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Copyright of Revista Enfermagem Digital Cuidado e Promoção da Saúde is the property of Revista Enfermagem Digital Cuidado e Promocao da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Avances en Enfermería is the property of Editorial Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study reports the case of a patient with multiple aneurysms and ectasias of the coronary arteries whose first manifestation was acute coronary syndrome. This is a 42-year-old male patient who was diagnosed with acute myocardial infarction without ST segment elevation. Cineangiocoronariography showed a three-vessel lesion with aneurysmatic and ectatic coronary dilations. Myocardial revascularization surgery was chosen, but he refused to undergo surgical treatment. He was discharged with optimized clinical treatment with outpatient follow-up. Months after diagnosis, the patient died and was being followed up in another service. Coronary artery aneurysm is a rare entity. The ideal management is still not well established, with doubts and disagreements about surgical and interventional treatment and when to indicate them. [ABSTRACT FROM AUTHOR]

Objetivo: Identificar os diagnósticos de enfermagem nos pacientes coronariopatas à luz da Teoria da Adaptação de Callista Roy. Métodos: Estudo descritivo, transversal, quantitativo, envolvendo 15 pacientes coronariopatas, no período pré-intervenção hemodinâmica. Desenvolveu-se em um hospital universitário do Rio de Janeiro-RJ, de maio a setembro de 2017. Utilizou-se questionário estruturado de acordo com as cinco necessidades básicas (oxigenação, nutrição, eliminação, atividade e repouso e proteção) e o processo complexo (função neurológica) do modo fisiológico de Callista Roy. Resultados: Foram estabelecidos 10 Diagnósticos de Enfermagem da taxonomia II da NANDA: risco de intolerância a atividade, ansiedade, medo, intolerância a atividade, padrão respiratório ineficaz, mobilidade física prejudicada, deambulação prejudicada, náusea, eliminação urinária prejudicada e diarreia. Conclusão: Conclui-se que o modelo da Adaptação de Callista Roy, propiciou o entendimento da vivência dos pacientes com adoecimento coronariano, mediante uma perspectiva de adaptação. Descritores: Síndrome coronariana aguda, Ajustamento social, Diagnóstico de enfermagem, Cuidados de enfermagem.

Acute coronary syndrome (ACS) is the main cause of mortality around the world; therefore, it is essential to recognize the clinical characteristics that increase its diagnostic suspicion. Traditionally, it has been defined as a so-called typical condition, consisting of retrosternal chest pain or pain in the left region of the thorax. It is described as a feeling of pressure or heaviness, lasting more than 20 minutes, which can radiate to the left or right upper limb, neck or jaw, and can be associated with diaphoresis and nausea. Various groups of patients such as women, diabetics, the elderly, and those with a history of heart failure or cerebrovascular accident, have so-called atypical clinical sets of symptoms, which in a large proportion may not present chest pain. Various studies suggest that there are not sufficiently sensitive and specific symptoms to be considered typical in the context of ACS, thus, the approach must include the electrocardiogram, risk factors and biomarkers in addition to the clinical evaluation. The use of risk scores such as the HEART has proven very useful in this scenario. [ABSTRACT FROM AUTHOR]

Objetivo: Analisar a produção cientifica acerca das síndromes coronarianas nos periódicos brasileiros de enfermagem. Metodologia: Estudo bibliométrico realizado a partir de acesso online aos periódicos brasileiros de enfermagem. A caracterização da produção versou sobre a lei de Lotka (acerca de informações sobre os autores), lei de Bradford (referente aos periódicos onde os artigos foram publicados) e a lei de Zipf (acerca das palavras–chave). Resultados: 305 autores foram encontrados nas 101 publicações que compuseram a amostra, das quais, 31 (30,69%) foram publicadas em periódicos de qualis A; 44 (43,56%) foram oriundas da região sudeste; 76 (75,25%) com abordagem quantitativa; 95 (94,06%) tratavam-se de estudos transversais, com nível de evidência 6. Os sinais e sintomas, o cuidado e tratamento de pacientes foram estudados em 47 (46,53%) artigos. A palavra-chave mais encontrada foi “infarto agudo do miocárdio”, em 46 (45,54%) artigos. Conclusão: A produção cientifica acerca das síndromes coronarianas nos periódicos brasileiros de enfermagem possuiu mais de 300 autores e foi, predominantemente, composta por estudos transversais, quantitativos, oriundos do sudeste e que investigaram a identificação do agravo e os cuidados aos pacientes, publicados em periódicos de qualis A e com a palavra-chave “infarto agudo do miocárdio”.

DOI: https://doi.org/10.26694/reufpi.v5i4.5546 Objetivo: Neste sentido, o presente estudo objetivou descrever os cuidados desenvolvidos pela equipe de enfermagem frente aos pacientes com IAM, bem como discorrer sobre a fisiopatologia desencadeada no IAM. Metodologia: Trata-se de uma revisão da literatura com busca dos artigos publicados entre 2011 a 2016, indexados nas bases de dados SciELO, Bireme, Lilacs. Após a busca foi realizado a leitura, análise dos resultados. Resultados: O Infarto Agudo do miocárdio tem como causa atribuída, uma redução ou interrupção do fluxo sanguíneo coronariano para o musculo cardíaco. Essa redução ou interrupção pode ser ocasionada por uma placa aterosclerótica decorrente do excesso de depósito de gordura na parede arterial. Os cuidados de enfermagem aos pacientes vítimas dessa patologia se baseiam no suporte psicológico e emocional, redução de estresse e ansiedade no momento da agudizacão dos sintomas, cuidado com a dor, suporte familiar, orientações, dentre outros. Conclusão: O cuidado ao paciente com IAM parte da elaboração da sistematização da assistência de enfermagem. A conduta de enfermagem ao paciente infartado exige capacitação e competência técnica para detecção e atuação imediata nesta situação, o que requer deste profissional assistência centrada no conhecimento científico.

DOI: https://doi.org/10.26694/reufpi.v3i2.1895 Objetivo: A pesquisa teve como objetivo analisar o perfil clínico e epidemiológico dos pacientes com Síndrome Coronariana Aguda atendidos em um Hospital de Urgência. Trata-se de um estudo do tipo descritivo; de análise documental exploratório e retrospectivo com abordagem quantitativa. Metodologia: A amostra foi de 150 prontuários referentes ao segundo semestre de 2012. Resultados: Infarto agudo do miocárdio sem supra no segmento ST foi diagnóstico mais incidente com 49,3%, o gênero masculino com 65,3%, a média da idade de 65 anos, os casados com 62,7%, e 40,0% tinham ensino fundamental incompleto, a hipertensão arterial sistêmica com 68,0%, a dor precordial 93,3%, o tratamento a terapia adjunta com 61,3%, e o óbito com 31,3%. Conclusão: O estudo possibilitou conhecer o perfil epidemiológico e clínico dos pacientes com síndrome coronariana aguda, confirmando que a população mais acometida pela síndrome coronariana aguda são as pessoas idosas, do gênero masculino e que apresentavam dor torácica.

RESUMO Objetivo: realizar a adaptação transcultural do instrumento Toronto Pain Management Inventory - Acute Coronary Syndrome para o Português brasileiro e analisar evidências de validade de face do instrumento adaptado. Métodos: para a adaptação transcultural foram seguidos os procedimentos propostos pelo Guideline for Establishing Cultural Equivalency of Instruments (RDC/TMD) Consortium Network (fase 1). Para verificar a concordância entre os juízes na análise das equivalências foi utilizado o índice de validade de conteúdo (IVC). A validade de face foi feita com enfermeiros durante o pré-teste e consistiu na avaliação da facilidade da compreensão para responder aos itens. Resultados: o instrumento adaptado alcançou equivalência linguística. As equivalências semântica, idiomática, experimental e conceitual tiveram IVC médios de 98,5 (IC 95% 97,1-100,0), 97,8 (IC 95% 96,0-99,5), 94,1 (IC95% 91,6-96,6) e 99,6 (IC 95% 98,9-100,0). No pré-teste, 92,5% dos enfermeiros consideraram o instrumento de fácil compreensão e 85% não encontraram dificuldade. Conclusão: o instrumento adaptado é culturalmente equivalente ao instrumento original e reúne evidências de validade de face. As propriedades psicométricas do instrumento ainda serão investigadas.

Abstract Background: Iron metabolism disorders have been associated with an increased risk of cardiovascular events. However, the prognostic impact on patients (pts) with acute coronary syndrome (ACS) has yet to be clarified. Objective: To determine the prognostic value of serum iron and ferritin levels in pts with ACS in the short and long-term. Methods: Consecutive pts admitted to a coronary care unit with a diagnosis of ACS, for a period of 2 years, were evaluated. The population was divided into tertiles of serum iron and ferritin distribution. The primary adverse events were the occurrence of in-hospital death or heart failure (HF) and death or HF at 1 year of follow-up. Results: We studied 280 pts (73% males; mean age 68 ± 13 years). The mean levels of serum iron and ferritin were 59 ± 34 mcg/dL and 205 ± 185 ng/mL, respectively. Patients included in the 1st tertile of serum iron (≤ 40 mcg/dL) had a higher rate of adverse events, in-hospital and after 1 year. Lower and higher levels of ferritin (1st and 3rd tertiles, ≤ 110; >219 ng/ml, respectively) were associated with a higher incidence of HF during hospitalization and death at 1 year. A ferritin value >316 ng /mL was an independent risk factor for death at 1 year (adjusted OR: 14; 95%CI: 2.6 to 75.9). Conclusion: In this population, iron metabolism alterations were associated with a higher rate of adverse events and higher ferritin levels constituted an independent mortality predictor in the long-term.

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The psychological variables have a special relevance in the coronary affectations. The aim of the present work was to study the evolution of different psychological variables, of quality of life and of adjustment psychosocial, in patients who have suffered an acute coronary syndrome (ACS) and attended a cardiac rehabilitation program, which included, among other, a module of physical activity. The measurements were made when the ACS debuted and 3 months after the cardiac event in a total of 146 men (57.86 years of age (dt = 9.45)) who had undergone a diagnostic catheterization with therapeutic intent within 3 days. The study design was of the quasi-experimental, prospective and longitudinal type. The results at 3 months after suffering the cardiac event show lower levels of anxiety (Cohen's d = .61; p < .01), depression (Cohen's d = .33; p < .05), psychological distress (Cohen's d =. 72; p < .01) and anger (Cohen's d = .34; p < .01), and higher personal strength scores (Cohen's d = .37; p < .01) or life appreciation (Cohen's d =. 35, p < .01). In the ACS, knowing the psychosocial evolution of the patient is considered fundamental next to the usual medical control. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To clinically validate the nursing diagnosis, disturbed sleep pattern (00198), in patients with acute coronary syndrome. DATA COLLECTION: A clinical validation study using the patient history, Visual Analog Sleep scale, and diagnostic inference. Accuracy techniques were performed. SYNTHESIS OF DATA: There were 75 patients: 76.00% were men, and 82.66% had a myocardial infarction. The defining characteristic, changes in sleep pattern, presented a sensitivity of 0.900 and specificity of 0.9714. CONCLUSION: Changes in sleep pattern was a predictor of the nursing diagnosis. IMPLICATIONS FOR PRACTICE: Results will contribute to the identification of sleep disturbances, by nurses, emphasizing the importance of improving sleep during hospitalization. OBJETIVO: Validar clinicamente o Diagnóstico de Enfermagem Padrão de Sono Prejudicado (00198) em pacientes com Síndrome Coronariana Aguda. MÉTODOS: Estudo de validação clínica, utilizando Histórico de Enfermagem, Escalas Visuais Análogas do Sono e inferência diagnóstica. Realizada medidas de acurácia. RESULTADOS: 75 pacientes, 76,00% homens e 82,66% com Infarto do Miocárdio. A característica definidora Alteração do Padrão de Sono teve 0,900 de Sensibilidade e 0,9714 de Especificidade. CONCLUSÕES: Alteração do padrão de sono foi preditora do diagnóstico de enfermagem. IMPLICAÇÕES PARA A PRÁTICA: Contribuirá na identificação de distúrbios do sono, pelos enfermeiros, ressaltando a importância da melhoria do sono durante a internação. [ABSTRACT FROM AUTHOR]

Resumo Contexto: O tabagismo é um importante fator de risco, modificável, responsável por inúmeras patologias, nomeadamente o Síndrome Coronário Agudo. Assumindo esta relação seria expectável verificar-se uma mortalidade superior nos doentes fumadores, contudo esta tendência não é consensual entre os estudos. Objetivo: Comparar as diferenças de mortalidade entre fumadores e não-fumadores com Síndrome Coronário Agudo. Método de Revisão: Aplicou-se a metodologia da Cochrane. Incluíram-se estudos que comparavam doentes fumadores e não-fumadores com Síndrome Coronário Agudo. Dois revisores independentes realizaram a avaliação crítica, extração e síntese dos dados. Resultados: Foram incluídos 6 estudos retrospetivos (n=24929) e os resultados da meta-análise mostraram maior mortalidade nos não fumadores, sendo esta significativa no intra-hospitalar (RR=0,66; IC 95%= 0,53-0,84; p

RESUMO Objetivos: descrever o nível de conhecimento do paciente em tratamento de síndrome coronariana aguda (SCA) Método: estudo transversal com aplicação do Maugerl Cardiac Prevention-Questionnaire aos pacientes com SCA submetidos ao cateterismo cardíaco (CATE) após alta da unidade coronariana de cuidados intensivos. Resultados: amostra composta de 50 pacientes, 76% do sexo masculino, com média de idade de 58 anos (±10.2), sendo que 72% apresentaram como principal fator de risco a hipertensão arterial sistêmica. Os pacientes apresentaram, de modo geral, bom índice de desempenho no questionário, apesar do baixo nível de escolaridade. A pontuação média no questionário foi proporcional à renda familiar (p=0,002) e ao nível de escolaridade (p=0,007) Conclusão: a utilização do instrumento O Micro-Q permitiu constatar que a escolaridade e o nível socioeconómico influenciam no entendimento do paciente sobre a própria doença. O instrumento foi uma ferramenta útil para a avaliação do nível de conhecimento do paciente acometido pela SCA, pois a adequada caracterização do perfil dos pacientes atendidos em cada instituição torna-se uma ferramenta facilitadora para planejamentos assistenciais e programas de vigilância em saúde.

Abstract Background: Behavioral scientists consistently point out that knowledge does not influence decisions as expected. GRACE Score is a well validated risk model for predicting death of patients with acute coronary syndromes (ACS). However, whether prognostic assessment by this Score modulates medical decision is not known. Objective: To test the hypothesis that the use of a validated risk score rationalizes the choice of invasive strategies for higher risk patients with non-ST-elevation ACS. Methods: ACS patients were consecutively included in this prospective registry. GRACE Score was routinely used by cardiologists as the prognostic risk model. An invasive strategy was defined as an immediate decision of the coronary angiography, which in the selective strategy was only indicated in case of positive non-invasive test or unstable course. Firstly, we evaluated the association between GRACE and invasiviness; secondly, in order to find out the actual determinants of the invasive strategy, we built a propensity model for invasive decision. For this analysis, a p-value < 0.05 was considered as significant. Results: In a sample of 570 patients, an invasive strategy was adopted for 394 (69%). GRACE Score was 118 ± 38 for the invasive group, similar to 116 ± 38 for the selective group (p = 0.64). A propensity score for the invasive strategy was derived from logistic regression: positive troponin and ST-deviation (positive associations) and hemoglobin (negative association). This score predicted an invasive strategy with c-statistics of 0.68 (95%CI: 0.63-0.73), opposed to GRACE Score (AUC 0.51; 95%CI: 0.47-0.57). Conclusion: The dissociation between GRACE Score and invasive decision in ACS suggests that the knowledge of prognostic probabilities might not determine medical decision.

Abstract Background: Despite its great relevance, there are no studies in our country evaluating the application of the 2012 guidelines for the appropriate use of cardiac diagnostic catheterization. Objective: To analyze the adequacy of coronary angiography performed in two hospitals in the southern region of Brazil. Methods: This is a multicenter cross-sectional study, which analyzed indications, results and proposals for the treatment of 737 coronary angiograms performed in a tertiary hospital with multiple specialties (Hospital A) and a tertiary cardiology hospital (Hospital B). Elective or emergency coronary angiographies were included, except for cases of acute myocardial infarction with ST segment elevation. The level of statistical significance adopted was 5% (p < 0.05). Results: Of the 737 coronary angiograms, 63.9% were performed in male patients. The mean age was 61.6 years. The indication was acute coronary syndrome in 57.1%, and investigation of coronary artery disease in 42.9% of the cases. Regarding appropriation, 80.6% were classified as appropriate, 15.1% occasionally appropriate, and 4.3% rarely appropriate. The proposed treatment was clinical for 62.7%, percutaneous coronary intervention for 24.6%, and myocardial revascularization surgery for 12.7% of the cases. Of the coronary angiographies classified as rarely appropriate, 56.2% were related to non-performance of previous functional tests, and 21.9% showed severe coronary lesions. However, regardless of the outcome of coronary angiography, all patients in this group were indicated for clinical treatment. Conclusion: We observed a low number of rarely appropriate coronary angiograms in our sample. The guideline recommendation in these cases was adequate, and no patient required revascularization treatment. Most of these cases are due to non-performance of functional tests.

Kounis syndrome, while an acute coronary syndrome, occurs in the context of a hypersensitivity reaction, allergies, or anaphylaxis and is subdivided into three types: coronary spasm in normal arteries, instability of plaques in atherosclerotic coronary arteries, and thrombosis of coronary stents. Herein, the case of a 73-year-old patient who, after administration of amoxicillin/clavulanic acid, went into cardiorespiratory arrest with evidence of ST-T segment elevation on electrocardiogram is reported. Coronarography revealed no obstructive lesions, and spontaneous resolution of electrocardiographic abnormalities was observed. A review of anamnesis with the family revealed a previous allergy to penicillin. The tryptase dosage was strongly positive. Kounis syndrome type 2 was diagnosed, and the clinical outcome was good. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rev Rene is the property of Rev Rene and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

O objetivo do estudo foi verificar o risco para síndrome coronariana aguda, em pacientes adultos jovens internados em um hospital de cardiologia do Rio Grande do Sul, entre setembro de 2010 e junho de 2012. Estudo transversal, com pacientes de 20 a 50 anos, ambos os sexos, com diagnóstico de síndrome coronariana aguda. Analisados fatores de risco cardiovasculares como: idade, história familiar positiva, tabagismo, índice de massa corpórea, atividade física, pressão arterial, glicemia, triglicerídeos, colesterol total e lipoproteína de alta densidade. Os resultados evidenciaram que dos 96 pacientes, 52(54,2%) eram do sexo masculino, idade média de 43±7,4 anos e 57(59,4%) com infarto agudo do miocárdio com supradesnivelamento do segmento ST. Os fatores de risco mais prevalentes foram: história familiar positiva 53(55,2%) e tabagismo 49(51%). A abordagem multidisciplinar deve ser instituída para modificação do estilo de vida, evitando ocorrência de novos eventos. ABSTRACT This cross-sectional study to determine risk for acute coronary syndrome in young adults examined patients of both sexes aged 20-50 years admitted to a cardiology hospital in Rio Grande do Sul State between September 2010 and June 2012 with diagnoses of acute coronary syndrome. The cardiovascular risk factors analyzed were: age, family history, smoking, body mass index, physical activity, blood pressure, glucose, triglycerides, total cholesterol and high density lipoproteins. The results comprised 96 patients, mean age 43±7.4 years, 52(54.2%) of them male, and 57(59.4%) with acute myocardial infarction with ST-segment elevation. The most prevalent risk factors were positive family history 53(55.2%) and smoking 49(51%). A multidisciplinary approach should be introduced to modify lifestyle and prevent new events. RESUMEN El objetivo del estudio fue determinar el riesgo de síndrome coronario agudo, en pacientes adultos jóvenes internados en un hospital de cardiología de Rio Grande do Sul, entre septiembre de 2010 y junio de 2012. Estudio transversal realizado junto a pacientes de 20 a 50 años, de ambos sexos, con diagnóstico de síndrome coronario agudo. Se analizaron los factores de riesgo cardiovascular como: edad, historia familiar, tabaquismo, índice de masa corporal, actividad física, presión arterial, glucemia, triglicéridos, colesterol total y lipoproteína de alta densidad. Los resultados consistieron en 96 pacientes, 52(54,2%) hombres, promedio de edad 43±7,4 años y 57(59,4%) con infarto agudo de miocardio y supradesnivelación del segmento ST. Los factores de riesgo más frecuentes fueron: historia familiar 53(55,2%) y tabaquismo 49(51%). El enfoque multidisciplinario debe ser instituido para la modificación de estilo de vida evitando la aparición de nuevos eventos. DOI: http://dx.doi.org/10.12957/reuerj.2015.5934

Objective to present the knowledge produced about sleep and Acute Coronary Syndrome in order to assist in the elaboration of the operational and conceptual definitions of the defining characteristics of the nursing diagnosis Disturbed Sleep Pattern (00198). Method integrative review in the following databases: COCHRANE; SCOPUS; MEDLINE (Medical Literature Analysis and Retrieval System Online) via Pubmed; LILACS (Latin American and Caribbean Health Science Literature Database); CINAHL (Cumulative Index to Nursing and Allied Health Literature) and EMBASE (The Excerpta Medical Database). At the end of the search, 2827 studies were found, 43 were selected for reading, and 10 were included in the review. The gray literature was also included. Results important findings related to clinical evidence and contributing factors of sleep were found in the review. However, in order to build definitions of the defining characteristics, it was necessary to use gray literature, such as a Portuguese dictionary and two textbooks about sleep. Conclusion the definitions will help nurses in their practice in the collection of information, in the determination of the nursing diagnosis studied here, and in directing care measures with respect to quantity and quality of sleep of Acute Coronary Syndrome inpatients. They will also assist in the next steps of the validation of this diagnosis to the referred population.

O estudo aqui apresentado teve como objetivo analisar a população atendida por meio de teleeletrocardiografia realizada por serviço público que pode ser referência para outros em matéria de atendimento pré-hospitalar móvel de urgência no município de Porto Alegre. Trata-se de estudo transversal retrospectivo. Foram analisados 1.338 eletrocardiogramas realizados de setembro 2013 a agosto 2014 pelo Samu/POA, com laudo a distância feito no Hospital do Coração (HCor) em São Paulo. Utilizou-se a metodologia embasada nas diretrizes STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Em 115 (8,6%) desses tele-eletrocardiogramas, os pacientes foram diagnosticados com supradesnivelamento do segmento ST. Esta alteração eletrocardiográfica prevaleceu no gênero masculino (p = 0,012) com idade acima de 60 anos (p = 0,014). Dor torácica típica retroesternal foi mencionada por 314 homens (54,3%) e 726 mulheres (56,3%). Síncope foi relatada por 94 homens (16,3%) e 107 mulheres (14,2%). A dispneia foi um sintoma apontado por 47 homens (8,1%) e 84 mulheres (11,1%). Os resultados do estudo revelaram que alterações eletrocardiográficas sugestivas de SCA (Síndrome coronariana aguda) predominam em homens idosos; embora as mulheres solicitem o serviço de atendimento com mais frequência, o supradesnivelamento do segmento ST mostrou-se preponderante no gênero masculino. A dor torácica ter sido mencionada como o sintoma mais referido está em concordância com a literatura atual. =O conhecimento de nossa realidade pode auxiliar a elaboração de protocolos de serviço.

Estudo documental, desenvolvido em hospital privado no município do Rio de Janeiro, que objetivou analisar o tempo de espera para a realização do primeiro eletrocardiograma (ECG) dos pacientes, com suspeita de síndrome coronariana aguda, na sala de emergência, e discutir suas implicações para o cuidado gerenciado nesta clientela. Foram analisados 116 exames de eletrocardiogramas, do período de janeiro e fevereiro 2010; o tempo médio do ECG inicial foi de 22 minutos. Nos pacientes com infarto agudo do miocárdio, com supradesnível do seguimento s-t (IMACSST), esta média foi de 7,5 minutos. Quanto ao laudo, 2,5% tiveram diagnóstico de IAMCSST; 7,1% de infarto agudo do miocárdio sem supradesnível do segmento s-t e 16,6% foram diagnos­ticados com angina instável. Conclui-se que o ECG inicial em tempo adequado contribui para a identificação e tratamento precoce dos pacientes com IAMCSST, porém ainda necessita de ajustes para maior adesão da equipe de saúde aos tempos preconizados. ABSTRACT This study examined waiting times to first electrocardiogram (ECG) in patients with suspected acute coronary syndrome in the emergency room, and discussed its implications in managed care for this clientele. A cross-sectional study was conducted at a private hospital in Rio de Janeiro municipality. In January and February 2010, 116 electrocardiograms were performed, and mean time to initial EEG was 22 minutes. In patients with acute ST segment elevation myocardial infarction (STEMI), mean time was 7.5 minutes. In the physicians’ reports, 2.5% were diagnosed as STEMI; 7.1% as non-ST segment elevation myocardial infarc­tion, and 16.6% as unstable angina. It was concluded that timely initial ECG contributes to the identification and early treatment of patients with STEMI. However, some adjustments are still needed to improve health teams’ adherence to recommended times. RESUMEN Estudio documental, desarrollado en hospital privado en Rio de Janeiro, que tuvo como objetivo analizar el tiempo de espera para la realización del primer electrocardiograma (ECG) de pacientes con sospecha de síndrome coronario agudo, en la sala de urgencias, y discutir sus implicaciones para la atención médica administrada a esta clientela. Se han analizado 116 pruebas de electrocardiogramas en el periodo de enero y febrero 2010 y el tiempo medio del ECG inicial fue de 22 minutos. En los pacientes con infarto agudo de miocardio con elevación del seguimiento s-t (IMACSST), este promedio fue de 7,5 minutos. En cuanto al informe, un 2.5% tuvo un diagnóstico de IAMCSST; 7,1% de infarto agudo de miocardio sin elevación del seg­mento s-t y un 16,6% fue diagnosticado de angina inestable. Se deduce que el ECG inicial en el tiempo adecuado contribuye a la identificación y al tratamiento precoz de los pacientes con IAMCSST, pero todavía necesita ajustes para una mayor adhesión del equipo de salud a los tiempos recomendados. DOI: http://dx.doi.org/10.12957/reuerj.2015.18332

Background: Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS). Objective: To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically active patients, hospitalized with ACS. Methods: Cross-sectional study conducted in a tertiary and private cardiology center, with economically active patients aged

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Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background: Although a proportion of CSX patients have impaired brachial artery flow-mediated dilatation (FMD) in response to hyperemia, suggesting that endothelial dysfunction in these patients may be systemic and not just confined to the coronary circulation; the underlying mechanisms triggering endothelial dysfunction in these patients are still incompletely understood. Objectives: To assess the association of the index of Microcirculatory Resistance (IMR) with endothelial dysfunction and inflammation in patients with CSX. Methods: We studied 20 CSX patients and 20 age and gender-matched control subjects. Thermodilution-derived coronary flow reserve (CFR) and IMR were measured using a pressure-temperature sensor-tipped guidewire. Brachial artery FMD was measured using high-resolution, two-dimensional ultrasound images obtained with a Doppler ultrasound device (HDI-ATL 5000, USA) with a 5 MHz to 12 MHz linear-array transducer. Results: Compared with in control subjects, CFR was significantly lower (2.42 ± 0.78 vs. 3.59 ± 0.79, p < 0.001); IMR was higher (32.2 ± 8.0 vs. 19.5 ± 5.5, p < 0.001); the concentration of hs-CRP and FMD was higher (4.75 ± 1.62 vs. 2.75 ± 1.50; 5.24 ± 2.41 vs. 8.57 ± 2.46, p < 0.001) in CSX patients. The Duke treadmill score (DTS) was correlated positively to CFR and FMD (0.489 and 0.661, p < 0.001), it was negative to IMR and hsCRP (-0.761 and -0.087, p < 0.001) in CSX patients. Conclusions: The main finding in this study is that the DTS measured in patients with CSX was associated to hsCRP and FMD. Moreover, the independent effects of exercise tolerance can significantly impair FMD and hsCRP in CSX patients; especially it is particularly important to whom where FMD was associated negatively with IMR.

Roubo coronariano da subclávia (RCS) é um fenômeno raro que ocorre em pacientes submetidos a cirurgia de revascularização miocárdica com enxerto de artéria torácica interna esquerda (ATIE) e que causa estenose da artéria subclávia ipsilateral e proximal à origem da ATIE. Relatamos o caso de um paciente masculino de 65 anos que apresentou quadro atípico de síndrome do RCS, manifestando-se como síndrome coronariana aguda no pós-operatório de cirurgia vascular. Palavras-chave: Síndrome coronariana aguda; angioplastia; síndrome do roubo coronário-subclávio

RESUMO OBJETIVO: identificar as evidências disponíveis quanto às estratégias para reduzir o tempo porta-balão nos pacientes com infarto agudo do miocárdio (IAM) que necessitam de transporte inter-hospitalar para serviços de hemodinâmica. MÉTODO: trata-se de uma revisão integrativa da literatura nas bases de dados LILACS e Medline via PubMed no período de janeiro de 2004 a julho de 2014. Das 21 publicações identificadas, nove foram incluídas na amostra. RESULTADOS: as estratégias com melhores resultados na redução do tempo porta-balão foram: eletrocardiograma pré-hospitalar com nível de evidência III, ativação precoce e transferência direta para os centros de hemodinâmica, com nível de evidência IV. Nos estudos que utilizaram essas intervenções, mais de 50% dos pacientes foram reperfundidos em menos de 90 minutos ou com tempo de até 60 minutos. CONCLUSÃO: intervenções para reduzir o tempo porta-balão foram pouco aplicadas isoladamente, sendo evidente a necessidade de estratégias conjuntas e padronizadas em todas as etapas do atendimento ao paciente com IAM.

Background: Cardiovascular disease is the leading cause of mortality in the western world and its treatment should be optimized to decrease severe adverse events. Objective: To determine the effect of previous use of angiotensin-converting enzyme inhibitors on cardiac troponin I measurement in patients with acute coronary syndrome without ST-segment elevation and evaluate clinical outcomes at 180 days. Methods: Prospective, observational study, carried out in a tertiary center, in patients with acute coronary syndrome without ST-segment elevation. Clinical, electrocardiographic and laboratory variables were analyzed, with emphasis on previous use of angiotensin-converting enzyme inhibitors and cardiac troponin I. The Pearson chi-square tests (Pereira) or Fisher's exact test (Armitage) were used, as well as the non-parametric Mann-Whitney's test. Variables with significance levels of 0.5 ng / mL) were high blood glucose at admission (p = 0.0034) and ST-segment depression ≥ 0.5 mm in one or more leads (p = 0.0016). The use of angiotensin-converting inhibitors prior to hospitalization was associated with troponin ≤ 0.5 ng / mL (p = 0.0482). The C-statistics for this model was 0.77. Conclusion: This study showed a correlation between prior use of angiotensin-converting enzyme inhibitors and reduction in the myocardial necrosis marker troponin I in patients admitted for acute coronary syndrome without ST-segment elevation. However, there are no data available yet to state that this reduction could lead to fewer severe clinical events such as death and re-infarction at 180 days.

Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset.

Background: Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC) is a priority. Objective: To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS) as a predictor of cardiovascular complications during hospitalization. Methods: Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1), point of minimum circumference (2); immediately above the iliac crest (3), umbilicus (4), one inch above the umbilicus (5), one centimeter above the umbilicus (6), smallest rib and (7) the point of greatest circumference around the waist (8). Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. Results: A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67%) patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. Conclusion: The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes.

Fundamento: O valor prognóstico incremental da dosagem plasmática de Proteína C-reativa (PCR) em relação ao Escore GRACE não está estabelecido em pacientes com síndromes coronarianas agudas sem supradesnivelamento do segmento ST (SCA). Objetivo: Testar a hipótese de que a medida de PCR na admissão incrementa o valor prognóstico do escore GRACE em pacientes com SCA. Métodos: Foram estudados 290 indivíduos, internados consecutivamente por SCA, os quais tiveram material plasmático colhido na admissão para dosagem de PCR por método de alta sensibilidade (nefelometria). Desfechos cardiovasculares durante hospitalização foram definidos pela combinação de óbito, infarto não fatal ou angina refratária não fatal. Resultados: A incidência de eventos cardiovasculares durante hospitalização foi 15% (18 óbitos, 11 infartos, 13 anginas), tendo a PCR apresentado estatística-C de 0,60 (95% IC = 0,51 - 0,70; p = 0,034) na predição desses desfechos. Após ajuste para o Escore GRACE, PCR elevada (definida pelo melhor ponto de corte) apresentou tendência a associação com eventos hospitalares (OR = 1,89; 95% IC = 0,92 - 3,88; p = 0,08). No entanto, a adição da variável PCR elevada no modelo GRACE não promoveu incremento significativo na estatística-C, a qual variou de 0,705 para 0,718 (p = 0,46). Da mesma forma, não houve reclassificação de risco significativa com a adição da PCR no modelo preditor (reclassificação líquida = 5,7%; p = 0,15). Conclusão Embora PCR possua associação com desfechos hospitalares, esse marcador inflamatório não incrementa o valor prognóstico do Escore GRACE.

Fundamento: Os modelos prognósticos disponíveis para Síndrome Coronariana Aguda (SCA) podem ter limitações de performance, por terem sido elaborados há vários anos, ou problemas de aplicabilidade. Objetivos: Elaborar escores para predição de eventos desfavoráveis em 30 dias e 6 meses, em pacientes com SCA, com ou sem Supradesnivelamento de ST (SST), atendida em hospital privado terciário. Métodos: Coorte prospectiva de pacientes consecutivos com SCA admitidos entre agosto/2009 a junho/2012. O desfecho primário composto foi a ocorrência de óbito, infarto ou reinfarto, Acidente Vascular Cerebral (AVC), parada cardiorrespiratória e sangramento maior. As variáveis preditoras foram selecionadas de dados clínicos, laboratoriais, eletrocardiográficos e da terapêutica. O modelo final foi obtido por meio de regressão logística e submetido a validação interna, utilizando-se bootstraping. Resultados: Incluímos 760 pacientes, 132 com SCA com SST e 628 sem SST. A idade média foi 63,2 ± 11,7 anos, sendo 583 homens (76,7%). O modelo final para eventos em 30 dias contém cinco preditores: idade ≥ 70 anos, antecedente de neoplasia, Fração de Ejeção do Ventrículo Esquerdo (FEVE) < 40%, troponinaI > 12,4 ng/mL e trombólise. Na validação interna, o modelo mostrou ter boa performance com área sob a curva de 0,71.Os preditores do modelo para 6 meses são: antecedente de neoplasia, FEVE < 40%, trombólise, troponina I > 14,3 ng/mL, creatinina > 1,2 mg/dL, antecedente de doença pulmonar obstrutiva crônica e hemoglobina < 13,5 g/dL. Na validação interna, o modelo apresentou boa performance com área sob a curva de 0,69. Conclusões: Desenvolvemos escores de fácil utilização e boa performance para predição de eventos adversos em 30 dias e 6 meses em pacientes com SCA.