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1.
Crit Care Resusc ; 22(1): 26-34, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32102640

RESUMO

BACKGROUND: Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial). METHODS: Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected). RESULTS: Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39-65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38-73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24-108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035). CONCLUSION: ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/terapia , Reperfusão Miocárdica , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Reanimação Cardiopulmonar/mortalidade , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Parada Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
2.
Int J Cardiovasc Imaging ; 36(1): 111-119, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31522312

RESUMO

Although intramyocardial hemorrhage (IMH) is a poor prognostic factor caused by ischemia reperfusion injury, little evidence is available regarding the association between IMH volume and biomarkers. In the present study, we measured IMH volume using three-dimensional (3D) T1-weighted magnetic resonance imaging (T1-MRI) and investigated its association with biomarkers. Moreover, the accuracy of semi-automatic measurement of IMH volume was validated. We retrospectively enrolled 33 consecutive patients (mean age 67 ± 11 years) who underwent cardiac MRI after reperfusion therapy for acute myocardial infarction. IMH was observed in 4 patients (12.1%). Receiver operating characteristics (ROC) analysis of creatine kinase (CK) and CK-muscle/brain (CK-MB) tests for detecting IMH were performed. IMH volume measured using semi-automatic methods by a 2 standard deviation (SD) threshold was compared to manual measurements using the Spearman's correlation coefficient (ρ) and Bland-Altman analyses. ROC analysis revealed optimal cutoff values of CK: 2460 IU/l and CK-MB: 231 IU/l (area under the curve: 0.95 and 0.91; sensitivity: 86% and 79%; specificity: 100% for both). IMH volume with the 2SD threshold correlated with that of the manual measurement [5.84 g (3.30 to 9.00) g vs. 8.07 g (5.37 to 9.33); ρ: 0.85, p < 0.01; bias (limit of agreement): - 0.01 g (- 0.51 to 0.49); intraclass correlation coefficients 0.84 (0.75 to 0.90)]. Our findings could help identify the risk of IMH after reperfusion therapy with biomarkers. 3D T1-MRI can semi-automatically provide accurate IMH volume without being time-consuming.


Assuntos
Hemorragia/diagnóstico por imagem , Imageamento Tridimensional/métodos , Imagem Cinética por Ressonância Magnética/métodos , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Reperfusão Miocárdica/efeitos adversos , Miocárdio/patologia , Idoso , Automação , Biomarcadores/sangue , Creatina Quinase Forma MB/sangue , Feminino , Hemorragia/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/sangue , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão Miocárdica/patologia , Miocárdio/enzimologia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos
3.
J Pak Med Assoc ; 69(9): 1313-1319, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511717

RESUMO

OBJECTIVE: To determine the frequency of no reperfusion therapy, its reasons, hospital management and intermediate-term outcome s of ST- elevation my ocardial in farction patients . METHODS: The retrospective ambi-directional observational study was conducted at Tabba Heart Institute, Karachi, and comprised record of ST-elevation myocardial infarction patients without immediate reperfusion therapy with symptom onset time of 12 hours who presented between January 2013 and December 2017. Prospective follow-up of all patients was performed till June 2018. Coronary angiography, non-invasive stress tests, medications and late revascularisation were explored. Predictors of hospital mortality and major adverse cardiovascular events at follow-up were analysed. Data was analysed using SPSS 19. RESULTS: Of the 1977 records evaluated, 218(11%) patients of mean age 60.3±12.4 years did not receive immediate reperfusion therapy. Coronary angiography was done in 163(74.7%) patients of whom 45(27.6%) were taken for immediate procedure. Besides, 26 (11.9%) patients died during hospital stay. Predictors of hospital mortality were no revascularisation (odds ratio: 24.1, 95% confidence interval: 1.3-500), cardiogenic shock (odds ratio: 65, 95% confidence interval: 5.7-745) and tachycardia (odds ratio: 17, 95% confidence interval: 1.2-254.5) at presentation. Predictor of major adverse cardiovascular events was guideline-directed medical therapy (hazard ratio 2.6, 95% confidence interval: 1.16-6.2) at discharge, while revascularisation was not a significant predictor (p>0.05). Conclusion: A huge number of salvageable ST-elevation myocardial infarction patients failed to receive reperfusion therapy. There is a huge potential of improvement in ST-elevation myocardial infarction care in terms of increasing community awareness, prompt reperfusion therapy and usage of optimal medical therapy.


Assuntos
Mortalidade Hospitalar , Reperfusão Miocárdica/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica/estatística & dados numéricos , Idoso , Institutos de Cardiologia , Angiografia Coronária , Ponte de Artéria Coronária/estatística & dados numéricos , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/métodos , Paquistão/epidemiologia , Intervenção Coronária Percutânea/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Choque Cardiogênico/epidemiologia , Taquicardia/epidemiologia
5.
N Z Med J ; 132(1498): 41-59, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31295237

RESUMO

AIM: Prompt access to cardiac defibrillation and reperfusion therapy improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The study aim was to describe the 'patient' and 'system' delay in patients who receive acute reperfusion therapy for ST-elevation myocardial infarction (STEMI) in New Zealand. METHODS: In 2015-17, 3,857 patients who received acute reperfusion therapy were captured in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. 'Patient delay' is the time from symptom onset to first medical contact (FMC), and 'system delay' the time from FMC until reperfusion therapy (primary percutaneous coronary intervention (PCI) or fibrinolysis). RESULTS: Seventy percent of patients received primary PCI and 30% fibrinolysis. Of those receiving fibrinolysis, 122 (10.5%) received pre-hospital fibrinolysis. Seventy-seven percent were transported to hospital by ambulance. After adjustment, people who were older, male and presented to a hospital without a routine primary PCI service were less likely to travel by ambulance. Patient delay: The median delay was 45 minutes for ambulance-transported patients and 97 minutes for those self-transported to hospital, with a quarter delayed by >2 hours and >3 hours, respectively. Delay >1 hour was more common in older patients, Maori and Indian patients and those self-transported to hospital. System delay: For ambulance-transported patients who received primary PCI, the median time was 119 minutes. For ambulance-transported patients who received fibrinolysis, the median system delay was 86 minutes, with Maori patients more often delayed than European/Other patients. For patients who received pre-hospital fibrinolysis the median delay was 46 minutes shorter. For the quarter of patients treated with rescue PCI after fibrinolysis, the median needle-to-rescue time was prolonged-four hours. CONCLUSIONS: Nationwide implementation of the NZ STEMI pathway is needed to reduce system delays in delivery of primary PCI, fibrinolysis and rescue PCI. Ongoing initiatives are required to reduce barriers to calling the ambulance early after symptom onset.


Assuntos
Reperfusão Miocárdica , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/estatística & dados numéricos , Nova Zelândia , Melhoria de Qualidade , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos
6.
Int J Cardiovasc Imaging ; 35(11): 2095-2102, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31267265

RESUMO

Cardiac magnetic resonance-tissue tracking (CMR-TT)-derived myocardial strain after ST-elevation myocardial infarction (STEMI) is related to adverse cardiac events. We aimed to investigate the feasibility of CMR-TT for the early prediction of adverse left ventricular (LV) remodeling after STEMI. We retrospectively searched our institution's STEMI registry for patients who underwent reperfusion therapy, post-reperfusion CMR within 1 week after STEMI, and follow-up CMR. CMR-TT analysis was performed using cine imaging of post-reperfusion CMR. Adverse LV remodeling was defined as an increase in end-diastolic LV volume by 20% or more on follow-up CMR (median interval between serial CMR exams, 197 days; interquartile, 174-241 days). A total of 82 patients (age, 59.2 ± 11.1 years; male:female = 73:9) were included and divided into two groups: STEMI without (n = 62) and with (n = 20) adverse LV remodeling. Patients with LV remodeling showed significantly higher peak creatine kinase-MB and troponin I levels and a larger infarct size compared with those without LV remodeling (p = 0.001, p = 0.001, and p = 0.010, respectively). Global circumferential, radial, and longitudinal strain (GLS) also differed significantly between the groups (p = 0.001, p = 0.004, and p < 0.001, respectively). Logistic regression and receiver operating characteristic curve analyses demonstrated that GLS was an independent predictor of LV remodeling [odds ratio (OR) = 1.282, 95% confidence interval (CI) = 1.060-1.55 p = 0.011] with an optimal cut-off of - 12.84 (AUC = 0.756, 95% CI = 0.636-0.887, p < 0.001). CMR-TT-derived GLS may aid the early prediction of adverse LV remodeling after reperfusion, within 1 week after STEMI.


Assuntos
Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Função Ventricular Esquerda , Remodelação Ventricular , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/efeitos adversos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo , Resultado do Tratamento
7.
Rev. esp. cardiol. (Ed. impr.) ; 72(7): 543-552, jul. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188551

RESUMO

Introducción y objetivos: A pesar de una mayor conciencia de las disparidades en el tratamiento y los resultados entre mujeres y varones con infarto agudo de miocardio (IAM), no parece que en la última década se hayan atenuado estas diferencias. El objetivo del estudio es identificar diferencias por sexo en el tratamiento y la mortalidad a 30 días utilizando los indicadores de calidad de la Asociación de Cuidados Cardiovasculares Agudos de la Sociedad Europea de Cardiología para el IAM. Métodos: Se calcularon las proporciones y los errores estándar de los 20 indicadores de calidad en 771 pacientes con IAM que ingresaron en el servicio de cardiología de 2 hospitales terciarios en Portugal entre agosto de 2013 y diciembre de 2014. La asociación entre el indicador de calidad compuesto y la mortalidad a 30 días se analizó por regresión logística. Resultados: Significativamente menos mujeres que varones elegibles recibieron una reperfusión oportuna, tratamiento antiagregante plaquetario doble y estatinas de alta intensidad al alta y rehabilitación cardiaca. Las mujeres recibieron con menos frecuencia las intervenciones recomendadas (el 59,6 frente al 65,2%; p < 0,001) y también tuvieron una puntuación más alta del riesgo GRACE 2.0 ajustado por la mortalidad a 30 días (el 3,0 frente al 1,7%; p < 0,001). Se observó una asociación inversa entre el indicador de calidad compuesto y la mortalidad bruta a 30 días en ambos sexos (tercil de mayor rendimiento en comparación con el menor, OR = 0,08; IC95%, 0,01-0,64). Conclusiones: El porcentaje de mujeres que recibieron tratamiento óptimo en el IAM fue menor que el de varones y se asoció con una mayor mortalidad a los 30 días. Los indicadores de calidad basados en directrices tienen el potencial de mejorar la prestación y el pronóstico de la atención médica de los pacientes con IAM en general y también de reducir la brecha entre mujeres y varones


Introduction and objectives: Despite increased awareness of sex disparities in care and outcomes of acute myocardial infarction (AMI), there appears to have been no consistent attenuation of these differences over the last decade. We investigated differences by sex in management and 30-day mortality using the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QIs) for AMI. Methods: Proportions and standard errors of the 20 Acute Cardiovascular Care Association QIs were calculated for 771 patients with AMI who were admitted to the cardiology departments of 2 tertiary hospitals in Portugal between August 2013 and December 2014. The association between the composite QI and 30-day mortality was derived from logistic regression. Results: Significantly fewer eligible women than men received timely reperfusion, were discharged on dual antiplatelet therapy and high-intensity statins, and were referred to cardiac rehabilitation. Women were less likely to receive recommended interventions (59.6% vs 65.2%; P < .001) and also had higher mean GRACE 2.0 risk score-adjusted 30-day mortality (3.0% vs 1.7%; P < .001). An inverse association between the composite QI and crude 30-day mortality was observed for both sexes (OR, 0.08; 95%CI, 0.01-0.64 for the highest performance tertile vs the lowest). Conclusions: Performance in AMI management is worse for women than men and is associated with higher 30-day mortality, which is also worse for women. Evidence-based QIs have the potential to improve health care delivery and patient prognosis in the overall AMI population and may also bridge the disparity gap between women and men


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Qualidade da Assistência à Saúde/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Reperfusão Miocárdica/estatística & dados numéricos , Inibidores da Agregação de Plaquetas/uso terapêutico , Distribuição por Sexo , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos
8.
Enferm. foco (Brasília) ; 10(3): 126-133, jul. 2019. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1050193

RESUMO

Objetivo: analisar aspectos epidemiológicos e angiográficos de pacientes submetidos à Angioplastia Transluminal Coronariana eletiva em um hospital de referência em cardiologia do estado do Rio Grande do Norte. Métodos: trata-se de uma pesquisa exploratória, descritiva, transversal com abordagem quantitativa. A coleta de dados ocorreu de abril/2017 a outubro/2017. Resultados: foram incluídos no estudo 129 pacientes, destes 65,8% eram do sexo masculino. O stent farmacológico foi mais utilizado nos procedimentos com 79 (61,2%). A via femoral predominou entre os dois sexos, com 29 (65,9%) entre mulheres e 54 (63,5%), nos homens.Conclusões:nota-se predomínio de pacientes do sexo masculino, idosos, baixo grau de escolaridade, pardos, casados e aposentados. A análise angiográfica constitui-se de pacientes com predominância de implantação de um (1) stent do tipo farmacológico, Descendente anterior e Coronária direita como coronárias tratadas, sendo a punção de acesso com maior prevalência a por via femoral. (AU)


Objective: to analyze epidemiological and angiographic aspects of patients submitted to elective Coronary Transluminal Angioplasty at a referral hospital in cardiology in the state of Rio Grande do Norte. Methodology: This is an exploratory, descriptive, transversal research with a quantitative approach. Data collection occurred from April / 2017 to October / 2017. Results: 129 patients were included in the study, of which 65.8% were male. The pharmacological stent was more used in the procedures with 79 (61.2%). The femoral route predominated between the two sexes, with 29 (65.9%) between women and 54 (63.5%), in men. Conclusions: a predominance of male patients, elderly, low educational level, pardos, married and retired people. Angiographic analysis consists of patients with a predominance of implantation of one (1) stent of the pharmacological type, Anterior descending and Right coronary as treated coronaries, being the access puncture with greater prevalence to the femoral route. (AU)


Objetivo: analizar aspectos epidemiológicos y angiográficos de pacientes sometidos a la Angioplastia Transluminal Coronariana electiva en un hospital de referencia en cardiología del estado de Rio Grande do Norte. Metodology: setrata de una investigación exploratoria, descriptiva, transversal con abordaje cuantitativo. La recolección de datos ocurrió de abril / 2017 a octubre / 2017. Resultados: fueron incluidos en el estudio 129 pacientes, de estos 65,8% eran del sexo masculino. El stent farmacológico fue más utilizado en los procedimientos con 79 (61,2%). La vía femoral predominó entre los dos sexos, con 29 (65,9%) entre mujeres y 54 (63,5%), en los hombres. Conclusiones: se observa predominio de pacientes del sexo masculino, ancianos, bajo grado de escolaridad, pardos, casados y jubilados. análisis angiográfico consistía en pacientes con despliegue predominante de (1) el tipo stent farmacológico antes de la arteria coronaria descendente y la coronaria derecha tratada como la punción de acceso con la prevalencia más alta a través de la arteria femoral. (AU)


Assuntos
Intervenção Coronária Percutânea , Doenças Cardiovasculares , Reperfusão Miocárdica , Angioplastia , Infarto do Miocárdio
9.
Med Sci Monit ; 25: 4149-4158, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31160548

RESUMO

BACKGROUND The aim of this study was to determine the role of AMP-activated protein kinase (AMPK) in myocardial insulin resistance after myocardial ischemia-reperfusion during cardiopulmonary bypass surgery in dogs. MATERIAL AND METHODS Twenty-four mongrel dogs were randomly assigned to 4 groups. The control group did not undergo aortic cross-clamping; the model group underwent 60 mins of aortic cross-clamping with 150 ml cardioplegic solution. The treatment group, the inhibition group respectively with 0.11mg/kg AICAR (AMPK agonist) in 150 ml cardioplegic solution and 0.11mg/kg Compound C (AMPK inhibitor) in 150 ml cardioplegic solution. The blood flow was determined and left ventricular myocardial tissue were taken at pre-bypass, 15, 60, and 90 min after aorta declamping, respectively. Expression of AMPK mRNA, p-AMPK and GLUT-4 proteins was determined by RT-PCR, IHC and WB. RESULTS Compared with the control group, receiving 60 min ischemia at 15 min after reperfusion, Myocardial Glucose Extraction Ratio were significantly decreased in the other 3 groups, it was significantly decreased from 20.0% to 1.2% at 60 min of reperfusion, and recovered to 6.1% after 90 min reperfusion in model group, while recovered to 4.1%, 12.0% after 90 min reperfusion respectively exposed to Compound C and AICAR. The expressions of p-AMPK, GLUT-4 protein and AMPK mRNA in myocardium were decreased in different experiment groups, but these changes occurred to a lesser extent in the treatment group. CONCLUSIONS The inability of GLUT-4 expression induced by the decreases in p-AMPK protein expression that may be one of the reasons for myocardial insulin resistance.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Resistência à Insulina/fisiologia , Traumatismo por Reperfusão Miocárdica/metabolismo , Aminoimidazol Carboxamida/análogos & derivados , Aminoimidazol Carboxamida/farmacologia , Animais , Soluções Cardioplégicas , Ponte Cardiopulmonar/métodos , Ponte Cardiopulmonar/veterinária , China , Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/cirurgia , Cães , Feminino , Glucose/metabolismo , Transportador de Glucose Tipo 4/metabolismo , Ventrículos do Coração/fisiopatologia , Isquemia/metabolismo , Masculino , Isquemia Miocárdica/metabolismo , Reperfusão Miocárdica/métodos , Miocárdio/metabolismo , Fosforilação , Pirazóis/farmacologia , Pirimidinas/farmacologia , Ribonucleotídeos/farmacologia
10.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 227-237, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002219

RESUMO

The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model, with evidence of impact on performance


Assuntos
Humanos , Masculino , Feminino , Indicadores de Qualidade em Assistência à Saúde , Serviço Hospitalar de Emergência/tendências , Síndrome Coronariana Aguda/mortalidade , Prescrições de Medicamentos , Heparina/uso terapêutico , Reperfusão Miocárdica/métodos , Análise Estatística , Telemedicina/métodos , Assistência Centrada no Paciente/métodos , Educação Médica Continuada/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência , Infarto do Miocárdio
11.
Rev. clín. med. fam ; 12(2): 75-81, jun. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186259

RESUMO

La cardiopatía isquémica es la causa más frecuente de muerte a nivel mundial. El infarto agudo de miocardio con elevación del segmento ST es una enfermedad tiempo-dependiente cuyo pronóstico se asocia, en gran medida, con el manejo óptimo inicial realizado en los Centros de Salud donde consultan un alto porcentaje de pacientes. Por ello, la labor del médico de familia es decisiva a la hora de tratar de forma inmediata y eficaz al paciente que acude con un infarto. Para mejorar la actuación entre el ámbito extrahospitalario y hospitalario, se creó un protocolo asistencial denominado Código de Reperfusión Coronaria de Castilla-La Mancha (CORECAM). Su objetivo es la atención urgente y coordinada que permita un acceso precoz a la estrategia de reperfusión, logrando disminuir la mortalidad y mejorar el pronóstico de los pacientes. En este artículo se realiza una revisión del código CORECAM con el propósito de resumir las medidas de actuación que deben ser llevadas a cabo en el abordaje de los pacientes con infarto agudo de miocardio en el ámbito de la Atención Primaria


Ischemic heart disease is the most common cause of death worldwide. Acute myocardial infarction with ST segment elevation is a time-dependent disease whose prognosis will depend, to a large extent, on the initial optimal management performed in health centers where a high percentage of patients seek medical care. Therefore, the work of the family doctor is decisive for an immediate and effective treatment of the patient who comes with a heart attack. In order to improve performance between out-of-hospital and hospital settings, a medical protocol called Code of Coronary Reperfusion of Castilla-La Mancha (CORECAM) was created. Its objective is to provide urgent and coordinated attention that allows early access to the reperfusion strategy, reducing mortality and improving prognosis. In this article, a revision of the CORECAM code is carried out with the purpose of summarizing the action measures that should be taken in the approach to patients with acute myocardial infarction in the field of Primary Care


Assuntos
Humanos , Reperfusão Miocárdica/normas , Traumatismo por Reperfusão/prevenção & controle , Infarto do Miocárdio/cirurgia , Tratamento de Emergência/métodos , Atenção Primária à Saúde , Protocolos Clínicos , Procedimentos Clínicos/organização & administração
12.
Kardiologiia ; 59(5): 18-25, 2019 May 25.
Artigo em Russo | MEDLINE | ID: mdl-31131764

RESUMO

BACKGROUND: During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11-19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood. OBJECTIVE: To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion. MATERIALS AND METHODS: We included in this study 68 patients with AMI and IMR aged 36-79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV). RESULTS: Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 - patients who had a decrease in IMR (n=23, 33.8 %), group 2 - patients with increase of IMR (n=28, 41.1 %), group 3 - patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24). CONCLUSION: Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.


Assuntos
Insuficiência da Valva Mitral , Infarto do Miocárdio , Intervenção Coronária Percutânea , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Moscou , Reperfusão Miocárdica , Função Ventricular Esquerda
13.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 227-237, may.-june. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1005940

RESUMO

Background: The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model , with evidence of impact on performance


Assuntos
Humanos , Masculino , Feminino , Indicadores de Qualidade em Assistência à Saúde , Serviço Hospitalar de Emergência/tendências , Síndrome Coronariana Aguda/mortalidade , Prescrições de Medicamentos , Heparina/uso terapêutico , Reperfusão Miocárdica/métodos , Análise Estatística , Telemedicina/métodos , Assistência Centrada no Paciente/métodos , Educação Médica Continuada/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência/métodos , Infarto do Miocárdio
14.
Life Sci ; 229: 98-103, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30991060

RESUMO

AIMS: The purpose of the study was to determine whether late therapeutic hypothermia (LTH), administered after reperfusion, could prevent adverse left ventricular (LV) remodeling and improve cardiac function in the rat myocardial ischemia/reperfusion model. MAIN METHODS: Rats were randomized to normothermia (n = 10) or LTH (initiated at 1 min after coronary artery reperfusion, n = 10) and subjected to 30 min of coronary occlusion followed by 6 weeks of reperfusion. Hypothermia was induced by pumping cold saline over the anterior surface of the LV until the temperature cooled to <32 °C. In the normothermic group, the heart was bathed in saline at 38 °C. KEY FINDINGS: After 6 weeks of recovery, fractional shortening of the LV was comparable in the LTH (20.2 ±â€¯0.6%) and normothermic group (20.0 ±â€¯2.1%; p = 0.918). Postmortem LV volume (0.47 ±â€¯0.04 ml in LTH and 0.44 ±â€¯0.05 ml in normothermic group) and lung wet/dry weight ratio were similar in both groups. There were no significant differences in scar size, scar thickness, infarct expansion index, LV cavity or transmurality (%) between groups. This data contrasts with our previous study showing that hypothermia administered during the ischemic phase significantly reduced the scar size; decreased LV cavity, infarct expansion index and transmurality (%), and improved the scar thickness. SIGNIFICANCE: LTH did not prevent adverse LV remodeling nor improve cardiac function in the rat myocardial ischemia/reperfusion model. To have a long term benefit on remodeling, hypothermia must be administered during the ischemic phase and not just the reperfusion phase.


Assuntos
Hipotermia Induzida/efeitos adversos , Traumatismo por Reperfusão Miocárdica/terapia , Reperfusão Miocárdica/efeitos adversos , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Remodelação Ventricular , Animais , Feminino , Ratos , Ratos Sprague-Dawley
17.
Med Sci Monit ; 25: 3100-3107, 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31028241

RESUMO

BACKGROUND The aim of this study was to investigate the effects of sevoflurane (SEV) on myocardial ischemia/reperfusion (I/R) injury in rats and its mechanism. MATERIAL AND METHODS Sixty male Sprague-Dawley rats were randomly divided into 3 groups: Sham group (n=20), I/R group (n=20) and I/R+SEV group (n=20). The I/R model was established by ligating and recanalizing the left anterior descending coronary artery (LAD). Triphenyl tetrazolium chloride (TTC) test and echocardiography (ECG) were used for analysis. Hematoxylin and eosin (H&E) staining was applied to detect the morphological changes. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was conducted to detect the apoptosis levels. The expression level of superoxide dismutase 2 (SOD2) was measured. Finally, the effect of SEV on the protein kinase B (Akt)/hypoxia-inducible factor 1-alpha (HIF-1alpha)/vascular endothelial growth factor (VEGF) signaling pathway was detected via western blotting. RESULTS SEV could significantly improve I/R-induced cardiac insufficiency, inhibit cardiac infarction, and as well as reduce the infarction area from 53.21±2.11% to 32.33±3.49% (P<0.05). Compared with rats in I/R group, the cardiac myofilament was better in alignment, degradation and necrosis were milder, and cell edema was notably reduced in the I/R+SEV group. Thus, SEV could significantly reverse the decreased expression of SOD2 caused by I/R and reduce oxidative stress in the heart (P<0.05). According to the western blotting results, SEV was capable of obviously activating the expressions of phosphorylated-Akt (p-Akt), HIF-1alpha, and VEGF. CONCLUSIONS SEV can significantly improve myocardial injury caused by I/R in rats, and its mechanism might be related to the activation of the Akt/HIF-1alpha/VEGF signaling pathway.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Proteínas Proto-Oncogênicas c-akt/metabolismo , Sevoflurano/farmacologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Apoptose/efeitos dos fármacos , Masculino , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/metabolismo , Reperfusão Miocárdica/métodos , Traumatismo por Reperfusão Miocárdica/metabolismo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
18.
J Clin Nurs ; 28(17-18): 3233-3241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31017336

RESUMO

AIMS AND OBJECTIVES: To establish and report cross-sectional data of reperfusion times for emergency primary percutaneous coronary interventions (PPCI) and to examine factors associated with times to reperfusion. BACKGROUND: Rapid coronary reperfusion can salvage myocardial tissue, preserve left ventricular function and reduce mortality. PPCI is the gold standard of management. Researchers have reported on international median reperfusion times, but this is the first Irish study to do so. METHODS: This observational, prospective, cross-sectional study included patients diagnosed with ST-segment elevation myocardial infarction (STEMI) and admitted for emergency PPCI. Descriptive and inferential statistics were used. The study was ethically approved. We adopted the STROBE guidelines. RESULTS: All patients (N = 133) who met the inclusion criteria were included initially. Of these, 105 (79%) were diagnosed with STEMI and received emergency PPCI. The majority of STEMIs were diagnosed by paramedics and most (67%) were reperfused within 120 min, with a median time of 96 min. The results suggested that younger patients achieved timelier PPCI and source of referral was also significant in that more of those transferred directly to the coronary catheterisation laboratory achieved reperfusion within 120 min, compared with those who presented to the emergency department. CONCLUSION: A timely reperfusion service is achieved for the majority. Attention is needed in respect of the ageing and those admitted directly to the emergency departments with STEMI. RELEVANCE TO CLINICAL PRACTICE: Further international research is recommended to compare current reperfusion times against guidelines and to identify areas for improvement. Clinicians should be mindful of the importance of rapid reperfusion and the implications of its delay for patients with STEMI. Those presenting to emergency departments with chest pain should be prioritised.


Assuntos
Reperfusão Miocárdica/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
19.
J Cardiovasc Transl Res ; 12(2): 87-94, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31016553

RESUMO

Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality. Pioneering preclinical work reported by Peter Maroko and Eugene Braunwald in 1971 identified oxygen supply and demand are primary determinants of myocardial infarct size in the setting of a heart attack. Since the 1950s, advances in mechanical engineering led to the development of short-term circulatory support devices that range from pulsatile to continuous flow pumps. The primary objective of these pumps is to reduce native heart work, enhance coronary blood flow, and sustain systemic perfusion. Whether these pumps could reduce myocardial infarct size in the setting of AMI became an intense focus for preclinical investigation with variable animal models, experimental algorithms, and pump platforms being tested. In this review, we discuss the design of these preclinical studies and the evolution of mechanical support platforms and attempt to translate these experimental methods into clinical trials.


Assuntos
Insuficiência Cardíaca/prevenção & controle , Coração Auxiliar , Infarto do Miocárdio/terapia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Reperfusão Miocárdica , Miocárdio/metabolismo , Consumo de Oxigênio , Implantação de Prótese/instrumentação , Função Ventricular Esquerda , Animais , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Reperfusão Miocárdica/efeitos adversos , Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Miocárdio/patologia , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
20.
Medisan ; 23(2)mar.-abr. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1002632

RESUMO

Introducción: el conocimiento sobre reperfusión coronaria en el infarto agudo del miocardio con elevación del segmento ST en el nivel primario de atención es de extraordinaria importancia para disminuir las complicaciones y la mortalidad. Objetivo: determinar las necesidades de aprendizaje de médicos de atención primaria sobre reperfusión coronaria en el infarto agudo del miocardio. Método: se realizó un estudio descriptivo de 65 galenos que laboraban en 5 policlínicos principales de urgencias de Santiago de Cuba en noviembre del 2017, para lo cual se aplicó una encuesta con variables de interés, que se calificó según metodología de evaluación y estándar previamente establecida por el equipo de trabajo. Resultados: del total de preguntas, solo una (5,9 por ciento) cumplió con el estándar de más de 70 por ciento de médicos con respuestas adecuadas; los años de experiencia y haber recibido adiestramiento influyeron positivamente en el número de dichas respuestas. La falta de capacitación fue la causa por la cual no se aplicó el tratamiento, y la planificación de esta, así como la creación de algoritmos de trabajo resultaron las medidas más propuestas por los galenos. Ninguno de ellos refirió sentirse adiestrado correctamente. Conclusiones: los médicos que laboraban en los 5 policlínicos principales de urgencias mostraron necesidades de aprendizaje y capacitación sobre el proceso de reperfusión coronaria.


Introduction: the knowledge on coronary reperfusion in the acute myocardial infarction with elevation of the ST segment in the primary care level is of extraordinary importance to decrease complications and mortality. Objective: to determine the necessities of doctors from primary care on coronary reperfusion in the acute myocardial infarction. Method: a descriptive study of 65 physicians who worked in 5 main polyclinics for emergencies of Santiago de Cuba was carried out in November, 2017 for which a survey with variables of interest was applied which was qualified according to evaluation methodology and previously established standard by the working team. Results: of all questions, only one (5.9 percent) fulfilled the standard of more than 70 percent of doctors with appropriate responses; the years of experience and receiving a previous training influenced positively in the number of these responses. The lack of training was the cause for which the treatment was not applied, and its planning, as well as the creation of working algorithms were the measures mostly proposed by the physicians. None of them referred to be correctly trained. Conclusions: doctors who worked in the 5 main emergency polyclinics showed learning necessities and training on the management for coronary reperfusion.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Reperfusão Miocárdica , Médicos de Atenção Primária/educação , Infarto do Miocárdio , Ensino , Epidemiologia Descritiva , Determinação de Necessidades de Cuidados de Saúde , Aprendizagem
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