Hemodynamic, metabolic and ventilatory responses to exercise in adults with congenital heart disease / Respostas hemodinâmicas, metabólicas e ventilatórias ao exercício em adultos com cardiopatia congênita

Background: Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF. Objective: To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease. Methods: Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed. Results: Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO2) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO2 at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg. Conclusion: Adults with congenital heart disease had similar responses to heart failure patients during exercise ­ reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure

Avaliação do consumo alimentar de crianças de 0 a 24 meses com cardiopatia congênita / Assessment of food intake in infants between 0 and 24 months with congenital heart disease

FUNDAMENTO: As crianças com cardiopatia congênita geralmente são desnutridas e apresentam algum grau de comprometimento funcional e/ou estrutural dos orgãos. Existe, ainda, uma deficiência na ingestão de nutrientes, corroborada pelo controle hídrico, que limita o aporte nutricional de alguns cardiopatas. OBJETIVO: Avaliar o consumo alimentar de crianças com cardiopatia congênita internadas na Unidade de Pediatria Cardiológica de hospital-escola público. MÉTODOS: O consumo de alimentos e nutrientes foi calculado pelo consumo alimentar de três dias (método direto de pesagem) e o cálculo das calorias e nutrientes foi feito pelo software Virtual Nutri. RESULTADOS: O consumo de calorias/kg peso, de proteínas diárias, de sódio e de vitamina A esteve dentro do recomendado (p < 0,05). Todavia, as calorias diárias, os lipídios, as fibras, o potássio e o ferro estiveram abaixo do recomendado (p < 0,05) e, as proteínas/kg peso, os carboidratos, o cálcio e a vitamina C estiveram acima do recomendado (p < 0,05). CONCLUSÃO: Crianças com cardiopatia congênita têm dietas inadequadas e, portanto, necessitam de orientação nutricional para haver ingestão dietética adequada e conseqüente melhora do crescimento e do desenvolvimento pondo-estatural, garantindo melhor qualidade de vida aos pacientes.

BACKGROUND: Children with congenital heart disease are usually malnourished and present some degree of functional and/or structural impairment of organs. There is also deficiency in nutrient intake, due to the control of fluids required by some patients which restrains the nutrient intake of some cardiac children. OBJECTIVE: To assess the food intake of children with congenital heart disease hospitalized in the pediatric heart unit of a "Public Teaching Hospital". METHODS: The intake of food and nutrients was calculated based on the food consumed during three days (direct weighting method) and the calories and nutrients were calculated using the Virtual Nutri software. RESULTS: The intake of calories per kilogram of body weight, of daily proteins, sodium and vitamin A was within the recommended levels (p < 0.05). However, the intake of daily calories, fats, fiber, potassium and iron was below the recommended levels (p < 0.05) and the intake of proteins per kilogram, carbohydrates, calcium and vitamin C was above the recommended levels (p < 0.05). CONCLUSION: Children with congenital cardiopathy have inadequate diets, and therefore, need nutritional guidance to foster adequate dietary intake and the resulting improvement in growth and weight and height development, guaranteeing better quality of life to the patients.

Estado nutricio del niño con cardiopatía congénita / Nutritional state in children with congenital heart disease

Objetivo: conocer la frecuencia y tipo de alteración nutricional del niño con cardiopatía congénita. Material y Métodos: Se estudiaron 66 niños con cardiopatía gongénita. A todos se les midió peso, talla, perímetro de barazo, pliegues tricipital y subescapular; se tomaron nuestras senguíneas para biometría hematica y albúmina sérica, t también se colectó orina para determinación de creatinina. Se calcularon las áreas muscular y grasa del brazo y el índice creatina talla. Para comparar los hallazgos de los niños con ambos tipos de cardiopatía se utilizó X² tomando como significativa una p< 0.05. Resultados: 41 fueron niñas y 25 niños; 42 con cardiopatía acianógena y 24 cianógena. Cincuenta fueron desnutridos (26 compensados, 23 descompensados y uno agudo); 16 fueron normales. El 85 por ciento de los niños presentaron área muscular disminuida y 97 por ciento el área grasa. El índice creatinina/talla se encontró disminuido en 94 por ciento de los casos. No se demostraron diferencia significativas entre ambos grupos, en los parámetros estudiados. Conclusión: Los resultados sugieren que la desnutrición en el niño con cardiopatía congénita es muy frecuente, de evolución prolongada, predominantemente compensada y la afectación del estado nutricio es a expensas tanto de la masa muscular como de la grasa