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1.
Int. j. cardiovasc. sci. (Impr.) ; 35(1): 58-64, Jan.-Feb. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1356321

ABSTRACT

Abstract Background In Brazil the factors involved in the risk of death in patients with COVID-19 have not been well established. Objective To analyze whether elevations of high-sensitivity troponin I (hTnI) levels influence the mortality of patients with COVID-19. Methods Clinical and laboratory characteristics of hospitalized patients with COVID-19 were collected upon hospital admission. Univariate and binary logistic regression analyzes were performed to assess the factors that influence mortality. P-value<0.05 was considered significant. Results This study analyzed192 patients who received hospital admission between March 16 and June 2, 2020 and who were discharged or died by July 2, 2020. The mean age was 70±15 years, 80 (41.7%) of whom were women. In comparison to those who were discharged, the 54 (28.1%) who died were older (79±12 vs 66±15years; P=0.004), and with a higher Charlson´s index (5±2 vs 3±2; P=0.027). More patients, aged≥60years (P <0.0001), Charlson´s index>1 (P=0.004), lung injury>50% in chest computed tomography (P=0.011), with previous coronary artery disease (P=0.037), hypertension (P=0.033), stroke (P=0.008), heart failure (P=0.002), lymphocytopenia (P=0.024), high D-dimer (P=0.024), high INR (P=0.003), hTnI (P<0.0001), high creatinine (P<0.0001), invasive mechanical ventilation (P<0.0001), renal replacement therapy (P<0.0001), vasoactive amine (P<0.0001), and transfer to the ICU (P=0.001), died when compared to those who were discharged. In logistic regression analysis, elevated hTnI levels (OR=9.504; 95% CI=1.281-70.528; P=0.028) upon admission, and the need for mechanical ventilation during hospitalization (OR=46.691; 95% CI=2.360-923.706; P=0.012) increased the chance of in-hospital mortality. Conclusion This study suggests that in COVID-19 disease, myocardial injury upon hospital admission is a harbinger of poor prognosis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Troponin I/blood , COVID-19/mortality , Myocarditis/complications , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/etiology , Retrospective Studies , Cohort Studies , COVID-19/complications
2.
Arq. bras. cardiol ; 117(5): 1010-1015, nov. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1350021

ABSTRACT

Resumo Fundamento: A doença pelo novo coronavírus (COVID-19) está associada a manifestações clínicas cardiovasculares, incluindo a ocorrência de arritmias cardíacas. Objetivos: Avaliar a incidência de arritmias cardíacas (taquiarritmia atrial, bradiarritmia e taquicardia ventricular sustentada) e de parada cardiorrespiratória (PCR) em uma coorte de pacientes internados com COVID-19 em hospital universitário terciário. Métodos: Estudo de coorte retrospectivo realizado por meio de revisão dos registros de prontuário médico. Para comparação entre os grupos, foi considerado como estatisticamente significativo valor de P < 0,05. Resultados: Foram incluídos 241 pacientes consecutivos com diagnóstico de COVID-19 (idade média, 57,8 ± 15,0 anos; 51,5% homens; 80,5% de raça branca) e 35,3% com necessidade de ventilação mecânica invasiva (VM). A mortalidade geral foi de 26,6%, sendo de 58,8% entre aqueles em VM. Arritmias cardíacas ocorreram em 8,7% dos pacientes, sendo a mais comum taquiarritmia atrial (76,2%). Pacientes com arritmias apresentaram maior mortalidade, 52,4% versus 24,1% (p=0,005). Em análise multivariada, apenas a presença de insuficiência cardíaca foi associada a maior risco de arritmias ( hazard ratio , 11,9; IC 95%: 3,6-39,5; p<0,001). Durante a internação, 3,3% dos pacientes foram atendidos em PCR, com predomínio de ritmos não chocáveis. Todos os atendidos em PCR evoluíram com óbito durante a internação. Conclusão: A incidência de arritmias cardíacas em pacientes internados com COVID-19 em hospital terciário brasileiro foi de 8,7%, sendo a mais comum taquiarritmias atrial. A presença de insuficiência cardíaca foi associada a maior risco de arritmias. Pacientes com COVID-19 atendidos em PCR apresentam elevada mortalidade.


Abstract Background: The coronavirus disease 2019 (COVID-19) is associated with cardiovascular clinical manifestations, including cardiac arrhythmias. Objective: To assess the incidence of cardiac arrhythmias (atrial tachyarrhythmia, bradyarrhythmia, and sustained ventricular tachycardia) and cardiac arrest (CA) in a cohort of patients hospitalized with COVID-19 in a tertiary university-affiliated hospital. Methods: Cohort study with retrospective analysis of electronic medical records. For comparison between groups, a value of p <0.05 was considered statistically significant Results: We included 241 consecutive patients diagnosed with COVID-19 (mean age, 57.8 ± 15.0 years; 51.5% men; 80.5% white), 35.3% of whom received invasive mechanical ventilation (MV). The overall mortality was 26.6%, being 58.8% among those on MV. Cardiac arrhythmias were identified in 8.7% of the patients, the most common being atrial tachyarrhythmia (76.2%). Patients with arrhythmias had higher mortality (52.4% versus 24.1%, p = 0.005). On multivariate analysis, only the presence of heart failure (HF) was associated with a higher risk of arrhythmias (hazard ratio, 11.9; 95% CI: 3.6-39.5; p <0.001). During hospitalization, 3.3% of the patients experienced CA, with a predominance of non-shockable rhythms. All patients experiencing CA died during hospitalization. Conclusions: The incidence of cardiac arrhythmias in patients admitted with COVID-19 to a Brazilian tertiary hospital was 8.7%, and atrial tachyarrhythmia was the most common. Presence of HF was associated with an increased risk of arrhythmias. Patients with COVID-19 experiencing CA have high mortality.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/epidemiology , COVID-19 , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/epidemiology , Retrospective Studies , Risk Factors , Cohort Studies , Hospital Mortality , SARS-CoV-2 , Middle Aged
3.
Rev. urug. cardiol ; 36(2): e702, ago. 2021. fot.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1290000

ABSTRACT

Un gossypiboma, oblitoma o textiloma se define como todo cuerpo extraño olvidado en el interior de un paciente durante una intervención quirúrgica. Representa una complicación posquirúrgica poco frecuente pero de consecuencias potencialmente graves. En general, se manifiesta con cuadros clínicos variables: una masa o pseudotumor, sangrados, fiebre, dolor, varios meses o años después de la cirugía original. También puede ser un hallazgo accidental. Describimos el caso clínico de una paciente con un gossypiboma vinculado a una cirugía cardíaca que se realizó 40 años antes al cuadro clínico actual, que se presenta con arritmia ventricular maligna.


A gossypiboma, oblitoma or textiloma is defined as a surgical object left in the interior of the body after surgery. It represents an uncommon but potentially life threatening post-surgery complication. Clinical manifestations are variable and depend on location, relations and size, from pseudo-tumoral masses, bleeding, fever, pain and other nonspecific presentations. The onset of symptoms is unpredictable, occurring from months or years after surgery. Patients may course asymptomatically and be diagnosed incidentally as an imaging finding. We describe a case of a patient with gossypiboma diagnosed 40 years after undergoing cardiac surgery, who presented with a malignant ventricular arrhythmia.


Um gossypiboma, oblitoma ou textiloma está definido como todo corpo estranho esquecido no interior de um paciente durante um procedimento cirúrgico, representando uma complicação pos cirúrgica pouco frequente, mas com consequências potencialmente graves. Geralmente, se manifesta com quadros clínicos variáveis: uma massa ou pseudotumor, sangramentos, febre, dor, varios meses ou anos após a cirurgia original ou ser um hachado acidental. Descrevemos o caso clínico de uma paciente com um gossypiboma vinculado a uma cirurgia cardíaca realizada 40 anos antes do quadro clínico atual, que se apresenta com arritmia ventricular maligna.


Subject(s)
Humans , Female , Middle Aged , Arrhythmias, Cardiac/etiology , Surgical Sponges , Foreign Bodies/diagnostic imaging , Postoperative Complications/surgery , Postoperative Complications/diagnostic imaging , Thoracic Surgery , Foreign Bodies/surgery
4.
Arch. cardiol. Méx ; 91(2): 186-189, abr.-jun. 2021. graf
Article in English | LILACS | ID: biblio-1248783

ABSTRACT

Abstract Objective: The objective of this study was to describe the case of a 19-year-old male presenting with bradycardia and hypotension after a honeybee sting making a review of the literature and pathophysiology of the cardiovascular and electrocardiogram (EKG) changes after a bee sting. Methods: The patient's airway was inspected and secured. Electrocardiogram with an idioventricular rhythm at 41' bpm. Oxygen was administered, an intravenous access was established, and the transcutaneous pacemaker leads were placed on the chest of the patient, then published guidelines management was induced. Results: The EKG showed idioventricular rhythm at a rate of 41 beats/min that resolved to a normal sinus rhythm after treatment. Conclusions: A full and prompt cardiovascular evaluation should be performed in all patients presenting to the emergency department after a bee sting, and published guidelines regarding the management of bradycardia and anaphylaxis should be followed to achieve successful outcomes.


Resumen Objetivo: Describir el caso de un paciente masculino de 19 años que presenta bradicardia e hipotensión después de una picadura de abeja haciendo una revisión de la literatura y fisiopatología de los cambios cardiovasculares y electrocardiográficos después de una picadura de abeja. Métodos: Se inspeccionó y aseguró la vía aérea del paciente. Un rastreo de ECG realizado al ingreso reveló ritmo idioventricular a una ritmo de 41 latidos por minuto. Se administró oxígeno, se estableció un acceso IV y se colocaron los cables del marcapasos transcutáneo en el tórax del paciente, luego se indujo el manejo de las guías publicadas. Resultados: El electrocardiograma mostró un ritmo idioventricular a una frecuencia de 41 latidos por minuto que se resolvió a un ritmo sinusal normal después del tratamiento. Conclusiones: Se debe realizar una evaluación cardiovascular completa y rápida en todos los pacientes que se presentan al departamento de emergencias después de una picadura de abeja, y se deben seguir las pautas publicadas sobre el manejo de la bradicardia y la anafilaxia para lograr resultados exitosos.


Subject(s)
Humans , Animals , Male , Pacemaker, Artificial , Arrhythmias, Cardiac/diagnosis , Shock , Bees , Bradycardia/etiology , Insect Bites and Stings/complications , Arrhythmias, Cardiac/etiology , Bradycardia/therapy , Electrocardiography , Heart Rate/physiology
5.
Arch. cardiol. Méx ; 90(4): 415-419, Oct.-Dec. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1152815

ABSTRACT

Resumen Antecedentes: El corazón pulmonar crónico (CPC) muestra un incremento en habitantes que viven en grandes altitudes. Objetivo: Investigar la frecuencia de arritmias cardíacas y factores de riesgo para su desarrollo. Métodos: Estudio descriptivo y transversal; se revisó el registro de pacientes internados del Departamento de Cardiología del Instituto Nacional de Tórax, La Paz, Bolivia, entre enero de 2017 y junio de 2018; se incorporó a todos los individuos con diagnóstico de CPC, definido por criterios clínicos, electrocardiográficos y ecocardiográficos; se incluyó a 162 pacientes que cumplieron los criterios en el análisis; se utilizaron la t de Student y ANOVA. Resultados: Arritmias: fibrilación auricular (FA), 125 (75%); aleteo auricular (AA), 17 (10.5%); taquicardia auricular (TA), 17 (10.5%); extrasístoles, 3 (1.9%). Según el análisis univariado, los factores relacionados con el desarrollo de arritmias fueron: eritrocitosis: FA, RR: 1.33, otras arritmias (RR: 1.67), p = 0.0001; hipertensión arterial pulmonar: FA, RR: 3.10, otras arritmias (RR: 3.21), p = 0.0001; dilatación de aurícula derecha (AD): FA, RR: 1.92, otras arritmias (RR: 2.13), p = 0.0001; obesidad: FA, RR: 3.47, p = 0.001, otras arritmias (RR: 3.70), p = 0.001; hipertensión arterial sistémica: FA, RR: 3.10, p = 0.001, otras arritmias (RR: 3.21), p = 0.001. Según el análisis multivariado: eritrocitosis (RR: 2.2), dilatación de AD (RR: 1.2), p = 0.0001. Conclusiones: Se encontró FA con mayor frecuencia en los pacientes con CPC; los factores de riesgo con mayor significancia estadística para su presentación fueron la eritrocitosis y la dilatación de la AD.


Abstract Background: Chronic cor pulmonale (CPC), with increased presentation in high-altitude inhabitants. Objectives: Investigating the frequency of cardiac arrhythmias, and risk factors for its development. Methods: Descriptive, cross-sectional study, the inpatient registry of the Department of Cardiology of the National Institute of Torax, La Paz-Bolivia, from January 2017 to June 2018 was reviewed, all were incorporated with the diagnosis of CPC, defined by clinical criteria, electrocardiographic and echocardiographic, 162 patients who met the criteria were taken, the student's t-test and ANOVA were used for the analysis. Results: Arrhythmias: atrial fibrillation (AF) 125 (75%), atrial flutter (AA) 17 (10.5%), atrial tachycardia (AT) 17 (10.5%), extrasystoles 3 (1.9%). Univariate analysis of factors related to the development of arrhythmias: erythrocytosis: FA, RR: 1.33, other arrhythmias RR: 1.67, p = 0.0001, pulmonary arterial hypertension: FA, RR: 3.10, other arrhythmias RR: 3.21, p = 0.0001, right atrial dilation (AD): FA, RR: 1.92, other arrhythmias RR: 2.13, p = 0.0001, obesity: FA, RR: 3.47, p = 0.001, other arrhythmias RR: 3.70, p = 0.001, systemic arterial hypertension: FA: RR: 3.10, p = 0.001, other arrhythmias RR: 3.21, p = 0.001. Multivariate analysis: erythrocytosis (RR: 2.2), AD dilation (RR: 1.2), p = 0.0001. Conclusions: AF was found more frequently in patients with CPC, the risk factors with the greatest statistical significance for presentation were: erythrocytosis and AD dilation.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Arrhythmias, Cardiac/epidemiology , Pulmonary Heart Disease/epidemiology , Altitude , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Polycythemia/epidemiology , Bolivia/epidemiology , Registries , Chronic Disease , Cross-Sectional Studies , Risk Factors
6.
Rev. bras. cir. cardiovasc ; 34(4): 444-450, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020503

ABSTRACT

Abstract Objectives: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Arrhythmias, Cardiac/etiology , Postoperative Complications/etiology , Coronary Artery Disease/surgery , Cardiopulmonary Bypass/adverse effects , Coronary Artery Bypass/adverse effects , Opioid-Related Disorders/complications , Arrhythmias, Cardiac/epidemiology , Postoperative Complications/epidemiology , Blood Pressure , Epinephrine/adverse effects , Central Venous Pressure , Heart Rate , Intensive Care Units
8.
Rev. bras. cir. cardiovasc ; 33(5): 448-453, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-977448

ABSTRACT

Abstract Objective: Cardiac arrhythmias are a common challenge following open-heart surgeries. Hypomagnesemia is believed to be correlated with this condition. Prophylactic intravenous magnesium supplementation has been practiced for a long time in patients undergoing CABG. This study was designed in an attempt to compare the efficacy of oral versus intravenous routes in the prevention of hypomagnesemia and arrhythmia. Methods: In this interventional clinical study, 82 patients were randomly assigned to 2 groups. All patients were evaluated for baseline serum magnesium level and arrhythmias. One group received 1,600 mg of oral magnesium hydroxide through nasogastric (NG) tube prior to surgery, while the other group received 2 g of magnesium sulfate during the induction of anesthesia. The serum magnesium level was monitored for 48 hours after the operation. The difference in preoperative hypomagnesemia was non-significant (Sig: 0.576). Results: During the operation, the serum magnesium level peaked around 4 mg/dL, and no hypomagnesemia was detected in any patient. Although the curve of oral group declined parallel and below that of intravenous (IV) group, no significant differences were detected during postoperative monitoring. In addition, a prevalence of arrhythmia of 13.9% and 6.5% was noticed in IV and oral groups, respectively (OR: 0.428). Conclusion: Providing 1,600 mg of oral magnesium supplement to patients is as effective as 2,000 mg of magnesium sulfate IV in preventing hypomagnesemia and arrhythmia after CABG. Thus, the authors introduce this treatment regimen as a promising and cost-effective method.


Subject(s)
Humans , Male , Female , Middle Aged , Arrhythmias, Cardiac/prevention & control , Postoperative Complications/prevention & control , Coronary Artery Bypass/adverse effects , Magnesium/administration & dosage , Magnesium/blood , Magnesium Hydroxide/administration & dosage , Arrhythmias, Cardiac/etiology , Time Factors , Coronary Artery Disease/surgery , Administration, Intravenous , Magnesium Sulfate/administration & dosage
9.
Arq. bras. cardiol ; 111(3): 364-372, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973751

ABSTRACT

Abstract Background: Chagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America. Objective: To investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD. Methods: Consecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Holter monitoring, echocardiogram and ambulatory blood pressure monitoring. Results: We evaluated 135 patients [age: 56 (45-62) years; 30% men; BMI: 26 ± 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, ≥ 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0.01; larger left atrial diameter [37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log10 (AHI) (b = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 - 1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01). Conclusions: OSA is independently associated with atrial and ventricular remodeling in patients with CD.


Resumo Fundamento: A doença de Chagas (DC) é uma causa importante de morbimortalidade por insuficiência cardíaca e arritmias malignas em todo o mundo, especialmente na América Latina. Objetivo: Investigar a associação entre apneia obstrutiva do sono (AOS) com remodelação cardíaca e arritmias cardíacas em pacientes com DC. Métodos: Foram incluídos pacientes consecutivos com DC, com idade entre 30 e 65 anos. Os participantes foram submetidos à avaliação clínica, estudo do sono, Holter de 24 horas, ecocardiograma e monitorização ambulatorial da pressão arterial. Resultados: Foram avaliados 135 pacientes [idade: 56 (45-62) anos; 30% homens; IMC: 26 ± 4 kg/m2, cardiomiopatia chagásica: 70%]. AOS moderada a grave (índice de apneia-hipopneia, IAH, ≥ 15 eventos/h) estava presente em 21% dos pacientes. AOS não estava associada a arritmias nessa população. Em comparação com pacientes com AOS leve ou ausente, pacientes com AOS moderada a grave apresentaram maior frequência de hipertensão (79% vs. 72% vs. 44%, p < 0,01) e pressão arterial sistólica noturna mais alta: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0,01; diâmetro do átrio esquerdo maior [37 (33‑42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0,01]; e maior proporção de disfunção ventricular esquerda [FEVE < 50% (39% vs. 28% vs. 11%), p < 0,01], respectivamente. O preditor de dimensão do átrio esquerdo foi Log10 (IAH) (β = 3,86, IC 95%: 1,91 a 5,81; p < 0,01). Os preditores de disfunção ventricular foram IAH >15 eventos/h (OR = 3,61, IC 95%: 1,31 - 9,98; p = 0,01), pressão arterial sistólica (OR = 1,06, IC95%: 1,02 - 1,10; p < 0,01) e sexo masculino (OR = 3,24, IC 95%: 1,31 - 8,01; p = 0,01). Conclusões: A AOS está independentemente associada à remodelação atrial e ventricular em pacientes com DC.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Arrhythmias, Cardiac/etiology , Chagas Cardiomyopathy/complications , Ventricular Remodeling , Sleep Apnea, Obstructive/etiology , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/pathology , Reference Values , Severity of Illness Index , Echocardiography , Chagas Cardiomyopathy/physiopathology , Chagas Cardiomyopathy/pathology , Anthropometry , Multivariate Analysis , Analysis of Variance , Electrocardiography, Ambulatory , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Statistics, Nonparametric , Blood Pressure Monitoring, Ambulatory , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/pathology , Heart Atria/physiopathology , Heart Atria/pathology
10.
Rev. bras. cir. cardiovasc ; 33(3): 286-290, May-June 2018. tab
Article in English | LILACS | ID: biblio-958417

ABSTRACT

Abstract Objective: Rhythm abnormalities following transcatheter aortic valve implantation (TAVI) and indications for permanent pacemaker implantation (PPI) were reviewed, which aren't well established in the current guidelines. New left bundle branch block and atrioventricular block are the most common electrocardiographic changes after TAVI. PPI incidence ranges from 9-42% for self-expandable and 2.5-11.5% for balloon expandable devices. Not only anatomical variations in conduction system have an important role in conduction disorders, but different valve characteristics and their relationship with cardiac structures as well. Previous right bundle branch block has been confirmed as one of the most significant predictors for PPI.


Subject(s)
Humans , Pacemaker, Artificial , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/therapy , Transcatheter Aortic Valve Replacement/adverse effects , Cardiac Pacing, Artificial/methods , Risk Factors , Treatment Outcome
11.
Arq. bras. cardiol ; 110(5): 412-417, May 2018. tab
Article in English | LILACS | ID: biblio-950150

ABSTRACT

Abstract Background: Sudden cardiac death is the most frequent death mechanism in Chagas disease, responsible for 55% to 65% of the deaths of patients with chronic Chagas cardiomyopathy (CCC). The most often involved electrophysiological mechanisms are ventricular tachycardia and ventricular fibrillation. The implantable cardioverter defibrillator (ICD) has a beneficial role in preventing sudden death due to malignant ventricular arrhythmias, and, thus the correct identification of patients at risk is required. The association of microvolt T-wave alternans (MTWA) with the appearance of ventricular arrhythmias has been assessed in different heart diseases. The role of MTWA is mostly unknown in patients with CCC. Objectives: To evaluate the association between MTWA and the occurrence of malignant ventricular arrhythmias in patients with CCC. Method: This is a case-control study including patients with CCC and ICD, with history of malignant ventricular arrhythmias (case group), and patients with CCC and no history of those arrhythmias (control group). The MTWA test results were classified as negative and non-negative (positive and indeterminate). The significance level adopted was a = 0.05. Results: We recruited 96 patients, 45 cases (46.8%) and 51 controls (53.1%). The MTWA test was non-negative in 36/45 cases (80%) and 15/51 controls (29.4%) [OR = 9.60 (95%CI: 3.41 - 27.93)]. After adjustment for known confounding factors in a logistic regression model, the non-negative result continued to be associated with malignant ventricular arrhythmias [OR = 5.17 (95%CI: 1.05 - 25.51)]. Conclusion: Patients with CCC and history of malignant ventricular arrhythmias more often have a non-negative MTWA test as compared to patients with no history of arrhythmia.


Resumo Fundamento: A morte súbita cardíaca é o mecanismo de morte mais comum na doença de Chagas, responsável pelo óbito de 55% a 65% dos pacientes com cardiomiopatia chagásica crônica (CCC). Os mecanismos mais frequentemente envolvidos são as taquiarritmias ventriculares. O cardioversor-desfibrilador implantável (CDI) apresenta impacto na redução da mortalidade por arritmias ventriculares e faz-se necessária a correta identificação de pacientes sob risco. A associação de microalternância de onda T (MTWA) com o aparecimento de arritmias ventriculares foi avaliada em diferentes cardiopatias através de um teste. O papel da MTWA na identificação de pacientes sob risco na CCC permanece incerto. Objetivo: Avaliar a associação entre MTWA e a ocorrência de arritmias ventriculares malignas na CCC. Método: Trata-se de um estudo caso-controle, que incluiu pacientes com CCC em uso de CDI, com história prévia de arritmias ventriculares malignas (casos) ou sem história prévia (controles). Os resultados do teste foram classificados em negativo e não negativo (positivo e indeterminado). O nível de significância foi a = 0,05. Resultado: Foram recrutados 96 pacientes, 45 no grupo caso (46,8%) e 51 no grupo controle (53,1%). O teste de MTWA apresentou resultado não negativo em 36/45 pacientes no grupo caso (80%) e 15/51 no grupo controle (29,4%), OR = 9,60 (IC95%: 3,41 - 27,93). Após ajuste para fatores de confusão num modelo de regressão logística, o resultado não negativo continuou associado à presença de arritmias ventriculares malignas, com OR = 5,17 (IC95%: 1,05 - 25,51). Conclusão: Na CCC, pacientes com história de arritmia ventricular maligna apresentam maior frequência de teste de MTWA não negativo quando comparados a pacientes sem ocorrência prévia de arritmias.


Subject(s)
Humans , Male , Female , Middle Aged , Arrhythmias, Cardiac/etiology , Death, Sudden, Cardiac/etiology , Chagas Disease/complications , Arrhythmias, Cardiac/physiopathology , Case-Control Studies , Survival Analysis , Risk Factors , Death, Sudden, Cardiac/prevention & control , Chagas Disease/physiopathology , Tachycardia, Ventricular/etiology , Defibrillators, Implantable , Electrocardiography
12.
West Indian med. j ; 67(1): 84-88, Jan.-Mar. 2018. graf
Article in English | LILACS | ID: biblio-1045805

ABSTRACT

ABSTRACT Non-compaction cardiomyopathy is a rare form of cardiac disease that presents with symptoms of congestive heart failure, ventricular arrhythmias or thromboembolism. Within the Caribbean setting, there are limited data regarding its existence. We present a case of non-compaction cardiomyopathy, diagnosed by transthoracic echocardiogram and cardiac magnetic resonance imaging, with the use of established criteria. It is interesting to highlight such a condition within the small Caribbean population, especially given its link to heritability and the ease with which it can be mistaken for a dilated cardiomyopathy.


RESUMEN La miocardiopatía no compactada o espongiforme es una forma rara de enfermedad cardíaca que se presenta con síntomas de insuficiencia cardíaca congestiva, arritmias ventriculares o tromboembolismos. En el entorno caribeño, hay datos limitados sobre su existencia. Presentamos un caso de cardiomiopatía no compactada, diagnosticada mediante ecocardiograma transtorácico y resonancia magnética cardíaca, con el uso de criterios establecidos. Es interesante destacar tal condición dentro de la pequeña población caribeña, especialmente dada su relación con la heredabilidad y la facilidad con la que se le puede confundir con una miocardiopatía dilatada.


Subject(s)
Humans , Male , Middle Aged , Isolated Noncompaction of the Ventricular Myocardium/diagnostic imaging , Arrhythmias, Cardiac/etiology , Thromboembolism/etiology , Magnetic Resonance Imaging , Echocardiography , Isolated Noncompaction of the Ventricular Myocardium/complications , Heart Failure/etiology
13.
Rev. mex. cardiol ; 29(1): 55-66, Jan.-Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-1004302

ABSTRACT

Abstract: Introduction: Atrial fibrillation is the most prevalent arrhythmia in clinical practice. Evidence has recently shown a relationship between epicardial adipose tissue and atrial fibrillation, which may be stronger than that for traditional obesity markers. Objective: To analyse the available evidence associating adipose epicardial tissue with incidence, severity and recurrences of atrial fibrillation. Methods: A systematic search in PubMed, EBSCO, Cochrane, SciELO and LILACS databases for observational studies published in the last 10 years, evaluating the association between atrial fibrillation and epicardial adipose tissue was undertaken. All articles were evaluated by two authors and differences were solved by consensus. Results: After having screened and evaluated articles for quality, 15 were selected for the qualitative synthesis. All studies reported a statistically significant association between total fat and periatrial epicardial adipose tissue and the presence of atrial fibrillation, which persisted after adjustment of covariates. The evidence was not uniform regarding arrhythmia severity. Periatrial epicardial fat was significantly higher in patients who had a recurrent disease. Conclusion: the presence of epicardial adipose tissue (total and periatrial) is significantly associated with atrial fibrillation and arrhythmia recurrence.(AU)


Resumen: Introducción: La fibrilación auricular es la arritmia más prevalente en la práctica clínica. Recientemente se ha demostrado una relación entre el tejido adiposo epicárdico y la fibrilación auricular, que puede ser más fuerte que la de los marcadores de obesidad tradicionales. Objetivo: Analizar las pruebas disponibles que asocian el tejido epicárdico adiposo con la incidencia, gravedad y recurrencia de la fibrilación auricular. Métodos: Se realizó una búsqueda sistemática en las bases de datos PubMed, EBSCO, Cochrane, SciELO y LILACS de estudios observacionales publicados en los últimos 10 años, evaluando la asociación entre la fibrilación auricular y el tejido adiposo epicárdico. Dos autores evaluaron todos los artículos y las diferencias se resolvieron por consenso. Resultados: Después de haber examinado y evaluado la calidad de los artículos, se seleccionaron 15 para la síntesis cualitativa. Todos los estudios informaron una asociación estadísticamente significativa entre la grasa total y el tejido adiposo epicárdico periatrial y la presencia de fibrilación auricular, que persistió después del ajuste de las covariables. Las evidencias no fueron uniformes con respecto a la gravedad de la arritmia. La grasa epicárdica periatrial fue significativamente mayor en los pacientes que tuvieron una enfermedad recurrente. Conclusión: La presencia de tejido adiposo epicárdico (total y periatrial) se asocia significativamente con fibrilación auricular y recurrencia de arritmia.(AU)


Subject(s)
Humans , Arrhythmias, Cardiac/etiology , Atrial Fibrillation/etiology , Adipose Tissue , Obesity/physiopathology
14.
Einstein (Säo Paulo) ; 15(3): 251-255, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-891410

ABSTRACT

ABSTRACT Objective To assess the association between cigarette smoking and ventricular arrhythmias in adolescents. Novel electrocardiographic parameters -Tp-e interval, as well as Tpe/QT and Tpe/QTc ratios - were used to make this assessment. Methods The study population consisted of 87 subjects aged between 16-19 years. Fifty-one adolescent smokers with no risk of arrhythmia comprised the Smoker Group, and 36 adolescents who had never smoked cigarettes comprised the Control Group. Smokers were defined as patients smoking more than three cigarettes per day, for at least 1 year. Body mass index, systolic, diastolic and mean blood pressures were measured, and electrocardiograms were performed on all subjects. Heart rate, PR and Tp-e intervals, and Tpe/QT, Tpe/QTc ratio were digitally measured. Results Adolescents in Smoker Group had smoked cigarettes for 2.9±1.4 years (range 1 to 6 years). The mean age at starting smoking was 13.8±1.4 years. There were no differences between smokers and Control Group as to baseline clinical variables (p>0.05). The PR, QT and QTc intervals were similar in all groups. Tp-e interval (98.4±12.7ms and 78.3±6.9 ms; p<0.001), Tpe/QT (0.28±0.04 and 22±0.03; p<0.01), Tpe/QTc (0.24±0.03 and 0.19±0.01; p<0.001) ratios were significantly higher in Smoker Group. There were no correlations between years of smoking, number of cigarettes per day, Tpe interval, Tpe/QT or Tpe/QTc ratios. Conclusion Cigarette smoking is associated with risk of ventricular arrhytmogenesis with prolonged Tp-e interval and increased Tpe/QT and Tpe/QTc ratios in adolescents.


RESUMO Objetivo Avaliar a associação entre tabagismo e arritmias ventriculares em adolescentes usando novos parâmetros eletrocardiográficos: intervalo Tp-e, e relações Tpe/QT e Tpe/QTc. Métodos A população do estudo incluiu 87 indivíduos de 16 a 19 anos de idade. Cinquenta e um adolescentes fumantes, sem risco de arritmia, formaram o Grupo Fumantes, e 36 adolescentes, que nunca tinham fumado cigarros, formaram o Grupo Controle. Os fumantes foram definidos como pacientes que fumavam mais de três cigarros por dia, há pelo menos 1 ano. O índice de massa corporal, e a pressão arterial sistólica, diastólica e média foram medidos, e foram realizados eletrocardiogramas em todos os participantes. Frequência cardíaca, intervalos PR e Tp-e, e as relações Tpe/QT e Tpe/QTc foram medidas por instrumentos digitais. Resultados Os adolescentes do Grupo Fumante fumavam há 2,9±1,4 anos (variação 1 a 6 anos). A média de idade ao começar a fumar foi 13,8±1,4 anos. Não houve diferença nas variáveis clínicas iniciais entre os Grupos Fumante e controle (p>0,05). Os intervalos PR, QT e QTc foram semelhantes em todos os grupos. O intervalo Tp-e (98,4±12,7ms e 78,3±6,9ms; p<0,001), e as relações Tpe/QT (0,28±0,04 e 22±0,03; p<0,01) e Tpe/QTc (0,24±0,03 e 0,19±0,01; p<0,001) foram significativamente maiores no Grupo Fumantes. Não houve correlação entre anos de tabagismo, número de cigarros por dia, intervalo Tpe e relações Tpe/QT e Tpe/QTc. Conclusão O hábito de fumar está associado ao risco de arritmogênese ventricular, com interval Tp-e prolongado e aumento nas relações Tpe/QT e Tpe/QTc em adolescentes.


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Arrhythmias, Cardiac/etiology , Cigarette Smoking/adverse effects , Arrhythmias, Cardiac/physiopathology , Electrocardiography , Cigarette Smoking/physiopathology , Heart Conduction System/physiology , Heart Rate/physiology
15.
J. bras. nefrol ; 39(2): 186-195, Apr.-June 2017. tab, graf
Article in English | LILACS | ID: biblio-893758

ABSTRACT

Abstract Patients with chronic kidney disease (CKD) are susceptible to the occurrence of ventricular arrhythmias. The leading cause of death in dialysis patients is cardiac arrhythmias. The pathophysiology of arrhythmias in this population is complex and seems to be related to structural cardiac abnormalities caused by CKD, associated with several triggers, such as water and electrolyte disorders, hormonal conditions, arrhythmogenic drugs, and the dialysis procedure itself. Little is known about the clinical outcomes in CKD patients with asymptomatic ventricular arrhythmias. The results of treatments with anti-arrhythmic drugs and invasive devices are controversial in these patients, according to the available literature. The aim of this study was to review this often-neglected topic, which is of special importance in the CKD population.


Resumo A população com doença renal crônica (DRC) está vulnerável à ocorrência de arritmias ventriculares. Os distúrbios do rítmo cardíaco constituem a principal causa de morte em pacientes dialíticos. A fisiopatologia das arritmias nesta população é complexa e parece relacionar-se às alterações da estrutura cardíaca causadas pela DRC, associadas a diversos gatilhos, tais como: distúrbios hidro-eletrolíticos e hormonais, uso de drogas arritmogênicas e aqueles relacionados ao próprio procedimento dialítico. Pouco se sabe sobre os desfechos clínicos dos pacientes com DRC portadores de arritmias ventriculares assintomáticas. O tratamento desta população com anti-arrítmicos e dispositivos invasivos tem resultados controversos na literatura. O objetivo desse trabalho foi revisar este tema muitas vezes negligenciado, mas de especial importância na população com DRC.


Subject(s)
Humans , Arrhythmias, Cardiac/etiology , Renal Insufficiency, Chronic/complications , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Renal Insufficiency, Chronic/physiopathology
17.
Arq. bras. cardiol ; 108(2): 122-128, Feb. 2017. tab
Article in English | LILACS | ID: biblio-838692

ABSTRACT

Abstract Background: A few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD). As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE) has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease. Objectives: To assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam. Methods: Retrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed. Results: Their mean age was 64±10 years and most patients were females (65.4%). No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%. Conclusion: DSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found.


Resumo Fundamento: Até poucas décadas atrás, os pacientes chagásicos eram predominantemente trabalhadores rurais, com baixo perfil de risco para doença obstrutiva coronária. Com a crescente urbanização, passaram a ter os mesmos fatores de risco para doença aterosclerótica que indivíduos não infectados. O ecocardiograma sob estresse com dobutamina (EED) é uma importante ferramenta no diagnóstico de coronariopatia. É referido, porém, como um método potencialmente arritmogênico, mas seguro, em pacientes coronarianos não chagásicos. Entretanto, há insegurança na prática clínica de indicá-lo no paciente chagásico, devido ao potencial arritmogênico já intrínseco nesta cardiopatia. Objetivos: Analisar a segurança do EED em uma população de chagásicos com suspeita clínica de coronariopatia. Métodos: Análise retrospectiva de um banco de dados de pacientes encaminhados para a realização do EED entre maio/2012 e fevereiro/2015. Avaliou-se pacientes consecutivos portadores de doença de Chagas e com suspeita de coronariopatia. Confirmou-se a sorologia para doença de Chagas em todos os pacientes. Resultados: A média etária dos 205 pacientes analisados foi de 64 ± 10 anos, sendo a maioria do sexo feminino (65,4%). Nenhum paciente apresentou eventos adversos significativos, como infarto agudo do miocárdio, fibrilação ventricular, assistolia, acidente vascular encefálico, ruptura cardíaca ou morte. Quanto às arritmias, extrassístoles ventriculares frequentes ocorreram em 48% dos pacientes, taquicardia ventricular não sustentada em 7,3%, bigeminismo em 4,4%, taquicardia supraventricular e taquicardia ventricular sustentada em 1% e fibrilação atrial em 0,5%. Conclusão: O EED mostrou ser um exame seguro nessa população de pacientes chagásicos, onde nenhum desfecho grave foi encontrado.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/diagnostic imaging , Chagas Disease/diagnostic imaging , Echocardiography, Stress/methods , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Reference Values , Blood Pressure/physiology , Coronary Artery Disease/physiopathology , Multivariate Analysis , Reproducibility of Results , Retrospective Studies , Risk Factors , Chagas Disease/physiopathology , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/physiopathology , Echocardiography, Stress/adverse effects , Heart Rate/physiology
18.
Arq. bras. cardiol ; 107(5): 411-419, Nov. 2016. tab, graf
Article in English | LILACS | ID: biblio-827867

ABSTRACT

Abstract Background: Atrial electromechanical delay (EMD) is used to predict atrial fibrillation, measured by echocardiography. Objectives: The aim of this study was to assess atrial EMD and mechanical function after anthracycline-containing chemotherapy. Methods: Fifty-three patients with breast cancer (48 ± 8 years old) who received 240 mg/m2of Adriamycin, 2400 mg/m2 of cyclophosphamide, and 960 mg/m2 of paclitaxel were included in this retrospective study, as were 42 healthy subjects (47 ± 9 years old). Echocardiographic measurements were performed 11 ± 7 months (median 9 months) after treatment with anthracyclines. Results: Left intra-atrial EMD (11.4 ± 6.0 vs. 8.1 ± 4.9, p=0.008) and inter-atrial EMD (19.7 ± 7.4 vs. 14.7 ± 6.5, p=0.001) were prolonged; LA passive emptying volume and fraction were decreased (p=0.0001 and p=0.0001); LA active emptying volume and fraction were increased (p=0.0001 and p=0.0001); Mitral A velocity (0.8 ± 0.2 vs. 0.6 ± 0.2, p=0.0001) and mitral E-wave deceleration time (201.2 ± 35.6 vs. 163.7 ± 21.8, p=0.0001) were increased; Mitral E/A ratio (1.0 ± 0.3 vs. 1.3 ± 0.3, p=0.0001) and mitral Em (0.09 ± 0.03 vs. 0.11 ± 0.03, p=0.001) were decreased; Mitral Am (0.11 ± 0.02 vs. 0.09 ± 0.02, p=0.0001) and mitral E/Em ratio (8.8 ± 3.2 vs. 7.6 ± 2.6, p=0.017) were increased in the patients. Conclusions: In patients with breast cancer after anthracycline therapy: Left intra-atrial, inter-atrial electromechanical intervals were prolonged. Diastolic function was impaired. Impaired left ventricular relaxation and left atrial electrical conduction could be contributing to the development of atrial arrhythmias.


Resumo Fundamento: Atraso eletromecânico atrial (AEA) é utilizado para prever fibrilação atrial, medido pela ecocardiografia. Objetivos: O propósito deste estudo era verificar o AEA e a função mecânica após quimioterapia com antraciclinas. Métodos: Cinquenta e três pacientes com câncer de mama (48 ± 8 anos) que receberam 240 mg/m2 de adriamicina, 2400 mg/m2 de ciclofosfamida, e 960 mg/m2 de paclitaxel foram incluídas neste estudo retrospectivo, além de 42 indivíduos saudáveis (47 ± 9 anos). Medidas ecocardiográficas foram realizadas por aproximadamente 11 ± 7 meses (média de 9 meses) após tratamento com antraciclinas. Resultados: AEA esquerdo intra-atrial (11,4 ± 6,0 vs. 8,1 ± 4,9, p=0,008) e AEA interarterial (19,7 ± 7,4 vs. 14,7 ± 6,5, p=0,001) foram prolongados; Volume de esvaziamento passivo e fracionamento de AE diminuíram (p=0,0001 e p=0,0001); Volume de esvaziamento ativo e fracionamento de AE (p=0,0001 e p=0,0001); Tempo de aceleração mitral A (0,8 ± 0,2 vs. 0,6 ± 0,2, p=0,0001) e de desaceleração de onda-E mitral (201,2 ± 35,6 vs. 163,7 ± 21,8, p=0,0001) aumentarão; Razão mitral E/A (1,0 ± 0,3 vs. 1,3 ± 0,3, p=0,0001) e mitral Em (0,09 ± 0,03 vs. 0,11 ± 0,03, p=0,001) diminuíram; Razão mitral Am (0,11 ± 0,02 vs. 0,09 ± 0,02, p=0,0001) e mitral E/Em (8,8 ± 3,2 vs. 7,6 ± 2,6, p=0,017) aumentaram nos pacientes. Conclusões: Em pacientes com câncer de mama após terapia com antraciclina: intervalos eletromecânicos intra-atriais esquerdos, intra-atriais foram prolongados. A função diastólica foi prejudicada. O relaxamento ventricular esquerdo foi prejudicado, e a condução elétrica atrial esquerda pode estar contribuindo para o desenvolvimento de arritmias atriais.


Subject(s)
Humans , Female , Adult , Middle Aged , Arrhythmias, Cardiac/etiology , Breast Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Ventricular Function, Left/physiology , Anthracyclines/adverse effects , Atrial Fibrillation/etiology , Atrial Fibrillation/physiopathology , Systole , Blood Pressure/physiology , Echocardiography , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Predictive Value of Tests , Retrospective Studies , Paclitaxel/administration & dosage , Paclitaxel/adverse effects , Ventricular Dysfunction, Left/physiopathology , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Diastole
19.
Arq. bras. cardiol ; 107(2): 116-123, Aug. 2016. tab
Article in English | LILACS | ID: lil-794566

ABSTRACT

Abstract Background: Stress echocardiography is well validated for diagnosis and risk stratification of coronary artery disease. Exercise stress echocardiography (ESE) has been shown to be the most physiological among the modalities of stress, but its safety is not well established. Objective: To study the complications related to ESE and clinical and echocardiographic variables most commonly associated with their occurrence. Methods: Cross-sectional study consisting of 10250 patients submitted to ESE for convenience, from January 2000 to June 2014. Cardiac Arrhythmias (CA) were the most frequent complications observed during the examination. The volunteers were divided into two groups according to the occurrence of CA during ESE: G1 group, composed of patients who have CA, and G2 formed by individuals who did not show such complication. Results: Group G1, consisting of 2843 patients (27.7%), and Group G2 consisting of 7407 patients (72.3%). There was no death, acute myocardial infarction, ventricular fibrillation or asystole. Predominant CAs were: supraventricular extrasystoles (13.7%), and ventricular extrasystoles (11.5%). G1 group had a higher mean age, higher frequency of hypertension and smoking, larger aortic roots and left atrium (LA) and lower ejection fraction than G2. G1 group also had more ischemic changes (p < 0.001). The predictor variables were age (RR 1.04; [CI] 95% from 1.038 to 1.049) and LA (RR 1.64; [CI] 95% from 1.448 to 1.872). Conclusion: ESE proved to be a safe modality of stress, with non-fatal complications only. Advanced age and enlargement of the left atrium are predictive of cardiac arrhythmias.


Resumo Fundamento: A ecocardiografia sob estresse constitui metodologia validada para diagnóstico e estratificação de risco da doença arterial coronária. A ecocardiografia sob estresse físico (EEF) tem se destacado como a mais fisiológica dentre as modalidades de estresse, todavia sua segurança não está bem estabelecida. Objetivo: Estudar as complicações relacionadas à EEF e as variáveis clínicas e ecocardiográficas preditoras dessas ocorrências. Método: Estudo transversal composto por 10250 pacientes submetidos à EEF por conveniência, de janeiro de 2000 a junho de 2014. As arritmias cardíacas (AC) foram as complicações mais frequentemente encontradas durante o exame. Os voluntários foramdivididos em dois grupos, de acordo com a ocorrência de AC à EEF: grupo G1 - composto por pacientes que apresentaram AC e grupo G2 - formado por indivíduos que não exibiram tal complicação. Resultados: O grupo G1 com 2843 (27,7%) pacientes, e grupo G2 formado por 7407 (72,3%). Não foram registrados óbitos, infarto agudo do miocárdio, assistolia ou fibrilação ventricular. As extrassístoles supraventriculares (13,7%) e as ventriculares (11,5%) foram as AC predominantes. O grupo G1 apresentou idade média mais elevada, maior frequência de hipertensão arterial sistêmica e tabagismo, maiores dimensões da raiz da aorta e do átrio esquerdo (AE) e menor fração de ejeção do ventrículo esquerdo que o G2. O grupo G1 exibiu também, mais alterações isquêmicas (p < 0,001). As variáveis preditoras foram idade (RR 1,04; [IC] 95% 1,038 - 1,049) e AE (RR 1,64; [IC] 95% 1,448 - 1,872). Conclusão: A presente investigação demonstrou que a EEF é uma modalidade segura, ocorrendo apenas complicações não-fatais. Idade avançada e aumento da dimensão do AE são preditores da presença de arritmias cardíacas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Arrhythmias, Cardiac/etiology , Coronary Artery Disease/diagnosis , Echocardiography, Stress/adverse effects , Exercise Test/adverse effects , Hypertension/etiology , Cross-Sectional Studies , Age Factors , Risk Assessment , Echocardiography, Stress/methods , Exercise Test/methods , Patient Safety
20.
Arq. bras. cardiol ; 107(2): 184-186, Aug. 2016. graf
Article in English | LILACS | ID: lil-794565

ABSTRACT

Abstract We describe the recurrence of cardiac abnormalities in a patient treated during the acute phase of Chagas disease after outpatient follow-up of 5 years.


Resumo Descreve-se a recorrência de alterações cardíacas em paciente tratado na fase aguda de doença de Chagas, após seguimento ambulatorial de 5 anos.


Subject(s)
Humans , Male , Adolescent , Arrhythmias, Cardiac/etiology , Chagas Cardiomyopathy/drug therapy , Chagas Disease/drug therapy , Arrhythmias, Cardiac/drug therapy , Recurrence , Trypanocidal Agents/therapeutic use , Acute Disease , Electrocardiography , Nitroimidazoles/therapeutic use
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