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1.
Med. leg. Costa Rica ; 37(1): 12-17, ene.-mar. 2020.
Article in Spanish | LILACS | ID: biblio-1098366

ABSTRACT

Resumen Objetivo: Correlacionar las generalidades de la etiología, patogenia, presentación clínica y métodos diagnósticos actuales disponibles para el aneurisma de arteria pulmonar con la muerte súbita o repentina de estos pacientes. Materiales y métodos: Se realizaron revisión del expediente clínico, análisis de la autopsia y revisión bibliográfica. Presentación de caso: Se presenta el caso de un masculino de 39 años con antecedente de hipertensión pulmonar que consultó por disnea súbita. Se abordó el caso como un tromboembolismo pulmonar. El paciente presentó una evolución clínica tórpida y falleció. La autopsia reveló un aneurisma de la arteria pulmonar. Conclusión: Los aneurismas de la arteria pulmonar son poco frecuentes. La presentación clínica es inespecífica. Los métodos diagnósticos más fiables son la sospecha clínica y los métodos de imagen, sin embargo siguen siendo motivo de muerte súbita y repentina; cuyo hallazgo es postmorten.


Abstract Objective: Correlate the generalities of etiology, pathogenesis, clinical presentation and current diagnostic methods available for pulmonary artery aneurysm with sudden death of these patients. Materials and methods: Review of medical record, autopsy analysis and scientific literature. Case presentation: A 39-year-old male with a history of pulmonary hypertension, who consulted for sudden dyspnea. The case was approached as a pulmonary thromboembolism. The patient presented bad clinical evolution and died. Autopsy revealed an aneurysm of the pulmonary artery. Conclusion: Aneurysms of the pulmonary artery are rare. The clinical presentation is nonspecific. The most reliable diagnostic methods are clinical suspicion and imaging methods, however they remain a cause of sudden death; whose finding is postmortem.


Subject(s)
Male , Adult , Pulmonary Artery/pathology , Hemoptysis/complications , Hypertension, Pulmonary/complications , Aneurysm/pathology , Costa Rica
2.
Rev. Assoc. Med. Bras. (1992) ; 65(7): 946-950, July 2019. tab
Article in English | LILACS | ID: biblio-1041046

ABSTRACT

SUMMARY A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. METHODS A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. RESULTS Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. CONCLUSION PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.


RESUMO OBJETIVO A hipertensão pulmonar (HP) indica elevação progressiva da resistência vascular pulmonar, levando ao excesso de enchimento, elevação da pressão venosa, congestão em vários órgãos e edema no sistema venoso. Este estudo teve como objetivo investigar se a HP é um fator de risco para trombose venosa profunda (TVP) das extremidades inferiores após cirurgia de prótese de quadril e joelho. MÉTODOS Um total de 238 pacientes que receberam a substituição da articulação das extremidades inferiores em nosso departamento de ortopedia de janeiro de 2009 a junho de 2012 foi examinado por ecocardiograma e fluxo de imagem Doppler colorido (CDFI) dos membros inferiores. De acordo com a pressão arterial pulmonar (PAP), os pacientes foram divididos em grupo PAP normal (n=214) e grupo PH (n=24). Todos os pacientes foram reexaminados por CDFI durante os cuidados pós-operatórios. RESULTADOS Entre os 238 pacientes, 18 pacientes tiveram TVP nas extremidades inferiores após a operação. A taxa de incidência total de TVP foi de 7,56% (18/238). No grupo PH, 11 pacientes tiveram TVP (45,83%, 11/24), mas no grupo PAP normal, apenas sete pacientes tiveram TVP (3,27%, 7/214). A incidência de TVP foi significativamente menor no grupo PAP normal do que no grupo PH (P<0,01). Além disso, houve uma correlação positiva entre a PAP e a incidência de TVP. CONCLUSÃO A HP poderia ser um fator de alto risco para a ocorrência de TVP nas extremidades inferiores do paciente após cirurgias de substituição articular.


Subject(s)
Humans , Male , Female , Aged , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Venous Thrombosis/etiology , Hypertension, Pulmonary/complications , Postoperative Complications/etiology , Reference Values , Echocardiography, Doppler , Retrospective Studies , Risk Factors , Venous Thrombosis/diagnostic imaging , Preoperative Period , Hip/blood supply , Hypertension, Pulmonary/diagnostic imaging , Knee/blood supply
4.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(4): 394-402, out.-dez. 2018. tab, ilus, graf
Article in English, Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-970499

ABSTRACT

A dor torácica aguda é um sintoma muito frequente nas unidades de emergência, constituindo-se em um possível sinal de alerta para as doenças com risco iminente de morte. Como a maioria desses pacientes é internada para avaliação de uma possível síndrome coronariana aguda, isso gera um custo hospitalar muito alto por paciente. Por conta dessa possibilidade diagnóstica, muitos emergencistas internam a maioria dos pacientes. Por outro lado, a liberação inapropriada daqueles com infarto agudo do miocárdio representa um risco para o médico e, especialmente, para o paciente. Outro ponto importante é a demora para o atendimento, em que há a influência de fatores relacionados ao paciente, assim como, pontos negativos na logística de atendimento dos serviços de emergência em nosso país. Para excelência no atendimento, é importante uma anamnese detalhada adicionada ao exame físico, a qual permite a elaboração das hipóteses diagnósticas. E para auxiliar os médicos na escolha da hipótese diagnóstica e na tomada rápida de decisão, escores de risco são disponibilizados, os quais, facilmente, identificam a probabilidade de eventos adversos. A conduta imediata de casos com risco de morte imediata tem como principal objetivo reduzir a morbidade e a mortalidade, aumentando, consequentemente, a segurança do profissional da emergência. Sugestões de fluxogramas e algoritmos para o atendimento desses pacientes na sala de emergência definem, de forma objetiva, quem fica e quem pode ser liberado


Acute chest pain is a frequent symptom in emergency units, being a possible war-ning sign of diseases with an imminent risk of death. Since most of these patients are hospitalized to evaluate possible acute coronary syndrome, this generates a very high hospital cost per patient. Because of this diagnostic possibility, emergency professionals admit most patients. In contrast, the inappropriate release of those with acute myocardial infarction poses a risk to the physician and, especially, the patient. Another important point is the delay in care, where there is an influence of patient-related factors, as well as negative points in the logistics of care in the emergency services in our country. For excellence in care, a detailed anamnesis added to the examination is important, allowing the elaboration of diagnostic hypotheses. Moreover, to assist physicians in selecting the diagnostic hypothesis and making fast decisions, there are risk scores that easily identify the likelihood of adverse events. The immediate management of cases with an imminent risk of death is the main objective to reduce morbidity and mortality and, consequently, increase the safety of emergency professionals. Flowcharts and algorithm suggestions targeting patients in the emergency room objectively define who stays and who can be released


Subject(s)
Humans , Male , Female , Chest Pain/diagnosis , Chest Pain/therapy , Diagnosis, Differential , Emergencies , Aorta , Troponin/therapeutic use , Echocardiography/methods , Radiography, Thoracic/methods , Biomarkers , Risk Factors , Electrocardiography/methods , Exercise Test/methods , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosis , Angina, Unstable/complications , Angina, Unstable/diagnosis , Myocardial Infarction/diagnosis
6.
Arch. cardiol. Méx ; 88(1): 25-38, ene.-mar. 2018. tab
Article in Spanish | LILACS | ID: biblio-1054985

ABSTRACT

Resumen: La hipertensión portopulmonar (HPP) es una entidad poco frecuente a nivel mundial, aunque se desconocen los datos epidemiológicos en México. Sin embargo, las enfermedades crónicas del hígado son muy prevalentes en mexicanos. La HPP es el 4.◦ subtipo en frecuencia del grupo de la hipertensión arterial pulmonar. Su diagnóstico está dentro de 2 escenarios: los pacientes con sospecha de hipertensión pulmonar y los candidatos a trasplante hepático ortotópico (THO). Tanto el ecocardiograma como el cateterismo cardiaco derecho son determinantes para el diagnóstico en ambos escenarios. La HPP es un reto para el THO, pues aumenta la mortalidad perioperatoria de manera importante. El uso de terapia específica es la piedra angular de este padecimiento, como una medida para poder mejorar el desenlace de los que llegan a ser candidatos a un THO con HPP moderada a grave. Es importante reconocer que la HPP puede llegar a ser una contraindicación para el THO. Hasta el momento el papel del trasplante combinado pulmón-hígado o corazón-pulmón-hígado como una medida de curación de la enfermedad vascular pulmonar en pacientes con HPP es incierto. © 2016 Instituto Nacional de Cardiolog´ıa Ignacio Cha´vez. Publicado por Masson Doyma Me´xico S.A. Este es un art´ıculo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).


Abstract: Portopulmonary hypertension (PPH) is a rare condition worldwide, although epidemiological data are unknown in Mexico. However, chronic liver diseases are very prevalent in Mexico. PPH is the 4th subtype in frequency in the group of pulmonary arterial hypertension. Its diagnosis is made within 2 scenarios: patients with suspected pulmonary hypertension and candidates for orthotopic liver transplantation (OLT). Both echocardiogram and a right cardiac catheterisation are crucial for diagnosis in both cases. PPH is a challenge for OLT, since it can significantly increase perioperative mortality. The use of specific therapy is the cornerstone of this disease, as a measure to improve the outcome of those who become candidates for OLT with moderate to severe PPH. It is important to recognise that PPH can be a contraindication to OLT. The role of lung-liver transplantation or heart-lung-liver transplantation as a measure to heal pulmonary vascular disease in patients with PPH is still uncertain.© 2016 Instituto Nacional de Cardiolog´ıa Ignacio Cha´vez. Published by Masson Doyma Me´xico S.A. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).


Subject(s)
Humans , Hypertension, Portal/complications , Hypertension, Pulmonary/complications , Liver Transplantation , Hypertension, Portal/diagnosis , Hypertension, Portal/therapy , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/therapy
8.
Arch. cardiol. Méx ; 87(1): 26-34, ene.-mar. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-887491

ABSTRACT

Resumen: La hipertensión pulmonar tromboembólica crónica (HPTEC) es un subtipo de hipertensión pulmonar (HP) caracterizada por la obstrucción mecánica de las arterias pulmonares causada por una tromboembolia pulmonar. Sin tratamiento es una enfermedad progresiva y devastadora, y es el único subgrupo de HP potencialmente curable mediante la endarterectomía pulmonar. La magnitud, así como la recurrencia de la embolia pulmonar, son determinantes y contribuyen al desarrollo de la HPTEC aun cuando está asociada solo a algunos factores trombofílicos. Una hipótesis es que la enfermedad es consecuencia de la resolución incompleta y la organización del trombo, favorecido por fenómenos de inflamación, inmunitarios y/o genéticos que promueven el desarrollo de estenosis de tipo fibroso que culminan con el remodelado vascular oclusivo de vasos proximales y distales. Los mecanismos involucrados en la fallida resolución del trombo aún no están esclarecidos. Los pacientes con HPTEC con frecuencia exhiben HP severa que no puede ser explicada por el grado de obstrucción vascular demostrada en estudios por imagen. En tales casos la arteriopatía pulmonar y las lesiones trombóticas obstructivas, distales al nivel subsegmentario, pueden contribuir al incremento fuera de proporción de las resistencias vasculares pulmonares. Los procesos que llevan al desarrollo de la arteriopatía pulmonar y los cambios microvasculares que ocurren en la HPTEC explican el comportamiento progresivo de la HP y el deterioro clínico gradual con pobre pronóstico para los pacientes, así como también la falta de correlación entre la magnitud de la obstrucción vascular y la medición de parámetros hemodinámicos, aun en ausencia de tromboembolismo venoso recurrente. Esta revisión resume los aspectos más relevantes y actuales de la patobiología y fisiopatología de la HPTEC.


Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) represents a unique subtype of pulmonary hypertension characterized by the presence of mechanical obstruction of the major pulmonary vessels caused by venous thromboembolism. CTEPH is a progressive and devastating disease if not treated, and is the only subset of PH potentially curable by a surgical procedure known as pulmonary endarterectomy. The clot burden and pulmonary embolism recurrence may contribute to the development of CTEPH however only few thrombophilic factors have been found to be associated. A current hypothesis is that CTEPH results from the incomplete resolution and organization of thrombus modified by inflammatory, immunologic and genetic mechanisms, leading to the development of fibrotic stenosis and adaptive vascular remodeling of resistance vessels. The causes of thrombus non-resolution have yet to be fully clarified. CTEPH patients often display severe PH that cannot be fully explained by the degree of pulmonary vascular obstruction apparent on imaging studies. In such cases, the small vessel disease and distal obstructive thrombotic lesions beyond the sub-segmental level may contribute for out of proportion elevated PVR. The processes implicated in the development of arteriopathy and microvascular changes might explain the progressive nature of PH and gradual clinical deterioration with poor prognosis, as well as lack of correlation between measurable hemodynamic parameters and vascular obstruction even in the absence of recurrent venous thromboembolism. This review summarizes the most relevant up-to-date aspects on pathobiology and pathophysiology of CTEPH.


Subject(s)
Humans , Pulmonary Embolism/complications , Pulmonary Embolism/physiopathology , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/physiopathology , Acute Disease , Chronic Disease
9.
Rev. chil. pediatr ; 87(6): 463-467, Dec. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-844566

ABSTRACT

El óxido nítrico inhalatorio (ONi) es actualmente la terapia de primera línea en la insuficiencia respiratoria hipoxémica grave del recién nacido; la mayor parte de los centros neonatales de regiones en Chile no cuentan con esta alternativa terapéutica. Objetivo: Determinar el costo-efectividad del ONi en el tratamiento de la insuficiencia respiratoria asociada a hipertensión pulmonar del recién nacido, comparado con el cuidado habitual y el traslado a un centro de mayor complejidad. Pacientes y método: Se modeló un árbol de decisiones clínicas desde la perspectiva del sistema de salud público chileno, se calcularon razones de costo-efectividad incremental (ICER), se realizó análisis de sensibilidad determinístico y probabilístico, se estimó el impacto presupuestario, software: TreeAge Health Care Pro 2014. Resultados: La alternativa ONi produce un aumento promedio en los costos de 11,7 millones de pesos por paciente tratado, con una razón de costo-efectividad incremental comparado con el cuidado habitual de 23 millones de pesos por muerte o caso de oxigenación extracorpórea evitada. Al sensibilizar los resultados por incidencia, encontramos que a partir de 7 casos tratados al año resulta menos costoso el óxido nítrico que el traslado a un centro de mayor complejidad. Conclusiones: Desde la perspectiva de un hospital regional chileno incorporar ONi en el manejo de la insuficiencia respiratoria neonatal resulta la alternativa óptima en la mayoría de los escenarios posibles.


Inhaled nitric oxide (iNO) is currently the first-line therapy in severe hypoxaemic respiratory failure of the newborn. Most of regional neonatal centres in Chile do not have this therapeutic alternative. Objective: To determine the cost effectiveness of inhaled nitric oxide in the treatment of respiratory failure associated with pulmonary hypertension of the newborn compared to the usual care, including the transfer to a more complex unit. Patients and method: A clinical decision tree was designed from the perspective of Chilean Public Health Service. Incremental cost effectiveness rates (ICER) were calculated, deterministic sensitivity analysis was performed, and probabilistic budget impact was estimated using: TreeAge Pro Healthcare 2014 software. Results: The iNO option leads to an increase in mean cost of $ 11.7 million Chilean pesos (€ 15,000) per patient treated, with an ICER compared with the usual care of $ 23 million pesos (€ 30,000) in case of death or ECMO avoided. By sensitising the results by incidence, it was found that from 7 cases and upwards treated annually, inhaled nitric oxide is less costly than the transfer to a more complex unit. Conclusions: From the perspective of a Chilean regional hospital, incorporating inhaled nitric oxide into the management of neonatal respiratory failure is the optimal alternative in most scenarios.


Subject(s)
Humans , Infant, Newborn , Respiratory Insufficiency/drug therapy , Bronchodilator Agents/administration & dosage , Hypertension, Pulmonary/complications , Nitric Oxide/administration & dosage , Respiratory Insufficiency/economics , Respiratory Insufficiency/etiology , Administration, Inhalation , Bronchodilator Agents/economics , Budgets , Decision Trees , Chile , Public Health/economics , Patient Transfer/economics , Cost-Benefit Analysis , Hospitalization/economics , Neonatology/economics , Nitric Oxide/economics
11.
Arq. bras. cardiol ; 107(1): 33-39, July 2016. tab, graf
Article in English | LILACS | ID: lil-792492

ABSTRACT

Abstract Background: Right-sided heart failure has high morbidity and mortality, and may be caused by pulmonary arterial hypertension. Fractal dimension is a differentiated and innovative method used in histological evaluations that allows the characterization of irregular and complex structures and the quantification of structural tissue changes. Objective: To assess the use of fractal dimension in cardiomyocytes of rats with monocrotaline-induced pulmonary arterial hypertension, in addition to providing histological and functional analysis. Methods: Male Wistar rats were divided into 2 groups: control (C; n = 8) and monocrotaline-induced pulmonary arterial hypertension (M; n = 8). Five weeks after pulmonary arterial hypertension induction with monocrotaline, echocardiography was performed and the animals were euthanized. The heart was dissected, the ventricles weighed to assess anatomical parameters, and histological slides were prepared and stained with hematoxylin/eosin for fractal dimension analysis, performed using box-counting method. Data normality was tested (Shapiro-Wilk test), and the groups were compared with non-paired Student t test or Mann Whitney test (p < 0.05). Results: Higher fractal dimension values were observed in group M as compared to group C (1.39 ± 0.05 vs. 1.37 ± 0.04; p < 0.05). Echocardiography showed lower pulmonary artery flow velocity, pulmonary acceleration time and ejection time values in group M, suggesting function worsening in those animals. Conclusion: The changes observed confirm pulmonary-arterial-hypertension-induced cardiac dysfunction, and point to fractal dimension as an effective method to evaluate cardiac morphological changes induced by ventricular dysfunction.


Resumo Fundamento: Insuficiência cardíaca direita apresenta grande morbimortalidade e pode ser causada por hipertensão arterial pulmonar. Um método diferenciado e inovador utilizado em avaliações histológicas é a dimensão fractal, que permite a caracterização de estruturas irregulares e complexas e pode quantificar alterações estruturais dos tecidos. Objetivo: Avaliar a utilização do método da dimensão fractal nos cardiomiócitos de ratos com hipertensão arterial pulmonar induzida por monocrotalina, associada com análise histológica e funcional. Métodos: Ratos Wistar machos foram divididos em 2 grupos: controle (C; n = 8) e hipertensão arterial pulmonar induzida por monocrotalina (M; n = 8). Após 5 semanas da indução da hipertensão arterial pulmonar pela monocrotalina, foi realizado ecocardiograma. Os animais foram eutanasiados, o coração dissecado e os ventrículos pesados para avaliação dos parâmetros anatômicos. Lâminas histológicas foram confeccionadas, coradas com hematoxilina/eosina para análise da dimensão fractal, realizada pelo método box-counting . Inicialmente foi testada a normalidade dos dados (teste Shapiro Wilk) e a comparação entre os grupos foi por meio do teste t de Student não pareado ou teste de Mann Whitney (p < 0,05). Resultados: Maiores valores da dimensão fractal foram observados no grupo M em comparação ao C (1,43 ± 0,06 vs. 1,37 ± 0,04; p < 0,05). O ecocardiograma apontou menores valores no grupo M para velocidade máxima pulmonar, tempo de aceleração pulmonar e tempo de ejeção, sugerindo piora funcional nesses animais, que também apresentaram hipertrofia cardíaca. Conclusão: As alterações observadas comprovam a disfunção cardíaca induzida pela hipertensão arterial pulmonar e apontam que a dimensão fractal é um método eficaz para avaliar alterações morfológicas cardíacas induzidas pela disfunção ventricular.


Subject(s)
Animals , Male , Fractals , Heart Failure/etiology , Heart Failure/pathology , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/pathology , Reference Values , Stroke Volume/physiology , Echocardiography , Reproducibility of Results , Monocrotaline , Rats, Wistar , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/pathology , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/pathology , Myocytes, Cardiac/pathology , Disease Models, Animal , Heart Failure/physiopathology , Hypertension, Pulmonary/physiopathology
14.
Article in English | IMSEAR | ID: sea-159446

ABSTRACT

Combined pulmonary fi brosis and emphysema (CPFE) is a recently recognized radiologically defi ned syndrome characterized by simultaneous coexistence of both upper lobe emphysema and lower lobe pulmonary fi brosis. We present a case of CPFE in a 57-year-old male smoker who presented with dry cough, progressive breathlessness, and swelling of feet. His chest X-ray revealed bilateral lower Zone reticulonodular opacities with hyperlucent upper Zones. Pulmonary function tests showed wellpreserved lung volumes and reduced diff using capacity of the lung for carbon monoxide. High-resolution computed tomogram showed bilateral lower lobe subpleural honeycombing along with fi brosis and traction bronchiectasis with bilateral upper lobe emphysema predominantly paraseptal type. His 2D echo was suggestive of moderate pulmonary arterial hypertension.


Subject(s)
Carbon Monoxide/analysis , Emphysema/diagnosis , Emphysema/epidemiology , Humans , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/epidemiology , Male , Middle Aged , Pulmonary Artery , Pulmonary Diffusing Capacity/methods , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/epidemiology , Tomography, X-Ray Computed/methods
15.
Rev. bras. cir. cardiovasc ; 30(1): 1-8, Jan-Mar/2015. tab, graf
Article in English | LILACS | ID: lil-742893

ABSTRACT

Objective: To apply and to compare the Society of Thoracic Surgery score (STS), EuroSCORE (Eurosc1), EuroSCORE II (Eurosc2) and InsCor (IS) for predicting mortality in patients undergoing to coronary artery bypass graft and/or valve surgery at the Santa Casa Marilia. Methods: The present study is a cohort. It is a prospective, observational, analytical and unicentric. We analyzed 562 consecutive patients coronary artery bypass graft and/or valve surgery, between April 2011 and June 2013 at the Santa Casa Marilia. Mortality was calculated for each patient through the scores STS, Eurosc1, Eurosc2 and IS. The calibration was calculated using the Hosmer Lemeshow test and discrimination by ROC curve. Results: The hospital mortality was 4,6%. The calibration is generally adequate group P=0.345, P=0.765, P=0.272 and P=0.062 for STS, Eurosc1, Eurosc2, and IS respectively. The discriminatory power of STS score 0.649 (95% CI 0.529 to 0.770, P=0.012), Eurosc1 0.706 (95% CI 0.589 to 0.823, P ≤0.001), Eurosc2 was 0.704 (95% CI 0.590-0.818 P=0.001) and InsCor 0.739 (95% CI 0.638 to 0.839, P ≤0.001). Conclusion: We can say that overall, the InsCor was the best model, mainly in the discrimination of the sample. The InsCor showed good accuracy, in addition to being effective and easy to apply, especially by using a smaller number of variables compared to the other models. .


Objetivo: Aplicar e comparar o Society of Thoracic Surgery score (STS), EuroSCORE (Eurosc1), EuroSCORE II (Eurosc2) e InsCor (IS) na predição de mortalidade nos pacientes submetidos à revascularização do miocárdio e/ou cirurgia valvar na Santa Casa de Marília. Métodos: O estudo representa uma coorte. É prospectivo, observacional, analítico e unicêntrico. Foram analisados 562 pacientes consecutivos operados de revascularização do miocárdio e/ou cirurgia valvar, entre abril de 2011 e junho de 2013 na Santa Casa de Marília. A mortalidade foi calculada em cada paciente com o uso dos escores STS, Eurosc1, Eurosc2 e IS. A calibração foi calculada utilizando o teste de Hosmer Lemeshow e a discriminação mediante a curva ROC. Resultados: A mortalidade hospitalar foi de 4,6%. A calibração foi adequada no grupo geral com P=0,345; P=0,765; P=0,272 e P =0,062 para o STS, Eurosc1, Eurosc2 e IS, respectivamente. O poder discriminatório do STS score 0,649 (IC95% 0,529 P=0,272- 0,770, P=0,012), do Eurosc1 0,706 (IC95% 0,589 - 0,823,P ≤0,001), do Eurosc2 foi 0,704 (IC95% 0,590 - 0,818, P=0,001) e do InsCor 0,739 (IC95% 0,638 - 0,839, P ≤ 0,001). Conclusão: Podemos afirmar que no geral o InsCor foi melhor modelo, principalmente na discriminação da amostra estudada. O InsCor mostrou boa acurácia, além de ser efetivo e de fácil aplicação, principalmente por utilizar um menor número de variáveis comparado aos outros modelos. .


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Heart Failure/physiopathology , Hypertension, Pulmonary/physiopathology , Stroke Volume , Cross-Sectional Studies , Heart Failure/complications , Hypertension, Pulmonary/complications
16.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 24(4): 56-60, out.-dez. 2014.
Article in Portuguese | LILACS | ID: lil-761241

ABSTRACT

Os sinais e sintomas cardiovasculares das doenças de tiroide são achados clinicamente relevantes que acompanham tanto o hipertiroidismo quanto o hipotiroidismo. Com o conhecimento dos mecanismos celulares da ação dos hormônios da tiroide no coração e no sistema cardiovascular, podemos entender as alterações no débito cardíaco, contratilidade miocárdica, pressão arterial, resistência vascular e distúrbios do ritmo que resultam da disfunção da tiroide. A importância do reconhecimento dos efeitos da doença da tiroide sobre o coração também vem da observação de que a normalização da função da tiroide reverte as alterações hemodinâmicas. Nesta revisão, discutiremos os testes de função da tiroide necessários para o diagnóstico, bem como o tratamento necessário para restaurar o estado de eutiroidismo. A avaliação da função da tiroide em pacientes com doenças crônicas é difícil, especialmente pacientes na Unidade de Terapia Intensiva.Muitos destes pacientes têm baixos níveis séricos tanto de tiroxina(T4) quanto de triiodotironina (T3), e os seus níveis séricos detirotropina (TSH) também podem estar baixos. Apesar destas anormalidades, o tratamento desses pacientes com hormônio tiroidiano, além de controverso, parece ser de pouco benefício,inclusive podendo ser deletério. É possível que as alterações nas funções da tiroide durante doenças graves sejam protetoras, pois previnem excessivo catabolismo tecidual. Nós também revisamos as alterações no metabolismo do hormônio tiroidiano e o seu tratamento em pacientes com alterações dos testes de função tiroidiana induzidos por amiodarona.


The cardiovascular signs and symptoms of thyroid disease areclinically relevant findings that accompany both hyperthyroidism and hypothyroidism. On the basis of the understanding of the cellular mechanisms of thyroid hormone action on the heart and cardiovascular system, it is possible to explain the changes in cardiacoutput, cardiac contractility, blood pressure, vascular resistance,and rhythm disturbances that result from thyroid dysfunction. The importance of the recognition of the effects of thyroid disease on the heart also derives from the observation that restoration of normal thyroid function most often reverses the abnormal cardiovascular hemodynamics. In the present review, we discuss the appropriate thyroid function tests to establish a suspected diagnosis as well asthe treatment modalities necessary to restore patients to a euthyroidstate. Assessment of thyroid function in patients with nonthyroidalillness is difficult, especially among those hospitalized in an intensive care unit. Many of them have low serum concentrations of both thyroxine (T4) and triiodothyronine (T3), and their serumthyrotropin (TSH) concentration also may be low. Despite these abnormalities, treatment of these patients with thyroid hormone,while controversial, appears to be of little benefit, and may beharmful. It is possible that the changes in thyroid function during severe illness are protective in that they prevent excessive tissue catabolism. We also review the alterations in thyroid hormone metabolism and the approach to the management of patients with amiodarone-induced alterations in thyroid function tests.


Subject(s)
Humans , Cardiomegaly/complications , Thyroid Gland/pathology , Hypertension, Pulmonary/complications , Thyroxine/adverse effects , Amiodarone/therapeutic use , Intensive Care Units/history
18.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 24(3): 63-68, jul.-set.2014.
Article in Portuguese | LILACS | ID: lil-763799

ABSTRACT

O transplante cardíaco está indicado para pacientes cominsuficiência cardíaca grave com sintomas incapacitantes, a despeitode estarem recebendo tratamento farmacológico otimizado e deterem se esgotado as possibilidades cirúrgicas de tratamento. Entreoutros fatores, as limitações referentes à disponibilidade de doadoresde coração efetivos, principalmente no Brasil, tornam a escolhacriteriosa do receptor cardíaco, além de um desafio, uma granderesponsabilidade para a prática diária do cardiologista clínico.Hiponatremia, insuficiência renal, caquexia cardíaca, anemia, baixosníveis de colesterol, queda dos níveis de hemoglobina e dependênciade inotrópicos são fatores clínico-laboratoriais associados a mauprognóstico em pacientes com insuficiência cardíaca (IC) avançada.Os escores de risco [HFSS (Heart Failure Survival Score) eSHFM (Seattle Heart Failure Model)] devem ser utilizados comoferramentas acessórias para avaliar a gravidade dos pacientes comIC avançada. VO2 pico < 10 ml/kg/min e VE/VCO2 > 34 no teste doexercício cardiopulmonar estão relacionados com mortalidade empacientes ambulatorialmente avaliados para transplante cardíaco. Ahemodinâmica pulmonar, assim como o perfil imunológico, deveser rotineiramente acessada em pacientes candidatos a transplantecardíaco. Os pacientes com hipertensão pulmonar fixa estão sobrisco de desenvolverem insuficiência cardíaca direita fatal apóso transplante cardíaco. Por sua vez, a presença de anticorposcirculantes contra os antígenos HLA (Human Leukocyte Antigen)é um fator de risco para rejeição do enxerto após o transplantede coração. Finalmente, a indicação do transplante cardíaco emsituações clínicas extremas vem aumentando e se tornando umdesafio na prática clínica cardiológica.


The heart transplantation is indicated for patients with severeheart failure and disabling symptoms despite being receivingoptimal pharmacological treatment and having exhausted thepossibilities of surgical treatment. Among other factors, thelimitations related to the availability of effective heart donor,mainly in Brazil, make a judicious choice of the heart receptorin addition to a challenge, a huge responsibility for the dailypractice of clinical cardiologists. Hyponatremia, renal failure,cardiac cachexia, anemia, low cholesterol levels, decrease inhemoglobin levels and dependence on inotropes are clinical andlaboratory factors associated with poor prognosis in patientswith advanced heart failure. The risk scores [HFSS (HeartFailure Survival Score) and SHFM (Seattle Heart FailureModel)] should be used as ancillary tools to assess the severityof patients with advanced HF. Peak of VO2 < 10 ml/kg/minand VE/VCO2 > 34 during the cardio-pulmonary exercise testare related to mortality in ambulatory patients evaluated forcardiac transplantation. Pulmonary hemodynamics as wellas the immunological profile should be routinely accessed inpatients who are candidates for cardiac transplantation. Patientswith fixed pulmonary hypertension are at risk for fatal rightheart failure after heart transplantation. In turn, the presenceof circulating antibodies to Human Leukocyte Antigen HLA)is a risk factor for graft rejection after heart transplantation.Finally, the indication of cardiac transplantation in extremeclinical situations are increasing and becoming a challenge incardiology clinical practice.


Subject(s)
Humans , Heart Failure/diagnosis , Heart Transplantation , Heart Transplantation/history , Heart Transplantation/rehabilitation , Comorbidity , Risk Factors , Hypertension, Pulmonary/complications , Ischemia/etiology , Donor Selection/ethics
19.
Rev. cuba. med. mil ; 43(3): 379-385, jul.-set. 2014.
Article in Spanish | LILACS, CUMED | ID: lil-731009

ABSTRACT

Paciente masculino de 32 años de edad, con antecedentes de asma bronquial desde pequeño. Comenzó a ingerir bebidas alcohólicas en edades tempranas y a partir de los 20 años presentó manifestaciones de insuficiencia cardíaca con dilatación del ventrículo izquierdo y fracción de eyección del ventrículo izquierdo de 49 %, lo que con tratamiento médico mejoró a un 60 %. Esto se asoció a otra sintomatología, por lo que se le diagnosticó miocardiopatía dilatada de posible etiología tóxica (alcoholismo). El paciente evolucionó tórpidamente, se deterioró su estado de salud hasta llegar a la muerte.


A male patient aged 32 years, with a history of bronchial asthma from infancy. He began drinking alcohol at very small ages and as of 20 years of age, he presented with heart failure symptoms with dilated left ventricule and ejection fraction of the left ventricule of 49%, but this figure improved to 60 % after medical treatment. This was related to other symptoms, so the diagnosis was dilated myocardiopathy of possible toxic etiology (alcoholism). The health condition of the patient worsened, he deteriorated and finally died.


Subject(s)
Humans , Male , Adult , Asthma/diagnosis , Shock, Cardiogenic/mortality , Echocardiography/statistics & numerical data , Cardiomyopathy, Dilated/diagnosis , Sepsis/complications , Hypertension, Pulmonary/complications
20.
Rev. paul. pediatr ; 32(2): 159-163, 06/2014. tab
Article in English | LILACS | ID: lil-718509

ABSTRACT

To determine the frequence and profile of congenital heart defects in Down syndrome patients referred to a pediatric cardiologic center, considering the age of referral, gender, type of heart disease diagnosed by transthoracic echocardiography and its association with pulmonary hypertension at the initial diagnosis. METHODS: Cross-sectional study with retrospective data collection of 138 patients with Down syndrome from a total of 17,873 records. Descriptive analysis of the data was performed, using Epi-Info version 7. RESULTS: Among the 138 patients with Down syndrome, females prevailed (56.1%) and 112 (81.2%) were diagnosed with congenital heart disease. The most common lesion was ostium secundum atrial septal defect, present in 51.8%, followed by atrioventricular septal defect, in 46.4%. Ventricular septal defects were present in 27.7%, while tetralogy of Fallot represented 6.3% of the cases. Other cardiac malformations corresponded to 12.5%. Pulmonary hypertension was associated with 37.5% of the heart diseases. Only 35.5% of the patients were referred before six months of age. CONCLUSIONS: The low percentage of referral until six months of age highlights the need for a better tracking of patients with Down syndrome in the context of congenital heart disease, due to the high frequency and progression of pulmonary hypertension...


Determinar la frecuencia y el perfil de las cardiopatías congénitas en portadores de síndrome de Down atendidos en servicio de referencia de cardiología pediátrica, considerándose la edad del encaminamiento, el sexo, el tipo de cardiopatía diagnosticada al ecocardiografía transtorácica y su asociación con hipertensión pulmonar al diagnóstico inicial. MÉTODOS: Estudio de cohorte transversal con recolección retrospectiva de datos de 138 pacientes portadores de síndrome de Down de un total de 17.873 prontuarios. Los datos fueron sometidos al análisis descriptivo, utilizando el programa Epi-Info, versión 7. RESULTADOS: Entre los 138 pacientes con síndrome de Down, hubo mayor prevalencia del sexo femenino (56,1%) y 112 (81,2%) fueron diagnosticados con cardiopatía congénita. Entre las cardiopatías, la más común fue la comunicación interatrial ostium secundum, con frecuencia del 51,8%, seguida por el defecto del septo atrioventricular, con 46,4%. La comunicación interventricular estaba presente en el 27,7%, mientras que la tetralogía de Fallot representó solamente un 6,3% de los casos. Otras cardiopatías totalizaron 12,5%. La hipertensión pulmonar se asoció al 37,5% de las cardiopatías. Sólo un 35,5% de pacientes fueron encaminados al servicio hasta los seis meses de edad. CONCLUSIONES: La proporción de cardiopatías congénitas en portadores de síndrome de Down fue mayor en el servicio estudiado respecto a lo descripto en la literatura. Aún así, el bajo porcentaje de encaminamiento hasta los seis meses llama la atención para la necesidad de un mejor rastreo de los portadores de la síndrome en el contexto de las cardiopatías congénitas, teniendo en vista la alta frecuencia y la progresión de la hipertensión pulmonar...


Determinar a frequência e o perfil das cardiopatias congênitas em portadores de síndrome de Down atendidos em serviço de referência de cardiologia pediátrica, considerando-se a idade do encaminhamento, o sexo, o tipo de cardiopatia diagnosticada ao ecocardiograma transtorácico e sua associação com hipertensão pulmonar ao diagnóstico inicial. MÉTODOS: Estudo de corte transversal com coleta retrospectiva de dados de 138 pacientes portadores de síndrome de Down de um total de 17.873 prontuários. Os dados foram submetidos à análise descritiva, utilizando-se o programa Epi-Info, versão 7. RESULTADOS: Entre os 138 pacientes com síndrome de Down, houve maior prevalência do sexo feminino (56,1%) e 112 (81,2%) foram diagnosticados com cardiopatia congênita. Entre as cardiopatias, a mais comum foi a comunicação interatrial ostium secundum, com frequência de 51,8%, seguida pelo defeito do septo atrioventricular, com 46,4%. A comunicação interventricular estava presente em 27,7%, enquanto a tetralogia de Fallot representou 6,3% dos casos. Outras cardiopatias totalizaram 12,5%. A hipertensão pulmonar associou-se a 37,5% das cardiopatias. Apenas 35,5% dos pacientes foram encaminhados ao serviço até os seis meses de idade. CONCLUSÕES: O baixo percentual de encaminhamento até os seis meses chama atenção para a necessidade de um melhor rastreamento dos portadores da síndrome no contexto das cardiopatias congênitas, tendo em vista a alta frequência e a progressão da hipertensão pulmonar...


Subject(s)
Humans , Male , Female , Child , Heart Defects, Congenital/complications , Hypertension, Pulmonary/complications , Prevalence , Down Syndrome/complications
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