Search

RESUMO O achado de supradesnivelamento do segmento ST no eletrocardiograma identifica muitos pacientes com infarto agudo do miocardio, mas com baixa sensibilidade. Recentemente, alguns novos padroes eletrocardiograficos foram descritos para identificacao precoce de infarto agudo do miocardio. Relatamos o caso de um paciente do sexo masculino, 53 anos, com infarto agudo do miocardio de parede anterior e padrao eletrocardiografico incomum. O eletrocardiograma apresentou complexo QRS discretamente alargado, progressao lenta da onda R na parede anterior, e segmento ST ascendente com [...]

INSTRODUCAO: O tempo de coagulacao ativada (TCA) apos intervencao coronaria percutânea (ICP) femoral pode ser utilizado para guiar a retirada precoce do introdutor arterial. Este estudo comparou os tempos de permanencia do introdutor arterial e de repouso apos a retirada do introdutor arterial, com e sem controle de TCA, em pacientes que realizaram ICP femoral. METODOS: Ensaio clinico randomizado com 78 pacientes submetidos a ICP femoral eletiva, alocados para retirada do introdutor arterial guiada pelo TCA (grupo 1) ou remocao desse dispositivo sem controle de TCA (grupo 2). No grupo 1, o introdutor arterial foi retirado quando o TCA medido era < 180 segundos. Apos a retirada do introdutor arterial, os pacientes permaneceram por mais 6 horas em repouso absoluto nos dois grupos. RESULTADOS: A media de idade foi de 60 ± 9 anos e 57% dos pacientes eram homens. Os grupos foram semelhantes quanto a caracteristicas clinicas, complexidade das lesoes coronarias, calibre do introdutor arterial, numero e tipo de stents utilizados, farmacos empregados e sucesso do procedimento. Os tempos de permanencia do introdutor arterial (95 ± 35 minutos vs. 240 ± 16 minutos; P < 0,01) e de repouso absoluto (454 ± 33 minutos vs. 600 ± 12 minutos; P < 0,01) foram significativamente menores no grupo 1. CONCLUSOES: A retirada do introdutor arterial guiada pelo TCA em pacientes submetidos a ICP femoral foi mais precoce e proporcionou reducao do tempo total de repouso em comparacao a estrategia padrao da instituicao.

Hypertensive response in treadmill testing is associated with the development of hypertension, but it is still unclear if it is better identified by systolic or diastolic response, and measured directly or corrected by working capacity. We investigated 75 patients with normal office blood pressure through a treadmill testing, ambulatory blood pressure (ABP) monitoring, and two-dimensional Doppler echocardiogram. Characteristics associated with systolic blood pressure (SBP) response corrected by the estimated metabolic equivalent (MET) were identified in multiple linear regression models. SBP response was associated more consistently with age, body mass index (BMI), systolic ABP and left ventricular posterior wall thickness (p0.001) than diastolic response in the bivariate analysis, especially when corrected by MET. Age, BMI and nightly SBP were independently associated with SBP response corrected by MET in the multivariate analysis. Individuals from the top tertile of SBP response corrected by MET (or =11.3 mmHg/MET) were older and had higher BMI, ABP and left ventricular septal and posterior wall thickness than individuals classified in the lower tertiles. These differences were more pronounced than the differences observed between individuals with and without a peak exercise blood pressure higher than 210 mmHg. We concluded that individuals with a high blood pressure response in treadmill testing have higher BMI, left ventricular posterior wall thickness and SBP measured by ABP monitoring than individuals without such a response. These differences were stronger when the variation of blood pressure during exercise was corrected by the amount of work performed.

Perfuracao de uma câmara cardiaca e uma complicacao maior do cateterismo cardiaco, condicao extremamente rara, porem de gravidade bem documentada. Relatamos um caso de perfuracao de ventriculo esquerdo ocorrido apos a realizacao de ventriculografia esquerda com cateter pig tail, seguido de colapso cardiovascular em decorrencia de tamponamento cardiaco. O quadro foi manejado com pronta realizacao de pericardiocentese, a qual foi suficiente para estabilizacao clinica e resolucao do caso.

FUNDAMENTO: O volume de placa (VP) está relacionado a eventos cardiovasculares maiores (ECVM) após o implante de stents coronarianos. OBJETIVO: Avaliar a associação entre o VP antes do procedimento avaliado por angiografia e desfechos clínicos. MÉTODOS: Trata-se de estudo de coorte prospectivo incluindo pacientes submetidos a implante de stents coronarianos em um centro de referência. O VP antes do implante do stent foi avaliado pela fórmula descrita por Giugliano (Am J Cardiol 2005; 95:173): VP = À X (comprimento da lesão) X [(diâmetro do vaso/2)² - (diâmetro luminal mínimo/2)²]. Os ECVM foram registrados no seguimento clínico de um ano e análise de regressão linear múltipla foi realizada para identificar os preditores de eventos. RESULTADOS: A amostra estudada consistiu em 824 pacientes, com idade média de 60 ± 11 anos, sendo 70,0% do gênero masculino. O diabete melito estava presente em 21,0% e o comprometimento triarterial em 12,0%. O diâmetro médio de referência foi de 3,3 ± 3,2 mm, a média do comprimento da lesão foi de 10,2 ± 4,7 mm e a média da estenose residual foi de 1,0% ± 12,0%. Os pacientes com ECVM apresentaram VP maior do que aqueles sem eventos (92,84 ± 42,85 vs 85 ± 46,85; p = 0,03). Outras variáveis associadas com ECVM na análise univariada foram comprometimento triarterial, IAM, diâmetro do vaso e comprimento da lesão tratada. O VP manteve a associação significativa com ECVM após ajuste para as variáveis descritas e diabete melito. CONCLUSÃO: O volume da placa do ateroma antes do implante do stent foi maior nos pacientes que apresentaram ECVM no seguimento clínico em um ano, independentemente de outros preditores de eventos. BACKGROUND: Plaque volume (PV) is related to major cardiovascular events (MACE) after coronary stent implantation. OBJECTIVE: To evaluate the association between PV before the procedure evaluated by angiography and clinical outcomes. METHODS: This is a prospective cohort study of patients undergoing coronary stent implantation in a referral center. PV before the stent implantation was evaluated by the formula described by Giugliano (Am J Cardiol 2005, 95:173): VP = À X (lesion length) X [(vessel diameter/2)² - (minimum luminal diameter/2)²]. The MACE were registered at clinical follow-up of one year and multiple linear regression analysis was performed to identify predictors of events. RESULTS: The sample consisted of 824 patients, mean age 60 ± 11 years, 70.0% were male. Diabetes mellitus was present in 21.0% and triple vessel involvement in 12.0%. Average reference diameter was 3.3 ± 3.2 mm, average lesion length was 10.2 ± 4.7 mm and mean residual stenosis was 1.0% ± 12.0%. Patients with MACE had higher PV than those without events (92.84 ± 42.85 vs 85 ± 46.85, p = 0.03). Other variables associated with MACE in the univariate analysis were triple vessel involvement, myocardial infarction, vessel diameter and length of the lesion treated. PV maintained a significant association with MACE after adjusting for the variables described and diabetes mellitus. CONCLUSION: The volume of atheromatous plaque before stenting was higher in patients with MACE on clinical follow-up in one year, regardless of other predictors of events. FUNDAMENTO: El volumen de placa (VP) está relacionado a eventos cardiovasculares mayores (ECVM) tras implantación de stentscoronarios. OBJETIVOS: Evaluar la asociación entre el VP antes del procedimiento evaluado por angiografía y desenlaces clínicos. MÉTODOS: Se trata de estudio de cohorte prospectivo que incluye a pacientes sometidos a implantación de stentscoronarios en un centro de referencia. El VP antes de la implantación del stent se evaluó por la fórmula descrita por Giugliano (Am J Cardiol 2005; 95:173): VP = Π X (longitud de la lesión) X [(diámetro del vaso/2)² - (diámetro luminal mínimo/2)²]. Los ECVM fueron registrados en el seguimiento clínico de un año y análisis de regresión lineal múltiple se llevó a cabo para identificar los predictores de eventos. RESULTADOS: La muestra estudiada consistió en 824 pacientes, con edad promedio de 60 ± 11 años, con el 70% del género masculino. El diabetes melito estaba presente en el 21,0% y el compromiso triarterial en el 12%. El diámetro medio de referencia fue de 3,3 ± 3,2 mm, la media del longitud de la lesión fue de 10,2 ± 4,7 mm y la media de la estenosis residual fue del 1% ± 12%. Los pacientes con ECVM presentaron VP mayor que aquellos sin eventos (92,84 ± 42,85 vs 85 ± 46,85; p = 0,03). Otras variables asociadas con ECVM en el análisis univariado fueron el compromiso triarterial, el IAM, el diámetro del vaso y longitud de la lesión tratada. El VP mantuvo la asociación significativa con ECVM tras ajuste para las variables descritas y diabetes melito. CONCLUSIÓN: El volumen de la placa del ateroma antes de la implantación del stent fue mayor en los pacientes que presentaron ECVM en el seguimiento clínico en un año, independientemente de otros predictores de eventos.

Plaque volume (PV) is related to major cardiovascular events (MACE) after coronary stent implantation.To evaluate the association between PV before the procedure evaluated by angiography and clinical outcomes.This is a prospective cohort study of patients undergoing coronary stent implantation in a referral center. PV before the stent implantation was evaluated by the formula described by Giugliano (Am J Cardiol 2005, 95:173): VP = π X (lesion length) X [(vessel diameter/2)² - (minimum luminal diameter/2)²]. The MACE were registered at clinical follow-up of one year and multiple linear regression analysis was performed to identify predictors of events.The sample consisted of 824 patients, mean age 60 ± 11 years, 70.0% were male. Diabetes mellitus was present in 21.0% and triple vessel involvement in 12.0%. Average reference diameter was 3.3 ± 3.2 mm, average lesion length was 10.2 ± 4.7 mm and mean residual stenosis was 1.0% ± 12.0%. Patients with MACE had higher PV than those without events (92.84 ± 42.85 vs 85 ± 46.85, p = 0.03). Other variables associated with MACE in the univariate analysis were triple vessel involvement, myocardial infarction, vessel diameter and length of the lesion treated. PV maintained a significant association with MACE after adjusting for the variables described and diabetes mellitus.The volume of atheromatous plaque before stenting was higher in patients with MACE on clinical follow-up in one year, regardless of other predictors of events.

Background Studies of the association between hypertensive response (HR) in the exercise treadmill testing (ETT) and end organ damage are mostly cross-sectional and have not used ABPM. We investigated the association of different definitions of HR with incidence of hypertension by ABPM and development of cardiac structural abnormalities. Methods Normotensive individuals were submitted to ETT and had clinical, office BP, ABPM, and echocardiogram done in the baseline evaluation and after 8.1±1.0 years of follow-up. The variation of these parameters and the incidence of hypertension by tertiles of BP response corrected by MET and by the absolute variation of BP were tested in multivariate models. Results 69 of the 75 (92%) participants were examined in the follow-up. The higher baseline office BP and ABPM, BMI and left atrial dimension in individuals classified at the top tertile persisted in the follow-up. Posterior wall (8.7±1.4, 9.0±1.2, 10.0±1.2 mm, P =0.005), septum thickness (9.4±1.7, 10.1±2.3, 11.0±1.6 mm, P =0.030), and isovolumetric relaxation time (0.73±0.19, 0.76±0.15, 0.85±0.14 s, P =0.044) became significantly higher in the follow-up visit in the top tertile. The incidence of hypertension by ABPM was higher in individuals with HR defined by the top tertile in comparison with the absolute response ≥210 mmHg. Conclusions The correction of the HR in the ETT by MET may improve the prediction of hypertension by ABPM and of cardiac structural abnormalities.

OBJETIVO: Identificar características clínicas, laboratoriais e ecocardiográficas diferenciais em indivíduos com diagnóstico de pericardite secundária e idiopática. MÉTODOS: De janeiro/1999 a dezembro/2001, foram identificados 84 pacientes com diagnóstico clínico e ecocardiográfico de pericardite em clínica de cardiologia. Foram estudados, retrospectivamente, quanto à idade, sexo, características antropométricas, hábitos, pressão arterial casual, causas potenciais, comorbidades, sinais e sintomas, medicação e complicações. Os indivíduos foram divididos em 2 grupos: grupo A constituído de 61 pacientes com causas potenciais conhecidas e grupo B com 23 casos considerados idiopáticos. Os grupos foram comparados, utilizando-se o teste do Qui-quadrado, considerando-se estatisticamente significativas as associações com p < 0,05. RESULTADOS: Os dois grupos foram semelhantes quanto à idade, sexo, medidas antropométricas, hábitos e pressão arterial casual. No grupo B, 23 (100%) casos foram diagnosticados entre os meses de abril e agosto contra 24 (39,4%) no mesmo período no grupo A (p

Dear Editor, Our recently published article in the Brazilian Archives of Cardiologia1 aimed to evaluate the implementation of vaccination against influenza (INF) and Pneumococcus virus (pneumonia) in a specific subgroup of patients with heart failure (HF), due to consensus recommendation of the NorthAmerican, European and Brazilian guidelines on HF. The increased susceptibility to respiratory infections in patients with heart failure is attributed to pulmonary congestion. Dear Editor, Martins et al1 recommend measures for increasing influenza and pneumococcal immunization based on the reduced rates detected in patients with heart failure in the city of Teresopolis. We understand that, in spite of the benefit of this strategy at the population level to prevent infections and complications, we must evaluate mass vaccination and immunization extended to special groups such as immunologically susceptible individuals and those with comorbidities2. Even vaccines made from inactivated agents may trigger important and unpredictable reactions, such as, for instance, Guillain-Barre syndrome. We recently reported a case series of symptomatic pericardial effusion with increased incidence in patients who received influenza vaccine. The patients, mostly elderly and individuals with compensated diseases, showed viral symptoms, increased incidence in the peri-immunization period and resolution of the clinical draw with anti-inflammatory drug use3. Post-vaccination myopericarditis has been reported and may be underdiagnosed and sub-notified4,5.