ABSTRACT
An increase in daily mortality from myocardial infarction has been observed in association with meteorological factors and air pollution in several cities in the world, mainly in the northern hemisphere. The objective of the present study was to analyze the independent effects of environmental variables on daily counts of death from myocardial infarction in a subtropical region in South America. We used the robust Poisson regression to investigate associations between weather (temperature, humidity and barometric pressure), air pollution (sulfur dioxide, carbon monoxide, and inhalable particulate), and the daily death counts attributed to myocardial infarction in the city of São Paulo in Brazil, where 12,007 fatal events were observed from 1996 to 1998. The model was adjusted in a linear fashion for relative humidity and day-of-week, while nonparametric smoothing factors were used for seasonal trend and temperature. We found a significant association of daily temperature with deaths due to myocardial infarction (P < 0.001), with the lowest mortality being observed at temperatures between 21.6 and 22.6ºC. Relative humidity appeared to exert a protective effect. Sulfur dioxide concentrations correlated linearly with myocardial infarction deaths, increasing the number of fatal events by 3.4 percent (relative risk of 1.03; 95 percent confidence interval = 1.02-1.05) for each 10 µg/m increase. In conclusion, this study provides evidence of important associations between daily temperature and air pollution and mortality from myocardial infarction in a subtropical region, even after a comprehensive control for confounding factors.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Air Pollutants , Atmospheric Pressure , Humidity , Myocardial Infarction/mortality , Temperature , Body Mass Index , Brazil/epidemiology , Myocardial Infarction/etiology , Poisson Distribution , Risk Factors , SeasonsABSTRACT
Paciente jovem, etilista, que sofreu infarto agudo do miocárdio. Após terapêutica trombolítica sem sucesso, a cineangiocoronariografia na fase aguda evidenciava trombos em múltiplas artérias. Um 2§ CATE, realizado no 7§ dia de internação revelou coronárias normais. Não havia nenhum distúrbio do metabolismo lipídico, assim como outro fator de risco de doença arterial coronária, a não ser o fato de ser tabagista de oito a 10 cigarros ao dia, há dois anos, o que nos levou a acreditar que o abuso de álcool etílico possa ter contribuído para esse evento.
Subject(s)
Humans , Male , Adult , Coronary Thrombosis , Myocardial Infarction , Cardiac Catheterization , Clinical EvolutionABSTRACT
To determine whether or not slow coronary flow (SF) depends on hemodynamic variables, we studied 17 patients (15 men, mean age = 47.8 years) with SF at coronariography. Exercise thallium-201 myocardial scintigraphy revealed perfusion abnormalities in 13 (76.4 per cent) patients. We then selected 89 individuais submitted to cinecoronariography for comparison: 15 were normal and 74 had heart disease. The coronary flow velocity was evaluated by the number of heart beats (HB) needed for coronary artery dye filling. The patients in the SF group had normal hemodynamic variables which were significantly different from those of patients with heart disease (P = 0.001). Patients with heart disease needed no more than 4 HB to fill their arteries, in contrast to 6.88 ñ 1.68 (5 to 11) in the SF group (P<0.OOO1). Thus, in our patients with myocardial scintigraphy suggesting ischemia, SF was found to be an event which did not depend on hemodynamic factors.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Angina Pectoris , Coronary Circulation/physiology , Coronary Disease , Thallium Radioisotopes , Analysis of Variance , Hemodynamics/physiology , Blood Flow Velocity/physiologyABSTRACT
Objetivo - comparar a eficácia e segurança da adenosina-trifosfato (ATP) e verapamil endovenosos na reversäo das taquicardias paroxísticas supraventriculares (TPSV). Métodos - foram analisados 50 pacientes com diagnóstico de TPSV pelo eletrocardiograma convencional. Excluíram-se aqueles com insuficiência cardíaca, quadro isquêmico agudo, uso de dipiridamol e metilxantinas. Os pacientes foram distribuídos por sorteio em dois grupos: A) ATP em bolo de 10 ou 20 mg; V) verapamil em infusäo rápida de at15 mg. Avaliaram-se sucesso, tempo de reversäo, dose empregada e efeitos colaterais. Resultados - Ocorreu sucesso na reversão em 96% do grupo A e em 92 % do grupo V (p= 1,0). O tempo médio de reversão foi de 30s no grupo A e 248s no V. Efeitos colaterais foram encontrados em 33% no grupo A, e não ocorreram no grupo V Conclusão - O ATP é uma opção atraente para a reversão das TPSV, apresentando efeitos colaterais fugazes, podendo ser droga de escolha no tratamento desses episódios na presença de disfunção ventricul
Purpose - To evaluate the efficacy and safety of intravenous (IV) adenosine-triphosphate (ATP) and verapamil to convert acute episodes of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm. Methods - Fifty patients with PSVT were randomized in two groups: A) 25 treated with IV bolus of ATP (10 or 20mg), and V) 25 treated with IV verapamil, up to 15mg, during 3min. We evaluated the time delay necessary to convert the arrhytmia, doses, and side-effects. Patients with acute ischemic syndromes (<3 weeks), severe congestive heart failure, and treatment with dipyridamole or methylxanthine were excluded. Results - There were no differences between the two groups regarding to age, sex, and success rate. The average time till reversal were respectively, 30s and 248s for ATP and verapamil. Ventricular ectopy and general disconfort were observed in 33% of patients receiving ATP, where as no side-effects occurred in group V. Conclusion - ATP is a good option to convert rapidly PSVT to sinus rhythm and, probably, could be the first choice to treat PSVT patients with ventricular dysfunction
Subject(s)
Tachycardia , Verapamil , Adenosine Triphosphate , Tachycardia, ParoxysmalABSTRACT
The outcome of 38 beta-blocker users (group BB, 28 men and 10 women with a mean age of 56 ñ 4 years) was compared to that of 100 non-users (group NU, 69 men and 31 women with mean age of 57 ñ 8 years) after acute myocardial infarction (AMI). The two groups were compared in terms of electrocardiographic (EKG) location of the AMI (anterior, inferior and lateral), EKG Q and non-Q wave infarction, clincial functional class of Forrester, serum cratine phosphokinase MB fraction (CKMB) peak release and intrahospital mortality.There were no differences between groups concerning sex or severity of coronary artery disease bath arterial hypertension was 3-fold more prevalent group BB. The EKG location of the AMI was similar int he two groups. Non-Q infarction was significantly more prevalent in group BB (37 percent) than in group NU (5 percent). The incidence of clinical functional class IV of Forrester and the serum CKMB peaks were significantly lower in goup BB (2.6 percent vs 16.0 percent and 53 ñ 3 vs 68 ñ 9 UI/1, respectively. Intrahospital mortality was also significantly lower in group BB (2.6 percent) than in group NU (10 percent). These data suggest the beneficial effect of previous long-term use of beta-blockers as indicated by a lower incidence of cardiogenic shock and a significant decrease in intrahospital mortality after AMI
Subject(s)
Humans , Male , Female , Middle Aged , Adrenergic beta-Antagonists/therapeutic use , Myocardial Infarction/drug therapy , Creatine Kinase/blood , Electrocardiography , Hypertension/physiopathology , Hypertension/drug therapy , Hospital Mortality , Myocardial Infarction/physiopathology , Myocardial Infarction/mortality , Prospective Studies , Ventricular Function, LeftABSTRACT
A aorta normal é responsável pela conduçÝo de quase 200.000.000 de litros de sangue e por receber o impacto de aproximadamente três bilhSes de batimentos cardíacos durante a vida. este grande vaso é uma estrutura de condutância e de resistência, composto por uma túnica interna - a íntima - uma externa - a adventícia - e pela túnica média. Na túnica média se encontra uma grande quantidade de fibras elásticas, apostas em forma de espiral, dando a esse órgÝo uma grande capacidade de absorver tensSes e elasticidade, fundamentais para a onda de pulso, que permite a manutençÝo de fluxo no sistema arterial, na fase diastólica do coraçÝo. Na porçÝo ascendente e no arco estÝo os pressoceptores que enviam estímulos ao centro vasomotor do tronco cerebral (exemplo: seio carotídeo), desempenhando importante papel no controle da pressÝo arterial. Anatomicamente a aorta é subdividida em três partes: a ascendente, a crossa ou arco e a descendente. A ascendente tem no adulto em torno de 3 cm de diâmetro, se estendendo da base do coraçÝo, onde se situa dentro do saco pericárdico, em direçÝo cefálica, com comprimento entre 5 e 6 cm, onde se une ao arco aórtico. Neste percurso, levemente à direita da linha média, relaciona-se com o tronco da artéria pulmonar à sua frente e atrás com o átrio esquerdo, o brônquio fonte direito e o ramo direito da artéria pulmonar. O arco aórtico tem orientaçÝo ântero-posterior e dele emergem todos os ramos braquiocefálicos. Encontra-se no mediastino supeiror e se relaciona com os nervos frênicos, vago e o laríngeo recorrente esquerdo. A aorta descendente é a continuaçÝo do arco e se coloca à esquerda da coluna vertebral no mediastino posterior, depois se anterioriza em relaçÝo a coluna vertebral, ficando atrás do esôfago, e transpassa o diafragma ao nível da 12 vértebra torácica. As porçSes ascendente e crossa nÝo sÝo fixadas a estruturas torácicas, ao passo que a descendente o é pelas reflexSes das pleuras e pelas saídas das artérias intercostais. Por esse motivo, a regiÝo do istmo (junçÝo entre crossa e descendente) é o local mais frequente de ruptura em casos de trauma, além de ser o local onde ocorre a coartaçÝo. Na regiÝo abdominal originam-se todos os ramos esplâncnicos e a aorta se bifurca ao nível da quarta vértebra lombar.