Résumé
OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64 percent) patients were eligible for exercise testing, but only 268 (40 percent) underwent the test. RESULTS: The mean age of the patients studied was 51.7±12.1 years, and 188 (70 percent) were males. Twenty-eight (10 percent) patients had a previous history of coronary artery disease, 244 (91 percent) had a normal or unspecific electrocardiogram, and 150 (56 percent) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13 percent) were positive, 191 (71 percent) were negative, and 43 (16 percent) were inconclusive. In the group of patients with a positive exercise test, 21 (62 percent) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated
Sujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Douleur thoracique , Service hospitalier d'urgences , Épreuve d'effort , Études de cohortes , Sécurité du matériel , Études de faisabilité , Études prospectives , Résultat thérapeutiqueRésumé
PURPOSE: To identify in the elderly adaptations imposed by exercise in both sexes. METHODS: 1528 stress tests were performed on subjects divided in: group I (GI) (90) between 65 to 75 years old, and group II (GII) more than 75 years old. Protocols applied were Bruce (72), and modified Naughton (28). Clinical, hemodynamic and electrocardiographic variables were estimated as recommended by the World Health Organization, and the metabolic variables in the adapted Naughton protocols by the American College of Sports Medicine standards. RESULTS: Analysis of GI and GII, respectively disclosed: 1) stress electrocardiogram (ECG): normal, 36 and 35; ST depression, 20 and 22; ST elevation, 6 and 1; ventricular ectopic beats, 11 and 14; supra ventricular ectopic beats, 5 and 6; 2) metabolic and hemodynamic variables: the double-product: 26636 (+/-1539) and 23133 (+/-3218) mmHg X bpm (p < 0.0001). Maximum oxygen uptake measured in METS: GI, men, 7.7 (+/-1.9), women 5.4 (+/-0.8) (p < 0.0001); GII, NS, curve of systolic blood pressure: GI, men, 8.4 +/- (0.5), women, 10.6 (+/-1.8) mmHg/Met (p = 0.03); GII- NS. Difference of diastolic blood pressure and heart rate during exercise were similar between the two groups; 3) chest pain was the main clinical variable. CONCLUSION: The more frequent indication for stress testing to evaluate chest pain in GI, did not correspond to a predominance of this symptom in this group, during exercise; in GI, in contrast to what is seen in the young, the curve of systolic blood pressure was greater in women; despite the greater prevalence of coronary artery disease in aged subjects, it was not observed significative differences between the two groups, to ischaemic ST depression.
Sujets)
Humains , Mâle , Femelle , Sujet âgé , Épreuve d'effort/méthodes , Études rétrospectives , Électrocardiographie , Consommation d'oxygène , Hémodynamique , Pression artérielleRésumé
Foi realizado um estudo preliminar sobre clearance de creatinina em 22 pacientes com distúrbios cardiovasculares, após tratamento intravenoso com EDTA e antioxidantes por via oral (quelaçäo). Os resultados mostraram significativa melhoria na depuraçäo de creatinina assim como diminuiçäo da creatininemia