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3.
Cambios rev. méd ; 19(2): 114-128, 2020-12-29. tabs.
Article in Spanish | LILACS | ID: biblio-1179674

ABSTRACT

1. INTRODUCCIÓNSegún la Organización Mundial de la Salud (OMS) se registran cada año más de 17 200 000 fallecimientos a nivel del mundo por causas cardiovasculares1-3.La enfermedad coronaria causa habitual de Paro Cardiorrespiratorio (PCR) en adultos4. Los pacientes de mayor riesgo corresponden a 50 y 70 años de edad, en un 70% hombres vs 30% mujeres, el 80% de estos se dan por Fibrilación Ventricular (FV) o Taquicardia Ventricular Sin Pulso (TVSP), datos registrados en 20175-7.En el Ecuador, acorde al Instituto Na-cional de Estadísticas y Censos (INEC) en el año 2019 se registraron 8 779 muertes a causa de isquemias del corazón, convir-tiéndose en la principal causa de morta-lidad general con un 11,80%8.En esta ruta se describe cuál es el papel de la enfermera como parte del equipo de respuesta ante un PCR, con base a las Guías de la American Heart Association (AHA).El procedimiento a seguir está expre-sado en el contexto de la Taxonomía de la North American Nursing Diagnosis Asso-ciation (NANDA), Nursing Interventions Classification (NIC), el nombre y siglas en inglés de la clasificación estandarizada y codificada de las intervenciones de en-fermería y Nursing Outcomes Classifica-tion (NOC), la clasificación de resultados obtenidos luego de los cuidados.


1. INTRODUCTIONAccording to the World Health Organiza-tion (WHO), more than 17 200 000 deaths worldwide are registered each year from cardiovascular causes1-3.Coronary heart disease is a common cause of Cardiorespiratory Arrest (CRP) in adults4 The highest risk patients co-rrespond to 50 and 70 years of age, 70% men vs 30% women, 80% of these are due to Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (PVT), data recorded in 20175-7. In Ecuador, according to the National Ins-titute of Statistics and Censuses (INEC) in 2019, 8 779 deaths were recorded due to ischemia of the heart, becoming the main cause of general mortality with 11.80%8.This route describes the role of the nurse as part of the response team to a CRA, based on the American Heart Association (AHA) Guidelines.The procedure to be followed is expressed in the context of the Taxonomy of the North American Nursing Diagnosis As-sociation (NANDA), Nursing Interven-tions Classification (NIC), the name and acronym in English of the standardized and coded classification of nursing inter-ventions and Nursing Outcomes Classifi-cation (NOC), the classification of results obtained after care.


Subject(s)
Humans , Male , Female , Nursing Diagnosis , Cardiopulmonary Resuscitation , Standardized Nursing Terminology , American Heart Association , Heart Arrest , Nursing Process , Ventricular Fibrillation , Tachycardia, Ventricular , Advanced Cardiac Life Support , Myocardial Infarction , Nurses , Nursing Care
4.
Arch. cardiol. Méx ; 90(4): 379-388, Oct.-Dec. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1152811

ABSTRACT

Resumen Introducción y objetivos: La tormenta eléctrica (TE) se caracteriza por episodios repetidos de taquicardia ventricular o fibrilación ventricular relacionados con mal pronóstico a corto y largo plazos. El objetivo fue evaluar la prevalencia, resultados y supervivencia de los pacientes sometidos a tratamiento intervencionista por TE en un centro de referencia. Métodos: Estudio unicéntrico, observacional y retrospectivo. Se revisaron los procedimientos de ablación por TE y se evaluaron las características basales de los pacientes, tipo de procedimiento, mortalidad total, recurrencia de arritmia, mortalidad cardiovascular y necesidad de trasplante. Resultados: Desde enero de 2009 hasta diciembre de 2016 se realizaron 67 procedimientos (38% de complejos: 19% de ablación endoepicárdica, 7.5% de crioablación epicárdica quirúrgica, 3% de simpatectomía, 3% de inyección coronaria con alcohol; 6% de apoyo con oxigenación con membrana extracorpórea) en 41 pacientes (61% de causa isquémica) por TE. La mortalidad intraprocedimiento fue del 1.5%. La mediana de seguimiento fue de 23.5 meses (RIQ, 14.2-52.7). Tras el primer ingreso por TE (uno o varios procedimientos), la mortalidad a un año fue de 9.8%. La incidencia acumulada de trasplante cardiaco por TE fue de 2.4%. En el análisis multivariado, el riesgo de recurrencias arrítmicas o muerte por cualquier causa fue significativamente mayor en pacientes con arritmias clínicas inducibles (HR, 9.03; p = 0.017). Conclusiones: El tratamiento de pacientes con TE, instituido en un centro de referencia y con experiencia, se relacionó con una tasa baja de recurrencia y supervivencia elevada, con una tasa de trasplante cardiaco por TE muy baja. Ante una recurrencia temprana es recomendable practicar un nuevo procedimiento durante el ingreso.


Abstract Introduction and objective: Electrical storm (ES) is characterized by repeated episodes of ventricular tachycardia or ventricular fibrillation, with poor short and long term prognosis. Our objective was to evaluate the prevalence, results of interventional treatment and survival of patients undergoing interventional treatment for ES in our center. Methods: Retrospective, unicentric and observational study. ES ablation procedures were revised and data regarding baseline characteristics of the patients, type of procedure, total mortality, recurrence of arrhythmia, cardiovascular mortality and the need for transplantation were evaluated. Results: From January 2009 to December 2016, 67 procedures (38% complex procedures: 19% epicardial ablation, 7.5% surgical epicardial crioablation, 3% simpatectomy, 3% coronary alcohol injection, 6% extracorporeal membrane oxygenation support) were performed in 41 patients (61% Ischemic etiology) due to ES. Intraprocedural mortality was 1.5%. The median follow-up was 23.5 months (IQR [14.2-52.7]). After the first admission for ES (one or several procedures), 1-year mortality was 9.8%. The cumulative incidence of cardiac transplantation was 2.4%. The risk of arrhythmic recurrences or death was significantly higher in patients with inducible clinical arrhythmias after ablation (HR: 9.03, p = 0.017). Conclusions: The treatment of patients with ES, performed in a reference center, allows obtaining good rates of recurrence and survival, with very low rates of cardiac transplantation for ES. In the presence of an early recurrence, it is advisable to perform a new procedure during admission.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Ventricular Fibrillation/surgery , Tachycardia, Ventricular/surgery , Catheter Ablation/methods , Prognosis , Recurrence , Ventricular Fibrillation/physiopathology , Ventricular Fibrillation/mortality , Survival Rate , Retrospective Studies , Follow-Up Studies , Heart Transplantation/statistics & numerical data , Tachycardia, Ventricular/mortality , Mexico
5.
Arq. bras. cardiol ; 115(5 supl.1): 11-11, nov. 2020. ilus
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1128956

ABSTRACT

INTRODUÇÃO: A ablação por cateter para FV surgiu como uma estratégia nos pacientes nos quais um batimento ectópico é identificado como gatilho. Descrevemos um caso de ablação de FV com sucesso, desencadeada por EV's com origem na cúspide coronariana esquerda (CCE). Relato de caso: Uma mulher de 73 anos com MCP dilatada não isquêmica (FEVE de 20%) e CDI implantado há 9 anos devido a FV induzida em EEF, foi admitida em nosso serviço por choque apropriado. ECG demonstrou EV's frequentes com morfologia de BRE e eixo inferior. Holter 24h revelou EV's monomórficas frequentes (19%) e 68 episódios de TVNS. A interrogação do dispositivo mostrou um episódio de EV desencadeando TV rápida que logo degenerou em FV. Realizada telemetria do CDI concomitante à gravação de ECG, confirmando que as ectopias espontâneas e as que desencadeavam os episódios de TV/FV eram exatamente da mesma morfologia. A paciente foi encaminhada para ablação por cateter. O mapeamento do VE foi realizado por via de acesso retroaórtica. A ativação mais precoce foi registrada na CCE com potenciais precedendo o QRS da extrassístole em 50ms. A energia de RF (potência 50W, temperatura 60°C) foi aplicada no VE em posição subcúspide (Fig.1), com eliminação imediata dos batimentos ectópicos. O Holter 24h foi repetido 2 meses após o procedimento e não mostrou arritmias ventriculares. A paciente evoluiu bem, com resolução dos sintomas e melhora da classe funcional. Discussão: O ECG desempenha um papel importante na identificação da origem das EV's. No presente caso, foram observadas EV's com morfologia de BRE e achados sugestivos de local de origem em VSVE / cúspide coronariana. As cúspides coronarianas esquerdas representam 5-8% do total de sítios focais de extrassístoles ventriculares. Este é o primeiro caso relatado de FV desencadeada por extrassístoles decorrentes da cúspide coronariana esquerda e com resolução completa dos sintomas e densidade da arritmia durante o acompanhamento. Conclusões: Descrevemos um caso de FV desencadeada por EV tratada com sucesso com ablação por RF. A raridade da FV relacionada à cúspide coronariana esquerda é o principal destaque deste caso.


Subject(s)
Ventricular Fibrillation , Catheter Ablation , Ventricular Premature Complexes
6.
Arch. cardiol. Méx ; 90(3): 341-346, Jul.-Sep. 2020.
Article in Spanish | LILACS | ID: biblio-1131053

ABSTRACT

Resumen Objetivo: Analizar el comportamiento de posibles causas predisponentes de muerte súbita (MS) intrahospitalaria luego de un infarto agudo de miocardio (IMA) en registros cubanos. Material y método: Se realizó una búsqueda de registros clínicos de pacientes con IMA en Cuba en las bases de datos de revistas nacionales, Scientific Library On-line (ScieLO) y Medline. Se priorizaron los artículos publicados desde 2016 para ser incluidos. Se definió como muerte súbita aquélla secundaria a arritmias ventriculares malignas (TV y FV), así como los pacientes con rotura cardíaca y actividad eléctrica sin pulso o asistolia como forma de presentación. Con posterioridad se evaluó la relación de este parámetro con la aparición de muerte súbita en 710 pacientes del Registro de Síndromes Coronarios Agudos (RESCUE). Resultados: En el contexto extrahospitalario, más de la mitad de las muertes súbitas cardíacas son secundarias a un infarto agudo de miocardio. En el hospital, la mortalidad en Cuba por IMA es homogénea. Sólo los centros con intervencionismo coronario escapan a este fenómeno. Aunque no del todo letales, las arritmias ventriculares malignas se relacionan con un peor pronóstico y su prevalencia no es homogénea en los registros revisados. Conclusiones: La muerte súbita luego de infarto agudo de miocardio será aún en Cuba una de las principales causas de muerte en los pacientes de fase aguda.


Abstract Objective: To analyze possible predisposing causes of in hospital sudden cardiac death (SCD) after an acute myocardial infarction (IMA) in Cuban registries. Material and methods: A search of clinical records of patients with IMA in Cuba was performed in the databases of national journals, Scientific Library On-line and Medline. Those articles published since 2016 were prioritized for inclusion. Sudden death is defined as that secondary to malignant ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation) as well as patients with cardiac rupture with pulseless electrical activity or asystole as a form of presentation. Subsequently, the relationship of this parameter with the occurrence of sudden death was evaluated in 710 patients from the Registry of Acute Coronary Syndromes (RESCUE). Results: In the out-of-hospital setting, more than half of SCD are secondary to an IMA. Once in the hospital, mortality in Cuba from IMA is homogeneous. Only centers with coronary interventionism escape this phenomenon. Although not totally lethal, the presence of malignant ventricular arrhythmias is associated with a worse prognosis and its prevalence is not homogeneous in the reviewed records. Conclusions: Sudden death after IMA will continue to be one of the main causes of death of patients in the acute phase in Cuba.


Subject(s)
Humans , Death, Sudden, Cardiac/etiology , Myocardial Infarction/mortality , Ventricular Fibrillation/mortality , Ventricular Fibrillation/epidemiology , Registries , Death, Sudden, Cardiac/epidemiology , Tachycardia, Ventricular/mortality , Tachycardia, Ventricular/epidemiology , Cuba , Hospitals , Myocardial Infarction/epidemiology
7.
Rev. colomb. cardiol ; 27(4): 307-313, jul.-ago. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289230

ABSTRACT

Resumen El síndrome de takotsubo o miocardiopatía por estrés es una alteración de la funcionalidad miocárdica, que se asocia con frecuencia a situaciones de estrés físico o emocional. Corresponde entre el 1 y el 2% de todos los ingresos a urgencias por síndrome coronario agudo y tiene una prevalencia y tasa de mortalidad de 4,1% y 2% a 8%, respectivamente. Hasta el 10% de los pacientes presenta algún tipo de complicación. En Colombia los datos epidemiológicos son limitados. En la actualidad se desconoce con exactitud la fisiopatología subyacente y no hay consenso acerca del tratamiento del síndrome y las complicaciones asociadas; por consiguiente, estos interrogantes son posibles temas de investigación. Se expone un caso clínico de características inusuales, que cursó con alteraciones electrocardiográficas, cinéticas y de conducción miocárdica infrecuentes, además de evolución clínica inesperada, que culminó en paro cardiorrespiratorio secundario a taquicardia ventricular polimórfica por persistencia del intervalo QT prolongado. Con base en la experiencia clínica y en la evidencia científica disponible se recomienda monitorizar estrechamente a los pacientes con alteración adquirida de la repolarización miocárdica hasta que esta se normalice y considerar la implantación de un dispositivo cardiaco tipo cardiodesfibrilador en casos de alto riesgo.


Abstract Takotsubo syndrome or stress cardiomyopathy is a myocardial functional disorder, which is often associated with situations of physical or emotional stress. It accounts for between 1% and 2% of all those admitted to the Emergency Department due to acute coronary syndrome, and has a prevalence and mortality rate of 4.1% and 2% to 8%, respectively. Up to 10% of the patients have some type of complication. Epidemiological data are scarce in Colombia. The underlying pathophysiology is still not exactly known, and there is no consensus on the treatment of the syndrome and the associated complications. Therefore, these questions are possible research topics. A clinical case of unusual characteristics is presented, which included rare electrocardiographic, kinetic, and myocardial conduction characteristics. It also had an unexpected clinical outcome, which culminated in cardiorespiratory arrest secondary to a polymorphic ventricular tachycardia due to persistence of the prolonged QT interval. Based on clinical experience and on the available scientific evidence, it is recommended to closely monitor patients with an acquired change in myocardial repolarisation until it returns to normal, and to consider an implantable cardioverter defibrillator in cases of high risk.


Subject(s)
Humans , Female , Adult , Ventricular Fibrillation , Takotsubo Cardiomyopathy , Cardiomyopathies , Torsades de Pointes , Psychological Distress
9.
Article in English | WPRIM | ID: wpr-786213

ABSTRACT

BACKGROUND AND OBJECTIVES: Antiarrhythmic effect of renal denervation (RDN) after acute myocardial infarction (AMI) remains unclear. The goal of this study was to evaluate the effect of RDN on ventricular arrhythmia (VA) after AMI in a porcine model.METHODS: Twenty pigs were randomly divided into 2 groups based on RDN (RDN, n=10; Sham, n=10). After implanting a loop recorder, AMI was induced by occlusion of the middle left anterior descending coronary artery. Catheter-based RDN was performed for each renal artery immediately after creating AMI. Sham procedure used the same method, but a radiofrequency current was not delivered. Electrocardiography was monitored for 1 hour to observe VA. One week later, the animals were euthanized and the loop recorder data were analyzed.RESULTS: Ventricular fibrillation event rate and the interval from AMI creation to first VA in acute phase were not different between the 2 groups. However, the incidence of premature ventricular complex (PVC) was lower in the RDN than in the Sham. Additionally, RDN inhibited prolongation of the corrected QT (QTc) interval after AMI. The frequency of non-sustained or sustained ventricular tachycardia, arrhythmic death was lower in the RDN group in the early period.CONCLUSIONS: RDN reduced the incidence of PVC, inhibited prolongation of the QTc interval, and reduced VA in the early period following an AMI. These results suggest that RDN might be a therapeutic option in patients with electrical instability after AMI.


Subject(s)
Animals , Arrhythmias, Cardiac , Autonomic Denervation , Coronary Vessels , Denervation , Electrocardiography , Humans , Incidence , Methods , Myocardial Infarction , Renal Artery , Swine , Tachycardia, Ventricular , Ventricular Fibrillation , Ventricular Premature Complexes
10.
Korean Circulation Journal ; : 289-301, 2020.
Article in English | WPRIM | ID: wpr-811371

ABSTRACT

Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation (VF) and sudden cardiac death (SCD). To date, the standard therapy for the prevention of SCD in BrS is the use of an implantable cardioverter-defibrillator (ICD) especially in patients who have experienced a prior cardiac arrest or syncopal events secondary to VF. However, ICDs do not prevent the occurrence of VF but react to defibrillate the VF episode, thereby preventing SCD. Often patients with recurrent VF have to be maintained on antiarrhythmic drugs that are effective but have remarkable adverse effects. An alternative therapy for BrS with recurrent VF is catheter ablation which emerged as an effective therapy in eliminating VF-triggering premature ventricular complexes in limited case series; however, there has been a remarkable progress in effectiveness of catheter ablation since epicardial substrate ablation was first applied in 2011 and such approach is now widely applicable.


Subject(s)
Anti-Arrhythmia Agents , Brugada Syndrome , Catheter Ablation , Catheters , Death, Sudden, Cardiac , Defibrillators, Implantable , Heart Arrest , Humans , Ventricular Fibrillation , Ventricular Premature Complexes
11.
Journal of Biomedical Engineering ; (6): 1095-1100, 2020.
Article in Chinese | WPRIM | ID: wpr-879241

ABSTRACT

As an important medical electronic equipment for the cardioversion of malignant arrhythmia such as ventricular fibrillation and ventricular tachycardia, cardiac external defibrillators have been widely used in the clinics. However, the resuscitation success rate for these patients is still unsatisfied. In this paper, the recent advances of cardiac external defibrillation technologies is reviewed. The potential mechanism of defibrillation, the development of novel defibrillation waveform, the factors that may affect defibrillation outcome, the interaction between defibrillation waveform and ventricular fibrillation waveform, and the individualized patient-specific external defibrillation protocol are analyzed and summarized. We hope that this review can provide helpful reference for the optimization of external defibrillator design and the individualization of clinical application.


Subject(s)
Arrhythmias, Cardiac , Defibrillators , Heart , Heart Arrest , Humans , Ventricular Fibrillation/therapy
12.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2 (Supl)): 187-191, abr.-jun. 2019. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-1009725

ABSTRACT

Times de Resposta Rápida (TRR) são equipes multidisciplinares treinadas para atender indivíduos com intercorrências agudas e graves, incluindo parada cardiorrespiratória (PCR) súbita, nas unidades de internação. O objetivo deste trabalho é discutir as particularidades do emprego de um TRR hospitalar no atendimento de PCRs extra-hospitalares, utilizando a experiência do time do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHC-FMUSP) para elucidação. Metodologia: Estudo retrospectivo, descritivo, utilizando o banco de dados do TRR do ICHC-FMUSP. Foram levantados todos os casos classificados como PCR súbita atendidos em ambiente extra-hospitalar, nos anos de 2014 a 2016. Dados globais de cinco pacientes que evoluíram com alta hospitalar e nível neurológico preservado foram descritos e analisados em detalhes. Resultados: Entre 11 atendimentos, oito tiveram retorno da circulação espontânea (RCE) na cena (72,2%) e três morreram no local. Dos oito pacientes admitidos com vida no Departamento de Emergência, cinco tiveram alta hospitalar após o evento (45,5%). A média de tempo de resposta foi 3 ± 1,2 minutos e o intervalo chamada-choque foi de 7,25 ± 3,2 minutos. Os ritmos de parada foram fibrilação ventricular (80%) e atividade elétrica sem pulso (20%). Dois pacientes foram diagnosticados com doença coronariana grave e quatro receberam um cardiodesfibrilador implantável (CDI) para profilaxia secundária de morte súbita. Um paciente, entre os cinco que tiveram alta, faleceu em outro serviço. Conclusão: Apesar de pouco usual, o emprego de um TRR hospitalar no atendimento de PCRs extra-hospitalares pode ser benéfico. Os desfechos favoráveis provavelmente decorreram do treinamento da equipe e da rapidez na realização do atendimento. A investigação cardiológica dos sobreviventes identificou pacientes com doenças graves, que, portanto, mais se beneficiariam da assistência de um time especializado


Introduction: Rapid Response Teams (RRT) are multidisciplinary groups trained to treat individuals with severe and acute events, including sudden cardiac arrest (CA), in in-patient units. The aim of this report is to discuss the singularities of deploying a hospital RRT for out-of-hospital CA assistance, using the experience of the team at the Instituto Central of Hospital das Clínicas of the University of São Paulo School of Medicine (ICHC-FMUSP) as illustration. Methodology: A retrospective, descriptive analysis was conducted, using the RRT database of the ICHC-FMUSP. All cases classified as sudden CA treated outside of the hospital between 2014 and 2016 were surveyed. Global data for five patients who progressed to discharge from hospital free of neuro - logical impairment were described and analyzed in detail. Results: Of the 11 cases, 8 had return of spontaneous circulation (ROSC) at the scene (72.2%), and 3 died on site. Of the 8 patients admitted to the Emergency Department, 5 were discharged from the hospital after the event (45.5%). The average response time was 3±1.2minutes, and the call-to-shock time interval was 7.25±3.2minutes. The cardiac arrest rhythms were ventricular fibrillation (80%) and pulseless electrical activity (20%). Two patients were diagnosed with severe coronary disease and four received an implantable cardioverter-defibrillator (ICD) for secondary prophylaxis of sudden death. One patient, of the 5 discharged, died in another unit. Conclusion: Although unusual, the use of a hospital RRT for out-of-hospital CA assistance can be beneficial. The favorable outcomes likely resulted from the team's training and the speed with which the treatment was given. Cardiovascular evaluation of the survivors identified patents with severe diseases, which would, therefore, most benefit from the care of a specialized team


Subject(s)
Humans , Male , Female , Aged , Hospital Rapid Response Team , Out-of-Hospital Cardiac Arrest/diagnosis , Heart Arrest , Ventricular Fibrillation/complications , Coronary Artery Disease/complications , Echocardiography/methods , Magnetic Resonance Spectroscopy/methods , Cardiovascular Diseases/mortality , Retrospective Studies , Death, Sudden, Cardiac , Defibrillators, Implantable , Electrocardiography/methods , Inpatient Care Units
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2 (Supl)): 192-196, abr.-jun. 2019. tab
Article in English, Portuguese | LILACS | ID: biblio-1009728

ABSTRACT

Identificar a incidência de parada cardiorrespiratória (PCR) nas primeiras 24 horas de internação em Unidades de Terapia Intensiva (UTI) e seus fatores associados; verificar se a maior gravidade admissional está associada à maior ocorrência de PCR em pacientes internados em UTI. Métodos: Em um estudo secundário, foram analisados 530 prontuários completos de indivíduos pertencentes à casuística do estudo primário "Caracterização Clínica de Adultos e Idosos em UTI". Foram extraídos dados demográficos, clínicos, gravidade (Simplified Acute Physiology Score ­ SAPS II) e ocorrência de PCR (eventos/24 horas; tempo; ritmo; medida de reversão e desfecho). Para as análises foram utilizados testes de comparação de médias e de associação. Foi feita correlação ponto bisserial e regressão logística com análise da capacidade preditiva por meio da curva ROC. O valor de p foi fixado em 0,05 e as análises foram feitas por meio do software SPSS (versão 22) e Medcalc. Resultados: A incidência de PCR nas primeiras 24 horas de internação foi de 3,6% (n = 19). Cada indivíduo teve em média 1,61 ± 0,97 eventos de PCR com tempo médio de 7,68 ± 10,59 minutos. Os ritmos mais frequentes foram: AESP (42,1%), AS 21,1%); TV sem pulso (5,3%). A única comorbidade que se associou à PCR foi o choque (p = 0,003). Os métodos de reversão mais utilizados foram: químico (31,6%), químico+elétrico (10,5%) e apenas elétrico (5,3%). Não houve retorno da circulação espontânea em 57,9% dos casos. A SpO2 (p < 0,001), o nível de consciência (p < 0,001) e a gravidade (p = 0,032) associaram­se à ocorrência de PCR. A gravidade admissional foi um preditor independente de ocorrência de PCR (OR = 1,032; p = 0,034), com boa capacidade preditiva (AUC = 0,618). O ponto de corte do SAPS2 que melhor prediz a PCR é 38,0 pontos (sensibilidade: 52,6; especificidade: 72,4). Conclusões: A incidência de PCR nas primeiras 24 horas de internação em UTI foi de 3,6%. Os fatores associados à PCR foram: saturação de oxigênio, nível de consciência e gravidade. A gravidade admissional é um preditor de ocorrência de PCR com boa capacidade preditiva


To identify the incidence of cardiorespiratory arrest (CRA) in the first 24 hours of hospitalization in Intensive Therapy Units (ITU) and its associated factors; to determine whether greater severity on admission is associated with a higher occurrence of CRA in patients admitted to the ITU. Methods: In a secondary study, 530 complete patient records of individuals that comprised the case series of the primary study "Clinical Characterization of Adults and Elderly Patients in ITU" were analyzed. Demographic and clinical data were extracted, and also data on severity (Simplified Acute Physiology Score ­ SAPS II) and the occurrence of CRA (events/24 hours; time; rhythm; reversion measure and outcome). For the analyses, comparisons of means and association tests were used. Biserial point correlation and logistical regression were carried out with analysis of predictive capacity by means of the ROC curve. A p value was fixed at 0.05 and the analyses were performed using the software programs SPSS (version 22) and Medcalc. Results: The incidence of CRA in the first 24 hours of hospitalization was 3.6% (n = 19). Each individual had a mean of 1.61 ± 0.97 CRA events, with a mean time of 7.68 ± 10.59 minutes. The most frequent rhythms were: PEA (42.1%), AS (21.1%); pulseless VT (5.3%). The only comorbidity that was associated with CRA was shock (p = 0.003). The reversion methods most used were: chemical (31.6%), chemical+electrical (10.5%) and only electrical (5.3%). There was no spontaneous return-of-circulation in 57.9% of cases. The SpO2 (p < 0.001), level of consciousness (p < 0.001) and severity (p = 0.032) were associated with the occurrence of CRA. The severity on admission was an independent predictor of the occurrence of CRA (OR = 1.032; p = 0.034), with good predictive capacity (AUC = 0.618). The SAPS2 cutoff point that best predicts CRA is 38.0 points (sensitivity: 52.6; specificity: 72.4). Conclusions: The incidence of CRA in the first 24 hours of hospitalization in the ITU was 3.6%. The factors associated with CRA were: oxygen saturation, level of consciousness, and severity. Severity on admission is a predictor of the occurrence of CRA with good predictive capacity


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Risk Factors , Heart Arrest , Intensive Care Units , Ventricular Fibrillation/complications , Prevalence , Cross-Sectional Studies , Statistical Analysis , Predictive Value of Tests , ROC Curve , Hospitals, University , Nursing Care
15.
Arq. bras. cardiol ; 112(1): 32-37, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-973843

ABSTRACT

Abstract Background: Whole body vibration training (WBV) is a new training program, which is safe and effective. It can be followed by the public. However, data on the safety and efficacy of vibration on myocardial ischemia reperfusion (IR) injury are lacking. Objective: To examine the effect of WBV on the tolerance of the myocardium to acute IR injury in an experimental rat model. Methods: Twenty-four male Wistar rats were divided into control and vibration groups. Vibration training consisted of vertical sinusoidal whole body vibration for 30 min per day, 6 days per week, for 1 or 3 weeks (WBV1 and WBV3 groups, respectively). All the rats were submitted to myocardial IR injury. Myocardial infarct size and ischemia-induced arrhythmias were assessed. Differences between variables were considered significant when p < 0.05. Results: No differences were observed between the groups regarding the baseline hemodynamic parameters. Infarct size was smaller in the experimental group (control, 47 ± 2%; WBV1, 39 ± 2%; WBV3, 37 ± 2%; p < 0.05, vs. control). Vibration produced a significant decrease in the number and duration of ventricular tachycardia (VT) episodes compared to the control value. All ventricular fibrillation (VF) episodes in the vibration groups were self-limited, while 33% of the rats in the control group died due to irreversible VF (p = 0.02). Conclusion: The data showed that vibration training significantly increased cardiac tolerance to IR injury in rats, as evidenced by reduction in the infarct size and cardiac arrhythmias, and by facilitating spontaneous defibrillation.


Resumo Fundamento: O treinamento com vibração de corpo inteiro (WBV) é um novo programa de treinamento seguro e eficaz, e pode ser seguido pelo público. No entanto, dados sobre a segurança e eficácia da vibração na lesão de isquemia e reperfusão (IR) do miocárdio estão em falta. Objetivo: Examinar o efeito da WBV na tolerância do miocárdio à lesão aguda por IR em um modelo experimental em ratos. Métodos: Vinte e quatro ratos Wistar machos foram divididos em 2 grupos: controle e vibração. O treino de vibração consistiu em vibração sinusoidal vertical de corpo inteiro durante 30 min por dia, 6 dias por semana, durante 1 ou 3 semanas (grupos WBV1 e WBV3, respectivamente). Todos os ratos foram submetidos a lesão por IR do miocárdio. O tamanho do infarto do miocárdio e as arritmias induzidas por isquemia foram avaliados. As diferenças entre as variáveis foram consideradas significativas quando p < 0,05. Resultados: Não foram observadas diferenças entre os grupos em relação aos parâmetros hemodinâmicos basais. O tamanho do infarto foi menor no grupo experimental (controle, 47 ± 2%; WBV1, 39 ± 2%; WBV3, 37 ± 2%; p < 0,05, vs. controle). A vibração produziu uma diminuição significativa no número e duração das taquicardia ventriculares (TV) em comparação com o valor de controle. Todos os episódios de fibrilação ventricular (FV) nos grupos de vibração foram autolimitados, enquanto 33% dos ratos do grupo controle morreram devido a FV irreversível (p = 0,02). Conclusão: Os dados mostraram que o treinamento com vibração de corpo inteiro aumentou significativamente a tolerância cardíaca à lesão de IR em ratos, como evidenciado pela redução do tamanho do infarto e arritmias cardíacas, e pela facilitação da desfibrilação espontânea.


Subject(s)
Animals , Male , Physical Conditioning, Animal/methods , Vibration/therapeutic use , Myocardial Reperfusion Injury/prevention & control , Myocardial Infarction/prevention & control , Physical Conditioning, Animal/physiology , Time Factors , Ventricular Fibrillation/prevention & control , Random Allocation , Reproducibility of Results , Risk Factors , Rats, Wistar , Hemodynamics
16.
Article in Korean | WPRIM | ID: wpr-758482

ABSTRACT

Heat stroke is characterized by hyperthermia with an associated altered mental status. Most heat stroke patients experience a change in consciousness as the first symptom and show a variety of electrocardiography abnormalities. No prior case report has described heat stroke, in which the first symptom was cardiac arrest with ventricular fibrillation. A 67-year-old male presented to the emergency department with an altered mental status after a cardiac arrest. His electrocardiogram at the scene was ventricular fibrillation, and he recovered his spontaneous circulation after defibrillation. The heat stroke was treated with aggressive cooling. Emergency physicians should be aware that heat stroke can cause ventricular fibrillation and can be treated with defibrillation and aggressive cooling.


Subject(s)
Aged , Consciousness , Electrocardiography , Emergencies , Emergency Service, Hospital , Fever , Heart Arrest , Heat Stroke , Hot Temperature , Humans , Male , Ventricular Fibrillation
17.
Article in English | WPRIM | ID: wpr-785620

ABSTRACT

OBJECTIVE: Pralidoxime is widely used for the treatment of organophosphate poisoning. Multiple studies have reported its vasoconstrictive property, which may facilitate the restoration of spontaneous circulation (ROSC) after cardiac arrest by increasing the coronary perfusion pressure (CPP). 2,3-Butanedione monoxime, which belongs to the same oxime family, has been shown to facilitate ROSC by reducing left ventricular ischemic contracture. Because pralidoxime and 2,3-butanedione monoxime have several common mechanisms of action, both drugs may have similar effects on ischemic contracture. Thus, we investigated the effects of pralidoxime administration during cardiopulmonary resuscitation in a pig model with a focus on ischemic contracture and CPP.METHODS: After 14 minutes of untreated ventricular fibrillation, followed by 8 minutes of basic life support, 16 pigs randomly received either 80 mg/kg of pralidoxime (pralidoxime group) or an equivalent volume of saline (control group) during advanced cardiovascular life support (ACLS).RESULTS: Mixed-model analyses of left ventricular wall thickness and chamber area during ACLS revealed no significant group effects or group-time interactions, whereas a mixed-model analysis of the CPP during ACLS revealed a significant group effect (P=0.038) and group-time interaction (P<0.001). Post-hoc analyses revealed significant increases in CPP in the pralidoxime group, starting at 5 minutes after pralidoxime administration. No animal, except one in the pralidoxime group, achieved ROSC; thus, the rate of ROSC did not differ between the two groups.CONCLUSION: In a pig model of cardiac arrest, pralidoxime administered during cardiopulmonary resuscitation did not reduce ischemic contracture; however, it significantly improved CPP.


Subject(s)
Animals , Cardiopulmonary Resuscitation , Diacetyl , Heart Arrest , Hemodynamics , Humans , Ischemic Contracture , Organophosphate Poisoning , Perfusion , Swine , Ventricular Fibrillation
18.
Article in English | WPRIM | ID: wpr-785614

ABSTRACT

OBJECTIVE: Head elevation at an angle of 30° during cardiopulmonary resuscitation (CPR) was hemodynamically beneficial compared to supine position in a previous porcine cardiac arrest experimental study. However, survival benefit of head-up elevation during CPR has not been clarified. This study aimed to assess the effect of head-up tilt position during CPR on 24-hour survival in a porcine cardiac arrest experimental model.METHODS: This was a randomized experimental trial using female farm pigs (n=18, 42±3 kg) sedated, intubated, and paralyzed on a tilting surgical table. After surgical preparation, 15 minutes of untreated ventricular fibrillation was induced. Then, 6 minutes of basic life support was performed in a position randomly assigned to either head-up tilt at 30° or supine with a mechanical CPR device, LUCAS-2, and an impedance threshold device, followed by 20 minutes of advanced cardiac life support in the same position. Primary outcome was 24-hour survival, analyzed by Fisher exact test.RESULTS: In the 8 pigs from the head-up tilt position group, one showed return of spontaneous circulation (ROSC); all eight pigs expired within 24 hours. In the eight pigs from the supine position group, six had the ROSC; six pigs survived for 24 hours and two expired. The head-up position group showed lower 24-hour survival rate and lower ROSC rate than supine position group (P<0.01).CONCLUSION: The use of head-up tilt position with 30 degrees during CPR showed lower 24-hour survival than the supine position.


Subject(s)
Advanced Cardiac Life Support , Agriculture , Animal Experimentation , Cardiopulmonary Resuscitation , Electric Impedance , Female , Head , Heart Arrest , Humans , Models, Theoretical , Supine Position , Survival Rate , Swine , Ventricular Fibrillation
19.
Gac. méd. espirit ; 20(3): 78-91, set.-dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-989848

ABSTRACT

RESUMEN Fundamento: La dispersión del intervalo QT es un marcador electrocardiográfico que puede resultar útil en la estratificación de riesgo arrítmicos en pacientes con infarto agudo del miocardio. Objetivo: Describir la influencia de la dispersión del intervalo QT corregido en asociación a otros factores de riesgo como predictores de arritmias ventriculares en el infarto agudo del miocardio con elevación del segmento ST. Metodología: Se estudiaron de menera prospectiva 209 pacientes que ingresaron de forma consecutiva con diagnóstico de infarto agudo de miocardio con elevación del segmento ST de enero de 2013 a junio de 2014 en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus. Se recogieron datos clínicos, de laboratorio electrocardiográficos y ecocardiográficos; se determinó la implicación pronóstica de la dispersión del intervalo QT corregido en la aparición de arritmias ventriculares a través de la regresión logística binaria y las curvas de operador-receptor. Resultados: Las arritmias ventriculares se presentaron en 39 (18.7 %) pacientes. La dispersión del QT corregido mostró una adecuada capacidad de discriminación en la predicción de cualquier episodio arrítmico ventricular grave (c=0.768, p=0.0001). En el análisis multivariado la dispersión del QT resultó un predictor independiente de arritmias ventriculares (OR= 7.075; IC 95%= 1.6- 32.9; p=0.009). Conclusiones: La probabilidad de presentar arritmias ventriculares durante el infarto agudo del miocardio es mayor cuando se incrementan la dispersión del intervalo QT, por lo que se sugiere debe ser una variable a evaluar en la estratificación pronostica del infarto agudo del miocardio.


ABSTRACT Background: Dispersion of the QT interval is an electrocardiographic marker that can be useful in the stratification of arrhythmic risk in patients with acute myocardial infarction. Objective: To describe the influence of corrected QT interval dispersion in association with other risk factors as predictors of ventricular arrhythmias in acute myocardial infarction with ST-segment elevation. Methodology: 209 patients who entered consecutively with diagnosis of acute myocardial infarction with elevation of the ST segment from January 2013 to June 2014 at Camilo Cienfuegos General Provincial Hospital of Sancti Spíritus were studied prospectively. Clinical, electrocardiographic and echocardiographic laboratory data were collected; the prognostic implication of the corrected QT interval dispersion in the appearance of ventricular arrhythmias through binary logistic regression and operator-receiver curves was determined. Results: Ventricular arrhythmias occurred in 39 (18.7%) patients. The dispersion of the corrected QT showed an adequate discrimination capacity in the prediction of any serious ventricular arrhythmic episode (c = 0.768, p = 0.0001). In the multivariate analysis, QT dispersion was an independent predictor of ventricular arrhythmias (OR = 7.075, 95% CI = 1.6-32.9, p = 0.009). Conclusions: The probability of presenting ventricular arrhythmias during acute myocardial infarction is greater when the dispersion of the QT interval is increased, so it is suggested that it should be a variable to be evaluated in the prognostic stratification of acute myocardial infarction.


Subject(s)
Arrhythmias, Cardiac , Long QT Syndrome , Tachycardia, Ventricular , Ventricular Fibrillation , Myocardial Infarction
20.
Rev. Asoc. Méd. Argent ; 131(3): 4-13, Sept. 2018. graf, tab
Article in Spanish | LILACS | ID: biblio-1009216

ABSTRACT

Una de cada cinco muertes en adultos en países desarrollados se debe a causas cardiovasculares; la mitad de esas muertes se produce de forma súbita y un gran porcentaje en el ámbito extrahospitalario. Las medidas de prevención se dividen en: aquellas destinadas a prevenir en primer lugar que el evento de muerte súbita cardíaca suceda, y aquellas cuyo objetivo es actuar en el momento en que el evento de muerte súbita está sucediendo. Las primeras tienen como objetivo disminuir las principales causas de muerte súbita en países desarrollados: las cardiopatías estructurales (cuya principal causa es la enfermedad coronaria). En este sentido, con el fin de intentar paliar el desarrollo de una cardiopatía que predisponga a la aparición de arritmias fatales y la MSC, se implementan medidas de prevención primarias higiénico-dietéticas y farmacológicas (con el objetivo de disminuir y el controlar los factores de riesgo) y, en aquellos con enfermedad cardiovascular ya establecida, se implementan las estrategias secundarias farmacológicas y/o quirúrgicas (revascularización, reemplazo valvular, etc.). El segundo abordaje surge del hecho de que, a pesar de todas estas medidas, un gran número de pacientes presentará eventos arrítmicos en el ámbito extrahospitalario (MSCEH), ya sea porque aunque recibieron el tratamiento óptimo presentan aún un elevado riesgo de MSC, porque no fueron diagnosticados a tiempo o porque a pesar de haber hecho estudios complementarios el diagnóstico es muy dificultoso. Existen dos estrategias: la primera son los dispositivos de cardiodesfibrilación implantables (o, más recientes, los chalecos vestibles). Estos aparatos están indicados para una población seleccionada, sea por haber presentado ya un episodio de muerte súbita abortado, o por presentar una cardiopatía (estructural o genética) que predisponga a una mayor probabilidad de sufrir un evento. La segunda estrategia es la educación y el desarrollo de programas de salud pública que permitan capacitar a la población general en la realización de RCP y el uso de desfibriladores automáticos externos (DEAs), los cuales deberían estar disponibles en cualquier lugar público. Múltiples estudios demostraron que el acceso de la población general al aprendizaje de maniobras de RCP sencillas y pragmáticas y la presencia de DEAs se traduce en un gran aumento de sobrevida sin secuelas en víctimas de MSCEH. (AU)


One of every five deaths in adults is due to cardiovascular causes, in developed countries, and half of these deaths will occur suddenly. A large percentage occur in the out of hospital setting, so measures to prevent it are divided into: those designed to prevent, in the first place, the sudden cardiac death event from happening and those whose purpose is to act when the sudden death event that has already occurred and it´s ongoing. The first aims to reduce the main causes of sudden death in developed countries: structural heart disease (with coronary heart disease as its main cause). In this regard, with the purpose to mitigate the development of a heart disease that predisposes the occurrence of fatal arrhythmias and SCD, we have primary prevention measures, like healthy life style conduct with or without pharmacological treatment, (whose objective is the reduction and control of cardiovascular risk factors) and, in those with cardiovascular disease already established, there is an implementation of pharmacological and / or surgical strategies (Revascularization, valve replacement, etc.). The second objective arises from the fact that, despite all these preventive and therapeutic measures, a large number of patients will present out-of-hospital cardiac arrest (OHCA) either because although they received optimal treatment they still remain in high risk of SCD, even because they were not diagnosed on time, or because despite having complementary studies made the diagnosis is very difficult. There are two well strategies: the first are implantable cardio-defibrillation devices (or, more recently, wearable vests). These are indicated for a selected population, either because they have already presented an episode of sudden aborted death, or because they have heart disease (structural or genetic), which predisposes to a greater probability of suffering an event. The second strategy is the education and development of public health programs that enable the general population to be trained in CPR and the use of external automatic defibrillators. (AEDs) should be available in any public place. Multiple studies showed that access to the general population for learning simple and pragmatic CPR maneuvers and the presence of AEDs is making an impact on a significant increase in survival without consequences in OHCA victims. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Ventricular Fibrillation/complications , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Death, Sudden, Cardiac/epidemiology , Cardiopulmonary Resuscitation , Tachycardia, Ventricular/complications , Electric Countershock , Incidence , Cause of Death , Age Factors , Athletes
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