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1.
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1368708

ABSTRACT

Investigar o uso de drogas vasoativas e a sua relação com a intolerância dietoterápica em pacientes críticos. Métodos: Trata-se de um estudo longitudinal retrospectivo realizado em unidades de terapia intensiva (UTIs) de um hospital público de Goiânia, no período de setembro de 2020 a junho de 2021. Realizou-se o levantamento de dados em prontuários eletrônicos do início da terapia nutricional enteral (TNE) correlato ao uso de droga vasoativa (DVA) até o 3° dia de internação. Resultados: A análise incluiu 40 pacientes, observou-se a prevalência do sexo masculino (72,50%) e a média de idade observada foi de 53,67 ± 19,86 anos. Nesse estudo o uso de uma DVA (77,50%) foi mais prevalente do que o uso de duas ou mais DVAs. Verificou-se uma relação significativa entre desfecho clínico e uso de DVA, de modo que, o óbito foi mais frequente naqueles que usavam duas ou mais DVAs (p=0,016). Também foi observada a associação entre a hipoglicemia e o uso de DVA. Essa intercorrência foi frequente naqueles com uso de duas ou mais DVAs (p=0,030). O uso de DVA não se associou a intolerância dietoterápica, porém observamos que a obstipação foi a intercorrência mais prevalente (42,50%). Conclusão: O uso de DVA não se associou a intolerância dietoterápica nessa amostra. Porém observamos uma relação significativa entre o uso de DVA e o óbito. Ainda, verificou-se que a hipoglicemia também se relacionou ao uso de DVA


To investigate the use of vasoactive drugs and its relationship with dietary intolerance in critically ill patients. Methods: This is a retrospective longitudinal study carried out in intensive care units (ICUs) of a public hospital in Goiânia, from September 2020 to June 2021. Data were collected from electronic medical records from the beginning of the enteral nutritional therapy (ENT) correlated with the use of vasoactive drugs (VAD) until the 3rd day of hospitalization. Results: The analysis included 40 patients, there was a prevalence of males (72.50%) and the mean age observed was 53.67 ± 19.86 years. In this study, the use of one VAD (77.50%) was more prevalent than the use of two or more VADs. There was a significant relationship between clinical outcome and use of VAD, so that death was more frequent in those who used two or more VADs (p=0.016). An association between hypoglycemia and the use of VAD was also observed. This complication was more frequent in those using two or more VADs (p=0.030). The use of VAD was not associated with gastrointestinal intolerance (GI), but we observed that constipation was the most prevalent complication (42.50%). Conclusion: The use of VAD was not associated with GA in this sample. However, we observed a significant relationship between the use of VAD and death. Furthermore, it was found that hypoglycemia was also related to the use of VAD


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cardiovascular Agents/therapeutic use , Enteral Nutrition , Nutrition Therapy , Food Intolerance , Longitudinal Studies , Constipation , Hematoma, Subdural, Acute , Brain Injuries, Traumatic , Noncommunicable Diseases , Hypoglycemia , Aneurysm
2.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.436-441, tab, ilus.
Monography in Portuguese | LILACS | ID: biblio-1352663
3.
Chinese Medical Journal ; (24): 2656-2665, 2021.
Article in English | WPRIM | ID: wpr-921224

ABSTRACT

OBJECTIVE@#Cardiovascular diseases are associated with an increased risk of depression, but it remains unclear whether treatment with cardiovascular agents decreases or increases this risk. The effects of drugs on individual usage are also often unknown. This review aimed to examine the correlation between depression and common cardiovascular drugs, develop more potent interventions for depression in cardiovascular patients, and further research on the bio-behavioural mechanisms linking cardiovascular drugs to depression.@*DATA SOURCES@#The data in this review were obtained from articles included in PubMed, EMBASE, and Web of Science.@*STUDY SELECTION@#Clinical trials, observational studies, review literature, and guidelines about depression and cardiovascular drugs were selected for the article.@*RESULTS@#We systematically investigated whether the seven most used cardiovascular drugs were associated with altered risk of incident depression in this literature review. Statins have been proven to have antidepressant effects. Some studies believe angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARB) can exert an antidepressant influence by acting on the renin-angiotensin system, but further clinical trials are needed to confirm this. Beta-blockers have previously been associated with depression, but the current study found no significant association between beta blockers and the risk of depression. Aspirin may have antidepressant effects by suppressing the immune response, but its role as an antidepressant remains controversial. calcium channel blockers (CCBs) can regulate nerve signal transduction by adjusting calcium channels, but whether this effect is beneficial or harmful to depression remains unclear. Finally, some cases have reported that nitrates and diuretics are associated with depression, but the current clinical evidence is insufficient.@*CONCLUSIONS@#Statins have been proven to have antidepressant effect, and the antidepressant effects of ACEIs/ARB and aspirin are still controversial. CCBs are associated with depression, but it is unclear whether it is beneficial or harmful. No association has been found with β-blockers, diuretics, and nitrates.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Calcium Channel Blockers/therapeutic use , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/drug therapy , Depression/drug therapy , Humans , Hypertension/drug therapy , Renin-Angiotensin System
5.
Arq. bras. cardiol ; 113(5): 948-957, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055042

ABSTRACT

Abstract Backgrund: New-onset atrial fibrillation complicating acute myocardial infarction represents an important challenge, with prognostic significance. Objective: To study the incidence, impact on therapy and mortality, and to identify predictors of development of new-onset atrial fibrillation during hospital stay for ST-segment elevation myocardial infarction. Methods: We studied all patients with ST-elevation myocardial infarction included consecutively, between 2010 and 2017, in a Portuguese national registry and compared two groups: 1 - no atrial fibrillation and 2 - new-onset atrial fibrillation. We adjusted a logistic regression model data analysis to assess the impact of new-onset atrial fibrillation on in-hospital mortality and to identify independent predictors of its development. A p value < 0.05 was considered significant. Results: We studied 6325 patients, and new-onset atrial fibrillation was found in 365 (5.8%). Reperfusion was successfully accomplished in both groups with no difference regarding type of reperfusion. In group 2, therapy with beta-blockers and angiotensin-conversion enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) was less frequent, 20.6% received anticoagulation at discharge and 16.1% were on triple therapy. New-onset atrial fibrillation was associated with more in-hospital complications and mortality. However, it was not found as an independent predictor of in-hospital mortality. We identified age, prior stroke, inferior myocardial infarction and complete atrioventricular block as independent predictors of new-onset atrial fibrillation. Conclusion: New-onset atrial fibrillation remains a frequent complication of myocardial infarction and is associated with higher rate of complications and in-hospital mortality. Age, prior stroke, inferior myocardial infarction and complete atrioventricular block were independent predictors of new onset atrial fibrillation. Only 36.7% of the patients received anticoagulation at discharge.


Resumo Fundamento: A fibrilação auricular de novo no contexto de infarto agudo do miocárdio representa um importante desafio com potencial impacto prognóstico. Objetivo: Determinar a incidência, impacto na terapêutica e mortalidade, e identificar possíveis preditores do aparecimento de fibrilação auricular de novo durante o internamento por infarto agudo do miocárdio com supradesnivelamento do segmento ST. Métodos: Estudamos todos os pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST inseridos consecutivamente de 2010 a 2017 num registro nacional português e comparamos dois grupos: 1 - sem fibrilação auricular; 2- com fibrilação auricular de novo. Efetuamos análise com modelo de regressão logística para avaliar o impacto de fibrilação auricular de novo na mortalidade intra-hospitalar e identificar preditores independentes para o seu aparecimento. Para teste de hipóteses, considerou-se significativo p < 0,05. Resultados: Estudamos 6325 pacientes, dos quais 365 (5.8%) apresentaram fibrilação auricular de novo. Não houve diferença no número de pacientes reperfundidos nem na estratégia de reperfusão. No grupo 2, terapêutica com betabloqueadores e IECA/ARA foi menos frequente, 20.6% tiveram alta sob anticoagulação oral e 16.1% sob terapêutica tripla. A fibrilação auricular de novo associou-se a maior incidência de complicações e mortalidade intra-hospitalar, mas não foi preditor independente de mortalidade intra-hospitalar. Identificamos idade, acidente vascular cerebral prévio, infarto inferior e bloqueio auriculoventricular completo como preditores independentes de fibrilação auricular de novo. Conclusões: A fibrilação auricular de novo continua sendo uma complicação frequente do infarto agudo do miocárdio, estando associada a aumento das complicações e mortalidade intra-hospitalar. Apenas 36.7% desses pacientes teve alta sob anticoagulação.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Stents/statistics & numerical data , ST Elevation Myocardial Infarction/complications , Portugal/epidemiology , Recurrence , Atrial Fibrillation/mortality , Atrial Fibrillation/therapy , Cardiovascular Agents/therapeutic use , Myocardial Reperfusion/mortality , Incidence , Predictive Value of Tests , Retrospective Studies , Age Factors , Hospital Mortality , Coronary Angiography , Thrombectomy/mortality , Stroke/complications , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Heart Failure/complications , Hospitalization/statistics & numerical data , Length of Stay
6.
Rev. costarric. cardiol ; 20(2): 14-21, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-990966

ABSTRACT

Resumen Introducción y objetivos: La insuficiencia cardíaca es una patología que afecta a la población adulta mundial; se estima que más de 23 millones de personas en el mundo la padecen, siendo esta una de las principales causas de mortalidad cardiovascular. Dicha investigación buscó evaluar la terapia utilizada en un ambiente hospitalario privado y su correlación con respecto a las guías internacionales; todo esto con el fin de proyectar el posible impacto sobre la morbimortalidad del paciente. Métodos: Se llevó a cabo un estudio observacional retrospectivo analizando múltiples variables obtenidas de los expedientes físicos y electrónicos de todos los pacientes adultos hospitalizados por insuficiencia cardiaca en el Hos pital Clínica Bíblica enero 2014 y diciembre 2016, para comparar la farmacoterapia utilizada con la definida por las guías terapéuticas seleccionadas. Resultados: Se analizaron 72 pacientes, de los cuales 35% estaba entre 81-90 años, 58% eran hombres; 61% estuvieron hospitalizados entre 1-5 días (61%), 9 ingresaron por rehospitalización y el resto fue por primera vez; 69 fueron egresados y 3 fallecieron. La estrategia terapéutica más utilizada en estos pacientes fue un betabloqueador en conjunto con un antagonista del receptor de angiotensina y un diurético de asa. Un 78% mantuvo un tratamiento adecuado según las guías. Conclusiones: El abordaje farmacoterapéutico de los pacientes con falla cardiaca fue satisfac torio, estuvo en la mayoría de los casos de acuerdo con las guías clínicas, por lo que se podría esperar beneficios en torno a la mortalidad, tiempo de hospitalización y tasa de rehospitalización.


Abstract Pharmacotherapy of heart failure: analysis of cases of hospitalized patients in a private health center in Costa Rica Objective: Heart failure is a disease that affects a highly proportion of the adult population worldwide; about 23 million people endure this ailment, being one of the main causes of cardiovascular mortality. Therefore, the aim was to evaluate the correlation between the current therapy in a hospital setting and international guidelines, as well as the impact on morbidity and mortality. Methods: Observational prospective study, to analyze multiple variables from physical and electronic registers from all hospitalized patients for heart failure at Hospital Clínica Bíblica from January 2014 to December 2016, with the intention to compare the prescribed therapy at the hospital with selected therapeutical guidelines. Results: There were 72 patients, from which 35% were between 81 and 90 years old, 58% were men, 61% were hospitalized between 1-5 days, 9 were readmitted and 63 had their first admission, 69 were discharged and 3 perished. Conclusions: The pharmacotherapeutic approach in patients with heart failure has had a satisfactory evolution, and it's according to clinical guidelines, which could have repercussions regarding the reduction of mortality rates, hospitalization stays and rehospitalization rates.


Subject(s)
Humans , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases , Evidence-Based Medicine , Costa Rica , Heart Failure/drug therapy
7.
Medwave ; 18(7): e7331, 2018.
Article in English, Spanish | LILACS | ID: biblio-966433

ABSTRACT

INTRODUCCIÓN: La enfermedad coronaria estable posee varios tratamientos con beneficio probado tanto en mortalidad como en incidencia de eventos agudos. Sin embargo, el control de los síntomas, especialmente en aquellos que no responden a terapia de primera línea, sigue siendo controvertido. Este resumen pretende evaluar el papel de la ranolazina como terapia adicional al tratamiento antianginoso estándar en pacientes que persisten sintomáticos a pesar de éste. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron 16 estudios primarios, todos correspondientes a ensayos aleatorizados, de los cuales cuatro son atingentes para la pregunta específica. Concluimos que en pacientes con enfermedad coronaria estable que persisten sintomáticos a pesar de terapia antianginosa estándar, el tratamiento adicional con ranolazina podría disminuir los episodios de angina semanales pero aumentando la incidencia de efectos adversos, y resulta en poca o nula diferencia en el riesgo de muerte o infarto agudo al miocardio.


INTRODUCTION: There are several effective therapeutic alternatives for stable coronary artery, in terms of prevention of cardiovascular morbidity and mortality. However, the best way to achieve symptomatic control is a matter of debate, particularly in those who do not respond to first-line therapy. This summary aims to evaluate the role of ranolazine as an additional therapy to standard antianginal treatment in patients with persistent symptoms. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews including 16 studies overall, all of which were randomized trials. We concluded additional treatment with ranolazine might decrease the frequency of anginal episodes but increase adverse effects. It probably has no effect on the risk of death or acute myocardial infarction.


Subject(s)
Humans , Coronary Artery Disease/drug therapy , Cardiovascular Agents/therapeutic use , Ranolazine/therapeutic use , Coronary Artery Disease/physiopathology , Randomized Controlled Trials as Topic , Databases, Factual
9.
Yonsei Medical Journal ; : 90-98, 2017.
Article in English | WPRIM | ID: wpr-65058

ABSTRACT

PURPOSE: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS. MATERIALS AND METHODS: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 µg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. RESULTS: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. CONCLUSION: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.


Subject(s)
Acetylcholine , Aged , Angina Pectoris/diagnosis , Calcium Channel Blockers/therapeutic use , Cardiovascular Agents/therapeutic use , Coronary Angiography/adverse effects , Coronary Artery Disease/prevention & control , Coronary Vasospasm/diagnosis , Diltiazem/therapeutic use , Drug Therapy, Combination , Female , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/prevention & control , Nitrates/therapeutic use , Propensity Score , Time Factors , Vasodilator Agents/therapeutic use
10.
Arq. bras. cardiol ; 107(5): 455-459, Nov. 2016. tab, graf
Article in English | LILACS | ID: biblio-827874

ABSTRACT

Abstract Background: In the Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial (SHIFT), heart rate (HR) reduction with ivabradine was associated with improved survival and reduced hospitalizations in patients with heart failure (HF). The mechanisms by which elevated HR increases mortality are not fully understood. Objective: To assess the relationship of baseline HR with clinical, neurohormonal and cardiac sympathetic activity in patients with chronic HF and elevated HR. Method: Patients with chronic HF who were in sinus rhythm and had resting HR>70 bpm despite optimal medical treatment were included in a randomized, double-blind study comparing ivabradine versus pyridostigmine. This report refers to the baseline data of 16 initial patients. Baseline HR (before randomization to one of the drugs) was assessed, and patients were classified into two groups, with HR below or above mean values. Cardiac sympathetic activity was assessed by 123-iodine-metaiodobenzylguanidine myocardial scintigraphy. Results: Mean HR was 83.5±11.5 bpm (range 72 to 104), and seven (43.7%) patients had HR above the mean. These patients had lower 6-min walk distance (292.3±93 vs 465.2±97.1 m, p=0.0029), higher values of N-Terminal-proBNP (median 708.4 vs 76.1, p=0.035) and lower late heart/mediastinum rate, indicating cardiac denervation (1.48±0.12 vs 1.74±0.09, p<0.001). Conclusion: Elevated resting HR in patients with HF under optimal medical treatment was associated with cardiac denervation, worse functional capacity, and neurohormonal activation.


Resumo Fundamento: No SHIFT (Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial, ou Estudo do Tratamento da Insuficiência Cardíaca Sistólica com o Inibidor de If Ivabradina), a redução da frequência cardíaca (FC) com ivabradina associou-se com melhor sobrevida e redução das hospitalizações em pacientes com insuficiência cardíaca (IC). Os mecanismos pelos quais a FC elevada aumenta a mortalidade não são totalmente compreendidos. Objetivo: Avaliar a relação da FC basal com atividade clínica, neuro-hormonal e simpática cardíaca em pacientes com IC crônica e FC elevada. Método: Pacientes com IC crônica em ritmo sinusal e FC≥70 apesar de tratamento adequado foram incluídos em um estudo duplo-cego, randomizado, que comparou ivabradina com piridostigmina. Este artigo refere-se a dados basais dos primeiros 16 pacientes. A FC basal (antes da randomização para um dos medicamentos) foi avaliada, e os pacientes classificados em dois grupos, com FC abaixo ou acima dos valores médios. A atividade simpática cardíaca foi avaliada por cintilografia com metaiodobenzilguanidina marcada com iodo 123. Resultados: A FC média foi 83,5±11,5 bpm (intervalo 72 a 104), e sete pacientes (43.7%) tinham FC acima da média. Esses pacientes apresentaram menor distância percorrida no teste de caminhada de 6 minutos (292,3±93 vs 465,2±97,1 m, p=0,0029), valores mais altos de N-terminal do pró-BNP (mediana 708,4 vs 76,1, p=0,035) e menor relação coração/mediastino tardia, indicando desnervação cardíaca (1,48±0,12 vs 1,74±0,09, p<0,001). Conclusão: A FC de repouso elevada em pacientes com IC em tratamento médico adequado associou-se com desnervação cardíaca, pior capacidade funcional e ativação neuro-hormonal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Sympathetic Nervous System/diagnostic imaging , 3-Iodobenzylguanidine , Heart/innervation , Heart Failure/diagnostic imaging , Heart Rate/physiology , Sympathetic Nervous System/physiology , Cardiovascular Agents/therapeutic use , Radionuclide Imaging , Chronic Disease , Denervation , Exercise Test , Heart/diagnostic imaging , Heart Failure/drug therapy
11.
Rev. Méd. Clín. Condes ; 26(2): 198-209, mar. 2015.
Article in English | LILACS | ID: biblio-1128818

ABSTRACT

Las enfermedades cardiovasculares constituyen un importante problema de salud pública al ser la principal causa de morbilidad y mortalidad en el mundo. Por ello, existe la creciente necesidad de tratamientos farmacoterapéuticos más eficaces y seguros. Sin embargo, a pesar de que los médicos prescriben fármacos sobre la base de las características farmacológicas del medicamento y la probabilidad de obtener resultados clínicamente reproducibles, muchos de los fármacos son eficaces sólo entre 25-60% de los pacientes. En este sentido es que la Farmacogenómica, a través del estudio de variantes genéticas de proteínas involucradas en la farmacocinética y farmacodinamia de los medicamentos, persigue maximizar su eficacia y seguridad, Este trabajo pretende dar una visión general acerca de farmacogenómica cardiovascular y la posibilidad de utilizar, en la consulta clínica, herramientas genéticas para apoyar la decisión farmacoterapéutica, con el objeto de mejorar la respuesta al tratamiento de enfermedades cardiovasculares, un paso hacia la medicina personalizada en Chile.


Cardiovascular disease is a major public health problem being the leading cause of morbidity and mortality worldwide. Therefore, there is a growing need for safer and more effective pharmacotherapeutic treatments. However, although physicians prescribe drugs based on pharmacological properties of each drug and the probability of obtaining clinically reproducible results, many drugs are effective only in 25-60% of patients. In this respect, pharmacogenomics, through the study of genetic variants of proteins involved in the pharmacokinetics and pharmacodynamics of drugs, pursues to maximize their efficacy and safety, This paper aims to give an overview of cardiovascular pharmacogenomics and the possibility to use, in clinical practice, genetic tools to support pharmacotherapeutical decisions, in order to improve the response to treatment of cardiovascular diseases, a step toward personalized medicine in Chile.


Subject(s)
Humans , Pharmacogenetics , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/drug therapy , Cardiovascular Agents/pharmacokinetics , Cardiovascular Diseases/epidemiology , Risk Factors , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacokinetics , Anticoagulants/therapeutic use , Anticoagulants/pharmacokinetics
12.
Article in English | WPRIM | ID: wpr-214121

ABSTRACT

In women receiving evaluation for suspected ischemic symptoms, a "normal" diagnosis is five times more common than it is in men. These women are often labeled as having cardiac syndrome X, also known as microvascular angina (MVA). MVA is defined as angina pectoris caused by abnormalities of the small coronary arteries, and is characterized by effort chest pain and evidence of myocardial ischemia with a non-invasive stress test, although the coronary arteries can appear normal or near normal by angiography. MVA patients are often neglected due to the assumption of a good prognosis. However, MVA has important prognostic implications and a proper diagnosis is necessary in order to relieve the patients' symptoms and improve clinical outcomes. The coronary microvasculature cannot be directly imaged using coronary angiography, due to the small diameter of the vessels; therefore, the coronary microvascular must be assessed functionally. Treatment of MVA initially includes standard anti-ischemic drugs (beta-blockers, calcium antagonists, and nitrates), although control of symptoms is often insufficient. In this review, we discuss the pathophysiology, diagnosis, and treatment of MVA.


Subject(s)
Cardiovascular Agents/therapeutic use , Coronary Circulation , Coronary Vessels/physiopathology , Female , Heart Function Tests , Humans , Male , Microcirculation , Microvascular Angina/diagnosis , Predictive Value of Tests , Risk Factors , Sex Distribution , Sex Factors , Treatment Outcome
13.
Article in English | WPRIM | ID: wpr-30794

ABSTRACT

BACKGROUND/AIMS: Hyponatremia is a well-known risk factor for poor outcomes in Western studies of heart failure (HF) patients. We evaluated the predictive value of hyponatremia in hospitalized Asian HF patients. METHODS: The Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (the COAST) study enrolled hospitalized patients with systolic HF (ejection fraction < 45%) at eight centers in South Korea, Taiwan, and China. The relationship between admission sodium level and clinical outcomes was analyzed in 1,470 patients. RESULTS: The mean admission sodium level was 138 +/- 4.7 mmol/L, and 247 patients (16.8%) had hyponatremia defined as Na+ < 135 mmol/L. The 12-month mortality was higher in hyponatremic patients (27.9% vs. 14.6%, p < 0.001), and hyponatremia was an independent predictor of 12-month mortality (hazard ratio, 1.72; 95% confidence interval, 1.12 to 2.65). During hospital admission, 57% of hyponatremic patients showed improvement without improvement in their clinical outcomes (p = 0.620). The proportion of patients with optimal medical treatment was only 26.5% and 44.2% at admission and discharge, respectively, defined as the combined use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker and beta-blocker. Underuse of optimal medical treatment was more pronounced in hyponatremic patients. CONCLUSIONS: In hospitalized Asian HF patients, hyponatremia at admission is common and is an independent predictor of poor clinical outcome. Furthermore, hyponatremic patients receive less optimal medical treatment than their counterparts.


Subject(s)
Aged , Aged, 80 and over , Asia/epidemiology , Asian Continental Ancestry Group , Biomarkers/blood , Cardiovascular Agents/therapeutic use , Disease-Free Survival , Female , Guideline Adherence , Healthcare Disparities , Heart Failure/diagnosis , Hospitalization , Humans , Hyponatremia/blood , Male , Middle Aged , Practice Guidelines as Topic , Predictive Value of Tests , Proportional Hazards Models , Risk Factors , Sodium/blood , Stroke Volume , Time Factors , Treatment Outcome
15.
Rev. bras. cir. cardiovasc ; 28(2): 238-247, abr.-jun. 2013. tab
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: lil-682435

ABSTRACT

OBJETIVO: Demonstrar a eficácia de um programa de otimização da prática clínica em pacientes com doença arterial coronária para prescrição de medicamentos e documentar a prática clínica vigente quanto aos medicamentos e medidas para a mudança do estilo de vida. MÉTODOS: Estudo de corte transversal, seguido de componente longitudinal. Foram incluídos 710 pacientes consecutivos (Fase 1). Após aplicação de ferramentas para melhoria da prática clínica, foram incluídos, após seis meses, 705 pacientes com coleta dos mesmos dados (Fase 2). Foram selecionados aleatoriamente, a partir do primeiro grupo, 318 prontuários para comparação desses mesmos pacientes (Fase 3). RESULTADOS: Comparação entre as Fases 1 e 2: melhora em relação a tabagismo (P=0,019), dislipidemia (P<0,001), hipertensão arterial e atividade física regular (P<0,001). Diferença significativa para inibidores da enzima de conversão da angiotensina - IECA (67,2% vs. 56,8%, P<0,001); antagonistas do receptor da angiotensina II - ARA II (25,4% vs. 32,9%, P=0,002) e betabloqueador (88,7% vs. 91,9%, P=0,047). Comparação entre as Fases 1 e 3: houve redução do peso (P=0,044) e pressão arterial (P<0,001). Em relação à prescrição de medicamentos recomendados, diferença para IECA (64,8% vs. 61,6%, P=0,011) e ARA II (27,0% vs. 31,3%, P=0,035). CONCLUSÃO: Não houve mudança significativa na utilização de medicamentos; entretanto, observou-se melhora significativa em relação ao tabagismo e atividade física na Fase 2; melhora substancial nos níveis de pressão arterial, na comparação tanto entre as Fases 1 e 2 como entre as Fases 1 e 3. A inclusão de enfermeiro treinado para gerenciar o processo foi fundamental. Programas abrangentes de melhoria de qualidade assistencial, provavelmente, devem ser continuados por período de seguimento maior.


OBJECTIVE: To demonstrate the utilization of a clinical improvement program in stable coronary artery disease patients to increase the evidence-proven treatment utilization, and to describe the ongoing clinical practice and lifestyle change counseling. METHODS: Cross-sectional study followed by a longitudinal component in which the tools utilization to improve clinical practice was assessed by means of additional cross-sectional data collection. 710 consecutive patients were included (Phase 1). After tools implementation, within 6 months period, 705 patients were included (Phase 2) for comparative analysis. Randomly, 318 patients from Phase 1 were selected, 6-12 months after the first evaluation (Phase 3). RESULTS: Phase 1 to Phase 2: there were improvement on smoking cessation (P=0.019), dyslipidemia (P<0.001), hypertension and physical activity (P<0.001). There was significant difference on angiotensin converting enzyme inhibitors - ACEI (67.2% vs. 56.8%, P<0.001); angiotensin II receptor blockers - ARB II (25.4% vs. 32.9%, P=0.002) and beta-blocker (88.7% vs. 91.9%, P=0.047). Phase 1 to Phase 3: there was both weight (P=0.044), and blood pressure reduction (P<0.001). There was statistical significant difference on ACEI (64.8% vs. 61.6%, P=0.011) and ARB II (27.0% vs. 31.3%, P=0.035). CONCLUSION: There was no significant change on the evidence-based pharmacological treatment utilization between pre and post-intervention phases; there was significant improvement concerning smoking and physical activity in phase 2; substantial improvement on blood pressure levels in both comparisons (Phase 1 to 2 and Phase 1 to 3). The inclusion of a case-manager for the process management was crucial for program efficacy. Comprehensive programs for clinical practice should be pursued for longer follow-up period.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Coronary Disease/prevention & control , Guideline Adherence , Life Style , Secondary Prevention/methods , Cardiovascular Agents/therapeutic use , Coronary Disease/etiology , Cross-Sectional Studies , Dyslipidemias/therapy , Hypertension/drug therapy , Reproducibility of Results , Risk Factors , Smoking Cessation , Time Factors , Treatment Outcome
16.
Arq. bras. cardiol ; 100(3): 212-220, mar. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-670878

ABSTRACT

FUNDAMENTO: Dados de atendimento ambulatorial ao paciente de alto risco cardiovascular no Brasil são insuficientes. OBJETIVO: Descrever o perfil e documentar a prática clínica do atendimento ambulatorial de pacientes de alto risco cardiovascular no Brasil, no que diz respeito à prescrição de terapias baseadas em evidências. MÉTODOS: Registro prospectivo que documentou a prática clínica ambulatorial de indivíduos de alto risco cardiovascular, que foi definido como a presença de um dos seguintes fatores: doença arterial coronariana, cerebrovascular e vascular periférica; diabetes; ou aqueles com pelo menos três dos seguintes fatores: hipertensão arterial, tabagismo, dislipidemia, maiores 70 anos, histórico familiar de doença arterial coronariana, nefropatia crônica ou doença carotídea assintomática. Foram avaliadas características basais e a taxa de prescrição das intervenções medicamentosas e não medicamentosas. RESULTADOS: Foram incluídos 2.364 pacientes consecutivos, sendo 52,2% do gênero masculino, idade média de 66,0 anos (± 10,1). Dentre os pacientes incluídos, 78,3% utilizavam antiplaquetários, 77,0% estatinas e, dos pacientes com história de infarto do miocárdio, 58,0% receberam betabloqueadores. O uso concomitante destas três classes foi de 34%. Não atingiram as metas preconizadas pelas diretrizes 50,9% dos hipertensos, 67% dos diabéticos e 25,7% dos dislipidêmicos. Os principais preditores de prescrição de terapias com benefício comprovado foram centro com cardiologista e histórico de doença arterial coronariana. CONCLUSÃO: Este registro nacional e representativo identificou hiatos importantes na incorporação de terapias com benefício comprovado, oferecendo um panorama real dos pacientes de alto risco cardiovascular.


BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.


Subject(s)
Aged , Female , Humans , Male , Ambulatory Care/standards , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/therapy , Evidence-Based Medicine/standards , Life Style , Practice Guidelines as Topic/standards , Brazil , Cardiovascular Agents/classification , Epidemiologic Methods , Evidence-Based Medicine/methods , Risk Factors
17.
Acta cir. bras ; 28(supl.1): 83-87, 2013. ilus
Article in English | LILACS | ID: lil-663898

ABSTRACT

PURPOSE: The rationale of the present review is to analize the activity of Rosmarinus officinalis in the the cardiovascular system METHODS: A MEDLINE database search (from January 1970 to December 2011) using only rosmarinic acid as searched term. RESULTS: The references search revealed 509 references about rosmarinic acid in 40 years (the first reference is from 1970). There is a powerful prevalence of antioxidant and cancer studies. Other diseases are few cited, as inflammation, brain (Alzheimer and Parkinson disease) and, memory; allergy; diabetes; atherosclerosis, and; hypertension. It is necessary to consider the complete absence of studies on coronary artery disease, myocardial ischemia, heart failure or ischemia/reperfusion injury. CONCLUSION: Rosmarinic acid is underestimated as an experimental cardiovascular drug and deserves more attention.


OBJETIVO: A justificativa da revisão é analisar a atividade de Rosmarinus officinalis no sistema cardiovascular MÉTODOS: Uma busca de banco de dados MEDLINE (de janeiro de 1970 a dezembro de 2011), utilizando apenas o ácido rosmarínico como termo pesquisado. RESULTADOS: A busca referências revelou 509 referências sobre o ácido rosmarínico em 40 anos (a primeira referência é de 1970). Há uma prevalência poderoso antioxidante e estudos do câncer. Outras doenças são citados alguns, como o cérebro, inflamação (de Alzheimer e doença de Parkinson) e, a memória, hipertensão, alergia, diabetes, aterosclerose, e. É necessário ter em conta a ausência completa de estudos sobre a doença de artéria coronária, isquemia do miocárdio, insuficiência cardíaca ou isquemia / lesão de reperfusão. CONCLUSÃO: O ácido rosmarínico é subestimado como uma droga experimental cardiovascular e merece mais atenção.


Subject(s)
Humans , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/drug therapy , Cinnamates/therapeutic use , Depsides/therapeutic use , Cardiovascular Agents/pharmacology , Cinnamates/pharmacology , Depsides/pharmacology
18.
Rev. méd. Chile ; 140(2): 145-152, feb. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-627620

ABSTRACT

Background: Patients with postural orthostatic tachycardia syndrome (POTS) report dizziness, lightheadedness, weakness, blurred vision, and fatigue upon standing. The diagnosis of the syndrome is made when an orthostatic intolerance and tachycardia appear in the standing position. Aim: To report 15 patients with POTS. Material and Methods: Review of Tilt test reports in a period of 15 years. Those reports in which orthostatic postural tachycardia and symptoms compatible with POTS appeared, were selected for analysis. Results: We identified 15 patients (3.1% of all positive Tilt test reports) with compatible signs and symptoms. There was a lag of 8 -10 years between the onset of symptoms and the time of diagnosis. Most patients complained of orthostatic intolerance, dizziness and frequent fainting. Orthostatic tachycardia and symptoms occurred on average after 2.9 and 6.1 minutes, respectively,of staying in the standing position. These patients had a high frequency of family history of syncope orpresyncope (66% frequency) and hyper mobility syndrome (53% prevalence). Only 33% of the patients reported relief of their symptoms after being treated (most of them with fludrocortisone). Most patients that reported little or no relief, did not use medications or were treated for a short period. Conclusions: POTS syndrome is uncommon but disturbs quality of life of those who suffer it. Its association with hyper mobility syndromes must be investigated.


Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Postural Orthostatic Tachycardia Syndrome/diagnosis , Tilt-Table Test , Case-Control Studies , Cardiovascular Agents/therapeutic use , Fludrocortisone/therapeutic use , Genetic Predisposition to Disease , Postural Orthostatic Tachycardia Syndrome/drug therapy , Postural Orthostatic Tachycardia Syndrome/genetics , Retrospective Studies , Syncope, Vasovagal/genetics , Treatment Outcome
20.
Article in English | WPRIM | ID: wpr-60504

ABSTRACT

This was designed to assess the outcomes of side branch (SB) stenosis after implantation of three drug-eluting stents (DES). From 2,645 patients in the ZEST (Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary Lesions) Trial, 788 patients had 923 bifurcation lesions with SB > or = 1.5 mm were included. SB was treated in 150 lesions, including 35 (3.8%) receiving SB stenting. Of untreated SB with baseline stenosis < 50%, the incidences of periprocedural SB compromise was similar in the zotarolimus (15.8%), sirolimus (17.2%), and paclitaxel (16.6%) stent groups (P = 0.92). At follow-up angiography, delayed SB compromise occurred in 13.9%, 3.2%, and 9.4% (P = 0.010) of these groups. When classified into four groups (< 50%, 50%-70%, 70%-99%, and 100%), 9.0% of untreated SB were worsened, whereas improvement and stationary were observed in 9.6% and 81.4%. In a multivariable logistic regression model, main branch (MB) stenosis at follow-up (%) was the only independent predictor of SB stenosis worsening (odds ratio, 1.03; 95% confidence interval, 1.01-1.04; P < 0.001). After MB stenting in bifurcation lesions, a minority of SB appears to worsen. DES with strong anti-restenotic efficacy may help maintain SB patency.


Subject(s)
Acute Disease , Aged , Blood Vessels/physiopathology , Cardiovascular Agents/therapeutic use , Coronary Angiography , Coronary Stenosis/drug therapy , Drug-Eluting Stents/adverse effects , Female , Follow-Up Studies , Humans , Logistic Models , Male , Middle Aged , Myocardial Infarction/etiology , Myocardial Revascularization , Odds Ratio , Paclitaxel/therapeutic use , Predictive Value of Tests , Sirolimus/analogs & derivatives , Thrombosis/etiology , Treatment Outcome
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