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To describe cardiopulmonary bypass in the elderly under anesthesia of patients undergoing myocardial revascularization in the Intensive Care Unit. Cardiopulmonary bypass (CPB) can alter plasma concentrations of drugs used during anesthesia for cardiac surgery and cause effects on the central nervous system, leading patients to a greater degree of sedation, which alters the time of patient awakening. Method: This is a descriptive-qualitative-exploratory study, of a comprehensive nature, of the systematic type. Results: The three groups were compared in terms of weight, height, age and body mass index (BMI). Regarding intubation time and wake-up time, it was observed that the CPB group had higher values ​​for these variables, with a significant difference. Conclusion: The short duration of action of propofol of approximately 6 to 9 minutes can be explained by the high clearance and rapid distribution of the drug. Propofol concentration at the site of action also increases rapidly due to the rapid equilibrium between plasma and brain concentrations (< 4 minutes).

In addition to the deaths caused by coronavirus disease (COVID-19), several countries also observed an increase in the overall number of cardiovascular deaths during the pandemics compared with the same period in previous years. The presence of heart failure (HF) in the context of COVID-19 identifies a subgroup with complex management and may represent both a risk factor for worse infection outcomes and a severe cardiovascular complication caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with [...]

Heart failure (HF) is a leading cause of mortality and morbidity worldwide, and is associated with the high use of resources and healthcare costs. In Brazil, the HF prevalence is around 2 million patients, and its incidence is of approximately 240,000 new cases per year.The present investigation aimed to analyze the spatiotemporal trend of mortality caused by HF in Brazil, from 1996 to 2017.This is an ecological study developed with secondary data on HF mortality in Brazil. During the period, 1,242,014 cases of death caused by heart failure were analyzed. The existence of spatial autocorrelation of cases was calculated using the Global Moran Index (GMI) and, when significant, the Local Moran Index, considering p0.05. The relative risk of the clusters was calculated.The mortality rate due to HF was diversified in all Brazilian regions, with an emphasis in the South, Southeast, and Northeast. The GMI indicated positive spatial autocorrelation (p=0.01) in all periods. Municipalities located in the South, Southeast, Northeast, and Midwest showed a higher Relative Risk for mortality from HF, and most municipalities in the North were classified as a protective factor against this cause of death.The study showed a decline in mortality rates across the national territory. The highest concentration of mortality rates is in the North and Northeast regions, highlighting priority vulnerable areas in the planning and controlling strategies of health services.Insuficiência cardíaca (IC) é uma das principais causas de mortalidade e morbidade no mundo, e está associada ao alto uso de recursos e custos com saúde. No Brasil, a prevalência de IC é de aproximadamente 2 milhões de pacientes, e sua incidência é de aproximadamente 240.000 novos casos por ano.A investigação objetivou analisar a tendência espaço-temporal da mortalidade causada por IC no Brasil, de 1996 a 2017.Este é um estudo ecológico desenvolvido com dados secundários sobre mortalidade por IC no Brasil. Durante o período, 1.242.014 casos de morte causada por IC foram analisados. A existência da autocorrelação espacial de casos foi calculada utilizando o Índice de Moran Global (IMG) e, quando significativo, o Índice de Moran Local, considerando p0,05. O risco relativo dos grupos foi calculado.A taxa de mortalidade causada por IC foi diversificada em regiões brasileiras, com ênfase no sul, sudeste e nordeste. O IMG indicou autocorrelação espacial positiva (p=0,01) em todos os períodos. Cidades localizadas no sul, sudeste, nordeste e centro-oeste mostraram maior risco relativo para mortalidade causada por IC, e a maioria das cidades do norte foi classificada como um fator protetivo contra esta causa de morte.O estudo demonstrou declínio nas taxas de mortalidade no território nacional. A maior concentração de taxas de mortalidade está nas regiões norte e nordeste, enfatizando as áreas prioritárias de vulnerabilidade no planejamento e estratégias de controle de serviços de saúde.

Background and Objectives Cardiovascular health is monitored by many different approaches in order to diagnose and prevent critical patient conditions. The wide used of Photoplethysmography in medicine can facilitate heart status monitoring by heart rate variability (HRV) calculations extracted from blood volume variation measurements. The purpose of this work is to develop a computational process which relies on the evaluation of HRV as a prognostic marker in the stratification of the clinical heart conditions: Idiopathic Dilated Cardiomyopathy (IDC), Chagas Cardiomyopathy (CC) and Ischemic Cardiomyopathy (IC). Methods The database created for the study was developed with the assistance of Dr. Carlos Alberto Studart Gomes Hospital in the city of Fortaleza, CE. The detection of cardiac anomaly is analyzed by computational intelligence and pattern recognition algorithms. The classifiers used are the Multilayer Perceptron (MLP), Self-Organizing Map (SOM), Kernel kmeans (Kk-means), and k-Nearest Neighbors (k-NN). Results The results indicate SOM and Kk-means classifiers are the most suitable algorithms to be applied because they hold the highest true rates (Acc = 85.44% to 100%) and sensitivity (Se = 92.85% to 100%). Conclusions Among the heart conditions considered in this paper, Chagas Cardiomyopathy analysis presented the best results for any algorithm because the differences in the patterns of this disease are easier to identify due to arrhythmogenic characteristics. IDC and IC have similar statistical variables versus healthy subjects, which may complicate the pattern recognition performed by classifiers. The combination of extracted PPG signal features with machine learning may result in a high stratification performance and be of assistance to doctors for early diagnosis of disease.

Chagas cardiomyopathy is a major public health disease in Latin America and, due to migration, is becoming a worldwide health and economic burden. This review sought to present the clinical and epidemiological aspects of Chagas cardiomyopathy, as well as some specific features and principles of treatment. We also retrospectively assessed our institutional experience with mechanical circulatory support in refractory heart failure due to Chagas cardiomyopathy over a 10-year period. The role of antiparasitic treatment in patients with heart failure due to Chagas cardiomyopathy is controversial. Heart transplantation, although formerly contraindicated, is currently established as an important therapeutic option. Also, the favorable characteristics of Chagas patients, such as younger age, little comorbidity, and no reoperations or severe pulmonary hypertension, could be an advantage for a mechanical circulatory support indication in advanced heart failure due to Chagas cardiomyopathy. Despite the absence of large evidence-based data, much has been accomplished since Carlos Chagas’ discovery one century ago. Our institutional experience shows that mechanical circulatory support in Chagas patients is associated with more successful bridging to heart transplantation when compared to non-Chagas patients.

Visceral leishmaniasis (VL) in transplant patients is a serious disease, with atypical and aggressive manifestations, compromising patient survival. During the period from 2008 to 2012, 126 heart transplants were performed in the state of Ceara, Brazil, of which, two patients developed VL. Fever, pancytopenia and hepatosplenomegaly were the common clinical signs. Both patients were diagnosed and properly treated, but the first one had a clinical relapse and died, five months after treatment. These findings emphasize the importance of investigating VL in heart-transplant patients in endemic areas and highlight the importance of early diagnosis and treatment for favorable clinical outcomes.

OBJETIVO: Avaliar a evolucao do paciente miocardiopata apos transplante (Tx) cardiaco, analisando sua sobrevida, complicacoes trans e pos-operatorias e respostas cardiovasculares apos cerca de quatro anos do procedimento cirurgico. METODOS: A pesquisa foi realizada no periodo de fevereiro a maio de 2011, com pacientes submetidos a Tx cardiaco no Hospital Dr. Carlos Alberto Studart Gomes - Hospital de Messejana (HDM). A amostra foi composta de todos os pacientes transplantados no ano de 2007 no referido hospital. Inicialmente, foi aplicada uma ficha de avaliacao, coletando dados dos prontuarios, sobre a evolucao do paciente no periodo trans e pos-operatorio ate a alta hospitalar. Apos a coleta dessas informacoes, os pacientes foram submetidos ao teste da caminhada dos seis minutos (TC6). Os valores encontrados na distância percorrida foram comparados aos valores de referencia esperados para a populacao utilizando a equacao de Enright e Sherrill. RESULTADOS: Do total de 24 pacientes que realizaram Tx cardiaco no HDM no ano de 2007, 14 foram avaliados e 10 excluidos do estudo. Com relacao as complicacoes, no periodo transoperatorio, a mais evidenciada foi a disfuncao do ventriculo direito (64,3%) e, no pos-operatorio, quadro de taquicardia (64,3%). Analisando o TC6 observou-se diminuicao de 11,6% na distância percorrida quando comparada a distância estimada (486 ± 55 m, 550 ± 59 m, respectivamente). CONCLUSAO: Os resultados obtidos neste estudo perante o TC6 evidenciam que as respostas cardiovasculares dos pacientes avaliados estao abaixo do estimado, contudo dentro da faixa de normalidade estabelecida.