Linear and nonlinear analysis of heart rate variability in healthy subjects and after acute myocardial infarction in patients

The objectives of this study were to evaluate and compare the use of linear and nonlinear methods for analysis of heart rate variability (HRV) in healthy subjects and in patients after acute myocardial infarction (AMI). Heart rate (HR) was recorded for 15 min in the supine position in 10 patients with AMI taking β-blockers (aged 57 ± 9 years) and in 11 healthy subjects (aged 53 ± 4 years). HRV was analyzed in the time domain (RMSSD and RMSM), the frequency domain using low- and high-frequency bands in normalized units (nu; LFnu and HFnu) and the LF/HF ratio and approximate entropy (ApEn) were determined. There was a correlation (P < 0.05) of RMSSD, RMSM, LFnu, HFnu, and the LF/HF ratio index with the ApEn of the AMI group on the 2nd (r = 0.87, 0.65, 0.72, 0.72, and 0.64) and 7th day (r = 0.88, 0.70, 0.69, 0.69, and 0.87) and of the healthy group (r = 0.63, 0.71, 0.63, 0.63, and 0.74), respectively. The median HRV indexes of the AMI group on the 2nd and 7th day differed from the healthy group (P < 0.05): RMSSD = 10.37, 19.95, 24.81; RMSM = 23.47, 31.96, 43.79; LFnu = 0.79, 0.79, 0.62; HFnu = 0.20, 0.20, 0.37; LF/HF ratio = 3.87, 3.94, 1.65; ApEn = 1.01, 1.24, 1.31, respectively. There was agreement between the methods, suggesting that these have the same power to evaluate autonomic modulation of HR in both AMI patients and healthy subjects. AMI contributed to a reduction in cardiac signal irregularity, higher sympathetic modulation and lower vagal modulation.

Valvoplastia mitral percutânea de urgência em gestante / Emergency percutaneous balloon mitral valvoplasty in a pregnant woman

Gestante com 33 anos na 28ª semana e sinais de óbito fetal foi admitida em caráter de urgência com quadro de edema pulmonar agudo secundário à estenose mitral grave. Com insucesso do tratamento medicamentoso intensivo, a paciente foi submetida à valvoplastia mitralpercutânea de emergência com melhora imediata. O agravamento subseqüente do quadro, atribuído ao óbito fetal, foi tratado através parto cesário com melhora clínica considerável. A paciente teve alta hospitalar no10§ dia, e 11 meses após o procedimento, encontraÄse em classe funcional I, sem uso de medicaçäo e com sinais ecocardiográficos de estenose mitral leve (área valvar: 2,0cm "ao quadrado".