Protocolo estadual para tratamento farmacológico da hipertensão arterial pulmonar no âmbito do SUS em Santa Catarina complementar ao protocolo clínico e diretrizes terapêuticas do ministério da saúde / State protocol for the pharmacological treatment of pulmonary arterial hypertension within the scope of the SUS in Santa Catarina, complementary to the clinical protocol and therapeutic guidelines of the Ministry of Health

A Hipertensão Pulmonar (HP) é uma síndrome clínica e hemodinâmica ampla. O conceito recente, apresentado no 6º Simpósio Mundial em 2018 , define a HP como uma pressão média da artéria pulmonar >20 mm/Hg e Teste de Reatividade Vascular Pulmonar (RVP) ≥3 woods em repouso, aferidos obrigatoriamente pelo cateterismo cardíaco direito.

Hipertensión pulmonar. Definiendo la estructura y la función departamental a partir del riesgo / Pulmonary hypertension. Defining the structure and the departmental function based on risk

Se presenta un modelo departamental para la atención integral de pacientes con hipertensión pulmonar. Se resume el conocimiento actual de la hipertensión pulmonar, su mortalidad, pronóstico y la estratificación de su severidad que justifican la propuesta de la estructura y la función departamental.

A departmental model for the comprehensive care of patients with pulmonary hypertension is presented. The current knowledge of pulmonary hypertension, its mortality, prognosis and the stratification of its severity that justify the proposal of the departmental structure and function are summarized.

Caracterización de la adherencia terapéutica en adultos mayores hipertensos / Characterization of therapeutic adherence in hypertensive older adults

RESUMEN Introducción: la adherencia terapéutica es un problema multifactorial que ha generado el interés de muchos investigadores a nivel mundial. Objetivo: determinar la adherencia al tratamiento antihipertensivo en pacientes adultos mayores y los factores asociados a la no adherencia. Materiales y métodos: se realizó un estudio descriptivo longitudinal en pacientes adultos mayores hipertensos, pertenecientes al Policlínico Comunitario Sur, del municipio Morón, en la provincia de Ciego de Ávila. La adherencia al tratamiento fue evaluada por el cuestionario Martín-Bayarre-Grau y el nivel de conocimiento de la enfermedad por el Test de Batalla. Se identificaron las causas asociadas a los problemas de adherencia en dichos pacientes. Resultados: Predominó la no adherencia al tratamiento antihipertensivo en un 62 %. La adherencia parcial se constató en un 22 %. Los problemas de adherencia prevalecieron en las féminas de 60-69 años de edad. Se detectaron múltiples causas inherentes al paciente, como el olvido (48,4 %), la no disponibilidad de medicamentos (25,8 %) y el alivio de los síntomas (16,1 %). Entre otras causas se detectó el bajo nivel de conocimiento de la enfermedad y la presencia de comorbilidades. Conclusiones: se evidenció un predominio de adherencia al tratamiento antihipertensivo de los adultos mayores. Sus causas fundamentales fueron el olvido de ingerir el medicamento, la no disponibilidad de medicamentos, la falta de conocimientos sobre la enfermedad y la presencia de comorbilidades (AU).

ABSTRACT Introduction: therapeutic adherence is a multifactorial problem that has generated the interest of many researchers worldwide. Objective: to determine adherence to antihypertensive therapy in older adult patients and the factors associated with no adherence. Materials and methods: a longitudinal descriptive study was carried out in hypertensive elderly patients belonging to the South Community Polyclinic, in the municipality of Moron, in the province of Ciego de Avila. The adherence to treatment was evaluated by the Martín-Bayarre-Grau questionnaire and the level of knowledge of the disease by the Batalla test. The causes associated with adherence problems in these patients were identified. Results: non-adherence to antihypertensive therapy predominated in 62%. Partial adherence was found to be 22%. Adherence problems prevailed in women aged 60-69 years. Multiple causes related with the patient were detected, such as forgetfulness (48.4%), non-availability of medicines (25.8%) and relief of symptoms (16.1%). Among other causes, the low level of knowledge on the disease and the presence of comorbidities were detected. Conclusions: a predominance of adherence to antihypertensive treatment in older adults was evidenced. Its main causes were the forgetfulness of taking the medicine, the non-availability of medicines, the lack of knowledge about the disease and the presence of comorbidities (AU).

Del soplo inocente a la hipertensión arterial pulmonar / From an innocent heart murmur to pulmonary arterial hypertension

Resumen Introducción: La detección de cardiopatías congénitas en la etapa neonatal a partir de un soplo cardiaco o cianosis no es efectiva. Las cardiopatías congénitas críticas, como el tronco arterioso común (TAC), causan la mayoría de las muertes neonatales por malformaciones congénitas. El tamizaje por oximetría de pulso en los recién nacidos detecta hasta el 70% de estas cardiopatías. El TAC presenta una alta mortalidad en el primer año de vida. Caso clínico: Se presenta el caso de un paciente de sexo femenino de 4 años de edad con soplo cardiaco, palpitaciones, disnea y cianosis perioral, con diagnóstico al nacimiento de soplo inocente. Se detectó TAC mediante una ecocardiografía. Las resistencias vasculares pulmonares fueron evaluadas por medio de cateterismo cardiaco derecho, con hallazgo de hipertensión arterial pulmonar y vasorreactividad pulmonar. Se realizó corrección quirúrgica. A la fecha, la hipertensión arterial pulmonar continúa presente, por lo que se implementó Bosentan® (Actelion, USA) como tratamiento a largo plazo. Conclusiones: En recién nacidos, el tamizaje por oximetría de pulso después de las 24 horas de vida es un método efectivo para el diagnóstico oportuno de cardiopatías congénitas críticas antes de los signos de colapso cardiovascular. Por ello, resulta una herramienta diagnóstica fundamental para reducir la morbimortalidad. Aunque la corrección quirúrgica de cardiopatías congénitas con hipertensión arterial pulmonar es factible en algunos pacientes, su manejo subsecuente es complejo e impacta de manera adversa en la calidad de vida.

Abstract Background: The detection of congenital heart disease in newborns, based on a heart murmur or cyanosis is not effective. Critical congenital heart diseases, such as truncus arteriosus (TA), cause most of neonatal deaths due to congenital malformations. The screening for pulse oximetry in newborns detects up to 70% of these heart diseases. TA presents high mortality in the first year of life. Case report: A 4-year-old female patient with a heart murmur, palpitations, dyspnea, and perioral cyanosis was diagnosed with an innocent heart murmur at birth. TA was detected by echocardiography. Pulmonary vascular resistances were evaluated through right cardiac catheterization, and pulmonary arterial hypertension and pulmonary vasoreactivity were diagnosed as well. Surgical correction was performed. Currently, pulmonary arterial hypertension persists, for which Bosentan® (Actelion, USA) has been implemented as a long-term treatment. Conclusions: In newborns, the pulse oximetry screening after 24 hours of life is an effective method for suitable diagnosis of critical congenital heart disease before the signs of cardiovascular collapse. Therefore, it has become an essential diagnostic tool to reduce morbidity and mortality. Although the surgical correction of congenital heart disease with pulmonary arterial hypertension is feasible in some patients, its subsequent management is complex and has an adverse impact on the quality of life.

Nailfold capillaroscopy as a risk factor for pulmonary arterial hypertension in systemic lupus erythematosus patients

Abstract Background: Pulmonary arterial hypertension (PAH) is a rare and severe complication of systemic lupus erythematosus (SLE). This study aimed to evaluate clinical and laboratory risk factors associated with PAH in SLE patients. Methods: This was a retrospective case-control study in which patients with SLE with PAH (SLE-PAH) confirmed by right heart catheterization (RHC) were compared with SLE patients without PAH. Clinical and demographic variables related to SLE and PAH and nailfold capillaroscopy were evaluated by reviewing the medical records of the patients. Results: Twenty-one patients with SLE-PAH and 44 patients with SLE without PAH matched for sex and disease duration were included. The scleroderma (SD) pattern on nailfold capillaroscopy was more frequently found in patients with SLE-PAH than in those without PAH (56.3% versus 15.9%, respectively, p = 0.002). By univariate analysis, Raynaud's phenomenon, history of abortion, and SD pattern on capillaroscopy were associated with PAH. Arthritis was a protective factor for PAH development. Multivariate analysis showed that the SD pattern on capillaroscopy was the only variable associated with a significantly higher risk of PAH, with an odds ratio of 6.393 (95% confidence interval, 1.530-26.716; p = 0.011). Conclusion: In this study, SD pattern was associated with a 6.3-fold increased risk for PAH development in SLE patients, suggesting that nailfold capillaroscopy might be useful as a screening method to identify SLE patients with a high risk of developing this severe complication.

Caracterización de pacientes con enfermedades autoinmunes del tejido conectivo e hipertensión de arteria pulmonar atendidos en Hospital San Juan de Dios / Patients characterization with autoimmune diseases of the connective tissue and high blood pressure in the pulmonary artery seen in hospital San Juan de Dios

La hipertensión de la arteria pulmonar (HAP) es una grave complicación que pue-den presentar los pacientes con enfermedades autoinmunes del tejido conectivo de prevalencia variable según cada país. Habitualmente su diagnóstico es tardío lo que influye negativamente en su pronóstico y respuesta terapéutica. En el pre-sente trabajo se ha iniciado una revisión en conjunto entre la Unidad de Hemodi-namia y de Reumatología del Hospital San Juan de Dios, con el propósito de tener una caracterización de los pacientes con HAP y enfermedades autoinmunes del tejido conectivo y poder así elaborar planes de manejo de acuerdo a las caracte-rísticas clínicas de estos pacientes e intentar obtener un diagnostico precoz, para mejorar la sobrevida de los portadores de estas enfermedades.

High blood pressure in the pulmonary artery (HAP) is a serious complication that may occur in patients with autoimmune diseases of the connective tissue of vari-able prevalence according to each country. Diagnosis is usually late which affects negatively their prognosis and therapeutic response. In the present work has been initiated a review in conjunction between the unit of Hemodynamic and Rheumatology of the Hospital San Juan de Dios, with the purpose of having a characterization of patients with PAH and autoimmune diseases of the connective tissue and can thus develop management plans according to the clinical features of these patients and try to get an early diagnosis, to improve the survival of the carriers of these diseases.