Disritmias cardíacas e alterações do segmento ST em idosos no perioperatório de ressecção transuretral da próstata sob raquianestesia: estudo comparativo / Cardiac arrhythmias and ST changes in the perioperative period of elderly patients submitted to transurethral prostatectomy under spinal anesthesia: comparative study

JUSTIFICATIVA E OBJETIVOS: Idosos representam 25 por cento do total dos pacientes cirúrgicos. Muitos pacientes com doença arterial coronariana (DAC) apresentam eletrocardiograma (ECG) pré-operatório normal, e alta incidência de infarto agudo do miocárdio (IAM) silencioso na 1ª semana de pós-operatório. As disritmias aumentam com a idade, sendo observadas extrassístoles supraventriculares (ESSV) e ventriculares (ESV), fibrilação atrial e distúrbios da condução intraventricular. O objetivo deste estudo foi avaliar a prevalência de disritmias cardíacas e de alterações do segmento ST no perioperatório através do Sistema Holter em pacientes idosos submetidos à cirurgia de ressecção transuretral da próstata (RTU) e herniorrafia inguinal sob raquianestesia (controle). MÉTODO: Foram avaliados 21 pacientes com idades entre 65 e 84 anos submetidos a RTU da próstata e 16 pacientes com idades entre 65 e 86 anos, submetidos à herniorrafia inguinal, sob raquianestesia. Avaliação pelo Sistema Holter no pré-operatório (12 horas), intra-operatório (3 horas) e pós-operatório (12 horas). RESULTADOS: A prevalência de extrassístoles supraventriculares (ESSV) entre os grupos RTU e controle foi, no pré-operatório 85,7 por cento vs. 93,7 por cento, no intra-operatório 85,7 por cento vs. 81,2 por cento e no pós-operatório 76,2 por cento vs. 100 por cento. As extrassístoles ventriculares (ESV) tiveram prevalência de 76,2 por cento vs. 81,2por cento no pré, 80,9 por cento vs. 68,7 por cento no intra e 80,9 por cento vs. 81,2 por cento no pós-operatório. A prevalência de alterações do segmento ST entre os grupos RTU e controle foi, no pré-operatório 19 por cento vs. 18,7 por cento, no intra-operatório 4,7 por cento vs. 18,7 por cento e no pós-operatório de 14,3 por cento vs. 18,7 por cento , sem significância estatística. CONCLUSÕES: Os paciente idosos apresentam alta prevalência de ESSV e ESV. O número total de ESSV e ESV, e alterações do segmento ST, presentes no período pré-operatório, não foi alterado pela cirurgia de ressecção transuretral da próstata, bem como pela herniorrafia inguinal, nos períodos intra e pós-operatório.

[Cardiac arrhythmias and ST changes in the perioperative period of elderly patients submitted to transurethral prostatectomy under spinal anesthesia: comparative study.]. / Disritmias cardíacas e alterações do segmento ST em idosos no perioperatório de ressecção transuretral da próstata sob raquianestesia: estudo comparativo.

BACKGROUND AND OBJECTIVES: Elderly account for 25% of surgical patients. Several patients with arterial heart disease have normal preoperative ECG and a high incidence of silent myocardial acute infarction in the first postoperative week. Arrhythmias increase with age and supraventricular and ventricular premature complexes, atrial fibrillation and intraventricular conduction abnormalities are observed. This study aimed at evaluating the prevalence of perioperative arrhythmias and ST changes through Holter System in elderly patients submitted to transurethral prostatectomy and inguinal hernia repair under spinal anesthesia. METHODS: Participated in this study 21 patients aged 65 to 84 years submitted to transurethral prostatectomy (TUP) and 16 patients aged 63 to 86 years submitted to inguinal hernia repair under spinal anesthesia. Monitoring with Holter System was performed in the preoperative (12 hours), intraoperative (3 hours) and postoperative (12 hours) periods. RESULTS: The prevalence of supraventricular premature complex was 85.7% vs. 93.7% in the preoperative period, 85.7% vs. 81.2% in the intraoperative and 76.2% vs. 100% in the postoperative period, respectively for groups TUP and control. The prevalence of ventricular premature complex was 76.2% vs. 81.2% in the preoperative period, 80.9% vs. 68.7% in the intraoperative period, and 80.9% vs. 81.2% in the postoperative period, respectively for groups TUP and control. The prevalence of ST changes was 19% vs. 18.7% in the preoperative period, 4.7% vs. 18.7% in the in the intraoperative period, and 14.3% vs. 18.7% in the postoperative period between groups TUP and control, without statistical significance. CONCLUSIONS: Elderly patients have a high prevalence of supraventricular and ventricular cardiac arrhythmias. The total number of preoperative arrhythmias and ST changes was not changed as a function of transurethral prostatectomy surgery or inguinal hernia repair, in the intra and postoperative periods.

Prevalence of cardiac arrhythmias during and after pregnancy in women with Chagas' disease without apparent heart disease.

OBJECTIVE: To evaluate cardiac arrhythmias during and after pregnancy in women with Chagas' disease without apparent heart disease using dynamic electrocardiography. METHODS: Twenty pregnant women with Chagas' disease without apparent heart disease aged 19 to 42 years (26.96 +/- 3.6) and a control group of 20 non-chagasic pregnant patients aged 16 to 34 years (22.5 +/- 4.8). The patients were submitted to passive hemagglutination and indirect immunofluorescence for the detection of Trypanosoma cruzi evaluation, and electrocardiography, echocardiography and 24-h dynamic electrocardiography. RESULTS: Supraventricular premature depolarizations were observed in 18 (90%) patients and ventricular premature depolarization in 11 (55%) patients of both groups during pregnancy. After delivery, supraventricular premature depolarizations were present in 13 (60%) chagasic patients and in 16 (89.4%) control patients (P

Prevalência das arritmias cardíacas em portadoras de doença de Chagas, sem cardiopatia aparente durante e após a gravidez / Prevalence of cardiac arrhythmias during and after pregnancy in women with Chagas' disease without apparent heart disease

OBJECTIVE: To evaluate cardiac arrhythmias during and after pregnancy in women with Chagas' disease without apparent heart disease using dynamic electrocardiography. METHODS: Twenty pregnant women with Chagas' disease without apparent heart disease aged 19 to 42 years (26.96 ± 3.6) and a control group of 20 non-chagasic pregnant patients aged 16 to 34 years (22.5 ± 4.8). The patients were submitted to passive hemagglutination and indirect immunofluorescence for the detection of Trypanosoma cruzi evaluation, and electrocardiography, echocardiography and 24-h dynamic electrocardiography. RESULTS: Supraventricular premature depolarizations were observed in 18 (90 percent) patients and ventricular premature depolarization in 11 (55 percent) patients of both groups during pregnancy. After delivery, supraventricular premature depolarizations were present in 13 (60 percent) chagasic patients and in 16 (89.4 percent) control patients (P<=0.05). Ventricular premature depolarization were observed in 9 (45 percent) chagasic patients and 11 (57.8 percent) control patients. CONCLUSION: The prevalence of ventricular premature depolarization was similar for the chagasic and control groups during and after pregnancy. The incidence of supraventricular premature depolarizations was similar in the two groups during pregnancy, while after delivery a predominance was observed in the control group compared to the chagasic group