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Bol. méd. postgrado ; 37(1): 21-26, Ene-Jun 2021. graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1147874


El tratamiento anticoagulante oral con fármacos inhibidores de la vitamina K como la warfarina se viene utilizando desde hace décadas para la terapia y prevención de la enfermedad tromboembólica con efectos secundarios ampliamente conocidos, pero con una utilidad clínica bien contrastada. El objetivo de este estudio fue determinar la proporción de mortalidad y hospitalización de la consulta de anticoagulación y trombosis del Centro Cardiovascular Regional ASCARDIO en el año 2017 para lo cual se realizó un estudio descriptivo transversal que incluyó una muestra de 294 pacientes. La principal indicación de anticoagulación fue la fibrilación auricular (73%) seguida de la enfermedad tromboembólica venosa (13%) e isquemia miocárdica (9%). Se registró una mortalidad de 11,7% siendo la principal causa de muerte de origen cardíaco (58%). La edad promedio de los pacientes fallecidos fue de 65 años, siendo 53% del sexo femenino; para el momento de la muerte, el 65% de los pacientes estaba tomando warfarina. La hospitalización se observó en el 10% de la muestra siendo la principal causa de la misma la cardíaca (60%) seguida de causas hemorrágicas (18%); de los pacientes hospitalizados, la edad promedio fue de 66 años siendo 52% del sexo femenino; el 90% de los pacientes estaba tomando warfarina al momento de la hospitalización. El análisis de riesgo para mortalidad y hospitalización según causa y estatus de warfarina no mostró significancia estadística. No se evidenció relación de riesgo estadísticamente significativa entre muerte, hospitalización y estatus de la warfarina. Hubo mayor proporción de muertes (45%) y hospitalización (17%) en el grupo que ingresó con diagnóstico de isquemia miocárdica(AU)

Oral anticoagulant treatment with vitamin K inhibitor drugs such as warfarin has been used for decades for the therapy and prevention of thromboembolic disease with widely known side effects but with well-proven clinical utility. To determine the proportion of mortality and hospitalization of the anticoagulation and thrombosis clinic of the ASCARDIO Regional Cardiovascular Center in 2017 a descriptive cross-sectional study was carried out that included a sample of 294 patients. The results show that the main indication for anticoagulation was atrial fibrillation (73%) followed by venous thromboembolic disease (13%) and myocardial ischemia (9%). An 11.7% mortality rate was observed. The mean age of the deceased was 65 years with a slight prevalence of the female sex (53%). The main cause of death was cardiac (58%) and 65% of the deceased patients were taking warfarin at the moment of death. A 10% hospitalization rate was observed with an average age of hospitalized patients of 66 years; 52% were females. The main cause of hospitalization was cardiac (60%) followed by hemorrhage (18%) and 90% of the patients were taking warfarin at the time of hospitalization. The risk analysis for mortality and hospitalization according to cause and status of warfarin did not show statistical significance. There was a higher proportion of deaths (45%) and hospitalization (17%) in the group admitted with a diagnosis of myocardial ischemia(AU)

Humans , Male , Female , Aged , Vitamin K/antagonists & inhibitors , Warfarin/therapeutic use , Venous Thrombosis/drug therapy , Anticoagulants , Atrial Fibrillation/drug therapy , Thromboembolism , Vascular Diseases , Myocardial Ischemia/drug therapy
Article in Chinese | WPRIM | ID: wpr-888044


In this study, the compound search was completed through SciFinder and CNKI databases, and the drug-like properties were screened in FAFdrugs4 and SEA Search Server databases. In addition, based on the target sets related to acute myocardial ischemia(AMI) searched in disease target databases such as OMIM database, GeneCards database and DrugBank, a network diagram of chemical component-target-pathway-disease was established via Cytoscape to predict the potential active components of Corydalis Herba, a traditional Tibetan herbal medicine which derived from the aerial parts of Corydalis hendersonii and C. mucronifera against AMI. A protein-protein interaction(PPI) network was constructed through the STRING database and the core targets in the network were predicted. And the enrichment analyses of core targets were completed by DAVID database and R software. Furthermore, a molecular docking method was used to verify the binding of the components with core targets using softwares such as Autodock Vina. The present results showed that there were 60 compounds related to AMI in Corydalis Herba, involving 73 potential targets. The GO functional enrichment analysis obtained 282 biological processes(BP), 49 cell components(CC) and 78 molecular functions(MF). KEGG was enriched into 85 pathways, including alcoholism pathway, endocrine resistance pathway, calcium signaling pathway, cAMP signaling pathway, vascular endothelial growth factor signaling pathway and adrenergic signaling transduction pathway of myocardial cells. The results of network topology analysis showed that the key components of anti-AMI of Corydalis Herba might be tetrahydropalmatine, etrahydrocolumbamine, N-trans-feruloyloctopamine, N-cis-p-coumaroyloctopamine, N-trans-p-coumaroylnoradrenline and N-trans-p-coumaroyloctopamine, and their core targets might be CDH23, SCN4 B and NFASC. The results of molecular docking showed that the key components of Corydalis Herba had stable binding activity with the core targets. This study provides reference for further elucidation of the pharmacological effects of Corydalis Herba against AMI, subsequent clinical application, and development.

Corydalis , Drugs, Chinese Herbal/pharmacology , Medicine, Tibetan Traditional , Molecular Docking Simulation , Myocardial Ischemia/drug therapy , Vascular Endothelial Growth Factor A
Article in Chinese | WPRIM | ID: wpr-879185


Rhus chinensis is an important resource plant. The aqueous extract of R. chinensis roots or stems was to produce Shuguantong Syrup, which is mainly used for the treatment of coronary heart disease and angina pectoris with definite curative effect. On this basis, the crude phenolic part of R. chinensis prepared by macroporous resin was evaluated for the cardio protective effect against myocardial ischemia in mice. The results showed that the phenolic part group with oral administration at the dosages of 190.8-381.6 mg·kg~(-1), compared with the model group, reduced the values of left ventricular end systolic diameter(LVEDs) and the left ventricular end diastolic diameter(LVEDd), and increased the cardiac ejection fraction(EF) and left ventricular fractional shortening(FS) rate, which could effectively improve cardiac function and exert its anti-myocardial ischemia effect, and reduce the rising levels of creatine kinase isoenzyme(CK-MB) and lactate dehydrogenase(LDH) in serum. HE staining showed that the phenolic part group reduced the infiltration of myocardial inflammatory cells and alleviated the degree of myocardial fibrosis and collagen deposition. TUNEL staining showed that the blue-green fluorescence of the phenolic part group decreased successively, and the degree of myocardial cell apoptosis was reduced. Immunohistochemical staining suggested that it could reduce the number of positive cells for p53 protein expression and significantly improve myocardial cell damage. All above data suggested that the phenolic part group had an anti-mycardial ischemis effect. Related mechanism studies revealed that the crude phenolic part could regulate the expressions of the p53 gene(p53), Bcl-2-associated X protein(Bax), B lymphoma-2 gene(Bcl-2), and caspase-3 protein(caspase-3) in myocardial tissue, suggesting that it could reduce cardiac remodeling and myocardial ischemic damage, and improve cardiac function by inhibiting myocardial apoptosis.This research laid a foundation for the elucidation of the pharmacological ingredients R. chinensis.

Animals , Apoptosis , Mice , Myocardial Ischemia/drug therapy , Myocardium , Myocytes, Cardiac , Plant Extracts/pharmacology , Rhus , bcl-2-Associated X Protein
Electron. j. biotechnol ; 45: 46-52, May 15, 2020. tab, graf, ilus
Article in English | LILACS | ID: biblio-1177424


BACKGROUND: The present study analyzed the synergistic protective effect of ß-alanine and taurine against myocardial ischemia/reperfusion. Myocardial infarct size, lipid peroxidation, and levels of glutathione peroxidase (Gpx), superoxide dismutase (SOD), reduced glutathione (GSH), catalase, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), reactive oxygen species (ROS), apoptosis, and the mRNA and protein expression of Janus kinase 2 (JAK2) and signal transducer and activator 3 of transcription (STAT3) were determined. The molecular docking was carried out by using AutoDock 4.2.1. RESULTS: Combined treatment with ß-alanine and taurine reduced myocardial infarct size, lipid peroxidation, inflammatory marker, ROS levels, and apoptosis and increased Gpx, SOD activity, GSH, and catalase activity. Furthermore, combined treatment significantly reduced JAK2 and STAT3 mRNA and protein expression compared with the control. The small molecule was docked over the SH2 domain of a STAT3, and binding mode was determined to investigate the inhibitory potential of ß-alanine and taurine. ß-Alanine bound to SH2 domain with ΔG of -7.34 kcal/mol and KI of 1.91 µM. Taurine bound to SH2 domain with ΔG of -7.38 kcal/mol and KI of 1.95 µM. CONCLUSION: Taken together, these results suggest that the combined supplementation of ß-alanine and taurine should be further investigated as an effective therapeutic approach in achieving cardioprotection in myocardial ischemia/reperfusion.

Animals , Male , Rats , Taurine/therapeutic use , Cardiotonic Agents/therapeutic use , Reperfusion Injury/drug therapy , beta-Alanine/therapeutic use , Myocardial Ischemia/drug therapy , Superoxide Dismutase , Immunohistochemistry , Lipid Peroxidation , Reactive Oxygen Species , Rats, Wistar , Reverse Transcriptase Polymerase Chain Reaction , Disease Models, Animal , Janus Kinase 2 , Molecular Docking Simulation , Glutathione Peroxidase , Heart Diseases/drug therapy , Inflammation
Acta cir. bras ; 35(3): e202000306, 2020. graf
Article in English | LILACS | ID: biblio-1130620


Abstract Purpose To evaluate whether the attenuation of mitochondrial Ca2+ overload produced by pharmacological blockade of mitochondrial Ca2+ uniporter (MCU) protects the myocardium against injuries caused by cardiac ischemia and reperfusion (CIR). Methods CIR was induced in adult male Wistar rats (300-350 g) by occlusion of the left anterior descendent coronary artery (10 min), followed by reperfusion (120 min). Rats were treated with different doses of MCU blocker ruthenium red (RuR), administered 5 min before ischemia or reperfusion. Results In untreated rats, the incidences of ventricular arrhythmias (VA), atrioventricular block (AVB) and the lethality (LET) induced by CIR were 85%, 79% and 70%, respectively. In rats treated with RuR before ischemia, the incidences of VA, AVB and LET were significantly reduced to 62%, 25% and 25%, respectively. In rats treated with RuR after ischemia, the incidences of VA, AVB and LET were significantly reduced to 50%, 25% and 25%, respectively. Conclusion The significant reduction of the incidence of CIR-induced VA, AVB and LET produced by the treatment with RuR indicates that the attenuation of mitochondrial Ca2+ overload produced by pharmacological blockade of MCU can protect the myocardium against injuries caused by CIR.

Animals , Male , Rats , Calcium Channels/drug effects , Myocardial Reperfusion Injury/drug therapy , Myocardial Ischemia/drug therapy , Calcium , Rats, Wistar
Arch. cardiol. Méx ; 87(2): 116-123, Apr.-Jun. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-887505


Resumen: Objetivo: Evaluar la utilidad diagnóstica y pronóstica de la cardiorresonancia magnética de estrés (RMCE) en pacientes con distinto perfil de riesgo cardiovascular y la importancia del grado de hipoperfusión en la toma de decisiones clínicas. Método: Se analizaron los pacientes sometidos a RMCE con adenosina por sospecha de isquemia miocárdica. Se evaluó su precisión diagnóstica mediante los cocientes de probabilidad (CP) y su valor pronóstico mediante curvas de supervivencia y regresión de Cox. Resultados: Se estudió a 295 pacientes. El CP positivo fue 3.40 y el negativo 0.47. Se demostró una mayor utilidad de la resonancia en: pacientes sin cardiopatía isquémica conocida (CP positivo 4.85); pacientes con dolor torácico atípico (CP positivo 8.56);pacientes con riesgo cardiovascular bajo o intermedio (CP positivo 3.87), y pacientes con hipoperfusión moderada o grave (CP positivo 8.63). Se registraron 60 eventos cardiovasculares mayores. Los pacientes con resultado negativo (p = 0.001) o hipoperfusión leve (p = 0.038) presentaron una supervivencia mayor. En el análisis multivariante, un resultado moderado o grave aumentó la probabilidad de sufrir eventos (hazard ratio [HR] = 2.2; IC 95% 1.26-3.92), sin diferencias entre resultado positivo leve y negativo (HR = 0.93; IC 95% 0.38-2.28). Conclusiones: La RMCE tuvo una mayor utilidad en pacientes con riesgo cardiovascular bajo o intermedio, con dolor torácico atípico, sin cardiopatía isquémica conocida y en aquellos con hipoperfusión moderada o grave. Además, el grado de hipoperfusión fue el principal factor para guiar las decisiones clínicas.

Abstract: Objective: The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions. Method: We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model. Results: 295 patients were studied. The positive LR was 3.40 and the negative one 0.47. The maximal usefulness of the test was found in patients without previous ischemic cardiomyopathy (positive LR 4.85), patients with atypical chest pain (positive LR 8.56), patients with low or intermediate cardiovascular risk (positive LR 3.87) and those with moderate or severe hypoperfusion (positive LR 8.63). Sixty cardiovascular major events were registered. The best survival prognosis was found in patients with a negative result (p = 0.001) or mild hypoperfusion (p = 0.038). In the multivariate analysis, a moderate or severe hypoperfusion increased cardiovascular event probability (HR = 2.2; IC 95% 1.26-3.92), with no differences between a mild positive and a negative result (HR = 0.93; IC 95% 0.38-2.28). Conclusions: Stress CMR was specially useful in patients with low or intermediate cardiovascular risk, patients with atypical chest pain, patients without previous ischemic cardiomyopathy and those with moderate or severe hypoperfusion. Hypoperfusion degree was the main issue factor to guide clinical decisions.

Humans , Male , Female , Middle Aged , Magnetic Resonance Imaging , Myocardial Ischemia/drug therapy , Exercise Test/methods , Prognosis , Cardiovascular Diseases/epidemiology , Predictive Value of Tests , Prospective Studies , Risk Factors , Cardiac-Gated Imaging Techniques
Rev. Assoc. Med. Bras. (1992) ; 63(3): 252-260, Mar. 2017. tab
Article in English | LILACS | ID: biblio-956430


Summary Introduction: The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine. Objective: To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources, approaching patients with ischemic heart disease. Method: A cross-sectional study was conducted using face-to-face interviews. We applied semi-structured questionnaires to 347 individuals and recorded 141 interviews for qualitative analysis. Descriptors were selected to identify eight categories of analyses. The quantitative data were submitted to descriptive analysis of frequency. Results: Only 2% had good medication adherence according to score on Morisky questionnaire. About 23% bought statins; the others obtained statin in the public health institution. Thirty-six speeches were selected and classified according to the following categories: knowledge about disease and medication, difficulty of acquisition, self management of treatment, difficulties of access to health services, side effect of statins, caregiver support, transportation to health services and concerns about the disease progression. However, it was noticed that about 1/3 of the care outside the research institution can be characterized as an attempt to bring rationalization to the health system. Conclusion: The improved adherence to chronic treatment of ischemic heart disease depends on the establishment of effective flows for referral and counter-referral from one care unit to another, relevant information and clarification of the questions for the patients and the attention of health professionals to the many social and cultural factors involved in treatment adherence. New research should be focused on educational groups by integrated multidisciplinary teams in order to share treatment decisions, thereby increasing the patient's commitment to his own health.

Resumo Introdução: A efetividade do tratamento das doenças crônicas depende da participação do paciente, influenciada por diferentes motivos socioculturais, pouco reconhecidos pela rotina assistencial. Objetivo: Identificar os fatores de adesão ao tratamento e o uso dos recursos assistenciais de pacientes com doença isquêmica do coração. Método: Estudo transversal com entrevistas presenciais de 347 indivíduos submetidos a questionários semiestruturados, com 141 delas gravadas para análise qualitativa com identificação dos descritores distribuídos por oito categorias. Os dados quantitativos tiveram análise descritiva de frequência. Resultados: Somente 2% tiveram boa adesão medicamentosa; 23% compraram estatina, os demais obtiveram o medicamento em serviços públicos. Foram classificadas 36 falas com as categorias: conhecimento sobre a doença e o tratamento, dificuldade de aquisição do medicamento, gerenciamento pessoal do tratamento, acesso aos serviços de saúde, efeito colateral das estatinas, apoio do cuidador, transporte até o ambulatório, receios quanto à evolução da doença, efeito colateral das estatinas. Foi observado que 1/3 dos atendimentos fora da instituição podem ser caracterizados como tentativa de racionalização da rede. Conclusão: A melhora da adesão ao tratamento da doença isquêmica do coração depende do estabelecimento de fluxos efetivos para referência e contrarreferência entre unidades assistenciais; adequada informação e esclarecimento das dúvidas do paciente; atenção dos profissionais de saúde aos múltiplos fatores sociais e culturais envolvidos com a adesão. São necessários novos estudos sobre o papel da assistência farmacêutica, grupos educativos e integração da equipe multiprofissional no engajamento do paciente para compartilhar as decisões sobre o tratamento, e assim ampliar seu grau de comprometimento com a própria saúde.

Humans , Male , Female , Myocardial Ischemia/drug therapy , Medication Adherence/statistics & numerical data , Self Care , Socioeconomic Factors , Chronic Disease , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Treatment Outcome , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Qualitative Research , Health Services Accessibility/statistics & numerical data
Lima; s.n; jun. 2016.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848617


INTRODUCCIÓN: Antecedentes: El presente dictamen expone la evaluación de tecnología sanitaria acerca de la eficacia y seguridad del medicamento Trimetazidina 35mg para el tratamiento de pacientes con cardiopatía isquémica refractaria y no tributarios a revascularización miocárdica percutánea o quirúrgica. Aspectos Generales: La angina pectoris estable es un síndrome clínico de dolor, presión o molestia temporal en el pecho pudiéndose extender a la mandíbula, hombro, espalda o brazo. Es la manifestación clínica más común de la cardiopatía isquémica, la cual es la principal causa de muerte en los Estados Unidos. Los factores pronósticos más importantes de la angina pectoris son la función sistólica ventricular y clase funcional además de co-morbilidades como la diabetes mellitus y la enfermedad vascular periférica. Tecnología Sanitaria de Interés: El medicamento Trimetazidina (Vastarel®, Laboratorios Servier) es un anti-angínico, inhibidor parcial de la oxidación de ácidos grasos, con fórmula química Trimetazidina-1-(2,3,4 trimetoxi benzil)-piperazina dihidroclorido, que inhibe la enzima [3-Ketoacil-CoA tiolasa, la cual forma parte del proceso de oxidación de ácidos grasos en las células. METODOLOGIA: Estrategia de Busqueda: Se realizó una estrategia de búsqueda sistemática de la evidencia científica con respecto a la eficacia y seguridad de TMZ 35mg en pacientes con angina estable sintomática severa que han recibido terapia óptima con nitratos, calcio - antagonistas y beta bloqueadores en dosis máximas tolerables y no son tributarios de ser beneficiarios mediante revascularización miocárdica percutánea o quirúrgica. Para la búsqueda primaria se revisó la información disponible por entes reguladoras y normativas como la Administración de Drogas y Alimentos (FDA), la EMA y la DIGEMID. Posteriormente se buscaron Guías de Práctica Clínica a través de los metabuscadores: Translating Research into Practice (TRIPDATABASE), National Library of Medicine (Pubmed-Medline), The National Guideline of Clearinghouse, y Health Systems Evidence. Finalmente, se realizó una búsqueda dentro de la información generada por grupos internacionales que realizan revisiones sistemáticas, evaluación de tecnologías sanitarias y guías de práctica clínica, tales como The Cochrane Library, The National Institute for Health and Care Excellence (NICE), The Canadian Agency for Drugs and Technologies in Health (CADTH), The Scottish Medicines Consortium (SMC), que a su vez fue complementada con una búsqueda en, para identificar estudios primarios en elaboración o que no hayan sido publicados aún. RESULTADOS: Tras la búsqueda bibliográfica se encontró evidencia que sustenta la eficacia y seguridad de TMZ 35mg en pacientes con angina estable sintomática severa que han recibido terapia óptima con nitratos, calcio ­ antagonistas y beta bloqueadores a dosis máximas tolerables y no son tributarios de ser beneficiarios mediante revascularización miocárdica percutánea o quirúrgica. Sinopsis de la Evidencia: Se encontró evidencia acerca de la eficacia y seguridad de TMZ 35mg en pacientes con angina estable sintomática severa que han recibido terapia óptima con nitratos, calcio - antagonistas y beta bloqueadores a dosis máximas tolerables y no son tributarios de ser beneficiarios mediante revascularización miocárdica percutánea o quirúrgica. CONCLUSIONES: En la presente evaluación de tecnología sanitaria se ha encontrado evidencia acerca de la eficacia y seguridad de TMZ en pacientes con cardiopatía isquémica refractaria y que no son tributarios de ser beneficiarios mediante revascularización miocárdica percutánea o quirúrgica. Los resultados de las revisiones sistemáticas de ensayos clínicos aleatorizados evidencian que TMZ no ha demostrado ser superior a otros agentes anti-angínicos como monoterapia de primera línea. Sin embargo, se encontraron resultados de eficacia muy limitada para el tratamiento con TMZ como medicamento concomitante a otras terapias óptimas como beta-bloqueadores, calcio-antagonistas y nitratos en pacientes cuya condición clínica no haya sido controlada adecuadamente por los mismos o que sean intolerantes a ellas. Se encontró que la eficacia mínima de TMZ en terapia combinada, fue evaluada para desenlaces secundarios y no relevantes para la evaluación establecida en el presente Dictamen. No existen en la actualidad estudios que evalúen desenlaces duros y clínicamente importantes desde la perspectiva del paciente. El Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, no aprueba el uso de Trimetazidina MR 35mg BID para el tratamiento de pacientes con cardiopatía isquémica refractaria y que no son tributarios a revascularización miocárdica percutánea o quirúrgica. El presente Dictamen Preliminar tiene vigencia de dos años a partir de la fecha de su publicación.

Humans , Trimetazidine/administration & dosage , Myocardial Ischemia/drug therapy , Angina, Stable/physiopathology , Myocardial Revascularization/methods , Treatment Outcome , Cost-Benefit Analysis
Braz. j. med. biol. res ; 49(2): e5039, 2016. tab, graf
Article in English | LILACS | ID: biblio-951660


Phosphorylated-cyclic adenosine monophosphate response element-binding protein (Phospho-CREB) has an important role in the pathogenesis of myocardial ischemia. We isolated the iridoid glycoside cornin from the fruit of Verbena officinalis L, investigated its effects against myocardial ischemia and reperfusion (I/R) injury in vivo, and elucidated its potential mechanism in vitro. Effects of cornin on cell viability, as well as expression of phospho-CREB and phospho-Akt in hypoxic H9c2 cells in vitro, and myocardial I/R injury in vivo, were investigated. Cornin attenuated hypoxia-induced cytotoxicity significantly in H9c2 cells in a concentration-dependent manner. Treatment of H9c2 cells with cornin (10 µM) blocked the reduction of expression of phospho-CREB and phospho-Akt in a hypoxic condition. Treatment of rats with cornin (30 mg/kg, iv) protected them from myocardial I/R injury as indicated by a decrease in infarct volume, improvement in hemodynamics, and reduction of severity of myocardial damage. Cornin treatment also attenuated the reduction of expression of phospho-CREB and phospho-Akt in ischemic myocardial tissue. These data suggest that cornin exerts protective effects due to an increase in expression of phospho-CREB and phospho-Akt.

Animals , Male , Myocardial Ischemia/drug therapy , Verbena/chemistry , CREB-Binding Protein/metabolism , Iridoid Glycosides/pharmacology , Fruit/chemistry , Phytotherapy , Troponin/blood , Cell Line/drug effects , Cell Survival/drug effects , Blotting, Western , Rats, Sprague-Dawley , Creatine Kinase/blood , Disease Models, Animal , CREB-Binding Protein/drug effects , Iridoid Glycosides/isolation & purification , Hypoxia/drug therapy
Rev. bras. anestesiol ; 64(4): 281-285, Jul-Aug/2014. graf
Article in English | LILACS | ID: lil-720476


A 58-year-old female without cardiovascular risk factors, was going to be operated to repair the rotator cuff. Induction and interscalene brachial plexus block were uneventful, but after her placement for surgery the patient started with severe bronchospasm, hypotension, cutaneous allergic reaction and ST elevation on the electrocardiogram. An anaphylactic shock was suspected and treated but until the perfusion of nitroglycerina was started no electrocardiographic changes resolved. After necessary diagnostic test the final diagnosis was variant I of Kounis syndrome due to cefazolin and rocuronium. Ephinephrine is the cornerstone of treatment for anaphylaxis but should we use it if the anaphylactic reaction is also accompanied by myocardial ischemia? The answer is that we should not use it because myocardial ischemia in this syndrome is caused by vasospasm, so it would be more useful drugs such as nitroglycerin. But what if we do not know if it is a Kounis syndrome or not? In this article we report our experience that maybe could help you in a similar situation.

Paciente do sexo feminino, 58 anos, sem fator de risco cardiovascular, submetida a cirurgia para reparação do manguito rotador. A indução do bloqueio do plexo braquial interescalênico foi feita sem intercorrência, mas, após seu posicionamento para a cirurgia, a paciente apresentou broncoespasmo grave, hipotensão, reação alérgica cutânea e elevação do segmento ST ao eletrocardiograma. Houve suspeita de choque anafilático que foi tratado, mas até que a perfusão de nitroglicerina fosse iniciada não houve resolução das alterações eletrocardiográficas. Após teste diagnóstico necessário, o diagnóstico final foi de variante tipo I da síndrome de Kounis por causa de cefazolina e rocurônio. Epinefrina é a base sólida do tratamento para anafilaxia, mas devemos usá-la se a reação anafilática também for acompanhada de isquemia miocárdica? A resposta é que não devemos usá-la, porque a isquemia miocárdica nessa síndrome é causada por vasoespasmo; portanto, drogas como a nitroglicerina seriam mais úteis. Porém, e quando não sabemos se é ou não uma síndrome de Kounis? Neste artigo relatamos nossa experiência que, talvez, possa ajudar em uma situação similar.

Paciente del sexo femenino, 58 años de edad, sin factor de riesgo cardiovascular, sometida a cirugía para la reparación del manguito rotador. La inducción del bloqueo del plexo braquial interescalénico fue realizada sin intercurrencias, pero después de su posicionamiento para la cirugía, la paciente presentó broncoespasmo grave, hipotensión, reacción alérgica cutánea y elevación del segmento ST al electrocardiograma. Hubo sospecha de choque anafiláctico que fue tratado, pero hasta que la perfusión de nitroglicerina se iniciase no hubo resolución de las alteraciones electrocardiográficas. Después del test diagnóstico necesario, el diagnóstico final fue de variante tipo i del síndrome de Kounis debido a la cefazolina y al rocuronio. La epinefrina es la base sólida del tratamiento para la anafilaxia, pero ¿debemos usarla si la reacción anafiláctica también viene seguida de isquemia miocárdica? La respuesta es que no debemos usarla porque la isquemia miocárdica en ese síndrome está causada por el vasoespasmo; por tanto, fármacos como la nitroglicerina serían más útiles. Sin embargo, ¿y cuando no sabemos si es o no un síndrome de Kounis? En este artículo, relatamos nuestra experiencia que, tal vez, pueda ayudarle a usted a hacer frente a una situación similar.

Female , Humans , Middle Aged , Anaphylaxis/diagnosis , Coronary Vasospasm/drug therapy , Myocardial Ischemia/drug therapy , Nitroglycerin/administration & dosage , Androstanols/adverse effects , Cefazolin/adverse effects , Coronary Vasospasm/diagnosis , Coronary Vasospasm/etiology , Electrocardiography , Myocardial Ischemia/diagnosis , Myocardial Ischemia/etiology , Rotator Cuff/surgery , Syndrome , Vasodilator Agents/administration & dosage
Article in English | IMSEAR | ID: sea-154406


Idopathic pulmonary artery aneurysm (PAA) is a rare lesion. Clinical experience with this condition is limited and current knowledge is mainly derived from autopsy findings. We report a patient who came to us with complaints of chest pain, breathlessness on exertion and pedal oedema and was diagnosed to have PAA.

Adrenergic beta-Antagonists/therapeutic use , /diagnosis , Diagnosis, Differential , Diuretics/therapeutic use , Echocardiography , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Ischemia/diagnosis , Myocardial Ischemia/drug therapy , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Treatment Refusal
Bogotá; IETS; oct. 2013.
Monography in Spanish | LILACS, BRISA | ID: biblio-847415


Antecedentes: Descripción de la condición de salud de interés (indicación): La isquemia miocárdica es un problema causado por el estrechamiento de las arterias que irrigan el corazón. Cuando hay obstrucciones en las arterias, se disminuye el flujo de sangre y oxígeno que irriga el músculo cardiaco. En el momento en que \r\naumentan los requerimientos de oxígeno, como con el ejercicio, el corazón no puede satisfacer la demanda del mismo, por lo cual se generan los síntomas. La cardiopatía isquémica es un síndrome que abarca una serie de patologías que incluyen: la angina estable e inestable, síndrome coronario agudo, y la cardiopatía isquémica crónica. Descripción de la tecnología: El nebivolol es un beta bloqueador selectivo ß-1 de los receptores cardíacos, posee acción vasodilatadora, su acción es prolongada. Es empleado en el tratamient o de la hipertensión arterial, angina de pecho, insuficiencia cardíaca congestiva. Evaluación de efectividad y seguridad: Pregunta de evaluación: En adultos mayores de 18 años con isquemia miocárdica, no complicada¿ Cuál es la efectividad y seguridad de nebivolol comparado con metoprolol como tratamiento ambulatorio de primer a línea? La pregunta de investigación fue refinada y validada con base en: autorización de mercadeo de la tecnología para la indicación de interés (registro sanitario INVIMA), listado de medicamentos vitales no disponibles, cobertura de las tecnologías en el Plan Obligatorio de Salud (POS) (Acuerdo 029 de 2011), revisión de grupos terapéuticos (código ATC: Anatomical, Therapeutic, \r\nChemical classification system), recomendaciones de guías de práctica clínica actualizadas, disponibilidad de evidencia sobre efectividad y seguridad (reportes de evaluación de tecnologías, revisiones sistemáticas de la literatura), uso de las tecnologías (listas nacionales de recobro, estadísticas de prescripción, etc), consulta con expertos temáticos (especialistas clínicos), y otros actores clave. No se identificaron otros comparadores relevantes para la evaluación. Población: Adultos mayores de 18 años con \r\nisquemia miocárdica, no complicada. Tecnología de interés: Nebivolol. Metodología: Búsqueda de literatura, Búsqueda en bases de datos electrónicas. Conclusiones: Efectividad: no se identificó evidencia de efectividad que describa el uso de nebivolol comparado con metoprolol para el tratamiento de la isquemia miocárdica. \r\nSeguridad: no se identificó evidencia de seguridad que describa el uso de nebivolol comparado con metoprolol para el tratamiento de la isquemia miocárdica. Costo-efectividad: no se identificaron estudios de costo-efectividad para Colombia.

Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Myocardial Ischemia/drug therapy , Nebivolol/administration & dosage , Outpatients , Acute Coronary Syndrome , Angina, Stable , Angina, Unstable , Colombia , Myocardial Ischemia , Technology Assessment, Biomedical , Treatment Outcome
Arq. bras. cardiol ; 97(5): 390-396, nov. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-608930


FUNDAMENTO: A ressuscitação de parada cardíaca pode apresentar disfunção miocárdica determinada pelo tempo da isquemia, e a inibição da enzima conversora de angiotensina (ECA) pode reduzir a disfunção cardíaca durante a reperfusão. OBJETIVO: Investigar os efeitos da angiotensina-I e diferentes períodos de isquemia na recuperação funcional em corações de ratos isolados. MÉTODOS: Os corações isolados de ratos Wistar (n = 45; 250-300 g) foram submetidos a diferentes períodos de isquemia global (20, 25 ou 30 min) e reperfundidos (30 min) com o tampão Krebs-Henseleit, ou com a adição de 400 nmol/L de angiotensina-I, ou com 400 nmol/L de angiotensina-I + 100 µmol/L de captopril durante o período de reperfusão. RESULTADOS: A derivada positiva máxima de pressão (+dP/dt max) e o produto frequência-pressão foram reduzidos nos corações expostos à isquemia de 25 min (~ 73 por cento) e à isquemia de 30 min (~ 80 por cento) vs. isquemia de 20 min. A pressão diastólica final do ventrículo esquerdo (PDFVE) e a pressão de perfusão (PP) foram aumentadas nos corações expostos à isquemia de 25 min (5,5 e 1,08 vezes, respectivamente) e à isquemia de 30 min (6 e 1,10 vezes, respectivamente) vs. isquemia de 20 min. A angiotensina-I ocasionou uma diminuição no +dP/dt max e no produto frequência-pressão (~ 85-94 por cento) em todos os períodos de isquemia e um aumento na PDFVE e na PP (6,9 e 1,25 vezes, respectivamente) apenas na isquemia de 20 min. O captopril foi capaz de reverter parcial ou completamente os efeitos da angiotensina-I na recuperação funcional nas isquemias de 20 e 25 min CONCLUSÃO: Os dados sugerem que a angiotensina-II participa direta ou indiretamente no dano pós-isquêmico e que a capacidade de um inibidor da ECA atenuar esse dano depende do tempo de isquemia.

BACKGROUND: Cardiac arrest resuscitation can present myocardial dysfunction determined by ischemic time, and inhibition of the angiotensin-converting enzyme (ACE) can reduce cardiac dysfunction during reperfusion. OBJECTIVE: To investigate the effects of angiotensin-I and different periods of ischemia on functional recovery in isolated rat hearts. METHODS: Isolated hearts from Wistar rats (n=45; 250-300 g) were submitted to different periods of global ischemia (20, 25 or 30 min) and reperfused (30 min) with Krebs-Henseleit buffer alone or with the addition of 400 nmol/L angiotensin-I, or 400 nmol/L angiotensin-I + 100 mmol/L captopril along the reperfusion period. RESULTS: The maximal positive derivative of pressure (+dP/dt max) and rate-pressure product were reduced in hearts exposed to 25 min ischemia (~73 percent) and 30 min ischemia (~80 percent) vs. 20 min ischemia. Left ventricular end-diastolic pressure (LVEDP) and perfusion pressure (PP) were increased in hearts exposed to 25 min ischemia (5.5 and 1.08 fold, respectively) and 30 min ischemia (6 and 1.10 fold, respectively) vs. 20 min ischemia. Angiotensin-I caused a decrease in +dP/dt max and rate-pressure product (~85-94 percent) in all ischemic periods and an increase in LVEDP and PP (6.9 and 1.25 fold, respectively) only at 20 min ischemia. Captopril was able to partially or completely reverse the effects of angiotensin-I on functional recovery in 20 min and 25 min ischemia. CONCLUSION: These data suggest that angiotensin-II directly or indirectly participates in the post-ischemic damage, and the ability of an ACE inhibitor to attenuate this damage depends on ischemic time.

Animals , Male , Rats , Angiotensin I/pharmacology , Myocardial Ischemia/drug therapy , Myocardial Reperfusion/methods , Recovery of Function/drug effects , Analysis of Variance , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Captopril/pharmacology , Models, Animal , Myocardial Ischemia/physiopathology , Myocardial Reperfusion Injury/prevention & control , Random Allocation , Rats, Wistar , Time Factors
Arq. bras. cardiol ; 97(3): 209-216, set. 2011. graf, tab
Article in Portuguese | LILACS | ID: lil-601809


FUNDAMENTO: A injúria de isquemia e reperfusão constitui um mecanismo fisiopatológico frequente e de difícil controle durante a Cirurgia de Revascularização do Miocárdio (CRVM) com circulação extracorpórea, sendo o momento crítico o término da cirurgia, quando ocorre o desclampeamento da aorta e a liberação dos radicais hiperóxidos causadores da injúria. OBJETIVO: Avaliar, em estudo prospectivo, duplo-cego randomizado, controlado com placebo, os efeitos da Trimetazidina (Tmz) sobre a injúria de isquemia e reperfusão miocárdica, identificando a variação dos marcadores plasmáticos de agressão miocárdica (troponina T e Cpk-Mb), e as alterações ecocardiográficas da função ventricular. MÉTODOS: Foram estudados 60 pacientes, divididos em dois grupos (Placebo e Tmz) com, no máximo, disfunção ventricular leve, estratificados por ecocardiografia e recebendo medicação/placebo na dose - no pré-operatório sem medicação, 12 a 15 dias de medicação/placebo colhida cinco minutos após o desclampeamento aórtico, e nas 12, 24 e 48 horas seguintes. RESULTADOS: Tanto a troponina T como a CpK-Mb atingiram valores altamente significativos (p = 0,0001) no grupo tratado em relação ao grupo controle nos quatro momentos analisados − 5 min, 12 h, 24 h e 48 h. As variáveis ecocardiográficas não evidenciaram mudanças evolutivas em cada grupo isoladamente e quando comparados em conjunto. CONCLUSÃO: A trimetazidina mostrou-se eficaz na redução da injúria de isquemia e reperfusão, não interferiu na função ventricular esquerda, e não foram observados efeitos colaterais.

BACKGROUND: The ischemia and reperfusion ischemia is a common physiopathological mechanisms, which has difficult control during Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass, the critical moment of which happening by the end of surgery, when there is declamping of aorta and release of hyperoxic radicals causing the injury. OBJECTIVE: Evaluate, in a randomized double-blind prospective study, controlled with placebo, the effects of Trimetazidine (Tmz) on ischemic injury and myocardial reperfusion, identifying the change in plasma markers of a myocardial aggression (troponin T and CPK-MB), and echocardiographic changes of ventricular function. METHODS: We studied 60 patients divided in two groups (placebo and Tmz) with mild ventricular dysfunction at the most, stratified by echocardiography and receiving medication/placebo at a dose of 20 mg/3x/day, starting from 12 to 15 days after pre-operative period up to 5 to 8 days after post-operative period. Troponin T and Cpk-Mb were measured preoperatively without medication, 12 to 15 days of medication/placebo taken five minutes after aortic declamping, and at subsequent 12, 24 and 48 hours. RESULTS: Both Troponin T and Cpk-Mb reached highly significant values (p = 0.0001) in the treated group compared to the control group at the four moments analyzed - 5 min, 12h, 24h and 48h. The echocardiographic variables did not show evolutive changes in each group severally considered and when compared among themselves. CONCLUSION: Trimetazidine was effective in reducing ischemic injury and reperfusion, had no effect on left ventricular function, and no side effects were observed.

Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Myocardial Ischemia/drug therapy , Myocardial Reperfusion Injury/drug therapy , Postoperative Complications/drug therapy , Trimetazidine/therapeutic use , Vasodilator Agents/therapeutic use , Biomarkers/blood , Creatine Kinase, MB Form/blood , Double-Blind Method , Myocardial Ischemia/blood , Myocardial Reperfusion Injury/blood , Placebo Effect , Prospective Studies , Postoperative Complications/blood , Time Factors , Treatment Outcome , Trimetazidine/administration & dosage , Troponin T/blood , Vasodilator Agents/administration & dosage
Clinics ; 66(5): 777-784, 2011. ilus, graf, tab
Article in English | LILACS | ID: lil-593840


BACKGROUND: A limited number of studies have used Tissue Doppler Imaging (TDI) to evaluate the effect of statin therapy on left ventricular dysfunction in patients with chronic heart failure. In this work, we aimed to determine whether statin administration influenced prognosis, inflammatory activation and myocardial performance evaluated by Tissue Doppler Imaging in subjects enrolled in the Daunia Heart Failure Registry, a local registry of patients with chronic heart failure. METHODS: This study retrospectively analyzed 353 consecutive outpatients with chronic heart failure (mean follow-up 384 days), based on whether statin therapy was used. In all patients, several Tissue Doppler Imaging parameters were measured; circulating levels of interleukin (IL)-6, IL-10 and C-reactive protein were also assayed. RESULTS: Statin administration in 128 subjects with ischemic heart disease was associated with a lower incidence of adverse events (rehospitalization for HF 15 percent vs. 46 percent, p<0.001; ventricular arrhythmias 5 percent vs. 21 percent, p<0.01; cardiac death 1 percent vs. 8 percent, p<0.05), lower circulating levels of IL-6 (p<0.05) and IL-10 (p<0.01), lower rates of chronic heart failure (p<0.001) and better Tissue Doppler Imaging performance (E/E' ratio 12.82 + 5.42 vs. 19.85 + 9.14, p<0.001; ET: 260.62+ 44.16 vs. 227.11 +37.58 ms, p<0.05; TP: 176.79 + 49.93 vs. 136.7 + 37.78 ms, p<0.05 and St: 352.35 + 43.17 vs. 310.67 + 66.46 + 37.78 ms, p<0.05). CONCLUSIONS: Chronic ischemic heart failure outpatients undergoing statin treatment had fewer readmissions for adverse events, blunted inflammatory activation and improved left ventricular performance assessed by Tissue Doppler Imaging.

Aged , Female , Humans , Male , Middle Aged , Heart Failure/drug therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Myocardial Ischemia/drug therapy , Biomarkers/blood , Chronic Disease , Cytokines/blood , Echocardiography, Doppler , Heart Failure/blood , Myocardial Ischemia/complications , Prognosis , Retrospective Studies , Ventricular Function, Left/drug effects