0.12, 0.80 ± 0.11, 0.82 ± 0.10, 0.84 ± 0.09, 0.85 ± 0.08, 0.86 ± 0.08, and 0.87 ± 0.07, respectively. Conversely, FFRB decreased with incrementally higher inputs value of LVM: 0.86 ± 0.08, 0.85 ± 0.08, 0.84 ± 0.09, 0.84 ± 0.09, 0.83 ± 0.10, 0.83 ± 0.10, and 0.82 ± 0.10, respectively. Noninvasive FFRB calculated using measured MBP and LVM on a total of 30 vessels was 0.84 ± 0.09 and correlated well with invasive FFR (0.83 ± 0.09) (r = 0.92, P < 0.001). Positive association was observed between FFRB and MBP input values (mmHg) and negative association between FFRB and LVM values (g). Respective slopes were 0.0016 and -0.005, respectively, suggesting potential application of FFRB in a clinical setting. Inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions.NEW & NOTEWORTHY While brachial mean blood pressure (MBP) and left ventricular mass (LVM) measured from CTCA are the two CFD simulation input parameters, their effects on noninvasive fractional flow reserve (FFRB) have not been systematically investigated. We demonstrate that inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions. This is important in the clinical application of noninvasive FFR in coronary artery disease diagnosis.


Assuntos
Pressão Arterial , Artéria Braquial/fisiopatologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Ventrículos do Coração/diagnóstico por imagem , Modelos Cardiovasculares , Tomografia Computadorizada Multidetectores , Modelagem Computacional Específica para o Paciente , Interpretação de Imagem Radiográfica Assistida por Computador , Idoso , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Hidrodinâmica , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
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