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1.
Arq. bras. cardiol ; 117(3): 544-553, Sept. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1339198

ABSTRACT

Resumo Aproximadamente 300 milhões de cirurgias não cardíacas são realizadas anualmente no mundo, e eventos cardiovasculares adversos são as principais causas de morbimortalidade no período perioperatório e pós-operatório. A lesão miocárdica após cirurgia não cardíaca (MINS, do inglês myocardial injury after non-cardiac surgery) é uma nova entidade clínica associada com desfechos cardiovasculares adversos. MINS é definida como uma lesão miocárdica que pode resultar em necrose secundária à isquemia, com elevação dos biomarcadores. A lesão tem importância prognóstica e ocorre em até 30 dias após a cirurgia não cardíaca. Os critérios diagnósticos para MINS são: níveis elevados de troponina durante ou em até 30 dias após a cirurgia não cardíaca, sem evidência de etiologia não isquêmica, sem que haja necessariamente sintomas isquêmicos ou achados eletrocardiográficos de isquemia. Recentemente, pacientes com maior risco para MINS têm sido identificados por variáveis clínicas e biomarcadores, bem como por protocolos de vigilância quanto ao monitoramento eletrocardiográfico e dosagem de troponina cardíaca. Pacientes idosos com doença aterosclerótica prévia necessitam medir troponina diariamente no período pós-operatório. O objetivo deste trabalho é descrever este novo problema de saúde pública, seu impacto clínico e a abordagem terapêutica contemporânea.


Abstract Approximately 300 million non-cardiac surgeries are performed annually worldwide and adverse cardiovascular events are the main cause of morbidity and mortality in the peri- and postoperative period. Myocardial injury after non-cardiac surgery (MINS) is a new clinical entity associated with adverse cardiovascular outcomes. MINS is defined as myocardial injury that can result in necrosis due to ischemia, marked by increase in biomarker levels. It has prognostic relevance and occurs within up to 30 days after non-cardiac surgery. The diagnostic criteria for MINS are an elevated postoperative measure of troponin judged as secondary to myocardial ischemia, i.e., with no evidence of a non-ischemic etiology, during or within 30 days after non-cardiac surgery, and without the requirement of an ischemic symptom or electrocardiographic finding of ischemia. Recently, patients at higher risk for MINS have been recognized using clinical variables and biomarkers and established protocols for greater surveillance in relation to electrocardiographic monitoring and cardiac troponin dosage. Elderly patients with previous atherosclerotic disease need to measure troponin daily in the postoperative period. The aim of the present work is to describe this new public health problem, its clinical impact and contemporary therapeutic approach.


Subject(s)
Humans , Aged , Myocardial Ischemia/etiology , Heart Injuries , Postoperative Complications/etiology , Postoperative Period , Troponin
2.
ABC., imagem cardiovasc ; 34(3)2021. ilus
Article in Portuguese | LILACS | ID: biblio-1292756

ABSTRACT

O sinal RAC (retroaortic anomalous coronary ou artéria coronária anômala retroaórtica) é um achado desconhecido, descrito ao ecocardiograma transtorácico como uma estrutura tubular ecogênica, localizada na face atrial do sulco atrioventricular. Apresentamos um caso onde o sinal RAC se apresenta na ecocardiografia transesofágica (ETE). O conhecimento do sinal RAC e a avaliação com ETE aumentam a sensibilidade e a especificidade e conferem a oportunidade de avaliar características anatômicas de alto risco, importantes na avaliação do risco de morte súbita.(AU)


Subject(s)
Humans , Middle Aged , Myocardial Ischemia/etiology , Coronary Vessel Anomalies/genetics , Stroke/diagnosis , Death, Sudden/etiology , Heart Defects, Congenital , Sinus of Valsalva/abnormalities , Echocardiography/methods , Echocardiography, Transesophageal/methods
3.
Rev. cuba. endocrinol ; 31(2): e228, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1138895

ABSTRACT

RESUMEN Introducción: La diabetes mellitus tipo 2 es considerada una situación de alto riesgo cardiovascular. En la mujer con diabetes se añade el riesgo que representa el déficit estrogénico posmenopáusico. Objetivo: Determinar la frecuencia de enfermedad cardiovascular en las etapas del climaterio. Métodos: Se realizó un estudio transversal y descriptivo con 611 mujeres con diabetes mellitus tipo 2 en edad mediana (40-59 años), que ingresaron consecutivamente en el Centro de Atención al Diabético de Bayamo, Granma, desde el año 2010 al 2017. Se excluyeron los casos con menopausia artificial. Se empleó la prueba de chi cuadrado para comprobar la relación que pudiera existir entre las variables cualitativas, mientras que para comparar los valores promedio de las variables cuantitativas entre los grupos se utilizó t de Student. Resultados: La frecuencia de hipertensión arterial, hipercolesterolemia y síndrome metabólico fue claramente superior en las mujeres posmenopáusicas que en las premenopáusicas (p = 0,0257; p = 0,0391 y p = 0,0591, respectivamente). Las enfermedades cardiovasculares aumentaron significativamente con la menopausia y con el tiempo de ocurrencia de este evento (p = 0,0014). La relación fue más notoria en el caso de la cardiopatía isquémica y la enfermedad arterial periférica (p = 0,0521 y p = 0,0011, respectivamente). Conclusiones: En las mujeres con diabetes mellitus tipo 2 la enfermedad cardiovascular aumenta significativamente con el avance de la peri a la posmenopausia tardía, fundamentalmente la cardiopatía isquémica y la enfermedad arterial periférica(AU)


ABSTRACT Introduction: Type 2 diabetes mellitus is considered a situation of high cardiovascular risk. Among diabetic women, the risk for postmenopausal estrogen deficiency is added. Objective: To determine the frequency of cardiovascular disease in climacteric stages. Methods: A cross-sectional and descriptive study was carried out with 611 middle-aged (40-59 years old) women with type 2 diabetes mellitus and who were admitted consecutively to the Diabetic Care Center in Bayamo city, Granma, from 2010 to 2017. The cases with artificial menopause were not included in the study. The chi-square test was used to verify the relationship that might exist between qualitative variables, while Student's t test was used to compare the average values of the quantitative variables between the groups. Results: The frequency of arterial hypertension, hypercholesterolemia and metabolic syndrome was clearly higher among postmenopausal women than among premenopausal women (p = 0.0257, p = 0.0391, and p = 0.0591, respectively). Cardiovascular disease increased significantly with menopause and with the time of occurrence of this event (p = 0.0014). The relationship was more noticeable in the case of ischemic heart disease and peripheral arterial disease (p = 0.0521 and p = 0.0011, respectively). Conclusions: In women with type 2 diabetes mellitus, cardiovascular disease increases significantly with the progression from the perimenopausal stage to the late postmenopausal stage, mainly ischemic heart disease and peripheral arterial disease(AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Climacteric , Cardiovascular Diseases/etiology , Myocardial Ischemia/etiology , Postmenopause , Diabetes Mellitus, Type 2/epidemiology , Epidemiology, Descriptive , Cross-Sectional Studies , Metabolic Syndrome/etiology
4.
Rev. medica electron ; 41(4): 850-861, jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094093

ABSTRACT

RESUMEN Introducción: la Organización Mundial de la Salud, estima que la enfermedad renal crónica estará incluida dentro de las principales causas de discapacidad para el 2020. La prevalencia en países desarrollados es aproximadamente de 500 a 1400 pacientes por millón de habitantes y la incidencia anual se encuentra alrededor de 350 pacientes por millón de población. Objetivo: determinar la prevalencia de la enfermedad renal oculta e identificar algunos factores de riesgos predisponentes en adultos mayores con diabetes mellitus tipo 2 pertenecientes al Policlínico Universitario "Jimmy Hirzel", Bayamo, Granma, en el período comprendido entre junio 2016 - junio 2017. Materiales y métodos: se realizó estudio observacional descriptivo, de corte transversal en el que se incluyeron 180 gerontes con diabetes mellitus tipo 2. Resultados: se estableció el diagnóstico de enfermedad renal oculta en 167 individuos de 180 sujetos estudiados, el grupo de 70 - 79 años de edad fue el más afectado por la nefropatía crónica, mientras que el sexo femenino y la raza blanca fueron los de mayor prevalencia. Los principales factores de riesgo predisponentes de enfermedad renal oculta fueron: cardiopatía isquémica crónica, dislipemias e hipertensión arterial. Conclusiones: existe una alta morbilidad de enfermedad renal oculta en los senescentes estudiados.


ABSTRACT Introduction: the World Health Organization (WHO) estimates that chronic hidden renal disease (ERC) will be included within the principal causes of disability by 2020. The prevalence in developed countries is around 500 to 1400 patients per million inhabitants, and the yearly incidence is around 350 patients per million people. Objective: to determine the prevalence of the hidden renal disease and to identify some predisposing risk factors in elder people with type II diabetes mellitus belonging to the University Policlinic "Jimmy Hirzel", Bayamo, Gramma, in the period between June 2016 and June 2017. Material and methods: an observational descriptive, cross-sectional study was carried out in 180 elder people with type 2 diabetes mellitus. Results: the chronic hidden renal disease was diagnosed in 167 individuals from the 180 studied subjects; the 70-79 years-old-group was the most affected one by chronic renal disease, while the female sex and white race showed the highest prevalence. The main risk factors predisposing to chronic hidden renal disease were: chronic ischemic heart disease, dyslipidemia and arterial hypertension. Conclusions: there is a high morbidity due to hidden renal disease in the studied senescent people.


Subject(s)
Humans , Female , Aged , Prevalence , Risk Factors , Morbidity , Myocardial Ischemia/etiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/etiology , Diabetes Mellitus, Type 2/epidemiology , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/prevention & control , Renal Insufficiency, Chronic/epidemiology , Dyslipidemias/etiology , Hypertension/etiology , Epidemiology, Descriptive , Cross-Sectional Studies , Diabetic Nephropathies/etiology , Observational Study , Kidney Diseases/etiology
5.
Säo Paulo med. j ; 137(1): 60-65, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1004739

ABSTRACT

ABSTRACT BACKGROUND: Exposure to some air pollutants is associated with cardiovascular diseases. The objective of this study was to quantify the effect of exposure to fine particulate matter in hospitalizations due to ischemic heart disease and the costs to the healthcare system. DESIGN AND SETTING: Time-series ecological study conducted in Taubaté, Brazil. METHODS: Data on hospitalizations due to ischemic heart diseases (ICD I-20 to I-24) in the municipality of Taubaté (SP), Brazil, among adults of both sexes aged 40 years and over, from August 2011 to July 2012, were obtained from DATASUS. Fine particulate matter (PM2.5) concentrations were estimated from a mathematical model. Poisson regression was used in statistical analyses to estimate the relative risks of exposure to PM2.5 for both sexes and after stratification according to sex. The excess of hospitalizations and consequent excess expenditure for the healthcare system were calculated. RESULTS: There were 1040 admissions, among which 382 had ischemic heart diseases (257 males). Themean PM2.5 concentration was 13.2 µg/m3 (SD = 5.6). Significant effects from exposure were noted 4and 5 days after exposure (lag 4 and lag 5) for both sexes and for male sex; for female sex, the effect was 2 days after exposure (lag 2). There were 59 excess hospitalizations for an increase in PM2.5 concentration of 5 µg/m3 and excess expenditure of US$ 150,000 for the National Health System. CONCLUSIONS: An excess of hospital admissions due to ischemic heart disease, with excess expenditure, was identified consequent to PM2.5 exposure.


Subject(s)
Humans , Male , Female , Adult , Myocardial Ischemia/etiology , Air Pollutants/adverse effects , Particulate Matter/adverse effects , Hospitalization/statistics & numerical data , Reference Values , Seasons , Temperature , Time Factors , Brazil/epidemiology , Poisson Distribution , Sex Factors , Risk Factors , Myocardial Ischemia/epidemiology , Sex Distribution , Risk Assessment , Inhalation Exposure/adverse effects , Air Pollution/adverse effects , Humidity
6.
Rev. chil. cardiol ; 37(1): 42-54, abr. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-959338

ABSTRACT

Resumen: En los últimos años, la diabetes mellitus tipo 2 (DM2) ha evolucionado en forma epidémica, experimentando un rápido crecimiento y afectando a millones de individuos a nivel mundial. La cardiopatía isquémica es la principal causa de mortalidad en los pacientes diabéticos, quienes poseen un mayor riesgo cardiovascular respecto a los no diabéticos. La DM2 y la cardiopatía isquémica se caracterizan por ser prevenibles, sin embargo, existen diversos factores de riesgo comunes que contribuyen a su desarrollo. Los mecanismos que explican la ateroesclerosis acelerada y el incremento de riesgo de enfermedades cardiovasculares en los pacientes diabéticos tipo 2 incluyen a la hiperglicemia, dislipidemia y la inflamación del endotelio vascular. La diabetes es resultado de una interacción compleja entre la genética y el medio ambiente. Recientemente se han descrito varios genes implicados en el desarrollo de la diabetes y cardiopatía isquémica y que podrían significar nuevas opciones terapéuticas. En este artículo se revisa la relación entre ambas patologías, los mecanismos moleculares y el descubrimiento de factores de riesgo genéticos comunes y su implicancia en el desarrollo de nuevos blancos terapéuticos.


Abstracts: In recent years, type 2 diabetes mellitus has evolved as a rapidly increasing epidemic and affects millions of people worldwide. Ischemic heart disease (IHD) is the main cause of death among diabetic patients, who have a higher cardiovascular risk than non-diabetics. Both, DM2 and IHD are characterized by being preventable, however there are several common risk factors that contribute to their development. The mechanisms that explain accelerated atherosclerosis and increased risk of cardiovascular diseases in patients with type 2 diabetes mellitus include damage by hyperglycemia, dyslipidemia and inflammation on vascular endothelium. Diabetes is the result of a complex interaction between genetics and the environment, recently, several genes have been identified that appear to be involved in diabetes and ischemic heart disease that could explain its relationship and serve as new therapeutic possibilities. In this article, we review the relationship between diabetes and ischemic heart disease, the molecular mechanisms and the discovery of genetic risk factors common to both diseases and their implication in the development of new therapeutic targets.


Subject(s)
Humans , Myocardial Ischemia/etiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/physiopathology , Diabetes Mellitus, Type 2/genetics , Polymorphism, Genetic/genetics , Genetic Therapy , Myocardial Ischemia/physiopathology , Myocardial Ischemia/genetics , Myocardial Ischemia/prevention & control , Diabetes Mellitus, Type 2/drug therapy , Dyslipidemias/physiopathology , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Hyperglycemia/physiopathology , Metformin/therapeutic use
7.
Int. j. cardiovasc. sci. (Impr.) ; 31(2): f:133-l:142, mar.-abr. 2018. tab, graf
Article in English | LILACS | ID: biblio-881967

ABSTRACT

Background: Cardiogenic Acute Pulmonary Edema (APE) is considered one of the main medical emergencies, and it is the extreme manifestation of acute heart failure. The main etiology of heart failure is ischemic heart disease. To date, the definition of ischemic etiology in acute pulmonary edema was based on criteria such as: clinical history of ischemic heart disease, noninvasive examinations and, in other patients, coronary angiography. Classified as such, ischemic heart disease has been shown to be its main etiology. The high prevalence between these two diseases was evaluated, but not by the exclusive angiographic criterion, the gold standard of this pathology and the reason of this study. Objective: To evaluate the predictors of obstructive coronary artery disease in patients with acute pulmonary edema of unclear origin. Method: Patients admitted to a cardiovascular disease referral emergency unit were recruited to undergo coronary angiography if the acute pulmonary edema etiology was not adequately elucidated. Obstructive coronary disease was considered if at least one epicardial vessel had 70% of occlusion. Results: Obstructive coronary disease was classified by coronary angiography in 149 consecutively evaluated patients, and coronary artery obstruction was the outcome variable of the predictor model. Among the variables related to coronary disease, the predictor variables were the history of coronary artery disease (p < 0.001) and myocardium segmental deficit at the echocardiogram (p < 0.02). Conclusion: The antecedent of coronary disease and the myocardium segmental deficit at the echocardiogram were able to discriminate patients with acute pulmonary edema associated with obstructive coronary disease. Troponin values classified by two cardiologists as secondary to an acute non-ST-segment elevation myocardial infarction, and chest pain preceding the clinical picture were not able to discriminate patients with or without coronary obstruction and thus, the diagnosis of obstructive coronary disease should not be pursued based on the troponin value and/or chest pain preceding the clinical picture


Fundamento: O Edema Agudo de Pulmão cardiogênico é considerado uma das maiores emergências médicas, é a manifestação extrema da insuficiência cardíaca aguda. A principal etiologia da insuficiência cardíaca é a cardiopatia isquêmica. Até o momento, a definição da etiologia isquêmica no edema agudo de pulmão foi baseada em critérios como: história clínica de doença cardíaca isquêmica, exames não invasivos e, em outros pacientes, na cinecoronariografia. Desta forma classificada, a doença isquêmica do coração demonstrou ser sua principal etiologia. A alta prevalência entre estas duas doenças foi avaliada, mas não pelo critério angiográfico exclusivo, o padrão-ouro desta patologia, a razão deste estudo. Objetivo: Avaliar os preditores da doença arterial coronária obstrutiva nos portadores de Edema Agudo de Pulmão de origem claramente não definida. Método: Pacientes admitidos em um pronto-socorro de referência no tratamento das doenças cardiovasculares foram recrutados a realizar a coronariografia se a etiologia do edema agudo de pulmão não era devidamente esclarecida. A doença coronária obstrutiva foi considerada se ao menos um vaso epicádico tivesse oclusão = 70%. Resultados: A doença coronária obstrutiva foi classificada pela cinecoronariografia em 149 pacientes consecutivamente avaliados, a obstrução da artéria coronária foi a variável desfecho do modelo preditor. Dentre as variáveis relacionadas a doença coronária, as variáveis preditoras foram a história de doença da artéria coronária (p < 0,001) e o déficit segmentar do miocárdio ao ecocardiograma (p < 0,02). Conclusão: O antecedente de doença coronariana e o déficit segmentar do miocárdio ao ecocardiograma foram capazes de discriminar pacientes com edema agudo de pulmão associado a doença coronária obstrutiva. Valores da troponina classificados por dois cardiologistas como secundário a um infarto agudo do miocárdio sem elevação do segmento ST a e a dor torácica antecedendo o quadro não foram capazes de discriminar doentes com ou sem obstrução coronária, logo, o diagnóstico de doença coronária obstrutiva não deve ser perseguido baseado no valor da troponina e ou dor torácica antecedendo o quadro


Subject(s)
Humans , Male , Female , Middle Aged , Coronary Artery Disease/diagnosis , Coronary Artery Disease/etiology , Predictive Value of Tests , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/etiology , Pulmonary Edema , Chest Pain , Diabetes Mellitus , Echocardiography/methods , Electrocardiography/methods , Heart Failure , Hypertension , Myocardial Ischemia/etiology , Observational Study , Data Interpretation, Statistical , Stroke , Troponin
8.
Rev. saúde pública (Online) ; 52: 72, 2018. tab, graf
Article in English | LILACS | ID: biblio-962257

ABSTRACT

ABSTRACT OBJECTIVE To analyze if the burden of ischemic heart disease mortality trend attributed to physical inactivity in Brazil differs from the global estimates. METHODS Databases from the Global Burden of Disease Study for Brazil, Brazilian states, and global information were used. We estimated the summary exposure value for physical inactivity, the total number of deaths, and the age-standardized death rates for ischemic heart disease attributed to physical inactivity in the years 1990 and 2015, and the population-attributable fraction. Data were presented according to sex. RESULTS The Brazilian population was found to have a risk of exposure to physical inactivity varying between 70.4% for men and 75.7% for women in the year of 1990. This risk of exposure was similar in 2015. In men, the mortality rate from ischemic heart disease attributed to physical inactivity decreased in 2015 by approximately 24% around the world and 45% in Brazil. For women, this decrease was in 31% around the world and 45% in Brazil. The states of Southern and Southeastern Brazil presented lower mortality rates due to ischemic heart disease attributed to physical inactivity. If physical inactivity were eliminated in Brazil, mortality from ischemic heart disease would be reduced by 15.8% for men and 15.2% for women. CONCLUSIONS Over 25 years, the risk of exposure to physical inactivity in Brazil did not change and was high compared to global estimates. The decrease in ischemic heart disease mortality results from the improvement of health services in Brazil and the control of other risk factors. Approximately 15% of deaths from ischemic heart disease in Brazil could be avoided if people met the recommendations for physical activity.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Myocardial Ischemia/etiology , Myocardial Ischemia/mortality , Risk Assessment/methods , Sedentary Behavior , Global Burden of Disease/trends , Time Factors , Brazil/epidemiology , Exercise , Sex Factors , Risk Factors , Cause of Death/trends , Age Factors , Sex Distribution , Age Distribution , Health Risk Behaviors , Income , Middle Aged
9.
Rev. chil. cardiol ; 36(3): 244-248, dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-899592

ABSTRACT

Resumen: Se presenta el caso de un paciente de sexo femenino de 42 años sin antecedentes clínicos de relevancia, con hipopotasemia severa y cambios electrocardiográficos imitando isquemia miocárdica con enfermedad corona-ria de múltiples vasos.


Abstracts: A 42-year-old woman with no previous medical history developed severe hypokalemia. The ECG changes suggested multivessel coronary artery disease with ischemia in several territories.


Subject(s)
Humans , Female , Adult , Myocardial Ischemia/diagnosis , Electrocardiography , Hypokalemia/diagnosis , Potassium/therapeutic use , Myocardial Ischemia/etiology , Diagnosis, Differential , Hypokalemia/complications , Hypokalemia/drug therapy
10.
Rev. bras. cir. cardiovasc ; 32(5): 394-400, Sept.-Oct. 2017. tab, graf
Article in English | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-897938

ABSTRACT

Abstract Objective: To correlate blood transfusions and clinical outcomes during hospitalization in coronary artery bypass grafting surgery (CABG). Methods: Transfusion, clinical and hematological data were collected for 1,378 patients undergoing isolated or combined CABG between January 2011 and December 2012. The effect of blood transfusions was evaluated through multivariate analysis to predict three co-primary outcomes: composite ischemic events, composite infectious complications and hospital mortality. Because higher risk patients receive more transfusions, the hospital mortality outcome was also tested on a stratum of low-risk patients to isolate the effect of preoperative risk on the results. Results: The transfusion rate was 63.9%. The use of blood products was associated with a higher incidence of the three coprimary outcomes: composite infectious complications (OR 2.67, 95% CI 1.70 to 4.19; P<0.001), composite ischemic events (OR 2.42, 95% CI 1.70 to 3.46; P<0.001) and hospital mortality (OR 3.07, 95% CI 1.53 to 6.13; P<0.001). When only patients with logistic EuroSCORE ≤ 2% were evaluated, i.e., low-risk individuals, the mortality rate and the incidence of ischemic events and infectious complications composites remained higher among the transfused patients [6% vs. 0.4% (P<0.001), 11.7% vs. 24,3% (P<0.001) and 6.5% vs. 12.7% (P=0.002), respectively]. Conclusion: The use of blood components in patients undergoing CABG was associated with ischemic events, infectious complications and hospital mortality, even in low-risk patients.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Blood Transfusion/statistics & numerical data , Coronary Artery Bypass/adverse effects , Postoperative Complications , Blood Transfusion/mortality , Coronary Artery Bypass/methods , Coronary Artery Bypass/mortality , Retrospective Studies , Risk Factors , Hospital Mortality , Myocardial Ischemia/etiology , Perioperative Period , Infections/etiology
11.
Yonsei Medical Journal ; : 67-74, 2017.
Article in English | WPRIM | ID: wpr-65061

ABSTRACT

PURPOSE: Recent evidence suggests that early repolarization (ER) is related with myocardial ischemia. Compression of coronary artery by a myocardial bridging (MB) can be associated with clinical manifestations of myocardial ischemia. This study aimed to evaluate the associations of MB in patients with ER. MATERIALS AND METHODS: In consecutive patients (n=1303, age, 61±12 years) who had undergone coronary angiography, we assessed the prevalence and prognostic implication of MB in those with ER (n=142) and those without ER (n=1161). RESULTS: MB was observed in 54 (38%) and 196 (17%) patients in ER and no-ER groups (p<0.001). In multivariate analysis, MB was independently associated with ER (odd ratio: 2.9, 95% confidence interval: 1.98–4.24, p<0.001). Notched type ER was more frequently observed in MB involving the mid portion of left anterior descending coronary artery (LAD) (69.8% vs. 30.2%, p=0.03). Cardiac event was observed in nine (6.3%) and 22 (1.9%) subjects with and without ER, respectively. MB was more frequently observed in sudden death patients with ER (2 out of 9, 22%) than in those without ER (0 out of 22). CONCLUSION: MB was independently associated with ER in patients without out structural heart disease who underwent coronary angiography. Notched type ER was closely related with MB involving the mid portion of the LAD. Among patients who had experienced cardiac events, a higher prevalence of MB was observed in patients with ER than those without ER. Further prospective studies on the prognosis of MB in ER patients are required.


Subject(s)
Aged , Coronary Angiography , Electrocardiography , Electrophysiological Phenomena , Female , Humans , Male , Middle Aged , Myocardial Bridging/complications , Myocardial Ischemia/etiology , Odds Ratio , Prevalence , Prognosis , Prospective Studies
13.
J. bras. nefrol ; 38(3): 320-326, July-Sept. 2016. tab, graf
Article in English | LILACS | ID: lil-796204

ABSTRACT

Abstract Introduction: Bone metabolism disorder (BMD) and vascular dysfunction contribute to excess cardiovascular mortality observed in hemodialysis patients. Vascular dysfunction, a new marker of atherosclerosis, can play a role in this risk. Even though associated with higher mortality in the general population, such vascular evaluation in patients on hemodialysis has not been extensively studied. Methods: In this cross-sectional study, hemodialysis patients were submitted to flow-mediated dilation, subendocardial viability ratio (SEVR) and ejection duration index assessment, in order to estimate the impact of BMD markers on vascular dysfunction. Results: A matched cohort of patients with (n = 16) and without (n = 11) severe secondary hyperparathyroidism (SHPT) was studied. Additionally, time spent under severe SHPT was also evaluated. Patients with severe SHPT had lower SEVR and higher ejection duration index, indicating higher cardiovascular risk. Lower SEVR was also associated to diastolic blood pressure (r = 0.435, p = 0.049), serum 25-Vitamin-D levels (r = 0.479, p = 0.028) and to more time spent under severe secondary hyperparathyroidism (SHPT), defined as time from PTH > 500pg/ml until parathyroidectomy surgery or end of the study (r = -0.642, p = 0.027). In stepwise multiple regression analysis between SEVR and independent variables, lower SEVR was independently associated to lower serum 25-Vitamin-D levels (p = 0.005), female sex (p = 0.012) and more time spent under severe SHPT (p = 0.001) in a model adjusted for age, serum cholesterol, and blood pressure (adjusted r² = 0.545, p = 0.001). Conclusion: Subendocardial perfusion was lower in patients with BMD, reflecting higher cardiovascular risk in this population. Whether early parathyroidectomy in the course of kidney disease could modify such results still deserves further investigation.


Resumo Introdução: Distúrbios do metabolismo ósseo (DMO) e alterações da função vascular contribuem para a elevada mortalidade de pacientes em hemodiálise. A disfunção vascular, um novo marcador de aterosclerose, pode contribuir para este risco. Apesar de associada a aumento de mortalidade na população geral, a avaliação de tal disfunção ainda não foi realizada de modo amplo em pacientes em hemodiálise. Métodos: Neste estudo transversal, pacientes em hemodiálise foram submetidos à avaliação da vasodilatação mediada por fluxo, razão de viabilidade subendocárdica (RVSE) e índice de duração de ejeção, como estimativas de avaliação dos marcadores de DMO sobre disfunção vascular. Resultados: Uma coorte pareada com (n = 16) e sem (n = 11) hiperparatireoidismo secundário (HPTS) grave foi estudada. Adicionalmente, o tempo transcorrido do diagnóstico de HPTS grave também foi avaliado. Pacientes com HPTS grave apresentaram menores valores de RVSE e maiores valores de índice de duração de ejeção, apontando maior risco cardiovascular. Baixa RVSE também foi associada à pressão arterial diastólica (r = 0,435, p = 0,049), níveis séricos de 25-Vitamina D (r = 0,479, p = 0,028) e maior tempo transcorrido desde diagnóstico de HPTS grave, definido como tempo em que o paciente permaneceu com valores de paratormônio superiores a 500 pg/ml até realização de cirurgia de paratireoidectomia ou término do estudo (r = -0,642, p = 0,027). Em regressão logística stepwise entre RVSE e variáveis independentes, menor RVSE foi independentemente associado a menores valores de 25-Vitamina D (p = 0,005), sexo feminino (p = 0,012) e maior tempo transcorrido desde diagnóstico de HPTS grave (p = 0,001) em um modelo ajustado para idade, colesterol sérico e pressão arterial (r2 ajustado = 0,545, p = 0,001). Conclusão: A perfusão subendocárdica foi menor em pacientes com DMO, refletindo o maior risco cardiovascular nesta população. Investigações adicionais são necessárias para definir se a paratireoidectomia precoce no curso da doença renal crônica poderia interferir neste risco.


Subject(s)
Humans , Male , Female , Middle Aged , Renal Dialysis , Myocardial Ischemia/epidemiology , Endocardium , Bone Diseases, Metabolic/etiology , Cross-Sectional Studies , Risk Factors , Myocardial Ischemia/etiology , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy
14.
Acta cir. bras ; 31(5): 338-345, May 2016. tab, graf
Article in English | LILACS | ID: lil-783802

ABSTRACT

ABSTRACT PURPOSE: To investigate the myocardial ischemia-reperfusion with sevoflurane anesthetic preconditioning (APC) would present beneficial effects on autonomic and cardiac function indexes after the acute phase of a myocardial ischemia-reperfusion. METHODS: Twenty Wistar rats were allocated in three groups: control (CON, n=10), myocardial infarction with sevoflurane (SEV, n=5) and infarcted without sevoflurane (INF, n=5). Myocardial ischemia (60 min) and reperfusion were performed by temporary coronary occlusion. Twenty-one days later, the systolic and diastolic function were evaluated by echocardiography; spectral analysis of the systolic arterial pressure (SAPV) and heart rate variability (HRV) were assessed. After the recording period, the infarct size (IS) was evaluated. RESULTS: The INF group presented greater cardiac dysfunction and increased sympathetic modulation of the SAPV, as well as decreased alpha index and worse vagal modulation of the HRV. The SEV group exhibited attenuation of the systolic and diastolic dysfunction and preserved vagal modulation (square root of the mean squared differences of successive R-R intervals and high frequency) of HRV, as well as a smaller IS. CONCLUSION: Sevoflurane preconditioning better preserved the cardiac function and autonomic modulation of the heart in post-acute myocardial infarction period.


Subject(s)
Animals , Male , Autonomic Nervous System/drug effects , Myocardial Ischemia/physiopathology , Anesthetics, Inhalation/pharmacology , Ischemic Preconditioning, Myocardial/methods , Methyl Ethers/pharmacology , Myocardial Infarction/physiopathology , Pulse , Autonomic Nervous System/physiology , Time Factors , Blood Pressure/drug effects , Blood Pressure/physiology , Echocardiography , Random Allocation , Rats, Wistar , Myocardial Ischemia/etiology , Myocardial Ischemia/diagnostic imaging , Models, Animal , Heart Rate/drug effects , Heart Rate/physiology , Myocardial Infarction/pathology , Myocardial Infarction/prevention & control , Myocardial Infarction/diagnostic imaging
15.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.693-698.
Monography in Portuguese | LILACS | ID: biblio-971561
16.
Colomb. med ; 46(1): 41-46, Jan.-Mar. 2015. tab
Article in English | LILACS | ID: lil-753534

ABSTRACT

Coronary heart disease (CHD) is highly prevalent in patients with diabetes mellitus (DM), and remains the single most common cause of death among this population. Regrettably, a significant percentage of diabetics fail to perceive the classic symptoms associated with myocardial ischemia. Among asymptomatic diabetics, the prevalence of abnormal cardiac testing appears to be high, raging between 10% and 62%, and mortality is significantly higher in those with abnormal scans. Hence, the potential use of screening for CHD detection among asymptomatic DM individuals is appealing and has been recommended in certain circumstances. However, it was not until recently, that this question was addressed in clinical trials. Two studies randomized a total of 2,023 asymptomatic diabetics to screening or not using cardiac imaging with a mean follow up of 4.4 ±1.4 yrs. In combination, both trials showed lower than expected annual event rates, and failed to reduce major cardiovascular events in the screened group compared to the standard of care alone. The results of these trials do not currently support the use of screening tools for CHD detection in asymptomatic DM individuals. However, these studies have important limitations, and potential explanations for their negative results that are discussed in this manuscript.


La enfermedad de la arterias coronarias (EAC) es muy prevalente en pacientes con diabetes mellitus (DM), y continúa siendo la principal causa de muerte en estos pacientes. Desafortunadamente, muchos diabéticos pueden carecer de síntomas de alerta en la presencia de isquemia miocárdica, por lo cual el diagnóstico de EAC puede ocurrir de manera tardía. Estudios observacionales han sugerido que la prevalencia de isquemia miocárdica puede ser alta en diabéticos asintomáticos (10 al 62% según la serie) y la mortalidad es mayor en esos pacientes. Por esto, el uso de pruebas para detección de EAC en el paciente diabético asintomático parece atractivo y es recomendado en ciertas circunstancias. Sin embargo, no fue si no hasta hace poco que dos estudios investigaron el verdadero rol de estas pruebas de manera randomizada. En conjunto, 2,023 pacientes diabéticos asintomáticos fueron aleatorizados a recibir o no una prueba para detección de EAC y fueron seguidos en promedio por 4.4 ±1.4 años. Al final de seguimiento, ambos estudios mostraron menos eventos cardiovasculares de los esperados, y el uso de pruebas para detección de EAC no redujo la tasa de eventos cardiovasculares comparado al no uso de estas pruebas. Los resultados de estos ensayos clínicos no soportan actualmente el uso de estas pruebas en el paciente diabético asintomático. Sin embargo, estos estudios tienen limitaciones importantes, y posibles hipótesis para explicar los resultados que son discutidas en el artículo.


Subject(s)
Humans , Coronary Disease/diagnosis , Diabetic Angiopathies/diagnosis , Mass Screening/methods , Coronary Disease/epidemiology , Coronary Disease/etiology , Diabetic Angiopathies/epidemiology , Myocardial Ischemia/diagnosis , Myocardial Ischemia/epidemiology , Myocardial Ischemia/etiology , Randomized Controlled Trials as Topic
17.
Article in English | IMSEAR | ID: sea-162086

ABSTRACT

Introduction: Cardiovascular disease is one of the common complications of Diabetes mellitus. Serum Cystatin C level has been suggested as a marker for cardiac complications in diabetes. Material and Methods: We studied serum Cystatin C level in Diabetics to fi nd if correlation exists between cardiac complications and elevated Cystatin C levels. Results: A total of 50 diabetics were studied out of whom 25 had cardiac complications and the rest did not have cardiac complications. No signifi cant diff erence was observed between Serum Cystatin C levels of diabetics with cardiac complications (mean 1∙5±0∙45) and diabetics without cardiac complications (1∙4±0∙46) although Cystatin C levels were found to be elevated in diabetic cases. Conclusion: Keeping in view the signifi cant diff erence (p=0∙000) in Cystatin C levels of healthy and diabetic patients, it is reasonable to accept the importance of Cystatin C as an indicator of diabetes and its associated complications.


Subject(s)
Cystatin C/analysis , Cystatin C/blood , Diabetes Mellitus/complications , Diabetes Mellitus/epidemiology , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Heart Diseases/etiology , Myocardial Ischemia/diagnosis , Myocardial Ischemia/epidemiology , Myocardial Ischemia/etiology
18.
Rev. bras. anestesiol ; 64(4): 281-285, Jul-Aug/2014. graf
Article in English | LILACS | ID: lil-720476

ABSTRACT

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.


Subject(s)
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
19.
Ann Card Anaesth ; 2014 Jan; 17(1): 52-55
Article in English | IMSEAR | ID: sea-149694

ABSTRACT

Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri‑operative management issues in a case of mitral valve replacement for acute severe MR following BMV.


Subject(s)
Adult , Anesthesia, General , Balloon Valvuloplasty/methods , Emergencies , Female , /methods , Humans , Mitral Valve/surgery , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/surgery , Myocardial Ischemia/etiology , Postoperative Complications/methods , Rheumatic Heart Disease/complications , Rheumatic Heart Disease/surgery , Shock/physiopathology , Shock/therapy
20.
Rev. cuba. endocrinol ; 24(2): 125-135, mayo-ago. 2013.
Article in Spanish | LILACS, CUMED | ID: lil-679978

ABSTRACT

Objetivo: determinar la prevalencia del síndrome metabólico y su relación con la enfermedad cardiovascular en pacientes con diabetes mellitus tipo 2.Métodos: se realizó un estudio transversal y descriptivo con 1 005 pacientes diabéticos tipo 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido entre octubre de 2008 a julio de 2011. Para la definición del síndrome metabólico se utilizaron los criterios diagnósticos de la Organización Mundial de la Salud, del III Reporte del Programa Nacional de Educación y Control del Colesterol y de la Federación Internacional de la Diabetes. De las historias clínicas se extrajeron los datos de las variables demográficas, clínicas y metabólicas estudiadas.Resultados: 782 casos (77,8 por ciento) presentaron síndrome metabólico según los criterios de la Federación Internacional de la Diabetes, 669 (66,6 por ciento) de acuerdo al III Reporte del Programa Nacional de Educación y Control del Colesterol, y 623 (61,9 por ciento), según la Organización Mundial de la Salud. La presencia del síndrome metabólico elevó el riesgo para desarrollar cardiopatía isquémica, independientemente del criterio diagnóstico utilizado (p< 0,05). En ausencia de este síndrome, ninguno de los factores de riesgo que lo componen tuvo una asociación significativa con el desarrollo de enfermedad cardiovascular.Conclusiones: la prevalencia del síndrome metabólico en la muestra estudiada es elevada. Su presencia incrementa el riesgo de cardiopatía isquémica, independientemente del criterio diagnóstico que se utilice(AU)


Objective: to ascertain the prevalence of the metabolic syndrome and its relationship with the cardiovascular disease observed in type 2 diabetes mellitus patients. Methods: a cross-sectional and descriptive study of 1 005 diabetes mellitus type 2 patients admitted to the Center for the Care of Diabetics in Bayamo, Granma province was conducted from October 2008 to July 2011. For the definition of this syndrome, the study used the diagnosing criteria of the World Health Organization, of the Third Report of the National Cholesterol Education Program and of the International Diabetes Federation. The clinical histories provided the demographic, clinical and metabolic data under study. Results: seven hundred eighty two cases (77.8 percent) presented with metabolic syndrome according to the criteria of the International Diabetes Federation; 669 (66.6 percent) had it in accordance with the Third Report of the National Cholesterol Education Program and 623 (61.9 percent) were also affected according to the World Health Organization. The existence of metabolic syndrome increased the risk of developing ischemic cardiopathy regardless of the diagnostic criteria (p< 0.05). None of the risk factors included in the metabolic syndrome was significantly associated to the occurrence of cardiovascular disease when this syndrome was non-existent. Conclusions: the prevalence of the metabolic syndrome was high in the studied sample. Its presence increased the risk of ischemic cardiopathy, regardless of the diagnostic criteria that are used(AU)


Subject(s)
Humans , Myocardial Ischemia/etiology , Metabolic Syndrome/epidemiology , Diabetes Mellitus, Type 2/complications , Risk Factors , Epidemiology, Descriptive , Cross-Sectional Studies
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