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1.
Femina ; 50(1): 61-64, 20220131. ilus
Article in Portuguese | LILACS | ID: biblio-1358222

ABSTRACT

O infarto agudo do miocárdio no período gravídico-puerperal é uma condição rara em que a principal causa é a dissecção espontânea da artéria coronária. É um evento comumente subdiagnosticado, com pouca literatura disponível e elevado índice de morbimortalidade. Esse relato descreve o caso de uma gestante de 36 semanas de gravidez gemelar, monocoriônica-diamniótica, com infarto agudo do miocárdio secundário à dissecção espontânea da artéria coronária. As equipes de cirurgia cardíaca e obstetrícia optaram pela realização de parto cesariano e histerectomia subtotal, seguido da revascularização da artéria mamária descendente anterior. Discutem-se as orientações adotadas na dissecção espontânea da artéria coronária, bem como a abordagem terapêutica e a conduta obstétrica, quando essa condição ocorre durante a gravidez.(AU)


Acute myocardial infarction in the pregnancy-puerperal period is a rare condition the main cause of which is the spontaneous coronary artery dissection. A commonly underdiagnosed event with little available literature and a high rate of morbidity and mortality. This case reports a 36-week pregnant woman of mono-chorionic-diamniotic pregnancy who had a myocardial infarction secondary to a spontaneous coronary artery dissection. In a joint discussion between the team of cardiac surgery and obstetrics, it was decided to perform a cesarean delivery and subtotal hysterectomy followed by revascularization of the mammary anterior descendant. It discusses the conducts to be adopted in a case of spontaneous coronary artery dissection as well as therapeutic approaches and obstetric conducts to be taken in a case of dissection during pregnancy.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/surgery , Coronary Vessels/pathology , Dissection/adverse effects , Acute Coronary Syndrome/pathology , Myocardial Infarction/complications , Cesarean Section , Pregnancy, High-Risk , Pregnancy, Twin , Heart Disease Risk Factors , Hysterectomy , Myocardial Infarction/etiology
2.
Autops. Case Rep ; 11: e2021263, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249034

ABSTRACT

Blunt chest trauma (BCT) is one of the rarest causes of acute myocardial infarction (AMI). This paper reports the case of a young married man who suffered from AMI due to BCT sustained in a fight with his wife. The histopathology examination revealed a rupture of atherosclerotic plaque with superimposed thrombus in the proximal left anterior descending artery. This report also reviews previously reported BCT-induced AMI cases in the literature.


Subject(s)
Humans , Male , Adult , Thoracic Injuries/pathology , Myocardial Infarction/etiology , Autopsy , Coronary Thrombosis , Plaque, Atherosclerotic , Morphological and Microscopic Findings
7.
Rev. Assoc. Med. Bras. (1992) ; 66(2): 227-231, Feb. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136169

ABSTRACT

SUMMARY BACKGROUND An association between increased serum ferritin levels and acute myocardial infarction (AMI) remains controversial. The purpose of this meta-analysis is to confirm the association between increased serum ferritin levels and AMI. METHODS We searched PubMed and China National Knowledge Infrastructure (CNKI) for relevant articles that assessed the association between serum ferritin and acute myocardial infarction using terms that included serum ferritin and acute myocardial infarction up to February 13, 2019. RESULTS A total of 11 studies were identified for analysis. All pooled analysis was based on a random-effects models. The variance was exhibited using a forest plot, and the heterogeneity among studies was examined using the I2 index, the publication bias was evaluated using a funnel plot. The pooled standard mean difference of ferritin levels between AMI and controls was 0.78 (95%CI,0.68-0.88). CONCLUSION The results of this meta-analysis demonstrate that serum ferritin in acute myocardial infarction patients is higher than that of healthy controls.


RESUMO ANTECEDENTES a correlação entre o aumento do nível de proteínas de ferro no soro e o infarto agudo do miocárdio (AMI) continua controversa. O objetivo desta análise é confirmar a relação entre o aumento dos níveis de proteínas de ferro no soro y o AMI. METODOLOGIA busca de artigos sobre Pubmed e a infraestrutura nacional de conhecimentos da China (cnki) para avaliar a relação entre a proteína de ferro no soro e o infarto agudo do miocárdio, incluída a proteína de ferro no soro e o infarto agudo de miocárdio, até 13 de fevereiro de 2019. RESULTADO foram identificados 11 estudos para sua analise e todas as análises resumidas tiveram base em modelos de efeitos aleatórios. Foram utilizados mapas florestais para mostrar as margens, foi utilizado o índice 12 para examinar a heterogeneidade dos estudos e foram utilizados mapas de funil para avaliar os desvios publicados.A diferença entre a norma de fusão dos níveis de proteína de ferro do Grupo ami e o Grupo de controle é de 0,78 (intervalo de confiança de 95% 0,68-0,88). CONCLUSÃO nos resultados das análises da meta indicam que os pacientes com infarto agudo do miocárdio têm proteínas de ferro superiores às do Grupo de controle de saúde.


Subject(s)
Humans , Ferritins/blood , Myocardial Infarction/blood , Risk Factors , Risk Assessment , Myocardial Infarction/etiology
8.
Rev. méd. Chile ; 147(9): 1128-1135, set. 2019. tab, graf
Article in English | LILACS | ID: biblio-1058655

ABSTRACT

ABSTRACT Background: After acute carbon monoxide intoxication, there may be a higher risk for late adverse cardiac events. However, these patients are usually not followed to monitor the appearance of these effects. Aim: To follow patients seen at an emergency department for carbon monoxide intoxication, monitoring the appearance of myocardial infarction. To assess the predictive value for such complication of serum troponin, carboxyhemoglobin, and procalcitonin levels at the moment of intoxication. Material and Methods: We followed 237 patients receiving emergency care for carbon monoxide intoxication, with a serum carboxyhemoglobin of 5% or more, between 2010 and 2012. Levels of procalcitonin and troponin I were measured. Patients were followed for five years after the intoxication. Results: During the follow up period, 35 patients had a myocardial infarction. These patients had significantly higher carboxyhemoglobin, procalcitonin and troponin I levels at the moment of the intoxication than their counterparts who did not had a myocardial infarction in the follow up. A logistic regression analysis showed that age, carboxyhemoglobin levels, procalcitonin, troponin 1 and length of CO exposure were associated with a higher risk of myocardial infarction. Procalcitonin, troponin and carboxyhemoglobin levels had a high sensitivity and specificity to predict the appearance of myocardial infarction, with high areas under the receiver operating characteristic (ROC) curves. Conclusions: In patients with CO intoxication, carboxyhemoglobin, troponin and procalcitonin levels at the moment of the intoxication are significant predictors of the late appearance of myocardial infarction.


Antecedentes: Después de una intoxicación con monóxido de carbono, hay un mayor riesgo de desarrollar problemas cardiovasculares a largo plazo. Sin embargo, estos pacientes no son seguidos habitualmente para evaluar la aparición de estos eventos. Objetivo: Efectuar un seguimiento de pacientes que han sufrido una intoxicación con CO, evaluando la aparición de infarto del miocardio. Evaluar el valor de los niveles de troponina, carboxihemoglobina y procalcitonina para predecir la aparición de estos eventos. Material y Métodos: Seguimos 237 pacientes que fueron atendidos de urgencia por una intoxicación con CO, con niveles de carboxihemoglobina de 5% o más, entre 2010 y 2012. Se midieron los niveles de procalcitonina, troponina 1 y carboxihemoglobina y los pacientes fueron seguidos por cinco años después de la intoxicación. Resultados: Durante el seguimiento, 35 pacientes tuvieron un infarto al miocardio. Estos pacientes tenían niveles significativamente más altos de procalcitonina, troponina 1 y carboxihemoglobina al momento de la intoxicación, que los pacientes que no tuvieron un infarto durante el seguimiento. Una regresión logística mostró que la edad, carboxihemoglobina, procalcitonina, troponina y la duración de exposición a CO se asociaron a un mayor riesgo de infarto. Procalcitonina, troponina 1 y carboxihemoglobina tuvieron una alta sensibilidad y especificidad para predecir la aparición de infarto, con áreas bajo la curva ROC (receiver operating characteristic) elevadas. Conclusiones: En pacientes con intoxicación por CO, la carboxihemoglobina, procalcitonina y troponina son predictores significativos de la aparición de infarto agudo de miocardio en el largo plazo.


Subject(s)
Humans , Carbon Monoxide Poisoning , Myocardial Infarction/etiology , Troponin , Carboxyhemoglobin , Carbon Monoxide
9.
Arch. cardiol. Méx ; 89(1): 5-11, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038470

ABSTRACT

Abstract Introduction: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.


Resumen La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carotid Artery Diseases/complications , Coronary Angiography , Stroke/etiology , Plaque, Atherosclerotic/complications , Myocardial Infarction/etiology , Carotid Artery Diseases/diagnosis , Survival Analysis , Retrospective Studies , Risk Factors , Follow-Up Studies , Disease Progression , Stroke/diagnosis , Stroke/mortality , Myocardial Infarction/diagnosis
11.
Einstein (Säo Paulo) ; 17(4): eAO4632, 2019. tab
Article in English | LILACS | ID: biblio-1019807

ABSTRACT

ABSTRACT Objective: To investigate the potential value of sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. Methods: A cross-sectional study based on data collected from elderly patients with acute myocardial infarction, admitted to a public hospital located in the Northeastern region of Brazil, from April to July 2015. The diagnosis of sarcopenia was based on muscle mass, muscle strength and physical performance measurements. Cardiovascular risk and prognostic markers, such as troponin and creatine kynase MB isoenzyme values, acute myocardial infarction classification according to ST segment elevation, and thrombolysis in myocardial infarction score were used. Results: The sample comprised 99 patients with mean age of 71.6 (±7.4) years. Prevalence of sarcopenia and sarcopenic obesity was 64.6% and 35.4%, respectively. Sarcopenia was more prevalent among males (p=0.017) aged >80 years (p=0.008). Thrombolysis in myocardial infarction was the only marker of cardiovascular risk significantly associated with sarcopenia (p=0.002). Conclusion: Prevalence of sarcopenia was high and associated with thrombolysis in myocardial infarction risk score. Sarcopenic obesity affected approximately one-third of patients and was not associated with any of the prognostic predictors.


RESUMO Objetivo: Verificar a relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos com infarto agudo do miocárdio internados. Métodos: Estudo transversal envolvendo pacientes idosos com infarto agudo do miocárdio, hospitalizados no período de abril a julho de 2015, em serviço público, no Nordeste brasileiro. A sarcopenia foi determinada por meio das medidas de massa muscular, força muscular e desempenho físico. Foram utilizados os marcadores de risco cardiovascular e de prognóstico, como os valores de troponina e da isoenzima MB da creatinina quinase, classificação do infarto agudo do miocárdio de acordo com a elevação do segmento ST e o escore de risco de trombólise em infarto do miocárdio. Resultados: Foram avaliados 99 pacientes, com média de idade de 71,6 (±7,4) anos. Verificou-se prevalência de sarcopenia de 64,6% e 35,4% de obesidade sarcopênica. A sarcopenia foi mais prevalente no sexo masculino (p=0,017), na faixa etária >80 anos (p=0,008). Dentre os marcadores de risco cardiovascular, apenas o escore de risco trombólise em infarto do miocárdio esteve estatisticamente associado à sarcopenia (p=0,002). Conclusão: A prevalência da sarcopenia foi elevada e se associou com o escore de risco de trombólise em infarto do miocárdio. A obesidade sarcopênica acometeu cerca de um terço dos pacientes e não se associou a nenhum parâmetro preditor prognóstico.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Muscle Strength/physiology , Sarcopenia/complications , Motor Activity/physiology , Myocardial Infarction/etiology , Obesity/complications , Prognosis , Biomarkers/blood , Geriatric Assessment , Cross-Sectional Studies , Predictive Value of Tests , Risk Factors , Sarcopenia/physiopathology , Middle Aged , Myocardial Infarction/physiopathology , Obesity/physiopathology
12.
Rev. Hosp. Clin. Univ. Chile ; 30(3): 223-230, 2019. tab
Article in Spanish | LILACS | ID: biblio-1051355

ABSTRACT

Acute myocardial infarction is one of the main causes of death in the world, this occurs in the in-hospital period as well as in the follow-up. It has been much studied what occurs in the in-hospital period, but much less what occurs in the follow-up of patients with this pathology. The objective of this study was to follow patients discharged after myocardial infarction for 1 year and analyze predictors of cardiovascular events. 1174 patients were followed for 1 year, of which 17% presented some serious cardiovascular event, associated with the presence of male sex, older age, arterial hypertension, previous history of angina, hospital treatment only pharmacological, inclusion of positive inotropes in the initial treatment and use of calcium channel blockers, factors already shown by international literature but less analyzed in our country, and furthermore, the demonstration that invasive management with coronary angioplasty or bypass surgery are protective factors of the occurrence of events in this period, which reinforces the idea of a more intensive and invasive management in patients with this pathology. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Myocardial Infarction/etiology , Myocardial Infarction/mortality , Myocardial Infarction/epidemiology , Follow-Up Studies
13.
Rev. cuba. med. mil ; 47(3): 1-6, jul.-set. 2018. ilus
Article in Spanish | LILACS | ID: biblio-985539

ABSTRACT

El pseudoaneurisma cardíaco es una entidad poco frecuente, que se produce cuando existe una rotura incompleta de la pared del corazón y el pericardio sella dicha rotura. Se desarrolla una neocavidad comunicada con la cavidad ventricular por un orificio estrecho. El objetivo del presente trabajo es reportar un caso de pseudoaneurisma ventricular izquierdo, entidad muy poco frecuente. Se presenta un paciente masculino de 69 años, con antecedentes de infarto del miocardio tres años previos al ingreso, que acude al cuerpo de guardia por dolor torácico y disnea. Se le realiza radiografía de tórax, vista póstero-anterior, donde se observa imagen radiopaca con tendencia nodular que borra el contorno cardiaco izquierdo, se complementa con ecografía transtorácica y tomografía helicoidal computarizada, se visualiza una imagen sacular por adición en la pared lateral del ventrículo izquierdo, con trombo mural en su interior, que comunicaba con este a través de cuello estrecho. Se llegó a la conclusión de que se trataba de un pseudoaneurisma ventricular izquierdo. Esta es una entidad que presenta una alta mortalidad, por lo que es necesario realizar un diagnóstico oportuno, a fin de tomar la conducta adecuada para prevenir las complicaciones(AU)


The cardiac pseudoaneurysm is a rare entity, which occurs when there is an incomplete rupture of the heart wall and the pericardium seals the rupture. A neocavity develops communicating with the ventricular cavity through a narrow orifice. The objective of this study is to report a rare case of left ventricular pseudoaneurysm. We present a 69-year-old male patient with a history of myocardial infarction three years prior to admission. The patient goes to the emergency room for chest pain and dyspnea. He underwent chest X-rays for rear-anterior view showing a radiopaque image with nodular tendency that erases the left cardiac line. Transthoracic ultrasound and computerized helical tomography are used to complement the examination. A saccular image is shown by adding to the lateral wall of the left ventricle with wall thrombus inside, a communicating narrow neck. It was concluded that it was a left ventricular pseudoaneurysm. This is an entity that presents high mortality, so it is necessary to make timely diagnosis, in order to take the appropriate medical behavior for preventing complications(AU)


Subject(s)
Humans , Male , Aged , Carotid Artery Injuries/diagnostic imaging , Tomography, Spiral Computed/methods , Myocardial Infarction/etiology
14.
Rev. habanera cienc. méd ; 17(4): 591-602, jul.-ago. 2018. tab
Article in Spanish | LILACS, CUMED | ID: biblio-978554

ABSTRACT

Introducción: Estudios epidemiológicos han señalado que la obesidad abdominal es el factor de riesgo más preponderante en los países latinoamericanos y el que mejor explica la ocurrencia de un primer infarto agudo de miocardio. Objetivo: Determinar el riesgo de enfermedad cardiovascular por la medición de la circunferencia abdominal en el Consultorio 22 del Policlínico Docente Aleida Fernández Chardiet del municipio La Lisa, La Habana, Cuba, en 2016. Material y métodos: Se realizó un estudio observacional descriptivo, de corte transversal en personas mayores de 17 años de edad. El universo estuvo constituido por 538 personas. Se utilizaron distribuciones de frecuencias, cálculos porcentuales y el test de Chi Cuadrado. Resultados: De acuerdo con el valor de la circunferencia abdominal, 42,9 por ciento de las personas presentó un riesgo de enfermedad cardiovascular incrementado. El riesgo incrementado predominó en el sexo masculino (48 por ciento). Solo el 16,5 por ciento de los pacientes diabéticos tuvo un riesgo bajo. El 50,6 por ciento de los pacientes con hipertensión arterial y 45,4 por ciento de los fumadores presentaron un riesgo de enfermedad cardiovascular incrementado. Conclusiones: El riesgo incrementado de enfermedad cardiovascular, según la medida de la circunferencia abdominal, predominó en la mayoría de los pacientes estudiados, fundamentalmente en los pacientes del sexo masculino, los diabéticos, los hipertensos y los fumadores. Se observó una relación estadísticamente significativa entre el riesgo de enfermedad cardiovascular, encontrado por la obesidad abdominal y la edad, el sexo, la Diabetes Mellitus y la hipertensión arterial(AU)


Introduction: Epidemiological studies have demonstrated that abdominal obesity is the most important risk factor and the one that best explains the occurrence of a first acute myocardial infarction in Latin American countries. Objective: To determine the risk of cardiovascular disease by measuring the abdominal circumference in Doctor's Office 22 of Aleida Fernández Chardiet Teaching Polyclinic, La Lisa municipality, Havana, Cuba, in 2016. Material and Methods: An observational descriptive cross-sectional study was conducted in people older than 17 years old. The universe of study was composed of 538 persons. Distributions of frequencies, percentage calculations, and the Chi-square test were used. Results: With regard to the value of abdominal circumference, 42,9 percent of people presented a high risk of cardiovascular disease, which predominated in the male sex (48,0 percent). Only 16,5 percent of diabetic patients presented a low risk. The 50,6 percent of patients with arterial hypertension, and the 45,4 percent of smokers presented a high risk. Conclusions: Regarding the evaluation of the abdominal circumference, a high risk of cardiovascular disease was observed in the majority of population studied, especially in the male sex, diabetics, hypertensive patients, and smokers. A statistically significant relationship was observed in patients with risk of cardiovascular disease due to abdominal obesity and age, sex, Diabetes Mellitus, and arterial hypertension.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Risk Assessment/methods , Obesity, Abdominal/complications , Myocardial Infarction/etiology , Epidemiology, Descriptive , Cross-Sectional Studies , Abdominal Circumference , Observational Study , Myocardial Infarction/complications
15.
J. appl. oral sci ; 26: e20170199, 2018. tab, graf
Article in English | LILACS, BBO | ID: biblio-893736

ABSTRACT

Abstract The presence of neopterin in gingival crevicular fluid (GCF) is a marker for local and acute immune activation, and the presence of vascular cell adhesion molecule (VCAM-1) in GCF is accepted as a marker for chronic vascular inflammation. Objectives This study aimed to evaluate effects of periodontal treatment on GCF levels of neopterin and VCAM-1 in patients with chronic periodontitis (CP) with acute myocardial infarction (AMI) compared with systemically healthy CP patients. Material and methods Sixty subjects (20 CP patients with AMI, 20 healthy CP patients, and 20 healthy controls) were included. GCF samples were analyzed at baseline and after 3 and 6 months, and the probing pocket depth (PD), clinical attachment level (CAL), bleeding on probing, gingival (GI) and plaque (PI) indices were recorded. We determined neopterin and VCAM-1 levels (concentration and total amount) using enzyme-linked immunosorbent assay (ELISA). No significant differences were seen between the AMI+CP and CP groups for PI, GI, GCF levels of neopterin and VCAM-1 at baseline. Results The number of teeth with 5 mm≤CAL<7 mm and CAL≥7 mm were significantly increased in the AMI+CP group at baseline. There were no significant differences between the AMI+CP and CP for PI, CAL, GCF volumes, and the AMI+CP group had the highest clinical improvement in the number of teeth with 5 mm≤CAL<7 mm at the sixth month. There were significant positive correlations between clinical periodontal inflammation and the presence of neopterin and VCAM-1 in GCF prior to and following periodontal treatment, and between the GCF volume and clinical parameters. Conclusions Data suggest that the total amount and concentration of neopterin and VCAM-1 in GCF seemed to be closely associated with periodontal disease severity in CP patients with AMI. Moreover, the results of our study demonstrate that the past periodontal status is potentially correlated between groups, with similar periodontal disease severity.


Subject(s)
Humans , Male , Female , Adult , Aged , Gingival Crevicular Fluid/chemistry , Vascular Cell Adhesion Molecule-1/analysis , Neopterin/analysis , Chronic Periodontitis/pathology , Chronic Periodontitis/therapy , Myocardial Infarction/pathology , Reference Values , Time Factors , Severity of Illness Index , Enzyme-Linked Immunosorbent Assay , Case-Control Studies , Periodontal Index , Dental Plaque Index , Analysis of Variance , Treatment Outcome , Periodontal Attachment Loss , Statistics, Nonparametric , Risk Assessment/methods , Chronic Periodontitis/complications , Middle Aged , Myocardial Infarction/etiology
16.
Braz. j. infect. dis ; 21(6): 577-580, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-888919

ABSTRACT

ABSTRACT The aim of this study was to compare the predictions of Framingham cardiovascular (CV) risk score (FRS) and the American College of Cardiology/American Heart Association (ACC/AHA) risk score in an HIV outpatient clinic in the city of Vitoria, Espirito Santo, Brazil. In a cross-sectional study 341 HIV infected patients over 40 years old consecutively recruited were interviewed. Cohen's kappa coefficient was used to assess agreement between the two algorithms. 61.3% were stratified as low risk by Framingham score, compared with 54% by ACC/AHA score (Spearman correlation 0.845; p < 0.000). Only 26.1% were classified as cardiovascular high risk by Framingham compared to 46% by ACC/AHA score (Kappa = 0.745; p < 0.039). Only one out of eight patients had cardiovascular high risk by Framingham at the time of a myocardial infarction event registered up to five years before the study period. Both cardiovascular risk scores but especially Framingham underestimated high-risk patients in this HIV-infected population.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Algorithms , Cardiovascular Diseases/etiology , HIV Infections/complications , Risk Assessment/methods , United States , Cardiology , Cross-Sectional Studies , Risk Factors , American Heart Association , Myocardial Infarction/etiology
17.
Rev. bras. reumatol ; 57(5): 412-418, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-899444

ABSTRACT

Abstract Objective: To estimate the prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis. Methods: A cross-sectional study using the American College of Rheumatology diagnostic criteria in order to select patients seen at primary or secondary health care units in Blumenau, Santa Catarina, Southern Brazil, in 2014. The presence of ischemic heart disease was defined as an acute myocardial infarction with percutaneous coronary intervention or coronary artery bypass graft surgery that has occurred after diagnosis. Fischer's exact test, Wald's linear trend test, and multivariate logistic regression analysis were used to test the associations. Results: Among 296 patients (83.1% female) with a mean age of 56.6 years and a mean rheumatoid arthritis duration of 11.3 years, 13 reported having acute myocardial infarction requiring a percutaneous or surgical reperfusion procedure, a prevalence of 4.4% (95% CI 2.0-6.7). Diabetes Mellitus (odds ratio [OR] 4.9 [95% CI 1.6-13.8]) and disease duration >10 years (OR 8.2 [95% CI 1.8-39.7]) were the only factors associated with an ischemic disease that remained in the final model, after the multivariate analysis. Conclusion: The prevalence of acute myocardial infarction was similar to that observed in other studies. Among the traditional risk factors, Diabetes Mellitus, and among the factors related to rheumatoid arthritis, disease duration, were the variables associated with comorbidity.


Resumo Objetivo: Estimar a prevalência da doença isquêmica cardíaca e os fatores associados em pacientes com artrite reumatoide. Métodos: Estudo transversal que usou o critério diagnóstico do Colégio Americano de Reumatologia para selecionar pacientes atendidos nas unidades de saúde da atenção primária ou secundária em Blumenau, Santa Catarina, sul do Brasil, em 2014. A presença de doença cardíaca isquêmica foi definida com infarto agudo do miocárdio com intervenção coronariana percutânea ou cirurgia de revascularização do miocárdio que tenha ocorrido depois do diagnóstico. Para testar as associações usou-se o teste exato de Fischer, o teste de tendência linear de Wald e a análise de regressão logística multivariada. Resultados: Entre 296 pacientes, 83,1% de mulheres, com média de 56,6 anos, tempo médio de artrite reumatoide de 11,3 anos, 13 relatam ter tido infarto agudo do miocárdio que necessitou de procedimento de reperfusão percutânea ou cirúrgica, prevalência de 4,4% (IC 95% 2,0-6,7). O diabetes melittus (razão de chance de 4,9 [IC 95% 1,6-13,8]) e o tempo de doença maior do que 10 anos (razão de chance de 8,2 [IC 95% 1,8-39,7]) foram os únicos fatores associados com a doença isquêmica que permaneceram no modelo final após análise multivariada. Conclusão: A prevalência de infarto agudo do miocárdio foi semelhante com a observada em outros estudos. Entre os fatores de risco tradicionais e entre os fatores relacionados à artrite reumatoide, o diabetes melittus e o tempo de doença foram as variáveis associadas à comorbidade


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Arthritis, Rheumatoid/complications , Myocardial Infarction/etiology , Brazil , Logistic Models , Odds Ratio , Prevalence , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , Self Report , Middle Aged , Myocardial Infarction/epidemiology
19.
Arq. bras. cardiol ; 108(4): 361-369, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838726

ABSTRACT

Abstract Obstructive sleep apnea (OSA) has been associated to cardiovascular risk factors. However, the association between OSA and cardiovascular disease is still controversial. The objective of the present study was to verify the association between OSA and myocardial infarction (MI). This is a systematic review of the literature performed through electronic data sources MEDLINE/PubMed, PubMed Central, Web of Science and BVS -Biblioteca Virtual em Saúde (Virtual Health Library). The descriptors used were: 'obstructive sleep apnea' AND 'polysomnography' AND 'myocardial infarction' AND 'adults NOT 'treatment.' The present work analysed three prospective studies, selected from 142 articles. The studies followed a total sample of 5,067 OSA patients, mostly composed by male participants. All patients underwent night polysomnography, and all studies found an association between OSA and fatal and non-fatal cardiovascular outcomes. Thus, we were able to observe that 644 (12.7%) of the 5,067 patients suffered MI or stroke, or required a revascularization procedure, and 25.6% of these cardiovascular events were fatal. MI was responsible for 29.5% of all 644 analysed outcomes. There is an association between OSA and MI, in male patients, and apnea and hypopnea index (AHI) are the most reliable markers.


Resumo A apneia obstrutiva do sono (AOS) tem sido associada a fatores de risco cardiovascular, porém a relação entre a AOS e doença cardiovascular ainda é controversa. O objetivo do presente estudo foi verificar a associação entre AOS e infarto do miocárdio (IM). Revisão sistemática de literatura por meio das fontes de dados eletrônicas MEDLINE/PubMed, PubMed Central, Web of Science e Biblioteca Virtual em Saúde (BVS). Os descritores utilizados foram: "obstructive sleep apnea" AND "polysomnography" AND "myocardial infarction" AND "adults" NOT "treatment".O presente trabalho analisou três estudos prospectivos, selecionados dentre 142 artigos encontrados. Os estudos acompanharam uma amostra total de 5.067 pacientes diagnosticados com AOS, composta majoritariamente por participantes do sexo masculino. Todos os pacientes realizaram polissonografia noturna, e todas as pesquisas encontraram associação entre AOS e desfechos cardiovasculares fatais e não fatais. Assim, foi possível observar que 644 (12,7%) dos 5.067 pacientes sofreram IM ou acidente vascular cerebral, ou precisaram de procedimento de revascularização, sendo que 25,6% desses eventos cardiovasculares foram fatais. O IM foi responsável por 29,5% do total de 644 desfechos analisados. Existe associação entre AOS e IM, no sexo masculino, sendo o índice de apneia e hipopneia (IAH) um dos marcadores mais fidedignos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Sleep Apnea, Obstructive/complications , Myocardial Infarction/etiology , Sex Factors , Risk Factors , Polysomnography/methods , Sleep Apnea, Obstructive/diagnosis , Hypertension/complications , Myocardial Infarction/mortality
20.
Medicina (B.Aires) ; 76(5): 321-325, Oct. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-841602

ABSTRACT

La estimulación por marcapasos se asocia con eventos adversos graves. En la siguiente serie de casos se evaluó la disincronía mecánica intraventricular izquierda (DMVI) en la estimulación endocárdica prolongada del ventrículo derecho a nivel septal. Se estudiaron 6 personas con marcapasos implantados no antes de un año utilizando SPECT gatillado con 99mTc-MIBI y análisis de fase en reposo. Se registraron variables clínicas, duración del QRS, tasa y modo de estimulación ventricular, presencia y extensión de isquemia y/o infarto, volúmenes cavitarios y FEVI en reposo. Utilizando V-Sync de Emory Cardiac Toolbox se obtuvieron el ancho de banda (AB) y el desvío estándar de fase (DEF) en reposo (grados), comparándolos con una población control. La estimulación endocárdica prolongada en el septum ventricular derecho se asoció con marcada DMVI, aun cuando la función sistólica estaba conservada. Aquellos con FEVI moderada/gravemente disminuida (caracterizados por diámetros cavitarios mayores, infarto o isquemia grave) exhibieron mayor disincronía que aquellos con FEVI conservada/levemente disminuida (AB: 177.3o vs. 88.3o; DEF: 53.1o vs. 33.8o). En los casos con cardiopatía isquémica portadores de marcapasos, el AF es una herramienta válida de potencial utilidad para evaluar la disincronía asociada al infarto y, eventualmente, aportar a la decisión oportuna del pasaje al modo de estimulación biventricular.


Pacemaker stimulation is associated with unpredictable severe cardiac events. We evaluated left ventricular mechanical dyssynchrony (LVMD) during prolonged septal right ventricular pacing. We performed 99mTc-MIBI gated-SPECT and phase analysis in 6 patients with pacemakers implanted at least one year before scintigraphy due to advanced atrioventricular block. Using V-Sync of Emory Cardiac Toolbox we obtained phase bandwidth (PBW) and standard deviation (PSD) from rest phase histogram. Clinical variables, QRS duration, rate and mode of pacing in septal right ventricle wall, chamber diameters, presence and extension of myocardial scar and ischemia and rest LVEF were recorded. Prolonged septal endocardial pacing is associated with marked LVMD, even when systolic function was preserved. More severe dyssynchrony was found in patients with impaired LVEF, higher left ventricle diameters, extensive infarct or severe ischemia than in patients with preserved LVEF (PBW: 177.3o vs. 88.3o; PSD: 53.1o vs. 33.8o). In the patients with ischemic heart disease and pacemaker, gated-SPECT phase analysis is a valid and potentially useful technique to evaluate LMVD associated with myocardial scar and to decide the upgrading to biventricular pacing mode.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pacemaker, Artificial/adverse effects , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Septum/physiopathology , Severity of Illness Index , Ventricular Dysfunction, Left/diagnostic imaging , Electrocardiography , Ventricular Septum/diagnostic imaging , Atrioventricular Block/surgery , Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography , Myocardial Infarction/etiology , Myocardial Infarction/diagnostic imaging
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