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Diagn. tratamento ; 27(3): 87-90, jul-set. 2022. ilus, ilus, ilus
Article in Portuguese | LILACS | ID: biblio-1380676
Article in Chinese | WPRIM | ID: wpr-928157


This study aims to explore the effect of icariin(ICA) on mitochondrial dynamics in a rat model of chronic renal failure(CRF) and to investigate the molecular mechanism of ICA against renal interstitial fibrosis(RIF). CRF was induced in male Sprague-Dawley(SD) rats with 5/6(ablation and infarction, A/I) surgery(right kidney ablation and 2/3 infarction of the left kidney). Four weeks after surgery, the model rats were randomized into the following groups: 5/6(A/I) group, 5/6(A/I)+low-dose ICA group, and 5/6(A/I)+high-dose ICA group. Another 12 rats that received sham operation were randomly classified into 2 groups: sham group and sham+ICAH group. Eight weeks after treatment, the expression of collagen-Ⅰ(Col-Ⅰ), collagen-Ⅲ(Col-Ⅲ), mitochondrial dynamics-related proteins(p-Drp1 S616, p-Drp1 S637, Mfn1, Mfn2), and mitochondrial function-related proteins(TFAM, ATP6) in the remnant kidney tissues was detected by Western blot. The expression of α-smooth muscle actin(α-SMA) was examined by immunohistochemical(IHC) staining. The NRK-52 E cells, a rat proximal renal tubular epithelial cell line, were cultured in vitro and treated with ICA of different concentration. Cell viability was detected by CCK-8 assay. In NRK-52 E cells stimulated with 20 ng·mL~(-1) TGF-β1 for 24 h, the effect of ICA on fibronectin(Fn), connective tissue growth factor(CTGF), p-Drp1 S616, p-Drp1 S637, Mfn1, Mfn2, TFAM, and ATP6 was detected by Western blot, and the ATP content and the mitochondrial morphology were determined. The 20 ng·mL~(-1) TGF-β1-stimulated NRK-52 E cells were treated with or without 5 μmol·L~(-1) ICA+10 μmol·L~(-1) mitochondrial fusion promoter M1(MFP-M1) for 24 h and the expression of fibrosis markers Fn and CTGF was detected by Western blot. Western blot result showed that the levels of Col-Ⅰ, Col-Ⅲ, and p-Drp1 S616 were increased and the levels of p-Drp1 S637, Mfn1, Mfn2, TFAM, and ATP6 were decreased in 5/6(A/I) group compared with those in the sham group. The levels of Col-Ⅰ, Col-Ⅲ, and p-Drp1 S616 were significantly lower and the levels of p-Drp1 S637, Mfn1, Mfn2, TFAM, and ATP6 were significantly higher in ICA groups than that in 5/6(A/I) group. IHC staining demonstrated that for the expression of α-SMA in the renal interstitium was higher in the 5/6(A/I) group than in the sham group and that the expression in the ICA groups was significantly lower than that in the 5/6(A/I) group. Furthermore, the improvement in the fibrosis, mitochondrial dynamics, and mitochondrial function were particularly prominent in rats receiving the high dose of ICA. The in vitro experiment revealed that ICA dose-dependently inhibited the increase of Fn, CTGF, and p-Drp1 S616, increased p-Drp1 S637, Mfn1, Mfn2, TFAM, and ATP6, elevated ATP content, and improved mitochondrial morphology of NRK-52 E cells stimulated by TGF-β1. ICA combined with MFP-M1 further down-regulated the expression of Fn and CTGF in NRK-52 E cells stimulated by TGF-β1 compared with ICA alone. In conclusion, ICA attenuated RIF of CRF by improving mitochondrial dynamics.

Adenosine Triphosphate/pharmacology , Animals , Female , Fibrosis , Flavonoids , Humans , Infarction/pathology , Kidney , Kidney Failure, Chronic , Male , Mitochondrial Dynamics , Rats , Rats, Sprague-Dawley , Renal Insufficiency, Chronic , Transforming Growth Factor beta1/metabolism
Braz. J. Pharm. Sci. (Online) ; 58: e19224, 2022. graf
Article in English | LILACS | ID: biblio-1383989


Abstract Ischemic heart disease is the leading cause of death in postmenopausal women. The activity of heart ACE increases whereas the activity of ACE-2 decreases after menopause. The present study was designed to investigate the role of ACE and ACE-2 in the abrogated cardioprotective effect of IPC in OVX rat heart. The heart was isolated from OVX rat and mounted on Langendorff's apparatus for giving intermittent cycles of IPC. The infarct size was estimated using TTC stain, and coronary effluent was analyzed for LDH, CK-MB, and nitrite release. IPC induced cardioprotection was significantly attenuated in the ovariectomized rat heart as compared to the normal rat heart. However, this attenuated cardioprotection was significantly restored by perfusion of DIZE, an ACE-2 activator, and captopril, an ACE inhibitor, alone or in combination noted in terms of decrease in myocardial infarct size, the release of LDH and CK-MB, and also increase in the release of NO as compared to untreated OVX rat heart. Thus, it is suggested that DIZE and captopril, alone or in combination restore the attenuated cardioprotective effect of IPC in OVX rat heart which is due to an increase in ACE-2 activity and decrease in ACE activity after treatment.

Animals , Female , Rats , Ovariectomy/classification , Myocardial Ischemia , Heart/physiopathology , Infarction/pathology , Myocardial Infarction/pathology , Women , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Captopril/pharmacology
Biociencias ; 16(1): [87-104], 20210601.
Article in Spanish | LILACS, COLNAL | ID: biblio-1291182


Múltiples investigaciones evidencian una máxima incidencia del infarto agudo de miocardio en la mañana. El objetivo de este artículo es revisar la organización del sistema circadiano, su importancia en la fisiología del sistema cardiovascular y su relación con el desarrollo del infarto agudo de miocardio. Se realizó una búsqueda bibliográfica en diferentes bases de datos para identificar artículos publicados durante los últimos 20 años, centrados en la variación circadiana del infarto agudo de miocardio y en la cronoterapia cardiovascular. Se preseleccionaron 115 artículos, de los cuales se escogieron 60. Se concluyó que la mayor incidencia matutina del infarto agudo de miocardio se explica por la acción conjunta de factores endógenos (aumento matutino de cortisol, catecolaminas, presión arterial, frecuencia cardiaca, resistencias vasculares) y exógenos (alteración en el ciclo sueño-vigilia, bipedestación, e inicio de la actividad) que predispone a ruptura de la placa ateromatosa y aparición de episodios trombóticos durante la mañana.

Multiple investigations show a maximum incidence of acute myocardial infarction in the morning. The objective of this article is to review the organization of the circadian system, its importance in the physiology of the cardiovascular system and its relationship with the development of acute myocardial infarction. A bibliographic search was carried out in different databases to identify articles published during the last 20 years, focused on the circadian variation of acute myocardial infarction and on cardiovascular chronotherapy. 115 articles were preselected, of which 60 were chosen. It was concluded that the higher morning incidence of acute myocardial infarction is explained by the joint action of endogenous factors (morning increase in cortisol, catecholamines, blood pressure, heart rate, vascular resistance) and exogenous (alteration in the sleep-wake cycle, standing, and onset of activity) that predisposes to rupture of the atheromatous plaque and the appearance of thrombotic episodes during the morning.

Humans , Infarction , Myocardial Contraction
Dement. neuropsychol ; 15(2): 216-222, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1286205


ABSTRACT. Various mechanisms contribute to dementia after first ischemic stroke as lesions on strategic areas of cognition and stroke premorbidity. Objectives: Assessing clinical and neuroimaging predictors of dementia after first ischemic stroke and its relation to stroke location, subtypes and severity. Methods: Eighty first ischemic stroke patients were included. Forty patients with dementia after first stroke and forty patients without dementia according to DSM-IV diagnostic criteria of vascular dementia. All patients were subjected to general and neurological assessment, National Institute Health Stroke Scale (NIHSS) for stroke severity, Montreal Cognitive Assessment (MoCA) scale for cognition assessment, MRI brain and Trial of Org 10172 in acute stroke treatment (TOAST) classification for stroke subtypes. Results: Left hemispheric ischemic stroke, strategic infarctions, diabetes mellitus and stroke of anterior circulation were found to be independent risk factors for dementia after first ischemic stroke (OR=3.09, 95%CI 1.67-10.3, OR=2.33, 95%CI 1.87-8.77, OR=1.88, 95%CI 1.44-4.55, OR=1.86, 95%CI 1.45-6.54, respectively). Hypertension, dyslipidemia, smoking, ischemic heart disease, high NIHSS score and large vessel infarction were significantly higher among post stroke dementia patients. However, on binary logistic regression, they did not reach to be independent risk factors. Conclusion: Stroke location (left stroke, strategic infarction, anterior circulation stroke) and diabetes mellitus could be predictors of dementia after first ischemic stroke, but stroke severity, stroke subtypes, hypertension, dyslipidemia, smoking and ischemic heart could not.

RESUMO. Vários mecanismos contribuem para a demência após o primeiro acidente vascular cerebral (AVC) isquêmico como lesões em áreas estratégicas da cognição e morbidades pré-AVC. Objetivos: Avaliar os preditores clínicos e de neuroimagem de demência após o primeiro AVC isquêmico e sua relação com a localização, subtipos e gravidade do AVC. Métodos: Oitenta pacientes com primeiro AVC isquêmico foram incluídos. Quarenta pacientes com demência após o primeiro AVC e quarenta pacientes sem demência de acordo com os critérios diagnósticos do DSM-IV para demência vascular. Todos os pacientes foram submetidos à avaliação geral e neurológica, o National Institute Health Stroke Scale (NIHSS) para gravidade de AVC, a escala de Avaliação Cognitiva de Montreal (Montreal Cognitive Assessment - MoCA) para avaliação de cognição, ressonância magnética cerebral e classificação pelo Trial of Org 10172 in acute stroke treatment (TOAST) para subtipos de AVC. Resultados: AVC isquêmico do hemisfério esquerdo, infartos estratégicos, diabetes mellitus e AVC da circulação anterior foram considerados fatores de risco independentes para demência após o primeiro AVC isquêmico. (OR=3,09, IC95% 1,67-10,3, OR=2,33, IC95% 1,87-8,77, OR=1,88, IC95% 1,44-4,55, OR=1,86, IC95% 1,45-6,54, respectivamente). Hipertensão, dislipidemia, tabagismo, cardiopatia isquêmica, escore NIHSS alto e infarto de grandes vasos foram significativamente altos entre pacientes com demência pós-AVC. No entanto, na regressão logística binária, não chegaram a ser fatores de risco independentes. Conclusão: A localização do AVC (AVC esquerdo, infarto estratégico, AVC da circulação anterior) e diabetes mellitus podem ser preditores de demência após o primeiro AVC isquêmico, mas a gravidade do AVC, subtipos de AVC, hipertensão, dislipidemia, tabagismo e coração isquêmico podem não ser de risco.

Humans , Stroke , Dementia , Infarction
J. bras. nefrol ; 43(1): 128-132, Jan.-Mar. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1154655


Abstract Thromboembolic events are frequent in patients with COVID-19 infection, and no cases of bilateral renal infarctions have been reported. We present the case of a 41-year-old female patient with diabetes mellitus and obesity who attended the emergency department for low back pain, respiratory failure associated with COVID-19 pneumonia, diabetic ketoacidosis, and shock. The patient had acute kidney injury and required hemodialysis. Contrast abdominal tomography showed bilateral renal infarction and anticoagulation was started. Kidney infarction cases require high diagnostic suspicion and possibility of starting anticoagulation.

Resumo Fenômenos tromboembólicos são frequentes em pacientes com infecção por COVID-19 e nenhum caso de infarto renal bilateral havia sido relatado. Apresentamos o caso de uma paciente do sexo feminino, de 41 anos, com diabetes mellitus e obesidade, que deu entrada no serviço de urgência por lombalgia, insuficiência respiratória associada à pneumonia COVID-19, cetoacidose diabética e choque. A paciente apresentava lesão renal aguda e demandava hemodiálise. A tomografia abdominal contrastada mostrou infarto renal bilateral e foi iniciada anticoagulação. Os casos de infarto renal requerem alta suspeita diagnóstica e possibilidade de iniciar a anticoagulação.

Humans , Female , Adult , Diabetes Complications , Acute Kidney Injury/complications , COVID-19/complications , Infarction/complications , Kidney/blood supply , Obesity/complications , Respiratory Insufficiency/complications , Severity of Illness Index , Immunoglobulin M/blood , Tomography, X-Ray Computed , Renal Dialysis/methods , Fatal Outcome , Acute Kidney Injury/therapy , SARS-CoV-2/immunology , COVID-19/drug therapy , COVID-19/virology , Antibodies, Viral/blood , Anticoagulants/therapeutic use
S. Afr. med. j. (Online) ; 111(11): 1046-1049, 2021. figures
Article in English | AIM | ID: biblio-1344518


South Africa has experienced three deadly waves of the COVID-19 pandemic with devastating consequences, but little is known about the experiences in small-town hospitals in the country. Between May 2020 and June 2021, author GC treated ~100 confirmed COVID-19 cases. This retrospective case series report describes 10 of these cases, 7 with unusual complications and 3 with sudden death.

Pneumonia , Hospitals, Urban , Comorbidity , COVID-19 , Neurologic Manifestations , Diabetes Mellitus, Type 2 , Dyspnea , Infarction
J. Health Biol. Sci. (Online) ; 9(1): 1-6, 2021. tab, graf
Article in English | LILACS | ID: biblio-1352368


Objective: In this work, rats isolated hearts were infused EPA before the ischemia period and during reperfusion for available get well in parameter relatives to redox reactions. Methods: The effect of EPA was tested on isolated hearts induced to ischemia and reperfusion, treatment occurred at different times (ischemia or reperfusion). Antioxidant capacity against peroxyl radicals, glutathione cysteine ligase activity, glutathione concentration, lactate dehydrogenase, and creatine kinase concentration was analyzed. Results: Hearts treated with eicosapentaenoic acid had the minor generation of species reactive oxygen and lipid damage after reperfusion. The GSH concentration was higher when the hearts were treated with eicosapentaenoic acid in the period of reperfusion. Conclusion: In conclusion, this study demonstrates that the dose of EPA (20µM) used before ischemia can act as a cardioprotective antioxidant molecule, prevented damage heart from ischemic and reperfusion injury

Objetivo: Neste trabalho, corações isolados de ratos foram infundidos com EPA antes do período de isquemia e durante a reperfusão para obtenção de melhora em parâmetros relativos às reações redox. Métodos: O efeito do EPA foi testado em corações isolados induzidos a isquemia e reperfusão, o tratamento ocorreu em diferentes momentos (isquemia ou reperfusão). A capacidade antioxidante contra os radicais peroxil, atividade da glutationa cisteína ligase, concentração de glutationa, lactato desidrogenase e concentração de creatina quinase foi analisada. Resultados: Corações tratados com ácido eicosapentaenóico tiveram a menor geração de espécies reativas de oxigênio e danos lipídicos após a reperfusão. A concentração de GSH foi maior quando os corações foram tratados com ácido eicosapentaenóico no período de reperfusão. Conclusão: Em conclusão, este estudo demonstra que a dose de EPA (20µM) utilizada antes da isquemia pode atuar como uma molécula antioxidante cardioprotetora, prevenindo danos ao coração por isquemia e lesão de reperfusão.

Heart , Infarction , Ischemia , Oxidation-Reduction , Oxidoreductases , Reperfusion , Eicosapentaenoic Acid , Lactic Acid , Reference Standards , Glutathione
Rev. baiana enferm ; 35: e44403, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1351622


Objetivo verificar a validade de conteúdo do aplicativo móvel Safe Heart para monitoramento e identificação de risco de infarto. Método estudo de validação de conteúdo. Participaram do estudo 10 juízes. Foram avaliados 21 itens, por meio da escala de Likert. Para estimativa do grau de concordância, foi utilizado o cálculo do coeficiente alfa de Cronbach. Resultados a análise estatística com alpha de Cronbach 0,9573 consolidou o Safe Heart quanto à validade e à confiabilidade na consistência interna do conteúdo desenvolvido no aplicativo; os juízes apresentaram consistência válida nos itens observados. Conclusão a validade de conteúdo do aplicativo móvel Safe Heart foi aprovada para monitoramento e identificação de risco de infarto.

Objetivo verificar la validez de contenido de la aplicación móvil Safe Heart para el seguimiento e identificación del riesgo de infarto. Método estudio de validación de contenido. Diez jueces participaron en el estudio. Veintiún ítems fueron evaluados mediante la escala Likert. Para estimar el grado de concordancia, se calculó el coeficiente alfa de Cronbach. Resultados el análisis estadístico con Cronbach de alfa 0,9573 consolidó Safe Heart en cuanto a validez y confiabilidad en la consistencia interna del contenido desarrollado en la aplicación; los jueces presentaron consistencia válida en los ítems observados. Conclusión la validez de contenido de la aplicación móvil Safe Heart ha sido aprobada para el seguimiento e identificación del riesgo de infarto.

Objective to verify the content validity of the Safe Heart mobile app for monitoring and identification of infarction risk. Method content validation study. Ten judges participated in the study. Twenty-one items were evaluated using the Likert scale. To estimate the degree of agreement, Cronbach's alpha coefficient was calculated. Results Cronbach's alpha statistical analysis with 0.9573 consolidated Safe Heart regarding validity and reliability in the internal consistency of the content developed in the application; the judges presented valid consistency in the observed items. Conclusion the content validity of the Safe Heart mobile app has been approved for monitoring and identification of infarction risk.

Humans , Male , Female , Adult , Technology Assessment, Biomedical , Telemonitoring , Infarction/prevention & control , Mobile Applications
J. oral res. (Impresa) ; 9(6): 511-515, dic. 31, 2020. ilus
Article in English | LILACS | ID: biblio-1178949


Introduction: Atherosclerosis is a progressive inflammatory disease that can trigger serious medical consequences like acute myocardial infarction or stroke. Case Report: The purpose of this study is to report an unusual case of finding calcified atheromatous plaques in the carotid arteries bilaterally using a panoramic radiography (PR). A 75-year-old female with a morbid history, attends the Teaching Dental Clinic of the Pontifical Catholic University with complementary exams. PR showed well-defined radiopaque structures adjacent to C4. Using a Doppler ultrasound, the presence of calcified atheromas in the right and left carotid arteries were confirmed. The patient was informed of these findings and is currently under medical follow-up. Conclusion: PR is a useful complementary resource in the detection of atherosclerotic plaques of the upper carotid region.

Introducción: La aterosclerosis es una enfermedad inflamatoria progresiva que puede desencadenar graves consecuencias médicas como infarto agudo de miocardio o accidente cerebrovascular. Case Report: El propósito de este estudio es reportar un caso inusual de hallazgo de placas ateromatosas calcificadas en las arterias carótidas de forma bilateral mediante una radiografía panorámica. Mujer de 75 años con antecedentes mórbidos, acude a la Clínica Odontológica Docente de la Pontificia Universidad Católica con exámenes complementarios. La radiografía panorámica mostró estructuras radiopacas bien definidas adyacentes a C4. Mediante ecografía Doppler se confirmó la presencia de ateromas calcificados en las arterias carótidas derecha e izquierda. El paciente fue informado de estos hallazgos y actualmente se encuentra en seguimiento médico. Conclusión: La radiografía panorámica es un recurso complementario útil en la detección de placas ateroscleróticas de la región carotídea superior.

Humans , Female , Aged , Radiography, Panoramic , Carotid Artery Diseases/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Ultrasonography , Stroke , Atherosclerosis/complications , Plaque, Atherosclerotic , Infarction
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1351-1354, Oct. 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1136158


SUMMARY Vertebral Artery Dissection (VAD) is a rare condition that can be caused by a wide amplitude of neck movement, which injures the vessel wall and can cause ischemia in the cerebellum. We present a 37-year-old man with herniated lumbar disc and allergic rhinosinusitis, which caused sneezing spells. After one of these bouts with a ricochet of the head, he presented C3 misalignment with local pain. Twenty-one days later, affected by a new crisis, he presented left temporal headache, nystagmus, and vertigo. After 3 days, Magnetic Resonance Imaging (MRI) identified 2 regions of cerebellar ischemia and filling failure of the right vertebral artery. After 2 days, Computed Angiotomography (CT Angiography) was performed and showed right VAD with a local thrombus, without aneurysmal signs. Transcranial Doppler did not indicate an increase in blood flow from this artery. The suggested treatment involved administration of anticoagulant Apixabana 5mg, 12/12h, for 3 months, until the condition was reevaluated with new Angio CT and MRI. It was recommended that the patient was released from work for 1 month and forbidden from doing intense physical exercises for 3 months; however, due to setbacks, these deadlines were extended until a new appointment, 4 months after the first visit. The new tests showed no changes, indicating that the condition was stable. This case aims to indicate the possible investigations of the diagnosis and therapeutic options of the rare association between VAD with cerebellar infarction in a well-documented case.

RESUMO A Dissecção da Artéria Vertebral (DAV) é quadro raro que pode ser causado por movimentação de grande amplitude do pescoço, que lesiona a parede desse vaso, podendo provocar isquemia no cerebelo. Apresentamos um homem de 37 anos, com hérnia de disco e rinossinusite alérgica que lhe causava crises de espirros em salva (CE). Após uma dessas crises com ricocheteamento da cabeça, apresentou desalinhamento de C3 com dor local. Vinte e um dias depois, acometido por nova crise, apresentou cefaleia temporal esquerda, nistagmo e vertigem. Decorridos 3 dias, o paciente foi submetido a Ressoânncia Magnética (RM), que identificou 2 regiões de isquemia cerebelar e enchimento comprometido da artéria vertebral direita. Após 2 dias, foram feitos Angiotomografia Computadorizada (Angio TC), que constatou DAV direita com trombo local, sem sinais aneurismáticos, e Doppler Transcraniano, que não indicou aumento do fluxo sanguíneo dessa artéria. O tratamento sugerido envolvia administração de anticoagulante Apixabana 5mg, 12/12h, por 3 meses, até que o quadro fosse reavaliado com novas Angio TC e RM. Foi recomendado que o paciente ficasse afastado do trabalho por 1 mês e de exercícios físicos intensos por 3 meses, porém devido a contratempos, esses prazos foram prorrogados até nova consulta, 4 meses após a primeira. Os novos exames não apresentaram alterações, indicando que o quadro estava estável. Esse caso tem como objetivo indicar as possíveis investigações do diagnóstico e opções terapêuticas da rara associação entre DAV com infarto cerebelar em caso bem documentado.

Humans , Male , Adult , Cerebellar Diseases , Vertebral Artery Dissection/etiology , Vertebral Artery Dissection/diagnostic imaging , Sneezing , Vertebral Artery , Magnetic Resonance Imaging , Infarction
Rev. colomb. cardiol ; 27(5): 481-484, sep.-oct. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289260


Resumen La displasia fibromuscular es una enfermedad no inflamatoria y no aterosclerótica, que puede afectar cualquier lecho arterial; sin embargo, las arterias renales y la carótida interna son las más comprometidas. Se presenta el caso de un paciente que cursó con dolor abdominal y cefalea hemicraneana posterior, con síndrome de Horner incompleto. En arteriografía renal y panangiografía cerebral realizada por Cardiología intervencionista se observó infarto renal derecho y disección de la carótida interna derecha con formación de pseudoaneurisma. Se hizo terapia endovascular con angioplastia y se dio de alta con antiagregación dual. Es importante conocer este tipo de presentación clínica ya que el diagnóstico podría confundirse con otras enfermedades que generan signos y síntomas similares; por consiguiente, es ideal tener sospecha clínica alta para evitar retrasos en el manejo.

Abstract Fibromuscular dysplasia is a non-inflammatory and non-atherosclerotic disease that can affect any arterial bed, with the renal and the internal carotid arteries being the most compromised. A case is presented on a patient that had abdominal pain and pain in the back of the head, and an incomplete Horner syndrome. In the renal arteriography and cerebral pan-angiography carried out by interventionist Cardiology, a right renal infarction and dissection of the right internal carotid was observed with a pseudo-aneurysm formation. Intravenous treatment was performed with angioplasty, and the patient was discharged with dual antiplatelet therapy. It is important to be aware of this type of clinical presentation, since the diagnosis can be confused with other diseases that produce similar signs and symptoms. It would be ideal to have a high clinical suspicion in order to avoid delays in the management.

Humans , Female , Middle Aged , Stroke , Carotid Artery, Internal, Dissection , Fibromuscular Dysplasia , Infarction
Rev. colomb. cardiol ; 27(4): 344-350, jul.-ago. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289236


Resumen Objetivo: Evaluar la factibilidad y los efectos sobre la capacidad funcional de un programa de entrenamiento físico supervisado, aplicado en pacientes con disfunción sistólica severa del ventrículo izquierdo después de infarto agudo de miocardio. Métodos: Se estudiaron 37 pacientes, de ambos sexos y sin límites de edad, con diagnóstico de disfunción sistólica severa del ventrículo izquierdo, después de haber sufrido un infarto agudo de miocardio, que consecutivamente se incorporaron al programa ambulatorio del Centro de Rehabilitación del Instituto de Cardiología. Se hicieron pruebas de esfuerzo máximas limitadas por síntomas con determinación de consumo de oxígeno, ecocardiogramas en reposo y ventriculografías isotópicas en reposo y esfuerzo a los 2, 8 y 18 meses de evolución, y un tiempo medio de seguimiento clínico de 4,1 años. A todos se les prescribió un régimen de entrenamiento físico moderado o intenso, durante un año como mínimo. Se consideró disfunción sistólica severa cuando la fracción de eyección del ventrículo izquierdo fue menor de 35%. Resultados: Todos los parámetros ergométricos que expresaron capacidad funcional incrementaron significativamente en la evaluación del octavo mes (p< 0,0005), permaneciendo invariables a los 18. La fracción de eyección del ventrículo izquierdo media en reposo inicial fue de 28,3 ± 5,3%, la cual no mostró variaciones significativas con el esfuerzo ni con otros estudios evolutivos. La mortalidad total y la morbilidad de la serie fueron de 10,5% y 47,3%, respectivamente. Conclusión: El entrenamiento físico supervisado en pacientes infartados con disfunción sistólica severa de ventrículo izquierdo fue seguro y efectivo, y mejoró su calidad de vida, sin causar efectos negativos sobre la función ventricular.

Abstract Objective: To evaluate the feasibility and effects on the functional capacity of a supervised physical training programme carried out on patients with severe left ventricular systolic dysfunction after an acute myocardial infarction. Methods: The study included a total of 37 patients, males and females of any age, with a diagnosis of severe left ventricular systolic dysfunction after having suffered an acute myocardial infarction. They were consecutively included into the ambulatory programme of the Institute of Cardiology Rehabilitation Centre. Maximum effort tests, limited by symptoms, were performed to determine oxygen consumption. Echocardiograms were also performed at rest, with isotopic ventriculography at rest and then at 2, 8, and 18 months. The mean clinical follow-up was 4.1 years. They were all prescribed to a moderate or intense training programme for at least one year. Severe left ventricular systolic dysfunction was considered when the left ventricular ejection fraction was less than 35%. Results: All the ergometric parameters that expressed functional capacity increased significantly in the evaluation at 8 months (P< .0005), and remained at 18 months. The initial mean left ventricular ejection fraction at rest was 28.3 ± 5.3%, which showed no significant changes with effort or in the other evaluation times. The overall mortality and morbidity of the series was 10.5% and 47.3%, respectively. Conclusion: Supervised physical training in patients after an acute myocardial infarction and with severe left ventricular systolic dysfunction was safe and effective, and improved the quality of life, without causing negative effects on ventricular function.

Humans , Male , Female , Exercise , Heart Failure, Systolic , Evaluation Study , Cardiac Rehabilitation , Infarction
Rev. méd. Urug ; 36(3): 322-324, 2020. graf
Article in Spanish | LILACS, BNUY | ID: biblio-1127111


Resumen: Introducción: el infarto segmentario idiopático de epiplón mayor es una excepcional causa de cuadro agudo de abdomen en el adulto. Caso clínico: se presenta el caso de un adulto joven que se operó de urgencia con diagnóstico de apendicitis aguda y el abordo por vía laparoscópica, comprobándose en la exploración un infarto segmentario de epiplón mayor que se resolvió mediante la omentectomía parcial con buena evolución y alta precoz. Discusión: si bien el diagnóstico imagenológico de infarto de epiplón mayor es posible dada su baja incidencia y las características de presentación clínica, su diagnóstico habitualmente es intraoperatorio. Su tratamiento es la omentectomía laparoscópica del sector afectado. Con diagnóstico preoperatorio, puede admitirse una conducta expectante, aunque la persistencia de la sintomatología es causa de reingreso y prolongación del tratamiento definitivo.

Summary: Introduction: idiopathic segmental infarction of the greater omentum constitutes an exceptional cause of an acute condition in adults. Clinical case: study presents the clinical case of a young adult who underwent an emergency laparoscopic appendectomy for the treamtent of acute apenditicis. The exploration revealed a segmental infarction of the greater omentum that was resolved by partial omentectomy. Evolution was good and the patient was allowed an early discharge. Discussion: despite the fact an image diagnosis of infarction of the greater omentum is possible, its low incidence and the characteristics of its clinical presentation result in it usually being diagnosed during surgery. Treatment consists in laparoscopic omentenctomy of the affected area. Preoperative diagnosis may allow for watchful waiting, although persistence of symptoms requires readmission to hospital and extension of the definitive treatment.

Resumo: Introdução: o infarto segmentar idiopático do grande omento é uma causa excepcional de quadro agudo de abdômen no adulto. Caso clínico: apresenta-se um caso clínico de um adulto jovem operado de urgência por via laparoscópica com diagnóstico de apendicite aguda comprovando-se na exploração um infarto segmentar de grande omento solucionado por uma omentectomia parcial com boa evolução e alta precoce. Discussão: embora o diagnóstico por técnicas de imagem de infarto do grande omento seja possível, seu diagnóstico habitualmente es intraoperatório devido à sua baja incidência e as características da apresentação clínica. O tratamento é a omentectomia laparoscópica do segmento afetado. Com diagnóstico pré-operatório, pode-se admitir uma conduta expectante, embora a persistência de sintomatologia é causa de re-internação e prolongamento do tratamento definitivo.

Male , Adult , Omentum/surgery , Infarction , Laparoscopy , Abdomen, Acute
Article in Chinese | WPRIM | ID: wpr-826344


Infective endocarditis is a microbial infection of the endocardium and can easily affect heart valve.Its characteristic lesion is vegetation formation,and the shedding of vegetation results in arterial embolism and ischemic necrosis of corresponding tissues and organs.A case of infective endocarditis with multiple extracardiac complications was described in this article.The characteristic ultrasound finding was the vegetation formation in anterior mitral valve.CT and MRI scans revealed involvements in multiple organs and blood vessels,which were manifested as splenic infarction,renal infarction,cerebral infarction,splenic aneurysm,superior mesenteric artery aneurysms,renal artery aneurysms,and distal segment stenosis and occlusion of right middle cerebral artery.

Embolism , Endocarditis , Endocarditis, Bacterial , Humans , Infarction , Mitral Valve