Electrocardiographic Findings Among Asymptomatic Adults With Haemophilia

Abstract Background: People with haemophilia (PwH) are living longer. Therefore, they can develop atherosclerotic cardiovascular disease (ASCVD). Electrocardiogram (ECG) alterations may be a sign of initial ASCVD before the occurrence of symptoms. Objective: To describe the prevalence of resting ECG alterations among PwH adults asymptomatic for ASCVD. Methods: PwH aged ≥ 30 years without previous ASCVD events were considered for the analysis. Resting ECG traces were analysed according to international reference values and the Brazilian Longitudinal Adult Health Study (ELSA-Brasil) results for asymptomatic Brazilian men. Based on the established normal values and using the QT index, we further described the altered ECGs as minor or major changes, according to the Minnesota Code. Differences between prevalences were evaluated by Pearson's χ2 test. Differences between medians were evaluated by the Mann-Whitney U test. A p-value < 0.05 was accepted as statistically significant. Results: A total of 64 PwH were included in the study. Median age was 44 years (interquartile range 35-52). Most patients had haemophilia A (81%) and 47% were severe. The prevalence of obesity, systemic arterial hypertension (SAH), diabetes mellitus (DM), and dyslipidaemia were 16%, 56%, 14%, and 72%, respectively. All the PwH had sinus rhythm, except for one, who had an implanted pacemaker due to idiopathic third-degree atrioventricular block. Altered ECGs were found in 25% and 30% of PwH, according to established criteria and ELSA-Brasil criteria, respectively. Major changes were found in eight (13%) PwH according to the Minnesota Code, including two ECGs with ischaemia-like wall inactivity. Conclusions: The prevalence of altered ECG varied from 25% to 30% among asymptomatic PwH.

Demographic and clinical characteristics of pulmonary arterial hypertension caused by schistosomiasis are indistinguishable from other etiologies

Abstract INTRODUCTION: Pulmonary arterial hypertension (PAH) is a serious pulmonary circulation disease caused by several etiologies, including schistosomiasis. The present study retrospectively evaluated the clinical and hemodynamic characteristics of patients with schistosomal PAH (PAH-Sch) compared to those of non-Sch PAH patients (non-Sch PAH). METHODS: Patients treated at the Pronto-Socorro Cardiológico de Pernambuco and diagnosed by right cardiac catheterization were divided into PAH-Sch and non-Sch PAH groups. Their socio-demographic and clinical characteristics, N-terminal-pro B-type natriuretic peptide (NT-proBNP), and echocardiography and hemodynamic parameters were retrospectively reviewed. RESULTS: Among the included 98 patients (mean age, 45 ± 14 years; 68 women [69.4%]), we found 56 PAH-Sch and 42 non-Sch PAH. The age distribution was heterogeneous in the PAH-Sch group, with patients predominantly ranging from 50-59 (p <0.004). Dyspnea was the most common symptom, reported by 92 patients (93.8%), and commonly present for over two years prior to diagnosis. Clinical symptoms were similar in both groups, with no differences in functional class, pulmonary artery systolic pressure (p = 0.102), 6-minute walk test score (p = 0.234), NT-proBNP serum levels (p = 0.081), or hemodynamic parameters. CONCLUSIONS: Patients with PAH-Sch present clinical, laboratory, and hemodynamic profiles similar to those with PAH resulting from other etiologies of poor prognosis. PAH is an important manifestation of schistosomiasis in endemic regions that is often diagnosed late.

Strain miocárdio do ventrículo esquerdo na doença arterial coronariana com remodelação / Myocardial strain of the left ventricle in coronary artery disease with remodeling

Introdução: A remodelação após infarto do miocárdio caracteriza-se por dilatação ventricular e aumento da esfericidade, o que ocorre também nas áreas não isquêmicas adjacentes ao infarto e mesmo em regiões distantes. Objetivo: Estudar, com strain bidimensional, a região isquêmica, de transição e distante da isquemia, em pacientes com infarto do miocárdio e remodelação do ventrículo esquerdo(VE). Método e material: Foram incluídos 39 pacientes (34 homens, 61,4 ± 9,1) anos, com infarto do miocárdio e remodelação doVE e 20 indivíduos saudáveis (15 homens, 60,5 ± 7,8 anos). Ao ecocardiograma foram avaliados: diâmetros, volumes, fração de ejeçãodo VE (Simpson), strain longitudinal, transversal e shear strain, nas áreas isquêmica (I), de transição (T) e distante da isquemia (D). Para comparações foi utilizado teste t e análise de variância; significante se p < 0,05. Resultados: O grupo de pacientes teve diâmetro diastólico do VE maior (59,8mm x 48,6mm; p< 0,0001) e fração de ejeção menor (36 x 56%; p< 0,0001). No grupo de pacientes, osvalores de strain longitudinal (D: -13,8; T: -7,6; I: -0,72), transversal (D: 28,7; T: 23,6; I: 2,8) e o shear strain (D: 0,12; T: 0,10; I: 0,07) foram menores do que nos controles (D: -17,8; T: 33,8; I: 0,43); p< 0,001). Houve diferença progressiva e significante do strain entreas regiões distante, de transição e isquêmica (p< 0,001). Conclusão: Em pacientes com infarto do miocárdio, detectou-se diminuição progressiva de todas as formas de strain nas regiões isquêmica, de transição e distante da isquemia.

Tratamento com stent em tronco de artéria coronária esquerda por compressão do tronco da artéria pulmonar em paciente com hipertensão pulmonar esquistossomótica / Stent treatment for a left main coronary artery compression by a dilated pulmonary trunk in a patient with schistosomotic pulmonary hypertension

A hipertensão arterial pulmonar frequentemente está associada a dor torácica com características anginosas e sua etiologia é desnconhecida. A compressão extrínseca do tronco de artéria coronária esquerda pela artéria pulmonar é uma causa tratável e deve ser considerada. É apresentado o caso de uma paciente com hipertensão arterial pulmonar de etiologia esquistossomótica, com angina do peito decorrente de compressão do tronco de artéria coronária esquerda, que foi tratada com stent intracoronário. Os sinais e sintomas isquêmicos foram completamente resolvidos e a ultrassonografia intracoronária, realizada na evolução tardia, mostrou a consolidação do resultado angiográfico.

Pulmonary hypertension is frequently associated to chest pain with anginous characteristics and its etiology is uncertain. Extrinsic compression of the left main coronary artery by the pulmonary artery is a treatable cause and should be taken into consideration. We present the case of a patient with pulmonary hypertension of schistosomotic etiology presenting angina due to compression of the left main coronary artery, who was treated with an intracoronary stent. Signs and symptoms of ischemia were completely resolved and a late follow-up intravascular ultrasound confirmed the vessel patency.

Hipertensão pulmonar associada à síndrome da imunodeficiência adquirida: apresentação de cinco casos e revisão da literatura / Pulmonary hypertension associated with acquired immunodeficiency syndrome: presentation of five cases and review of the literature

Diversas doenças cardiorespiratórias podem complicar a síndrome da imunodeficiência adquirida. A hipertensão pulmonar é uma rara doença com um pobre prognóstico. Nós descrevemos esta síndrome em cinco pacientes com infecção pelo vírus da imunodeficiência adquirida em nosso serviço com revisão da literatura.

Several cardiorespiratory diseases may complicate the acquired immunodeficiency syndrome. Pulmonary hypertension is a rare clinical disorder with a poor prognosis. We describe this syndrome in five patients seen at our service who presented infection with the acquired immunodeficiency virus, and we review the literature.

Hiperuricemia como factor de riesgo para el desarrollo de hipertensión, daño renal crónico y síndrome metabólico / Hyperuricemia as a risk factor for developing hypertension, chronic kidney damage and metabolic syndrome

Por mucho tiempo se ha descrito una asociación entre la hiperuricemia y el desarrollo de hipertensión arterial, enfermedades cardiovascular y renal, así como síndrome metabólico: sin embargo el mecanismo de año asociado a la hiperuricemia no ha sido aclarado totalmente, principalmente debido a la fala de un modelo experimental adecuado. actualmente existe un renovado interés por el posible papel patogénico del ácido úrico; estudios clínicos, epidemiológicos y expeirmentales sugieren que la hiperuricemia puede contribuir al desarrollo y permanencia de la hipertension arterial sistémica, las enfermedades cardiovasculares y renales, el síndrome metabólico y posiblemente la diabetes mellitus tipo 2.