Fatores de risco para infarto agudo do miocárdio evidenciados em pacientes hospitalizados em unidade coronariana / Risk factors for acute myocardial infarction evidenced in hospitalized patients in the coronary care unit / Factores de riesgo de infarto agudo de miocardio en evidencia en los pacientes hospitalizados en la unidad de cuidados coronarios

Objetivo: descrever os fatores de risco identificados em pacientes com infarto agudo do miocárdio hospitalizados em unidade coronariana. Método: estudo descritivo, transversal com abordagem quantitativa, realizado com 125 indivíduos com diagnóstico de infarto agudo do miocárdio. a amostra foi coletada por conveniência de forma consecutiva. os dados foram analisados com auxílio do programa estatístico Statistical Package for Social Sciences versão 21 e aprovado sob parecer 457.504. Resultados: predominou indivíduos do sexo masculino de etnia branca e com uma média de 62 anos. os fatores de risco mais prevalentes na amostra foram: sedentarismo, hipertensão arterial, histórico familiar, tabagismo, ingesta alcoólica e diabetes mellitus. Conclusão: a pesquisa traz dados relevantes para o controle dos fatores de risco identificados, mostra onde direcionar as ações preventivas, a fim de diminuir a incidência do infarto agudo do miocárdio, suas sequelas e a mortalidade

Objective: to describe the risk factors identified in patients with acute myocardial infarction hospitalized in coronary unit. Method: a descriptive, cross-sectional citado with a quantitative approach. conducted with 125 individuals diagnosed with acute myocardial infarction. the sample was collected for convenience consecutively. data were analyzed using the Statistical Package For Social sciences version 21 and approved under opinion 457 504. Results: the predominant male subjects were caucasian and with an average of 62 years. the most prevalent risk factors in the sample were: physical inactivity, high blood pressure, family history, smoking, alcohol consumption and diabetes mellitus. Conclusion: the research provided data relevant to the control of identified risk factors, showing where to focus preventive actions in order to reduce the incidence of acute myocardial infarction, its sequels and mortality

Objetivo: describir los factores de riesgo identificados en pacientes con infarto miocardio agudo hospitalizados en una unidad coronaria. Método:estudio descriptivo, transversal con enfoque cuantitativo, realizado con 125 personas con diagnostico de infarto miocardio agudo. la muestra fue recogida conveniencia consecutivamente. los datos se analizaron con ayuda del paquete statistical package for social sciences versión 21 y aprobado bajo la opinión 457.504. Resultados: predominou individuos del género masculino de étnico blanco y con un promedio de 62 años. los factores de riesgo más prevalentes de la muestra fueron: sedentarismo, hipertensión arterial, historia familiar, fumar, ingesta alcohólica y diabetes mellitus. Conclusión: la investigación trae datos relevantes para el control de factores de riesgo identificados, mostrando dónde enfocar las acciones preventivas, para reducir la incidencia de infarto de miocardio agudo, sus secuelas y mortalidad

Desfecho clínico de usuários internados em uma unidade intensiva coronariana / Desfecho clínico de usuários internados en una unidad intensiva coronariana / Clinical outcome of patients hospitalized in a coronary intensive care unit

Objetivo: verificar quais os desfechos clínicos dos usuários internados em uma Unidade de Terapia Intensiva Coronariana de um hospital no sul de Mato Grosso. Método: estudo do tipo coorte retrospectivo, documental, com abordagem quantitativa, com 593 usuários durante o ano de 2017. Resultados: verificou-se significância em relação ao desfecho clínico óbito no bloco de distúrbios mecânicos, em relação ao número menor de admissões e proporcionalmente um aumento do desfecho óbito com 36,3% o que reflete a associação estatística entre as variáveis (p-valor=0,0184); Também é imperativo destacar a relação entre o número de altas e de óbitos a partir do décimo sexto dia de internação, ocorrendo associação entre as varáveis (p-valor= 0,00001). Conclusão: espera-se que a partir dos dados sociodemográficos e clínicos dos usuários atendidos, a instituição consiga implementar da assistência ofertada, com foco no atendimento especializado, de modo a repercutir na redução do desfecho óbito na Unidade Coronariana

Objective: to verify the clinical outcomes of patients hospitalized in a Coronary Intensive Care Unit of a hospital in the south of Mato Grosso. Method: a retrospective, documental cohort study with a quantitative approach, with a sample of 593 users during the year 2017. Results: significance was verified regarding the clinical outcome of death in the block of mechanical disorders, in relation to the lower number of admissions and proportionately an increase in the death outcome with 36.3%, which reflects the statistical association between the variables (p-value = 0.0184); It is also imperative to highlight the relationship between the number of discharges and deaths from the sixteenth day of hospitalization, with an association between the variables (p-value = 0.00001). Conclusion: based on the socio-demographic and clinical data of the patients served, the institution is able to implement the offered assistance, focusing on the specialized care, so as to pass on the reduction of the death outcome in the Coronary Unit

Objetivo: verificar los resultados clínicos de los usuarios internados en una Unidad de Terapia Intensiva Coronaria de un hospital en el sur de Mato Grosso. Método: estudio del tipo cohorte retrospectivo, documental, con abordaje cuantitativo, con muestra de 593 usuarios durante el año 2017. Resultados: se verificó significancia en relación al desenlace clínico óbito en el bloque de disturbios mecánicos, en relación al número menor de admisiones y proporcionalmente un aumento del desencadenamiento óbito con 36,3% lo que refleja la asociación estadística entre las variables (p-valor = 0,0184); También es imperativo destacar la relación entre el número de altas y de muertes a partir del décimo sexto día de internación, ocurriendo asociación entre las variables (p-valor = 0,00001). Conclusión: se espera que a partir de los datos sociodemográficos y clínicos de los usuarios atendidos, la institución consiga implementar la asistencia ofrecida, con foco en la atención especializada, para repercutir en la reducción del desenlace muerto en la Unidad Coronaria

Impact of coronary intensive care unit in treatment of myocardial infarction / Impacto da unidade coronariana no tratamento do infarto do miocárdio

Summary Introduction: The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI) has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU). The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. Method: We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group) and between 2000 and 2002, before CICU implementation (before group). Results: The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850), but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. Conclusion: CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients.

Resumo Introdução: Apesar da diminuição da mortalidade por infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-ST) no mundo, a doença ainda acarreta elevados custos e morbidade. Muitas medidas contribuem para a redução da mortalidade, dentre elas a criação de unidades intensivas coronarianas (UCO). Objetivo: Avaliar o impacto da criação de uma UCO na prescrição de tratamentos preconizados e na mortalidade em 30 dias em pacientes com IAM-ST. Método: Foi realizado estudo retrospectivo e foram coletados dados de prontuários de pacientes internados na UCO de 2005 a 2006 (grupo depois). Esses dados foram comparados com dados do serviço de 2000 a 2002, previamente à criação da UCO (grupo antes). Resultados: Havia 101 e 143 pacientes nos grupos depois e antes, respectivamente. Não houve diferenças em relação às características populacionais e às características do infarto entre os períodos. Observamos aumento na prescrição de iECA, clopidogrel e estatinas. Apesar da ausência de mudanças no número de pacientes que receberam terapia de reperfusão, houve aumento de angioplastias primárias em detrimento ao uso de trombolíticos no período posterior à criação da UCO. Não observamos diminuição da mortalidade em 30 dias após IAM-ST (antes: 10,5%; depois: 8,9%; p=0,850), mas a prescrição de tratamentos preconizados foi alta em ambos os períodos. O uso de iECA e de betabloqueador diminuiu o risco de morte em 4,4 e 4,9 vezes, respectivamente. Conclusão: Em pacientes com IAM-ST, a criação da UCO não reduziu a mortalidade em 30 dias, mas houve aumento na prescrição de tratamentos preconizados.

Infarto agudo al miocardio en el adulto mayor: Características clínicas, evolución hospitalaria y a 5 años plazo / Features of acute myocardial infarction among aged patients

Background: Among aged patients, acute myocardial infarction has more complications and there is a tendency to underuse proven treatments. Aim: To report the features of acute myocardial infarction among aged patients. Material and Methods: Analysis of a registry of patients with acute myocardial infarction admitted to a coronary unit. For the purposes of analysis, patients aged 65 years or more were selected. Follow up was made consulting medical records, calling patients by telephone or consulting death records at the National Identification Service. Results: A total of 1.358 patients were admitted in the study period with a diagnosis of acute myocardial infarction and 580 (43%) were aged 65years or more. On admission, this age group had a higher frequency of hemodynamic instability and anterior wall infarctions. Reperfusion therapy and beta blockers were used less commonly in this group. Hospital mortality among patients younger or older than 65 year was 8 and 25%, respectively (p < 0.01). Among aged patients, five years mortality was 33%. Conclusions: Among aged patients, acute myocardial infarction has a higher risk profile on admission, is usually undertreated and has higher mortality than younger subjects.

Expressão não verbal do paciente no cuidado: percepção do enfermeiro em unidade cardiointensiva / No verbal expression from the patient in care: perception of the nurse in cardio intensive care unit

Este estudo trata da percepção de enfermeiros relativa à observação, à identificação e à análise da comunicação não verbal para traduzir a reação e o sentimento do paciente. Realizado em 2009 em um hospital no Rio de Janeiro com quatorze enfermeiros. RESULTADOS: A comunicação não verbal foi citada no banho no leito (12%), pré-operatório (12%), pós-operatório (12%), admissão (12%), punção venosa (12%), visita familiar (8%), preparo de material (3%), dissecção venosa (3%), aspiração (3%), cardioversão (3%); 18% das enunciações não atendidas referem-se a situações de medo da morte (pré-operatório) e à incapacidade diante do abandono familiar. Os autores destacam que 7% dos pensamentos são representados por palavras, 38%, pela paralinguagem e 55%, pelos sinais corporais. CONSIDERAÇÕES: O enfermeiro observa, identifica e analisa a CNV para traduzir a reação, o sentimento do paciente e as necessidades a serem atendidas pelo cuidado.

That is the perception of nurses related to observation, identification and analysis of non-verbal communication to translate the patient's reaction and feelings during the care provided. Method: Qualitative approach through creative dynamics with fourteen nurses in cardio intensive unit, in Rio de Janeiro's Hospital, in 2009. RESULTS: The non-verbal communications is presented in the bath in bed (12%) preoperative (12%), postoperative (12%), admission (12%), venous puncture(12%), family visit (8%), preparation of material (3%), venous dissection (3%), aspiration (3%), cardio version (3%), 18% of statements missed refer to situations of fear death (preoperative) and the inability against family abandonment. DISCUSSION: There is a validation that 7% of the thoughts are represented by words and 93% by body signals. Considerations: the nurse observes, identifies and analyses the NCV to translate the reaction, the patient's feeling and needs to be met by care.

El estudio trata de la percepción de los enfermeros sobre la observación, identificación y análisis de la comunicación no verbal del paciente para traducir la reacción y el sentimiento durante el cuidado prestado. Método: Abordaje cualitativo, a través de dinámicas creativas con catorce enfermeros de la unidad cardio-intensivista, en un hospital de Rio de Janeiro, en 2009. RESULTADOS: La comunicación no verbal se presenta en el baño en la cama (12%), preoperatorio (12%), postoperatorio (12%), admisión (12%), punción venosa (3%), aspiración (3%), cardioversión (3%), 18% de no atendidas se refiere a situaciones de miedo frente la muerte (preoperatorio) y la incapacidad frente al abandono familiar. DISCUSIÓN: Ha validación de que 7% de los pensamientos son representados por palabras, y un 93% por los señales corporales. Consideraciones: el enfermero observa, identifica y analiza la CNV para traducir la reacción, el sentimiento del paciente y las necesidades que sean atendidas por el cuidado.

Changing trends of in vitro antimicrobial resistance patterns in blood isolates in a tertiary care hospital over a period of 4 years.

Context: Multidrug-resistant organisms continue to be a problem for clinicians worldwide. AIMS: To analyze the changing trend of antimicrobial susceptibility patterns in the blood isolates over a period of 4 years in our hospital. Settings and Design: This is a retrospective study done in tertiary care cardiac institute over a period of 4 years. Materials and Methods: We retrospectively analyzed blood culture positive isolates and studied the antimicrobial susceptibility patterns of microorganisms during the period starting from January 2007 to December 2010. Statistical Analysis Used: Statistical analysis was conducted using SPSS for windows version 13.0. Fisher exact test or chi-square test was applied for comparison of categorical variables. P values less than .05 were considered as statistically significant. Results: The rate of blood culture positivity was 3.72%. Gram-negative bacteria were more common than Gram-positive bacteria. There was a gradual increase in Gram-negative bacteria especially Klebsiella pneumoniae and Acinetobacter species. Klebsiella pneumoniae showed a significant increase of resistance to cefoperazone sulbactam (P = .023), piperacillin tazobactam (P < 0.001), imipenem (P < 0.001), and meropenem (P < 0.001) between the first (2007-2008) and second period (2009-2010) of study. The carbapenems resistance is on rise in Gram-negative bacteria including Enterobacteriaceae and non-fermenters. Conclusions: Our findings suggest that there is a definite increase in the multidrug resistant organisms. The data on the changing trends in antibiotic resistance, we believe is an important pillar in our efforts at improving infection control practices.

Lipid profiles of acute coronary syndrome patients hospitalized in ICCU of Cipto Mangunkusumo Hospital.

AIM: to see which component of the triad lipid that has more important role and frequently found in patients with acute coronary syndrome, focusing on HDL cholesterol. METHODS: a lipid profile study has been conducted in 391 patients with acute coronary syndrome (ACS), who have been hospitalized in ICCU of Cipto Mangunkusumo Hospital since January 1st, 2001 - December 31st, 2005. RESULTS: there were 294 male patients (75.2%) and 97 female patients (24.8%), from 25-89 years age group, with mean value 57.35 +/- 11.05. The mean value of total cholesterol level was 205.23 mg/dl +/- 54.84. The LDL cholesterol level was 136.16 mg/dl +/- 47.29. The mean HDL cholesterol level was 42.84 mg/dl +/- 10.28, mean triglycerides level was 157.25 mg/dl +/- 100.16. There were 82 patients (21%) with high total cholesterol (> 240 mg/dl), 102 patients (26.1%) with high and very high LDL cholesterol level (> 160 mg/dl), 152 (38.6%) patients with low HDL cholesterol level (< 40 mg/dl), consisted of 126 male patients or 42.9% of total male patients, 26 female patients or 26.8% of total female patients. The number of patients with high / very high triglycerides level (> 200 mg/dl or 500 mg/dl) was 84 patients (21.5%). The number of patients with optimal lipid level, total cholesterol level < 200 mg/dl was 191 patients (48.8%); 82 patients (21%) had LDL cholesterol level < 100 mg/dl, 23 patients (5.9%) had HDL cholesterol level > 60 mg/dl, 226 patients (57.8%) had triglycerides level < 150 mg/dl. There were 260 patients with atherogenic lipid profile (64%), 135 patients with borderline lipid profile (34.5%), and optimal lipid profile was found only in 6 patients (1,5%). The mean value of HDL cholesterol level in male patients was 41.75 mg/dl +/- 9.9, while HDL cholesterol level in female patients was 46.16 mg/dl +/- 10.74. Principally, lipid profiles of all age groups were evenly distributed. ACS patients with history of family heart disease had a more atherogenic lipid profile compared to lipid profile of patients with hypertension, diabetes mellitus, and cigarette smoking. CONCLUSION: atherogenic lipid profile is more common risk factor in ACS patients than in other non-lipid risk factors. This study also demonstrated that the atherogenic lipid is most commonly found in patient with low HDL cholesterol level and it is least frequently found in patient with optimal lipid profile.

Resistencia Antimicrobiana en Unidades de Cuidado Intensivo de Bogotá, Colombia, 2001-2003 / Anti-microbial resistance in Intensive Care Units in Bogotá, Colombia, 2001-2003

Objetivos: Determinar la resistencia antimicrobiana entre los aislamientos bacterianos identificados en pacientes hospitalizados en Unidades de Cuidado Intensivo. Métodos: Se recolectó la información de los aislamientos de microbiología provenientes de las Unidades de Cuidado Intensivo (UCI) de 14 instituciones de tercer nivel, pertenecientes al Grupo para el Control de la Resistencia Bacteriana de Bogotá (GREBO), entre los años 2001 y 2003. Se obtuvieron 27301 aislamientos y su perfil de susceptibilidad fue analizado por el programa Whonet 5.3. Resultados: Los microorganismos aislados con mayor frecuencia fueron Staphylococcus aureus, Escherichia coli, Staphylococci coagulasa negativo (SCN), Pseudomonas aeruginosa y Klebsiella pneumoniae. Las tasas de resistencia de S. aureus y de SCN a oxacilina del 2001 al 2003 oscilaron entre 61 y 63 por ciento y entre 78 y 83 por ciento, respectivamente. La resistencia a cefalosporinas de tercera generación en E. coli fue cercana a 10 por ciento y a ciprofloxacina fue superior a 20 por ciento. La resistencia a cefalosporinas de tercera generación de K. pneumoniae fue superior a 30 por ciento durante el 2001. La resistencia de P. aeruginosa a varios grupos de antibióticos superó 30 por ciento y la frecuencia de cepas multirresistentes osciló entre 16 y 24 por ciento. Conclusión: Las tasas de resistencia encontradas son superiores a las mostradas por estudios de vigilancia en E.E.U.U., Europa y otras ciudades de América Latina.

Resultados del enfermo con infarto agudo del miocardio con trapia trombolítica. Experiencia en 473 enfermos de la unidad coronaria del Instituto Nacional de Cardiología "Ignacio Chávez" / Acute myocardial infarction treated with thrombolytic therapy. Experience of 473 patients in the coronary care unit of the National Institute of Cardiology \"Ignacio Chávez\"

Objetivo. Conocer la evolución del enfermo con Infarto Agudo del Miocardio (IAM) sometido a trombolisis, las complicaciones inherentes a dicha terapéutica y la mortalidad a 10 días. Material y método. De junio de 1989 a agosto 1994 fueron estudiados 473 enfermos que ingresaron a la Unidad Coronaria, con la diagnóstico de IAM a quienes se les administró trombolisis. En 20 pacientes la edad fue menor de 40 años, 373 entre 40 y 70 años, y 80 pacientes fueron mayores de 70 años; el 84 por ciento fueron hombres y 16 por ciento mujeres. Se describen sus características clínicas, complicaciones, evolución, y hallazgos angiográficos. Resultados: De un total de 473 enfermos con diagnóstico de IAM, el 86.3 por ciento recibieron estreptoquinasa (SK) y el 13.7 por ciento activador del plasminógeno tisular (rt-PA). La localización del IAM fué anterior en 234 pacientes, e inferior en 239. El 63 por ciento presentó lavado enzimático y en el 81 por ciento se observó descenso precoz del segmento ST. Las arritmias post-trombolisis se observaron en el 64.7 por ciento. El sangrado mayor se observó en el 11.8 por ciento y hemorragia cerebral en el 0.4 por ciento únicamente en pacientes trombolisados con rt-PA. El 22 por ciento tuvieron angor post-infarto y el reinfarto se presentó en el 4 por ciento, ruptura cardiaca en el 1.4 por ciento que evolucionaron al choque y muerte, insuficiencia mitral en el 2.1 por ciento demostrada por ecocardiografía. Se llevaron a angiografía coronaria 377 pacientes, (80 por ciento) la que se realizó en los primero 5 días en el 50.7 por ciento. La arteria responsable del infarto (ARI) fue la descendente anterior en 213 pacientes y en 95 la coronaria derecha. La disfunsión ventricular izquierda docuentada clínica, radiológica y demodinámicamente se observó en el 23 por ciento de pacientes con IAM anterior, y en 5 por ciento de los infartos de cara inferior. El choque cardiogénico se observó en el 7 por ciento. Se realizó cirugía de ravascularización coronaria en 106 pacientes, y angioplastía coronaria en 67. La mortalidad a 10 días fue el 8.8 por ciento, principlamente por choque cardiogénico, arritmias ventriculares malignas y ruptura ventricular. Conclusiones.La permeabilidad útil de la ARI fue del 40 por ciento por angiografía coronaria realizada en promedio a las 145 hs después de la administración de trombolítico. La mortalidad temprana fue menor del 10 por ciento

Manejo del cardiópata en cuidados intensivos / Management of the cardiopath in intensive care

En este artículo se analiza el paciente con cardiopatías que amerita ingresar a un área de cuidados intensivos. Se establecen los parámetros para definirlo, clasificarlo y se describe un protocolo general de manejo. Además de hacer una revisión histórica de la evolución de las áreas de cuidados intensivos y de los descubrimientos científicos relacionados a ellas.

Readmission in unstable angina

To determine the characteristics of patients re-admitted after unstable angina (UA) pectoris, 120 consecutive patients hospitalized due to primary UA pectoris were prospectively studied 22 +/- 3 months after discharge. The patients were grouped based on the readmission rate. Those in group A (50) had recurrent admissions (mean 2.6, range 2 to 5). Seventy patients (group B) did not have readmissions during the follow-up period. All patients underwent coronary angiogram and symptoms-limited exercise stress test before discharge. The univariate characteristics for readmission were: age over 70 years (p = 0.02), nondiagnostic exercise stress testing (p = 0.03), angiographically diffuse coronary artery disease (p = 0.004), and non-interventional management (P < 0.001). Patients readmitted had increased incidence of myocardial infarction (p = 0.004) but similar survival at 2 years. By regression analysis, important variables for readmission were non-interventional management (Chi-Square = 7.6, p = 0.01), non diagnostic treadmill test (Chi-Square = 6.9, p = 0.03) and diffuse coronary artery disease (Chi-Square = 6.2, p = 0.04). It is concluded that in the interventional era the most important factor for readmission after primary UA pectoris is non-interventional management. Coronary revascularization should not be denied solely on the basis of age

Acute myocardial infarction in north Kerala--a 20 year hospital based study.

This is a retrospective study of patients with first attack of myocardial infarction admitted to Medical College Hospital, Calicut during the years 1969 to 1988. The data analysed were compared to other hospital based studies in India and abroad. A striking increase in the percentage of acute myocardial infarction was observed. There was also an increase in the occurrence of myocardial infarction in the young. A properly designed population based study is warranted.