RESUMO
Conduit artery distensibility affects the pulsatile component of afterload and may contribute to impaired left ventricular function in patients with congestive heart failure (CHF). The objectives of this study were to (1) determine whether arterial distensibility is reduced in patients with CHF, and (2) determine whether decreased arterial compliance is related to an abnormality in vascular wall structure (i.e., wall thickness or excessive levels of circulating neurohumoral vasoconstrictors, or both). The study participants included 40 patients with CHF secondary to idiopathic dilated cardiomyopathy and 33 age-matched healthy volunteers. High-resolution ultrasonography was performed to directly visualize the common carotid artery and measure its diameter and wall thickness. Its elastic properties were determined by relating changes in arterial diameter to changes in pressure generated with each heart beat. Carotid artery distensibility was less (14.1 +/- 1.1 vs 25.3 +/- 1.6 10(-6).N-1.m2, p < 0.001) and Young's modulus of elasticity was greater (3.99 +/- 0.51 vs 2.29 +/- 0.23 10(5).N.m-2, p < 0.005) in patients with CHF than in normal subjects. Also, carotid artery wall thickness was increased in patients with CHF. When the entire population was considered, age, wall thickness, and plasma norepinephrine and aldosterone concentrations correlated inversely with distensibility, whereas age and plasma norepinephrine concentration correlated directly with elasticity. Among normal subjects, only age correlated inversely with distensibility; among patients with CHF, only plasma norepinephrine concentration correlated with elasticity. It is concluded that carotid artery distensibility is reduced in patients with CHF.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Cardiomiopatia Dilatada/complicações , Artéria Carótida Primitiva/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Adulto , Idoso , Aldosterona/sangue , Cardiomiopatia Dilatada/sangue , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/patologia , Complacência (Medida de Distensibilidade) , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Norepinefrina/sangue , Análise de Regressão , UltrassonografiaRESUMO
Thirty nine patients with cardiomyopathy were evaluated by a hemodynamic study at rest and during isotonic exercise. These patients were divided into two groups on the basis of their left ventricular ejection fraction (LVEF): A, control group (LVEF greater than 40%, N = 19); B, severe congestive heart failure group (LVEF less than or equal to 40%, N = 20). Patients in group A showed adequate cardiovascular responses to exercise, i.e. increased cardiac index (80%) and stroke volume index (17%), decreased systemic vascular resistance (36.8%) but no significant change in pulmonary arteriolar resistance values. In contrast, patients in group B showed a slight and heart rate-dependent increase in cardiac index (38.5%), no improvement of stroke volume index (-3.4%), decreased systemic vascular resistance (21.6%) and increased pulmonary arteriolar resistance (41.2%) with exercise. This group also showed a significant increase in right atrial pressure that might reflect a decrease in right ventricular performance secondary to an abnormal pulmonary vascular response during exercise.
Assuntos
Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Contração Miocárdica , Volume Sistólico , Adulto , Idoso , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Descanso , Resistência VascularRESUMO
PURPOSE: To evaluate the anxiety and depression levels during five days of stay in a Clinical Cardiological Intensive Care Unit (ICU) and verify the relation to different variables. METHODS: Forty seven patients were submitted to IDATE scale for anxiety and an avaliation for depression. The scores were compared to medical diagnoses, age, local of stay before the ICU, number of hospitalizations. RESULTS: Anxiety and depression scores decrease significant from first to fifth day of ICU stay. No significant correlation was found between age, number of hospitalizations, medical diagnoses and the anxiety and depression scores. Patients admitted from the emergency unit presented a correlation between anxiety and depression scores. CONCLUSION: Anxiety and depression decrease during the five days of ICU stay. Emotional reactions are not influenced by medical diagnoses, age and number of hospitalizations. The emergency unit stay affects emotionally the patient in the first days of ICU admission.
Assuntos
Ansiedade/etiologia , Depressão/etiologia , Pacientes Internados/psicologia , Tempo de Internação , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Unidades de Terapia Intensiva , Acontecimentos que Mudam a Vida , Pessoa de Meia-IdadeRESUMO
PURPOSE: To evaluate the toxicity of thiocyanate induced by the infusion of sodium nitroprusside in patients with severe congestive failure. METHODS: We studied 23 patients with congestive heart failure, in class IV (NYHA) under continuous infusion of sodium nitroprusside with doses varying between 0.5 and 5.5 micrograms/kg/min. Clinical evaluation, thiocyanate serum dosage and laboratorial evaluation of renal, hepatic and pulmonary functions were done. RESULTS: Seventeen patients (74%) presented toxic levels of thiocyanate (over 10 micrograms/ml), with the average of 29.9 +/- 4.4 micrograms/ml. Only renal function was related to the presence of intoxication. Clinical evaluation was not accurate to diagnose the thiocyanate toxicity in the patients. CONCLUSION: Sodium nitroprusside is potentially toxic, especially when the renal function is abnormal. Thiocyanate dosage is useful in diagnosing nitroprusside induced toxicity and then it contributes to an adequate treatment and prevention of clinical toxicity.
Assuntos
Insuficiência Cardíaca/sangue , Nitroprussiato/administração & dosagem , Tiocianatos/intoxicação , Adulto , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Nitroprussiato/efeitos adversos , Nitroprussiato/metabolismo , Estudos Retrospectivos , Fatores de TempoRESUMO
Fulminant hepatic failure is a complication of severe cardiocirculatory failure, with high morbidity and mortality, and is frequently misdiagnosed as fulminant viral hepatitis. We report three cases of patients with chronic severe heart failure who developed cardiogenic shock complicated by elevation of aminotransferase levels above 1,000 soon after the most severe episode of hypotension. All the three patients presented regression of hepatic enzymes 72h after admission. Two patients developed hepatic encephalopathy and renal failure. One underwent the implantation of an artificial left ventricle, followed by orthotopic heart transplantation. One died of systemic multiple organ failure, after he had showed improvement on his hepatic profile, and one was sent to the ward, after 15 days with marked improvement on his clinical status and no signs of hepatic disease.
Assuntos
Cardiomiopatia Dilatada/complicações , Falência Hepática Aguda/etiologia , Choque Cardiogênico/etiologia , Adulto , Alanina Transaminase/análise , Humanos , Falência Hepática Aguda/enzimologia , Masculino , Choque Cardiogênico/enzimologiaRESUMO
OBJECTIVE: To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation. METHODS: Twelve healthy volunteers aged 30+/-1 years (control group) and 14 asymptomatic patients with severe aortic regurgitation aged 29+/-2 years and left ventricular ejection fraction of 0.61+/-0.02 (radioisotope ventriculography) were studied. High-resolution ultrasonography was performed to measure the systolic and diastolic diameters of the common carotid artery. Simultaneous measurement of blood pressure enabled the calculation of arterial compliance and distensibility. RESULTS: No differences were observed between patients with aortic regurgitation and the control group concerning age, sex, body surface, and mean blood pressure. Pulse pressure was significantly higher in the aortic regurgitation group compared with that in the control group (78+/-3 versus 48+/-1mmHg, P<0.01). Arterial compliance and distensibility were significantly greater in the aortic regurgitation group compared with that in the control group (11.0+/-0.8 versus 8.1+/-0.7 10(-10) N-1 m4, P=0.01 e and 39.3+/-2.6 versus 31.1+/-2.0 10(-6) N-1 m2, P=0.02, respectively). CONCLUSION: Patients with chronic aortic regurgitation have increased arterial distensibility. Greater vascular compliance, to lessen the impact of systolic volume ejected into conduit arteries, represents a compensatory mechanism in left ventricular and arterial system coupling.
Assuntos
Insuficiência da Valva Aórtica/fisiopatologia , Artérias/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Insuficiência da Valva Aórtica/diagnóstico por imagem , Artérias/diagnóstico por imagem , Estudos de Casos e Controles , Doença Crônica , Elasticidade , Feminino , Humanos , Masculino , UltrassonografiaRESUMO
PURPOSE: To test a circulatory assist device (CAD) developed in the University of São Paulo. Heart Institute, Bioengineering Division. It is a valveless chamber working through the counterpulsation principle, aiming at assistance to temporary the left ventricle. PATIENTS AND METHODS: The CAD consists of a rigid polycarbonate shell, which houses in its interior a polyurethane bag with a maximum volume of 110 cm3, driven alternately by pressure and vacuum from an external electropneumatic device synchronized with the ECG. The device worked for 300 hours in a test bench simulating the cardiovascular system in order to verify its resistance to wear and fatigue. The CAD was implanted near the aortic root of five dogs, in whom cardiac failure was induced through the use of propranolol and plasma expanders. The CAD was driven for five periods of 2 minutes separated by pauses of equal duration. The hemodynamic parameters were measured during the mentioned periods. RESULTS: "In vitro" testing resulted in no wear or fatigue. No leakage was observed. In the "in vivo" testing the averages obtained during the on and off periods of the device showed for the on periods; a) lowering of the systolic pressures of both the aorta (17.5%) and the left ventricle (LV) 15.1%), lowering of the final diastolic pressure of the LV (15.4%) and lowering of the diastolic pressure of the aorta (27.4%); b) increase in cardiac output (45.5%); c) increase of the endocardial viability ratio by 37.5%. CONCLUSION: The tested device represents a therapeutic option in cases of acute left ventricle failure, since with it an improved cardiac performance was measured and an increased coronary perfusion can be presumed.
Assuntos
Contrapulsação , Coração Auxiliar , Animais , Cães , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/terapia , Hemodinâmica , Masculino , Substitutos do Plasma/farmacologia , Propranolol/farmacologiaRESUMO
PURPOSE: To verify the exercise-induced hemodynamic changes in moderate hypertensive patients. METHODS: Twenty nine patients were studied and they were submitted to cycloergometer supine exercise (50w and 100w) during cardiac catheterization. The hemodynamic variables were measured: cardiac index (CI), stroke volume (SV), systemic arterial resistance (SAR), pulmonary arterial resistance (PAR), wedge pressure (WP), right atrial pressure (RA), systolic arterial pressure (SP), diastolic arterial pressure (DP), mean arterial pressure (MP) and heart rate (HR). To evaluate the cardiac function, the patients were divided in two groups: GI with CI > 2.5 ml/min/m2 and GII CI < 2.5 ml/min/m2. RESULTS: During exercise, patients from GI and GII were similar-according to MAP, RA, WP, and HR. On the other hand, GI and GII exhibited different (#) behavior regarding SV, PAR and SAR. During the three exercise conditions, rest (R), 50w and 100w it was observed: a) PAR-R = 50 = 100 (GI); b) MP, PAR, WP, SV, SAR-R #50 #100 (GI); c) HR, PAR and SAR-R #50 #100 (GII). There was no correlation between the cardiac function (CI, SV) and the circulatory adjustment (PAR and SAR) or the pressure curve (SP, DP, MP) and HR. CONCLUSION: The results suggest that the cardiac function of GI patients depends, mainly, on the inotropism, while in GII patients it depends on the decrease of the afterload (PAR and SAR). Those changes may appear even in the late exercise stage (100w), with a bias to attain the GI levels. Those observations suggest functional changes in vasomotor tone of GII patients.
Assuntos
Hemodinâmica/fisiologia , Hipertensão/fisiopatologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Teste de Esforço , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Resistência Vascular/fisiologiaRESUMO
PURPOSE: To evaluate the effects of intravenous furosemide over hemodynamics variables and colloid osmotic pressure in patients with pulmonary edema. METHODS: Eight patients with pulmonary edema, mean age of 58.3 +/- 7.5 years, 6 men, were evaluated. Hemodynamic monitoring was performed by Swan-Ganz catheter in pulmonary artery to obtain RAP and PAWP, in mmHg, and HR, in bpm. Cardiac output (CO) was obtained by thermodilution method. Cardiac index (CI) in L/min/m2, and systolic index, in ml, arose from variables above. Mean arterial pressure (MAP), in mmHg, was obtained through catheterization of radial artery. patients were treated with 20 mg of intravenous furosemide, and hemodynamic variables were measured before and after 5, 15, 30, 60 and 120 minutes. COP was measured in Weil oncometer (IL 196) at same intervals. RESULTS: A significant reduction of RAP (p = 0.002) and PAWP (p < 0.0001), HR (p = 0.02), COP (p < 0.0001) and gradient between PAWP-COP (p < 0.0001) were observed. RAP and PAWP reduction was greater in the first five minutes and, otherwise, COP reduction was gradual in 120 min. PAWP-COP gradient initially positive, stayed negative during all study. MAP, CI, SI and SVR did not show statistical differences. CONCLUSION: Furosemide administration reduced RAP, PAWP, HR, COP and PAWP-COP gradient, probably by a redistribution of fluid excess in the interstitial to intravascular space, through changes in driving fluid forces, with predominance in colloid osmotic pressure, which reverse fluid from intravascular to interstitial observed in pulmonary edema.
Assuntos
Furosemida/administração & dosagem , Edema Pulmonar/tratamento farmacológico , Doença Aguda , Idoso , Avaliação de Medicamentos , Feminino , Furosemida/farmacologia , Hemodinâmica/efeitos dos fármacos , Humanos , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Pressão Osmótica/efeitos dos fármacos , Edema Pulmonar/fisiopatologiaRESUMO
A 21-year-old white man presented with cardiogenic shock and refractory pulmonary congestion. At the transthoracic echocardiogram a subvalvar left ventricular aneurysm of the inferior wall with severe mitral regurgitation was observed. The outcome was favorable after surgical correction of the mitral regurgitation and of the subvalvar aneurysm. We emphasize that, whenever possible, valvar repair is better than mitral replacement, since annulus tissue fragility causes suturing of the mitral prosthesis to be difficult.
Assuntos
Aneurisma Cardíaco/complicações , Insuficiência da Valva Mitral/etiologia , Adulto , Eletrocardiografia , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração , Humanos , Masculino , Insuficiência da Valva Mitral/cirurgiaRESUMO
We describe the case of a 61 year-old female patient admitted to the hospital with acute lateral myocardial infarction, in pulmonary edema, who evolved to cardiogenic shock in the first hours. Transesophageal echodoppler-cardiogram and nuclear magnetic resonance imaging showed the diagnosis of a left ventricular pseudoaneurysm. Surgical repair was successfully undertaken.