Relação entre Norepinefrina Urinária, Fibrose e Arritmias na Cardiopatia Chagásica Crônica com Fração de Ejeção Preservada ou Minimamente Reduzida / Relationship between Urinary Norepinephrine, Fibrosis, and Arrhythmias in Chronic Chagas Heart Disease with Preserved or Mildly Reduced Ejection Fraction

Resumo Fundamento: Na cardiomiopatia chagásica crônica (CCC), impõem-se estudos com a proposta de identificar fatores de risco arritmogênicos em pacientes nos quais a disfunção ventricular de moderada a grave não está presente. Objetivos: Verificar a dependência entre arritmias ventriculares frequentes (ARV), fração de ejeção de ventrículo esquerdo (FEVE), extensão da fibrose pela ressonância magnética cardíaca (RMC) e dosagem de norepinefrina urinária (NOREPI) na CCC com FEVE preservada ou minimamente comprometida. Métodos: Foi analisada no Holter a presença de extrassístoles ventriculares >30/hora. Na RMC, avaliou-se a FEVE e a quantificação de massa fibrosada. Foi realizada a dosagem de NOREPI pelo método de Muskiet. A matriz de correlação foi calculada para aferir a capacidade de as variáveis preverem outra sendo considerado significante p<0,05. Resultados: Foram incluídos no estudo 59 pacientes, com idade média de 57,9±10,94 anos. Arritmia ventricular frequente (ARV) foi detectada em 28 pacientes. A variável fibrose mostrou-se inversamente proporcional à fração de ejeção de ventrículo esquerdo (FEVE) (R de −0,61) e à norepinefrina urinária (NOREPI) (R de −0,68), assim como a variável ARV mostrou-se inversamente proporcional à FEVE (R de −0,33) e à NOREPI (R de −0,27). Já a FEVE mostrou-se diretamente proporcional à NOREPI (R de 0,83). Conclusão: Nesta amostra, em pacientes com CCC com FEVE preservada ou discretamente reduzida, observa-se a integridade do sistema nervoso autonômico em corações com pouca fibrose e FEVE mais elevada, apesar da presença de tradicionais fatores de risco para morte súbita cardíaca. Há dependência entre os níveis de NOREPI, FEVE e fibrose miocárdica, mas não com ARV.

Abstract Background: In Chronic Chagas Cardiomyopathy (CCC), studies are needed to identify arrhythmogenic risk factors in patients in which moderate to severe ventricular dysfunction is not present. Objective: To verify the correlation between frequent ventricular arrhythmias (PVC), left ventricular ejection fraction (LVEF), extension of fibrosis by cardiac magnetic resonance (CMR), and urinary norepinephrine measurement (NOREPI) in CCC with preserved or mildly compromised LVEF. Methods: The presence of ventricular extrasystoles > 30/h was analyzed on Holter. At CMR, LVEF and quantification of fibrosis mass were evaluated. The dosage of NOREPI was performed using the Muskiet method. The correlation coefficient matrix was calculated to measure the predictive ability of the variables to predict another variable, with p < 0.05 being considered significant. Results: A total of 59 patients were included. The mean age was 57.9 + 10.94 years. PVC was detected in 28 patients. The fibrosis variable was inversely proportional to LVEF (R of −0.61) and NOREPI (R of −0.68). Also, the variable PVC was inversely proportional to LVEF (R of −0.33) and NOREPI (R of −0.27). On the other hand, LVEF was directly proportional to NOREPI (R of 0.83). Conclusion: In this sample, in patients with CCC with preserved or slightly reduced LVEF, integrity of the autonomic nervous system is observed in hearts with little fibrosis and higher LVEF despite the presence of traditional risk factors for sudden cardiac death. There is correlation between the levels of NOREPI, LVEF, and myocardial fibrosis, but not with PVC.

Anaesthetic management of a patient with non compaction cardiomyopathy for implantable cardioverter defibrillator lead replacement

Non compaction cardiomyopathy (NCM) is a rare, primary genetically derived cardiomyopathy with a variable clinical presentation ranging from absence of symptoms to congestive heart failure, systemic thromboembolism, arrythmias and sudden cardiac death. Being an uncommon condition, the perioperative concerns in a patient with NCM have not been studied much. With increasing awareness and improved diagnostic tools including high resolution echocardiography and cardiac MRI, there has been an increase in the reporting of cases which stresses on the need for a complete understanding of this form of cardiomyopathy and its perioperative anaesthetic management. Authors report the case of a 24 years old female, with NCM who underwent prophylactic Implantable cardioverter defibrillator (ICD) insertion 5 years ago and was now posted for ICD removal and replacement in view of inappropriate ICD functioning.

Clinical analysis of emergency coronary after interventional reperfusion arrhythmia / 重庆医学

Objective To explore the characteristics of the reperfusion arrhythmia after acute myocardial infarction (AMI) pa-tients underwent emergency coronary interventional therapy ,in order to reduce the incidence of serious arrhythmia ,and improve the prognosis and quality of life .Methods Clinical data of 147 patients from January 2009 to May 2012 with acute myocardial infarction occurrence reperfusion arrhythmia after underwent emergency coronary interventional treatment were analyzed .Results In 147 ca-ses ,62 cases of reperfusion arrhythmia occurred .Infarct-related artery for the left anterior descending branch (LAD) 33 patients (LAD group ) ,left circumflex artery (LCX) 7 cases (LCX group ) after surgery ,the right coronary artery(RCA) 22 cases (RCA group) .The tachyarrhythmia in LAD group was higher than RCA group(P6 h arrhythmia had 19 cases occurred ;Arrhythmia after acute myocardial infarction occurred mainly in infarct related artery opened earlier .Conclusion AMI occurrence reperfusion arrhythmia after underwent emergency coronary interventional treatment have high incidence ,there is a correlation between the arrhythmia type and infarct-related artery ,also has a correlation between incidence and reperfusion time .

Patología cardiovascular en la acromegalia / Cardiovascular Disease in Acromegaly

A pesar de los modernos tratamientos de la acromegalia, esta enfermedad somete al paciente, a un riesgo cardiovascular dos a tres veces mayor que el de la población adulta normal. Ello es el resultado de una prolongada exposición de los cardiomiocitos al exceso de GH. Esto produce cambios histológicos y en la configuración geométrica de las miofibrillas, fibrosis del intersticio e hipertrofia biventricular. La historia natural de esta cardiopatía de la acromegalia presenta varios períodos evolutivos. En la primera etapa, se puede observar un lento desarrollo de la hipertrofia del miocardio, que luego se asocia a alteraciones del ritmo cardíaco. Estas arritmias, que representan un importante factor de riesgo de accidente cardiovascular, son secundarias a los mencionados cambios estructurales observados en el miocardio y configuran el llamado "síndrome hiperquinético de la acromegalia". Diversos estudios epidemiológicos informan que una proporción variable (25 hasta un 50 %) de los acromegálicos cursa con hipertensión arterial. Ésta es secundaria a la rentención de sodio y la consiguiente expansión del volumen plasmático. Su presencia implica una sobrecarga del trabajo cardíaco y constituye un factor agravante de la patología cardiovascular. En la segunda etapa evolutiva se observan signos ecocardiográficos de reducción del llenado ventricular diastólico. El tercer estadio se caracteriza por la afectación de una o más válvulas cardíacas y alteraciones de la función sistólica y diastólica en reposo y signos de cardiopatía dilatada, que conducen finalmente hacia la insuficiencia cardíaca congestiva. Esta última etapa es irreversible aún con una terapia eficaz. Surge entonces, que el diagnóstico precoz de la enfermedad y un seguimiento estricto de los niveles séricos de GH-IGF-I durante un tratamiento adecuado, es mandatario. Los autores declaran no poseer conflictos de intereses.

Despite modern treatments for acromegaly, this disease is associated with a two to three-fold increase in cardiovascular risk in relation to the normal adult population. This results from a long term exposure of cardiomyocytes to GH excess, which causes histological changes in the geometric configuration of myofibrils, interstitial fibrosis and biventricular hypertrophy. The natural history of acromegalic heart disease includes several stages. In the early phase, there is a slow development of myocardial hipertrophy, subsequently associated with heart rhythm abnormalities. These arrhythmias, which represent a major risk factor for cardiovascular events, are secondary to the above mentioned structural changes in the myocardium, and make up the so-called "hyperkinetic syndrome of acromegaly". According to various epidemiological studies, a variable rate of patients with acromegaly (25 % to 50 %) has hypertension. This complication is secondary to sodium retention and the consequent plasma volume expansion, which implies cardiac overload and constitutes a worsening factor for cardiovascular disease. In the second stage, there are echocardiographic signs of reduced ventricular diastolic filling. The third stage is characterized by alteration of one or more heart valves and impaired systolic and diastolic function at rest, as well as signs of dilated cardiomyopathy, leading to congestive heart failure. This last stage is irreversible even with adequate therapy. Thus, early diagnosis of disease and a close monitoring of serum CH-IGF-I levels are mandatory. No financial conflicts of interest exist.

Prevenção de eventos tromboembólicos em portadores de fibrilação atrial - novos anticoagulantes / Prevention of thromboembolic events in patients with atrial fibrillation – new anticoagulants

The authors present alternatives for the treatment of cardiac arrhythmias. Its detection is based on the use of different methods that record the cardiac electrical activity. The treatment involves intervening in the underlying disorder, antiarrhythmic drugs, stimulation and cardiac defibrillation devices, and, less often, surgery. The technological advances in the last two decades have provided greater efficiency in diagnoses and therapy. Atrial fibrilation patients will benefit from a new set of anticoagulant drugs tested in the past three years. The potential advantages include greater safety and efficacy, as well as convenience for not requiring frequent laboratory controls.

Os autores apresentam as alternativas terapêuticas para o tratamento das arritmias cardíacas. Sua detecção baseia-se no uso de diferentes métodos de registro da atividade elétrica cardíaca. O tratamento envolve intervenção sobre o distúrbio de base, drogas antiarrítmicas, dispositivos de estimulação e desfibrilação cardíaca e, em casos infrequentes, cirurgia. Avanços tecnológicos nas últimas duas décadas têm propiciado maior eficiência diagnóstica e terapêutica nesse campo. Pacientes portadores de fibrilação atrial vão se beneficiar de um novo conjunto de drogas anticoagulantes testadas nos últimos 3 anos. As vantagens potenciais incluem maior segurança e eficácia, assim como comodidade por dispensarem controles laboratoriais frequentes.

Apnéia obstrutiva do sono e arritmias cardíacas: [revisão] / Obstructive sleep apnea and cardiac arrythmias: [review] / Apnea obstructiva del sueño y arritmias cardiacas: [revisión]

A síndrome da apnéia obstrutiva do sono (SAOS) é uma condição prevalente, frequentemente não diagnosticada, associada à elevação do risco cardiovascular, incluindo as arritmias. O reconhecimento da síndrome requer avaliação clínica detalhada, realizada por cardiologistas, e pode ser confirmada por meio da polissonografia. Arritmias que ocorrem durante o sono foram relatadas pela primeira vez em 1965, em pacientes com Síndrome de Pickwick. Desde então, diversos estudos foram realizados sobre incidência, fatores de risco, tratamentos, bem sobre sua importância clínica. Este artigo aborda a fisiopatologia e os aspectos clínicos das arritmias durante a apnéia do sono, por meio de uma revisão dos principais artigos sobre o assunto.

ABSTRACT: The syndrome of obstructive sleep apnea (OSA) is a prevailing condition in the population associated with increased cardiovascular risk, often undiagnosed, including arrhythmias. Therecognition of the syndrome requires a high degree of clinical suspicion, particularly by cardiologists, and it can be confirmed by polysomnography. Arrhythmias that occur during sleep have been reported since 1965 in patients with syndrome of Pickwick. Since then there have been several studies to analyze the frequency, risk factors, treatments, as well as the clinical importance. This article coversthe physiopathology and clinical aspects of arrhythmias during sleep apnea, through a review of the main articles on the subject.

RESUMEN: El síndrome de la apnea obstructiva del sueño (SAOS) es una condición prevalente en la población, asociada con el mayor riesgo cardiovascular, a menudo no diagnosticada, incluyéndose las arritmias. El reconocimiento del síndrome requiere alto grado de sospecha clínica, especialmentepor cardiólogos, y se la puede confirmar por medio de la polisonografia. Las arritmias que ocurren durante el sueño se relatan desde 1965 en pacientes con Síndrome de Pickwick. Desde esa época, se han llevado a cabo diversos estudios a fin de analizar su frecuencia, factores de riesgo, tratamientos, así como su importancia clínica. Este artículo aborda la fisiopatología y los aspectos clínicos de las arritmias durante la apnea del sueño, a través de una revisión de los principales artículos sobre el tema.