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1.
Prensa méd. argent ; 108(2): 108-112, 20220000. tab
Article in English | LILACS | ID: biblio-1368488

ABSTRACT

Los pacientes con infección perioperatoria por COVID-19 tienen un alto riesgo de muerte y complicaciones posoperatorias. En la actualidad, la infección por COVID-19 en Irak representó 1.696.390 casos con 19.087 muertes. Un estudio nacional, único y observacional que incluyó pacientes con infección por COVID-19 que se sometieron a cualquier tipo de cirugía en el Hospital General de Abu-Graib, Bagdad, Irak, durante el período del 19 de marzo de 2020 al 30 de abril de 2021. Tiempo desde el diagnóstico de la infección por COVID-19 El día de la cirugía se recogió como factor categórico dividido en: (a) 0-3 semanas; (b) 4­6 semanas; (c) >6 semanas. Edad; sexo; estado físico de la Sociedad Americana de Anestesiólogos (ASA); comorbilidades cardíacas; comorbilidades respiratorias; indicación de cirugía; grado de cirugía; y se documentaron los tipos quirúrgicos. Se incluyeron un total de 378 pacientes con una edad media de 47,89±16,03 años. Las mujeres eran más que los hombres (65,87% > 34,13%). Aproximadamente, el 76,72% de los pacientes pertenecían a ASA I-II, mientras que el 23,28% eran ASA III-IV. Alrededor del 19,05% de los pacientes sufría de comorbilidades cardíacas. 266/378 de los pacientes se quejaron de comorbilidades respiratorias. Cirugía indicada en 35,45% condiciones benignas, 27,5% obstetricia, 7,65% cirugía oncológica y 29,4% operaciones traumáticas. Operaciones mayores documentadas en 205/378 pacientes. Las intervenciones quirúrgicas de urgencia realizadas en (176, 46,56%), mientras que los casos electivos fueron 202/378 (53,44%). En total, en el momento de la operación, 80 (21,16 %) pacientes tenían un diagnóstico preoperatorio de COVID-19. El tiempo desde el diagnóstico de COVID-19 hasta la cirugía fue de 0 a 3 semanas en 98 pacientes (25,93 %), de 4 a 6 semanas en 115 pacientes (30,42 %) y >6 semanas en 165 pacientes (43,65 %). La tasa de mortalidad postoperatoria global fue del 9,52% (36/378). Con respecto a la complicación cardiaca de la O.P., no hubo asociación significativa en relación al momento previo a la cirugía (p=0,08). Sin embargo, la complicación cardíaca global fue del 16,4%. En general, el 44,97 % (170/378) de los pacientes desarrollaron una complicación pulmonar por O.P. durante el período de seguimiento. Hasta donde sabemos, este es el primer estudio que proporciona datos sólidos sobre el momento óptimo para la cirugía después de la infección por COVID-19 en Irak. El momento óptimo de la cirugía después de la infección por COVID-19 fue de más de 6 semanas. Descubrimos que los riesgos de morbilidad y mortalidad por O.P. son mayores si los pacientes son operados dentro de las 6 semanas posteriores al diagnóstico de infección por COVID-19.


Patients with perioperative COVID-19 infection are at high risk of death and complications postoperatively. Nowadays, COVID-19 infection in Iraq accounted 1,696,390 cases with 19,087 deaths. A national, single, and observational study that included patients with COVID-19 infection undergoing any type of surgery in Abu-Graib General Hospital, Baghdad Iraq during period from 19 March 2020 to 30 April 2021. Time from the diagnosis of COVID-19 infection to day of surgery was collected as a categorical factor divided into: (a) 0­3 wks; (b) 4­6 wks; (c) >6 wks. Age; sex; American Society of Anesthesiologists (ASA) physical status; cardiac comorbidities; respiratory comorbidities; indication for surgery; surgery grade; and surgical types were documented. A total of 378 patient were included with mean age was 47.89±16.03 years. Females were more than males (65.87% > 34.13%). Approximately, 76.72% of patients belonged within ASA I-II, whereas 23.28% were ASA III-IV. About 19.05% of patients suffered from cardiac comorbidities. 266/378 of patients complained from respiratory comorbidities. Surgery indicated in 35.45% benign conditions, 27.5% obstetrics, 7.65% oncological surgery, and 29.4% traumatic operations. Major operations documented in 205/378 patients. Emergencies surgical intervention done in (176, 46.56%), whereas elective cases were 202/378 (53.44%). In total at operation timing, 80(21.16%) patients had a preoperative COVID-19 diagnosis. The time from COVID-19 diagnosis to surgery was 0­3 weeks in 98 patients (25.93%), 4­6 weeks in 115 patients (30.42%), and >6 weeks in 165 patients (43.65%). The overall postoperative mortality rate was 9.52% (36/378). In regard to P. O. cardiac complication, there was no significant association in relation to timing before surgery (p=0.08). However, the overall cardiac complication was 16.4%. Overall, 44.97% (170/378) of patients developed a P. O. pulmonary complication within period of follow-up. To our knowledge this is the first study to provide strong data regarding the optimal timing for surgery following COVID-19 infection in Iraq. The optimal timing of surgery after COVID-19 infection was more than 6 wks. We found that risks of P. O. morbidity and mortality are greatest if patients are operated within 6 wks of diagnosis of COVID-19 infection


Subject(s)
Humans , Adult , Middle Aged , Aged , Respiratory Tract Diseases/complications , Comorbidity , Aftercare , Emergencies , COVID-19/surgery , COVID-19/complications , Heart Diseases/complications , Time Factors
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.76-79, tab.
Monography in Portuguese | LILACS | ID: biblio-1349378
3.
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.298-302, ilus, tab.
Monography in Portuguese | LILACS | ID: biblio-1352326
4.
Rev. habanera cienc. méd ; 20(4): e4112, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289624

ABSTRACT

Introducción: Los pacientes fallecidos por COVID-19 al inicio de la pandemia evidencian características clínico-epidemiológicas particulares y su identificación, lo mismo que los aspectos asociados a su diagnóstico son fundamentales para la implementación de estrategias en salud pública que permitan la protección sanitaria de los grupos más vulnerables. Objetivo: Determinar las características clínico epidemiológicas de los pacientes fallecidos por COVID-19 y su asociación con el diagnóstico tardío en las primeras etapas de la pandemia en el departamento de Bolívar-Colombia. Materiales y Métodos: Estudio descriptivo de corte transversal con una muestra de 51 pacientes fallecidos por COVID-19; se calculó la frecuencia relativa de los factores de riesgo clínico epidemiológicos de estos pacientes y se realizó un análisis bivariado para evidenciar la asociación con la posibilidad de ser diagnosticado después de la muerte, usando la razón de disparidad (OR) con su intervalo de confianza Resultados: El 47,2 por ciento de los diagnósticos se hicieron después de la muerte; el promedio entre el inicio de los síntomas y la muerte fue aproximadamente 13 días, en los que se evidencia como comorbilidades importantes las enfermedades cardíacas (58,5 por ciento) y la hipertensión (35,8 por ciento). La asociación con el diagnóstico después de la muerte se relaciona con los casos notificados en abril y mayo (p=0,03), ser mayor de 80 años (p=0,03) y tener malnutrición (p=0,04). Conclusión: En el contexto del departamento de Bolívar se observan fallas en el diagnóstico oportuno de algunos grupos poblacionales vulnerables y a los pacientes con enfermedades cardíacas se debe prestar atención para evitar la alta mortalidad(AU)


Introduction: Patients who died from COVID-19 at the beginning of the pandemic show particular clinical-epidemiological characteristics and their identification as well as the aspects associated with the diagnosis are fundamental for the implementation of public health strategies that allow the sanitary protection of the most vulnerable groups. Objective: To determine the clinical-epidemiological characteristics of patients who died from COVID-19 and its association with late diagnosis in the early stages of the pandemic in the department of Bolívar-Colombia. Material and Methods: Descriptive cross-sectional study with a sample of 51 patients who died from COVID-19; the relative frequency of the clinical-epidemiological risk factors of these patients was calculated and a bivariate analysis was performed to show the association with the possibility of being diagnosed after death, using the disparity ratio (OR) with its confidence interval. Results: The 47,2 percent of the diagnoses were made after death; the average between the onset of symptoms and death was approximately 13 days, in which heart disease (58,5 percent) and hypertension (35,8 percent) were evidenced as important comorbidities. The association with diagnosis after death is related to the cases reported in April and May (p = 0.03), being older than 80 years (p = 0.03) and having malnutrition (p = 0.04). Conclusion: In the context of the department of Bolívar, failures are observed in the timely diagnosis of some vulnerable population groups, thus special attention should be paid to patients with heart disease to avoid high mortality(AU)


Subject(s)
Humans , Risk Groups , Vulnerable Populations/ethnology , Delayed Diagnosis/prevention & control , COVID-19/epidemiology , Heart Diseases/complications , Epidemiologic Factors , Epidemiology, Descriptive , Cross-Sectional Studies , Colombia , COVID-19/mortality
9.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 460-465, jan.-dez. 2020. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1053063

ABSTRACT

Objetivo: Determinar a prevalência da nefropatia induzida por contraste em pacientes cardiopatas submetidos a procedimentos angiográficos de diagnóstico e/ou tratamento. Método: Estudo prospectivo, quantitativo, realizado no setor de hemodinâmica de um hospital de grande porte, situado na região norte do Rio Grande do Sul, Brasil. A amostra foi constituída por 79 participantes através do cálculo de tamanho amostral. Resultados: A amostra foi formada por 52 (65,8%) homens e 27 (34,2%) mulheres. A idade média foi de 65,9 ± 9,52 anos. A incidência de nefropatia induzida por contraste foi de 30,38%, totalizando 24 pacientes. Conclusão: Foi evidenciada uma alta prevalência de nefropatia por contraste, apesar dos pacientes apresentarem poucos fatores de risco, o que ressalta a necessidade de medidas preventivas e redução do volume de contraste


Objective: To determine the prevalence of contrast-induced nephropathy in cardiac patients undergoing diagnostic and / or treatment angiographic procedures. Method: A prospective, quantitative study in the hemodynamics sector of a large hospital, located in the northern region of Rio Grande do Sul, Brazil. The sample consisted of 79 participants through the calculation of sample size. Results: The sample consisted of 52 (65.8%) men and 27 (34.2%) women. The mean age was 65.9 ± 9.52 years. The incidence of contrast-induced nephropathy was 30,38%, totaling 24 patients. Conclusion: A high prevalence of contrast nephropathy was evidenced, despite the fact that patients presented few risk factors, which highlights the need for preventive measures and reduction of contrast volume


Objetivo: Determinar la prevalencia de la nefropatía inducida por contraste en pacientes cardiopatas sometidos a procedimientos angiográficos de diagnóstico y / o tratamiento. Método: Estudio prospectivo, cuantitativo, realizado en el sector de hemodinámica de un hospital de gran porte, situado en la región norte de Rio Grande do Sul, Brasil. La muestra fue constituida por 79 participantes a través del cálculo de tamaño muestral. Resultados: La muestra fue formada por 52 (65,8%) hombres y 27 (34,2%) mujeres. La edad media fue de 65,9 ± 9,52 años. La incidencia de nefropatía inducida por contraste fue del 30,38%, totalizando 24 pacientes. Conclusión: Se evidenció una alta prevalencia de nefropatía por contraste, a pesar de que los pacientes presentaban pocos factores de riesgo, lo que resalta la necesidad de medidas preventivas y reducción del volumen de contraste


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Angiography/adverse effects , Heart Diseases/complications , Heart Diseases/diagnostic imaging , Kidney Diseases/chemically induced , Kidney Diseases/epidemiology , Prospective Studies , Contrast Media/adverse effects , Coronary Disease/complications , Acute Kidney Injury/chemically induced , Hemodynamics
10.
Rev. méd. Minas Gerais ; 30: e-3003, 2020.
Article in Portuguese | LILACS | ID: biblio-1116887

ABSTRACT

Introdução: Pacientes portadores de vasculopatia periférica internam recorrentemente para procedimentos cirúrgicos ou tratamento clínico devido a complicações da doença de base. O real impacto da desnutrição nesses pacientes durante a internação ainda é pouco compreendido. Objetivo: Investigar os fatores de risco associados à mortalidade em pacientes internados com doença vascular periférica devido a complicação da doença vascular. Métodos: Estudo observacional retrospectivo avaliou cento e dezessete pacientes acima de 18 anos admitidos no serviço de cirurgia vascular de hospital terciário no período de junho de 2013 a agosto de 2014 por complicação da doença vascular. Avaliados parâmetros clínicos, comorbidades, dados demográficos, complicações durante a internação e estado nutricional. Dados coletados por meio de entrevista, aplicação do questionário Avaliação Global Subjetiva (AGS), exame físico e laboratoriais e dados de prontuário. Resultados: Cento e dezessete pacientes com doença vascular periférica avaliados em relação a complicações vasculares durante internação. Mortalidade geral de 7,7% e pacientes desnutridos ou com suspeita de desnutrição eram 39% da amostra Através da análise multivariada, tanto a classificação AGS (OR 6,15 CI 1,092-34,74 P = 0,039) quanto a presença de doença cardíaca (OR 8,51 CI 1,56-47,44 P = 0,015) foram fatores preditores independentes para mortalidade. Pacientes com doença vascular classificados em suspeita de estarem desnutridos ou desnutridos apresentaram chance de ir a óbito durante a internação aumentada em 6,15 vezes, enquanto a cardiopatia elevou essa chance 8,51 vezes. Conclusão: Pacientes internados por complicação de doença vascular periférica apresentam como fatores de risco para mortalidade a desnutrição e a presença de doença cardíaca.(AU)


Patients with peripheral vasculopathy are routinely hospitalized for surgical procedures or clinical treatment due to complications of the underlying disease. The real impact of malnutrition in these patients during hospitalization is still poorly understood. Aim: This study aimed to assess mortality predictors in patients with peripheral vascular disease during hospitalization. Methods: This retrospective observational study evaluate one hundred and seventeen patients over 18 years admitted to the vascular surgery service of a tertiary hospital in the period of June 2013 and August 2014 due to complications of vascular disease. They were assessed for clinical parameters, comorbidities, demographics, complications during hospitalization and nutritional status. Data were collected through interviews, the questionnaire Subjective Global Nutritional Assessment (SGA), laboratory exam and physical examination. Results: One hundred and seventeen patients with peripheral vascular disease were followed during admission due to vascular complications. Overall mortality was 7.7%, and malnourished patients or patients at nutritional risk were 39,0% of the sampled population By multivariate analysis both rating by SGA (OR 6.15, CI 1.092 to 34.74, P = 0.039), the presence of heart disease (OR 8.51 CI 1,56 to 47.44 P = 0.015) were independent predictors of mortality. When the patient was classified as malnourished or suspected of being malnourished by SGA it increased 6.15 times the odds of death during hospitalization, while the presence of heart disease increased by 8.51 times. Conclusion: Patients hospitalized for complications of peripheral vascular disease present as risk factors for mortality: malnutrition and the presence of heart disease. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Malnutrition/complications , Peripheral Arterial Disease/mortality , Heart Diseases/complications , Serum Albumin/analysis , Nutrition Assessment , Nutritional Status , Retrospective Studies , Risk Factors , Peripheral Arterial Disease/etiology , Hospitalization
11.
Arq. bras. cardiol ; 113(3): 419-428, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038559

ABSTRACT

Abstract The finding of pulmonary hypertension (PH) by echocardiography is common and of concern. However, echocardiography is just a suggestive and non-diagnostic assessment of PH. When direct involvement of pulmonary circulation is suspected, invasive hemodynamic monitoring is recommended to establish the diagnosis. This assessent provides, in addition to the diagnostic confirmation, the correct identification of the vascular territory predominantly involved (arterial pulmonary or postcapillary). Treatment with specific medication for PH (phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostacyclin analogues) has been proven effective in patients with pulmonary arterial hypertension, but its use in patients with PH due to left heart disease can even be damaging. In this review, we discuss the diagnosis criteria, how etiological investigation should be carried out, the clinical classification and, finally, the therapeutic recommendations for PH.


Resumo O achado de hipertensão pulmonar (HP) em avaliação ecocardiográfica é frequente e preocupante. No entanto, o ecocardiograma é apenas um exame sugestivo e não diagnóstico de HP. Quando se suspeita de acometimento direto da circulação pulmonar, está indicada medida hemodinâmica invasiva para estabelecer o diagnóstico. Essa avaliação permite, além da confirmação diagnóstica, a correta identificação do território vascular predominantemente acometido (arterial pulmonar ou pós-capilar). O tratamento com as medicações específicas de HP (inibidores da fosfodiestarese 5, antagonistas do receptor de endotelina, análogos da prostaciclina e estimulador da guanilil ciclase solúvel) é comprovadamente eficaz para pacientes com hipertensão arterial pulmonar, mas seu uso em pacientes com HP decorrente de doença cardíaca de câmaras esquerdas pode até mesmo ser prejudicial. Discutiremos nesta revisão o critério diagnóstico, a maneira de proceder a investigação etiológica, a classificação clínica e, finalmente, as recomendações terapêuticas na HP.


Subject(s)
Humans , Hypertension, Pulmonary/diagnostic imaging , Echocardiography , Pulmonary Circulation , Risk Assessment , Pulmonary Disease, Chronic Obstructive/complications , Heart Diseases/complications , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/therapy
12.
Arq. bras. cardiol ; 111(6): 852-855, Dec. 2018. graf
Article in English | LILACS | ID: biblio-1038533

ABSTRACT

Abstract Erdheim-Chester Disease is a rare entity, classified as an inflammatory myeloid neoplasm, with an unknown incidence, occurring preferentially in men after 50 years of age. Classically, it has a multisystemic presentation, with the skeletal system being the most frequently affected (90% of the patients), followed by genitourinary involvement in 60% of cases and central nervous system in the pituitary and diabetes insipidus in 25% of the cases. Cardiovascular manifestations are present in more than half of the patients, with aortic infiltration and atrial pseudotumor being the most common forms.


Resumo A doença de Erdheim-Chester é uma entidade rara classificada como neoplasia mielóide inflamatória, com incidência desconhecida que ocorre preferencialmente em homens após os 50 anos de idade. Classicamente apresenta-se de forma multissistêmica, sendo sistema esquelético o mais frequentemente comprometido (90% dos pacientes), seguido do sistema geniturinário em 60% dos casos e sistema nervoso central em hipófise e diabetes insipidus em 25% dos casos. As manifestações cardiovasculares estão presentes em mais da metade dos pacientes, sendo a infiltração da aorta e o pseudotumor atrial as formas mais encontradas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Erdheim-Chester Disease/diagnostic imaging , Heart Diseases/diagnostic imaging , Biopsy , Magnetic Resonance Imaging , Erdheim-Chester Disease/complications , Erdheim-Chester Disease/pathology , Positron-Emission Tomography , Heart Diseases/complications , Heart Diseases/pathology
13.
Acta cir. bras ; 33(11): 1037-1042, Nov. 2018. tab, graf
Article in English | LILACS | ID: biblio-973474

ABSTRACT

Abstract Early cancer diagnosis, new therapies that increased survival of patients, besides the increasingly elderly population are some factors would be associated with possible cancer dissemination in patients under cardiopulmonary bypass (CPB) cardiac surgery. Also, the benefits, and risks, regarding long-term survival, have not yet been established. Therefore, cardiac surgery morbimortality may be superior in patients with cancer disease. Also, immunologic and inflammatory changes secondary to CPB can also increase tumor recurrence. After a brief introduction and CPB immunologic the two main topic subjects included: 1) Combined heart surgery and lung resection and; 2) Possible influence of neoplasia type. After observing the relative literature scarcity, we keep the opinion that "CPB has a modest association with cancer progression" and that "CPB and cancer dissemination should be a logical but unlikely association."


Subject(s)
Humans , Cardiopulmonary Bypass/adverse effects , Cardiac Surgical Procedures/adverse effects , Neoplasms/complications , Risk Factors , Disease Progression , Heart Diseases/surgery , Heart Diseases/complications
14.
Rev. Assoc. Med. Bras. (1992) ; 64(9): 787-790, Sept. 2018. graf
Article in English | LILACS | ID: biblio-1041023

ABSTRACT

SUMMARY Cardiac amyloidosis is an infiltrative cardiomyopathy, resulting from amyloid deposition within the myocardium. In primary systemic (AL-type) amyloidosis, the amyloid protein is composed of light chains resulting from plasma-cell dyscrasia, and cardiac involvement occurs in up to 50% of the patients We present a case of a 43-year-old man, with complaints of periodical swollen tongue and xerostomia, bleeding gums and haematuria for two months. His blood results showed normocytic anaemia, thrombocytopenia and a high spontaneous INR, therefore he was referred to the Internal Medicine clinic. In the first visit, he showed signs and symptoms of overt congestive heart failure and was referred to the emergency department. The electrocardiogram showed sinus tachycardia and low voltage criteria. Echocardiography showed biventricular hypertrophy with preserved ejection fraction, restrictive physiology with elevated filling pressures, thickened interatrial septum and atrioventricular valves, small pericardial effusion and relative "apical sparing" on 2D longitudinal strain. Cardiac MRI showed diffuse subendocardial late enhancement. Serum protein electrophoresis was inconclusive, however urine analysis revealed nephrotic range proteinuria, positive Bence Jones protein and an immunofixation test with a monoclonal lambda protein band. Abdominal fat biopsy was negative for Congo red stain, nevertheless a bone marrow biopsy was performed, revealing lambda protein monoclonal plasmocytosis, confirming the diagnosis of primary systemic amyloidosis. This case represents a rare cause of heart failure in a young adult. Low-voltage QRS complexes and typical echocardiography features should raise the suspicion for cardiac amyloidosis. Prognosis is dictated by the level of cardiac involvement; therefore, early diagnosis and treatment are crucial.


RESUMO A amiloidose cardíaca corresponde a uma miocardiopatia infiltrativa, resultante do depósito da proteína amiloide no miocárdio. Na amiloidose sistêmica primária (tipo AL), a proteína amiloide é composta por cadeias leves que resultam de discrasia dos plasmócitos, havendo envolvimento cardíaco em até 50% dos doentes. Apresentamos o caso de um homem de 43 anos, com queixas de edema periódico da língua e xerostomia, hemorragia gengival e hematúria há dois meses. Analiticamente havia a destacar anemia normocítica, trombocitopenia e um INR alto espontâneo, pelo que foi referenciado à consulta de Medicina Interna. Na primeira consulta, apresentou-se com sinais de insuficiência cardíaca congestiva franca, pelo que foi referenciado ao Serviço de Urgência. O eletrocardiograma demonstrou taquicardia sinusal e critérios de baixa voltagem. O ecocardiograma revelou hipertrofia biventricular com fração de ejeção preservada, fisiologia restritiva com elevação das pressões de enchimento, espessamento do septo interauricular e das válvulas auriculoventriculares, derrame pericárdico ligeiro e padrão de apical sparing no strain longitudinal 2D. Realizou ainda ressonância magnética cardíaca, que mostrou realce tardio subendocárdico difuso. A eletroforese das proteínas foi inconclusiva, contudo a análise da urina revelou proteinúria no espectro nefrótico, presença de proteína de Bence Jones e um teste de imunofixação com uma banda monoclonal de cadeias lambda. A biópsia da gordura abdominal foi negativa. Não obstante, foi realizada uma biópsia da medula óssea, verificando-se plasmocitose monoclonal lambda, o que confirmou o diagnóstico de amiloidose primária sistêmica. Este caso representa uma causa rara de insuficiência cardíaca no jovem adulto. A baixa voltagem no eletrocardiograma e os achados ecocardiográficos típicos devem fazer suspeitar de amiloidose cardíaca. O prognóstico é ditado pelo nível de envolvimento cardíaco, motivo pelo qual o diagnóstico e o tratamento precoces são essenciais.


Subject(s)
Humans , Male , Adult , Heart Diseases/complications , Heart Failure/etiology , Amyloidosis/complications , Biopsy , Echocardiography , Electrocardiography , Heart Diseases/physiopathology , Heart Diseases/diagnostic imaging , Heart Failure/physiopathology , Heart Failure/diagnostic imaging , Amyloidosis/physiopathology , Amyloidosis/pathology , Amyloidosis/diagnostic imaging
15.
Arch. argent. pediatr ; 116(4): 616-620, ago. 2018. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-950054

ABSTRACT

La hidatidosis es una zoonosis producida por el parásito Echinococcus granulosus. En el ciclo zoonótico del parásito, el hombre es un huésped intermediario y sufre la enfermedad tras la ingesta de alimentos y agua contaminados por la materia fecal de animales infectados. En Argentina, la enfermedad constituye un problema importante de salud pública. Suele manifestarse con compromiso hepático y pulmonar. La afectación de otros órganos, que incluyen el corazón, es infrecuente.


Hydatidosis is a parasitic infection caused by the Echinococcus granulosus larvae, transmitted by the ingestion of infected food, characterized by the formation of cysts in vital organs. In Argentina, the disease is spread throughout the territory, constituting an important public health issue. The disease usually affects the liver and lungs. The affection of other organs is rare, and even more uncommon the affection of the heart. We present the case of a disseminated hydatidosis in a pediatric patient, whose initial clinical manifestation was an acute arterial embolism of the right limb caused by the rupture of a hydatidic cardiac cyst.


Subject(s)
Humans , Male , Adolescent , Echinococcosis/diagnosis , Embolism/etiology , Heart Diseases/diagnosis , Acute Disease , Echinococcosis/complications , Embolism/parasitology , Heart Diseases/complications , Heart Diseases/parasitology
16.
Braz. j. med. biol. res ; 51(4): e6989, 2018. tab, graf
Article in English | LILACS | ID: biblio-889058

ABSTRACT

We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P<0.001). Primary endpoint-free survival was lower for patients with cardiogenic syncope (HR=2.97, 95%CI=1.94-4.55; P<0.001). The scores were analyzed for diagnostic performance with area under the curve (AUC) and did not help differentiate patients with an increased risk of adverse events. The differential diagnosis of syncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population.


Subject(s)
Humans , Male , Female , Aged , Cardiomyopathies/complications , Emergency Medical Services/statistics & numerical data , Syncope/etiology , Brazil/epidemiology , Cohort Studies , Disease-Free Survival , Heart Diseases/complications , Heart Diseases/epidemiology , Proportional Hazards Models , Risk Factors , Survival Analysis , Syncope/mortality
17.
Pakistan Journal of Medical Sciences. 2018; 34 (1): 58-61
in English | IMEMR | ID: emr-151171

ABSTRACT

Objective: To evaluate the diagnostic values of transesophageal echocardiography [TEE] and transthoracic echocardiography [TTE] in cardiogenic embolic cerebral infarction


Methods: Fifty patients with occult cerebral infarction who were admitted to the hospital between June 2015 and June 2016 were selected as research subjects. The patients were diagnosed by transesophageal echocardiography and transthoracic echocardiography. Diagnostic data were compared to analyze the values of the two diagnostic methods


Results: Sixteen out of fifty patients were diagnosed as cardiogenic embolic cerebral infarction by TEE [32%], including two cases of aortic plaques, six cases of atrial septal defect, two cases of atrial septal aneurysm, two cases of patent foramen ovale, one case of left atrial spontaneous echo contrast, one case of mitral prolapse and two case of mitral stenosis. Four cases were diagnosed as cardiogenic embolic cerebral infarction by TTE [8.0%], including one case of patent foramen ovale, one case of left atrial spontaneous echo contrast, one case of mitral prolapse and one case of mitral stenosis. The difference was statistically significant [P<0.05]. The main difference of TEE and TTE was detection of aorta atheromatous plaques and atrial septal lesions. Aortic atheromatous plaques of two cases and atrial septal lesions of eight cases were missed in the diagnosis by TTE


Conclusion: Detection and diagnosis of cardiac embolic cerebral infarction with TEE is highly accurate and advantageous. Therefore, TEE is worth promotion and application


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Echocardiography, Transesophageal , Embolism , Heart Diseases/complications , Echocardiography/methods
18.
Rev. cuba. angiol. cir. vasc ; 18(2): 178-191, jul.-dic. 2017.
Article in Spanish | LILACS | ID: biblio-844817

ABSTRACT

Introducción: Los pacientes con afecciones ateroscleróticas suelen presentar concentraciones intermedias de colesterol unido a lipoproteínas de baja densidad, lo que refleja la importancia de la interacción con otros factores de riesgo. El tratamiento con estatinas mejora el pronóstico, especialmente el tratamiento intensivo, e independientemente de los valores de colesterol, lo cual hace que se deba considerar esta estrategia terapéutica como una opción y por extensión, todos los pacientes con enfermedad vascular establecida. Objetivo: Examinar las tendencias actuales en el uso terapéutico de las estatinas. Fuente de datos: se realizó una revisión bibliográfica entre 2010-2015 en las bases de datos MedLine, Hinari, Cochrane, PubMed; de revistas líderes en la publicación de temas y artículos de interés. Síntesis de los datos: Las estatinas son fármacos eficaces para disminuir la concentración de colesterol y los triglicéridos en la circulación sanguínea. Además, aumentan moderadamente el colesterol unido a lipoproteínas de alta densidad y disminuyen la incidencia de enfermedad cardiovascular aterosclerótica, por lo que se las considera medicamentos de primera elección en el tratamiento de la dislipemia aterogénica. Se ha demostrado que el tratamiento hipolipemiante con estatinas, evita la progresión de la enfermedad hacia el episodio agudo. Conclusiones: Se actualizó que el efecto de las estatinas juega un papel fundamental en los pacientes con arteriopatía. Es conveniente iniciar el tratamiento lo más precoz posible y extenderlo a sectores arteriales como el cerebrovascular y el periférico(AU)


Introduction: Patients with acute atherosclerotic conditions usually present with moderate cholesterol concentrations together with low-density lipoprotein levels, which indicates the importance of the interactions with other risk factors. Statin therapy improves prognosis after the occurrence of an acute coronary syndrome, especially in intensive care and regardless of cholesterol values, which leads to consider this therapeutic strategy as an option to be extended to all the patients with a set vascular disease. Objective: To examine the present tendencies in the statin therapy. Data sourse: A literature review was made from 2010 to 2015 in MedLine Hinari, Cochrane and PubMed databases and in leading journals in the publication of topics and articles of interest. Data synthesis: Statins are effective drugs to decrease the blood cholesterol and triglyceride levels. Besides, they increase the high density lipoprotein cholesterol and reduce the incidence of atherosclerotic cardiovascular disease, therefore, they are considered first-choice drugs for the treatment of atherogenic dyslipidemia. It has been proved that hypolipidemic treatment with statin avoids the progression of the disease into the acute stage. Conclusions: The review provides an update on the fundamental role of statins in the treatment of patients with artheropathy. It is desirable to initiate the treatment as early as possible and to extend it to other arterial areas such as cerebrovascular and peripheral ones(AU)


Subject(s)
Humans , Dyslipidemias/diagnosis , Heart Diseases/complications , Hypercholesterolemia/complications
19.
Rev. eletrônica enferm ; 19: 1-10, Jan.Dez.2017. ilus, tab
Article in Portuguese | SES-SP, LILACS, BDENF, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-912952

ABSTRACT

A hipertensão arterial sistêmica é uma doença multifatorial, comportando-se como fator desencadeador das doenças cardiovasculares e da aterosclerose. O objetivo foi descrever a associação de idade, gênero, cor da pele e o grau de aterosclerose na artéria aorta na cardiopatia hipertensiva em indivíduos autopsiados. Foram avaliados 34 seguimentos de artérias aortas abdominais de indivíduos autopsiados com cardiopatia hipertensiva (20) e sem cardiopatia hipertensiva (14). A idade, gênero, cor da pele e causa de morte foram coletadas do laudo de autopsia, a quantificação da intensidade de aterosclerose e o grau de aterosclerose através de escala padronizada. Neste estudo, a causa de morte e a intensidade da aterosclerose apresentaram associação significativa com a cardiopatia hipertensiva; houve prevalência de placas de ateroma de maior extensão entre os indivíduos com esta entidade. Desse modo, a aterosclerose deve ser investigada em indivíduos com cardiopatia hipertensiva visando prevenir graves repercussões, que podem culminar com o óbito.


Systemic arterial hypertension is a multifactorial disease, behaving as a triggering factor for cardiovascular diseases and atherosclerosis. The objective was to describe the association of age, gender, skin color and, the atherosclerosis level in the aortic artery in hypertensive cardiopathy of autopsied individuals. We assessed 34 parts of abdominal aortic arteries of autopsied individuals with hypertensive cardiopathy (20) and without hypertensive cardiopathy (14). We collected age, gender, skin color and cause of death from the autopsy report; the quantification of the atherosclerosis intensity and the atherosclerosis level were determined using a standardized scale. In this study, the cause of death and atherosclerosis intensity had a significant association with hypertensive cardiopathy; there was a prevalence of large atheroma plaques among individuals with this entity. Thus, atherosclerosis should be investigated in individuals with hypertensive cardiopathy to prevent severe repercussions which could lead to death.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Mortality , Atherosclerosis/complications , Heart Diseases/complications , Hypertension/complications
20.
Rev. méd. Maule ; 33(1): 34-39, jun. 2017. ilus
Article in Spanish | LILACS | ID: biblio-1284406

ABSTRACT

Cardiac hydatidosis without involvement of extracardiac organs is an uncommun condition. We report a case of a 20 years old female without any prior disease, she consult for progressive dyspnea and palpitations. Echocardiogram and cardiac MRI shows cystic lesion in apical intraventricular septum suggestive of hydatid cyst. No other organs were affected. The patient underwent surgery with successful removal of hydatid cyst and medical treatment with Albendazole, after that, the patient remains asymptomatic.


Subject(s)
Humans , Female , Adult , Echinococcosis/complications , Heart Diseases/complications , Heart Diseases/parasitology , Echocardiography , Tomography, X-Ray Computed , Albendazole/therapeutic use , Chile , Echinococcosis/drug therapy
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