[Clonidine in the treatment of tobacco withdrawal. A comparison with nicotine chewing gum]. / Clonidina en el tratamiento de la deshabituación tabáquica. Comparación con chicles de nicotina.

The objective of our work was to carry out a prospective study on the effectiveness of clonidine and nicotine gum in the treatment of tobacco withdrawal. Sixty smokers were randomly distributed in two groups and were included in a tobacco withdrawal program. One group received oral clonidine treatment while the other group was given nicotine gum. Adjuvant therapy such as group therapy or psychotherapy was not performed. At the end of one year there were no significant differences between the two groups with regards to the number of subjects who have continued to stop smoking. There were also no significant differences between the two groups with regards to the symptoms of tobacco abstinence. When we studied the relation between treatment fulfillment and tobacco withdrawal we observed that the clonidine treated group had a significantly greater number of success compared to the nicotine group (p < 0.01).

[Aerobic capacity. Differences between smokers and non-smokers. Effects of withdrawal]. / Capacidad aeróbica. Diferencias entre fumadores y no fumadores. Efectos de la deshabituación.

The purpose of this study is to determine the aerobic capacity in a group of smokers and to carry out a prospective study of the changes in cardiorespiratory and metabolic response to exercise after smoking withdrawal. An aerobic capacity test was performed in 90 smokers and 30 non-smokers. Afterwards, the smokers were included in a smoking withdrawal program. One year later, the aerobic capacity test was repeated in those individuals who were able to stop smoking. The initial study of the aerobic capacity during exercise showed that smokers had significantly lower values of maximal oxygen uptake per kg body weight (VO2 max./kg) (28.7 +/- 8 vs. 35.1 +/- 7 ml/kg/min) (p < 0.001), work time (5.8 +/- 2.6 vs. 7.5 +/- 3.1 min) (p < 0.01) and work load (1.1 +/- 0.3 vs. 1.4 +/- 0.3 W/kg) (p < 0.001) under aerobic conditions. Aerobic capacity test performed one year after smoking withdrawal in those who were able to stop smoking showed a significant increase in VO2 max./kg (35.5 +/- 6.1 vs. 31.1 +/- 5.5) (p < 0.05), work time (8.1 +/- 3.2 vs. 5.8 +/- 3.2 min) (p < 0.05) and work load (1.5 +/- 0.4 vs. 1.1 +/- 0.4 W/kg) (p < 0.01) under aerobic conditions. No differences were observed in the aerobic capacity test performed on the ten subjects who did not stop smoking. From these data we suggest that tobacco consumption produces impairment of the aerobic capacity that can be reverted, at least in part, after smoking withdrawal.

[Respiratory function tests. Differences between smokers and non-smokers. Effects of withdrawal]. / Pruebas de función ventilatoria. Diferencias entre fumadores y no fumadores. Efectos de la deshabituación.

The purpose of this study is to determine the characteristics of spirometric performance in a group of smokers and to carry out a prospective study of the changes in ventilatory lung function after smoking withdrawal. The ventilatory lung function was studied in 90 smokers and 30 non-smokers. Afterwards the smokers were included in smoking withdrawal program. One year later, the ventilatory function tests were repeated in those individuals who were able to stop smoking. Respiratory function tests were likewise repeated in 10 subjects chosen randomly among those who were not able to stop smoking. The initial study of the ventilatory lung function showed that smokers had significantly lower values of FVC (p < 0.001), FEV1 (p < 0.001), FEVC1/FVC (p < 0.001), FEF25-75 (p < 0.01 and PEF (p < 0.01) compared to non-smokers. Likewise smokers also had a statistically significant higher prevalence rate of obstructive pulmonary disease (p < 0.001). Ventilatory function studies performed one year after smoking withdrawal on those who were able to stop smoking showed a significant improvement of respiratory function parameters compared to studies done one year before. There was also a significant decrease in the prevalence and severity of obstructive pulmonary disease. No differences were observed in the ventilatory function tests performed on the ten subjects who did not stop smoking. From these data we suggest that tobacco consumption produces obstruction of the airways that can be reverted, at least in part, after smoking withdrawal.

[24-hour ambulatory electrocardiographic registry: differences between smokers and non-smokers and habit breaking effects]. / Registro electrocardiográfico ambulatorio de 24 horas: diferencias entre fumadores y no fumadores y efectos de la deshabituación.

BACKGROUND: The purpose of this work was to determine the prevalence of arrhythmias in a group of 90 smokers and to carry out a prospective study on electrocardiographic modifications due to smoking withdrawal. METHODS: A Holter study was performed to 90 smokers and 30 non-smokers. Afterwards smokers were included in a smoking withdrawal program. One year later all subjects who stopped smoking underwent a new Holter study as well as 10 of the smokers who failed in smoking withdrawal. RESULTS: Initial Holter study revealed that smokers had a significantly higher mean cardiac rate (p < 0.001), prevalence of supraventricular arrhythmias (p < 0.01) and ventricular premature complexes (p < 0.05) than non-smokers. Holter study performed after smoking cessation, showed a statistically significant decrease of mean cardiac rate (p < 0.001) and supraventricular arrhythmias (p < 0.001). Holter study performed to the subjects who failed in smoking withdrawal showed no significant changes in relation to the study made the previous year. CONCLUSIONS: Smokers present a higher cardiac rate and prevalence of arrhythmias than non-smokers. From these data it could be suggested that tobacco consumption has an arrhythmogenic effect that can be reverted, at least in part, after smoking withdrawal.

[Somatometry and lipid profile in smokers. Modifications after smoking withdrawal]. / Somatometría y perfil lipídico en el fumador. Modificaciones tras la deshabituación.

BACKGROUND: The purpose of this work was to determine the somatometric and lipidic profile in a group of 90 smokers and to carry out a prospective study on modifications due to smoking withdrawal. METHODS: A somatometric and lipidic profile was performed to 90 smokers and 30 non-smokers. Afterwards smokers were included in a smoking withdrawal program. One year later all subjects who stopped smoking as well as 10 of the smokers who failed in smoking withdrawal underwent a new blood analysis and somatometric study. RESULTS: Initial somatometry showed that smokers had a significantly higher (p less than 0.05) overweight and endomorphic index, based on somatometric characteristics. In addition, smokers showed significant lower level of HDL-cholesterol (high-density lipoprotein) than non-smokers (p less than 0.001). Somatometric and lipidic profile performed one year after smoking cessation showed a statistically significant increase on HDL-cholesterol (p less than 0.05). Somatometric and lipidic profile of the subjects who failed in smoking withdrawal showed no significant changes in relation to the study made the previous year. CONCLUSIONS: From these data we suggest that modifications of lipidic profile induced by tobacco consumption can be reverted, at least in part, after smoking cessation. In addition smokers present higher overweight when theoretic weight is based on somatometric characteristics.

[Death in exercise test: immediate angiographic findings in 2 cases]. / Obito em prova de esforço: achados angiográficos imediatos em dois casos.

We present two cases of mortality during a stress test after which coronary arteriography was performed after the acute event. In both patients, left coronary arteries presented eccentric lesions with irregular bordes and intraluminal lucencies. We have discussed the probable pathophysiologic mechanisms involved in view of the angiographic findings. We concluded that the cracking of the plaque was an essential event in the pathogenesis of this picture.

Obito em prova de esfôrço: achados angiográficos imediatos em 2 casos / Death in stress testing: immediate angiographic findings in 2 cases

Dois casos de falecimento em provas ergométricas, com a particularidade de que se realizou coronariografia imediatamente depois do acidente agudo. Ambos apresentavam lesöes na artéria coronária esquerda, de tipo excêntrico, com bordas irregulares e brilho intraluminal. Concluí-se que a rotura da placa ateromatosa foi acontecimento fundamental na patogênese deste fenômeno

We present two cases of mortality during a stress test after which coronary arteriography was performed after the acute event. In both patients, left coronary arteries presented eccentric lesions with irregular bordes and intraluminal lucencies. We have discussed the probable pathophysiologic mechanisms involved in view of the angiographic findings. We concluded that the cracking of the plaque was an essential event in the pathogenesis of this picture.

[Clinical and angiographic study of intra-myocardial coronary bridges]. / Estudo clinico e angiografico de trajetos coronarios intra-miocardicos.

AIMS: Approach to the clinical profile of patients with intramyocardial coronary bridges. CONCEPT OF STUDY: Two years retrospective study on coronariangiography with a selection of patients, of our department, with myocardial bridges and no atherosclerotic lesions. MATERIAL AND METHODS: Out of 1620 patients, 26 cases had a suspected ischemic cardiopathy defined on the grounds of clinical, electrocardiographic, ergometric and coronariangiographic criteria. RESULTS: From the 1620 cases, 26 (1.6%) presented intramyocardial coronary pathes. All situated on the left anterior descendant artery. 10 of these cases showed left ventricular hypertrophy, a change which is frequently associated with myocardial bridges. There was no correlation between the severity of systolic coronary constriction and clinical data. CONCLUSIONS: The incidence of myocardial bridges in our group is different from other studies. The localization at the level of the left anterior descendant artery was the most frequent one. The findings in this study demonstrate a possible association between the intramyocardial coronary pathes and the left ventricular hypertrophy.

Utility and tolerance of stress testing in geriatric patients.

OBJECTIVES: To determine the sensitivity and specificity of stress testing in geriatric patients and to estimate the tolerance of these patients to exercise. DESIGN: A prospective study done in two populations with different ages. SETTING: Cardiologists and a stress testing laboratory. PATIENTS: Persons with ages above and under 65 years who were admitted in our center and submitted to stress testing and coronary angiography for suspicion of ischemic heart disease. PROCEDURES: All stress tests were performed on a Siemens Elama cicloergometer model 380-B adapted to a Hewlett Packard 1517 A ECG recorder. Our protocol started with an initial work load of 30 Watts with increments of other 30 Watts every three minutes. A 12 lead ECG was registered at rest, at maximum effort and in the recovery phase (approx. eight minutes after maximum effort). Three leads ECG's (V2, aVF, V5) were registered every three minutes. Stress finishing criteria were: symptom's limited, fatigue and maximum heart rate (220-age). Blood pressure was also controlled every three minutes during exercise and every two minutes during the recovery phase. Coronary angiographies were performed on a Siemens Cardoskop U (cine) using the Judkins technique. Left anterior oblique, right anterior oblique and postero anterior projections were used in all the procedures. RESULTS: Stress testing presents high sensitivity and low specificity in geriatric patients. A good tolerance to exercise was observed in this group of patients. CONCLUSIONS: A similar sensitivity was observed in the stress tests performed by patients with ages above and under 65 years. Sensitivity seems to be related to the severity of the coronary lesion. On the other hand stress testing presented a lower specificity in the geriatric patient. Finally, good tolerance to exercise was observed in patients older than 65 years.

[Functional capacity and rhythm changes after atrial correction of transposition of great arteries]. / Capacidad funcional y alteraciones del ritmo después de corrección auricular de la transposición de las grandes arterias.

A group of 12 patients, previously submitted to atrial correction of the transposition of the great vessels, were studied through stress test with direct metabolimetry and Holter to assess aerobic functional capacity and its relationship with conduction disturbances. The results were compared with those obtained with a control group of 23 non athletic healthy children. All the patients showed amputation of their heart rates on effort, though this parameter and the oxygen consumption were normal at low work load levels. The VO2 at anaerobic threshold, the maximum VO2, and the maximum work load were also decreased in most of the patients. Holter studies demonstrated sick sinus syndrome in nine of them. Aerobic functional capacity was reduced in most of the patients with atrial correction of the transposition of the great vessels. The amputation of the heart rate on effort is a common finding though its relationship with the decrease of the aerobic functional capacity in these patients is limited. Finally, the stress test is probably more sensible than Holter for the detection of slight degrees of sinus disfunction.

[Postoperative left ventricle-right auricle fistula: a case report]. / Fístula ventrículo izquierdo-aurícula derecha postquirúrgica: a propósito de un caso.

We present a case of a postoperative left ventricular--right atrial shunt in a 46 year-old patient operated for aortic valvulopathy. Through two-dimensional echocardiography and hemodynamic studies a communication between the left ventricle and the right atrium was observed. We review the literature about this rare anomaly.

[Oxygen-derived free radicals. Their role in cardiology]. / Radicales libres derivados de oxígeno. Su papel en Cardiología.

Oxygen-derived free radicals are highly reactive molecules characterized by the presence of an unpaired electron in one of its outer orbitals. They have been found responsible for some pathologic phenomenons which in the field of cardiology, occurs during tissue reperfusion of a previously ischemic area. Ischemia predisposes an outburst in the production of these molecules upon the reintroduction of oxygen during reperfusion. Animal experimental models have been designed to reduce the damages induced by free radicals using various pharmacologic agents. It is probable that these agents may form a part of the conventional treatment of certain cardiac pathologies in the future.

[Aneurysm of interauricular septum associated with mesosytolic click]. / Aneurisma del septo interauricular asociado a chasquido mesosistólico.

An echocardiographic study was performed to a patient with symptoms of cardiac failure and midsystolic click confirmed by phonocardiography. The echocardiograms suggested an incipient dilated myocardiopathy and also atrial septal aneurysm. We report the relationship between midsystolic click and atrial septal aneurysm.

[A comparative analysis of patients with coronary stenotic and ectatic lesions]. / Análisis comparativo de pacientes con lesiones estenóticas y ectásicas coronarias.

A total number of 177 patients with coronary lesions were studied. Sixty nine of them presented either a combination of stenotic and ectatic lesions (n = 18) or isolated ectatic lesions (n = 51) and 108 presented only stenotic lesions. Analyzing several clinical and epidemiological parameters we observed a significant difference with respect to the higher prevalence of hypertension among the group affected by ectatic lesions. We verified as well a higher prevalence of myocardial infarction in the group of ectasia associated to the stenotic lesions. Finally, a higher global mortality was observed in the group of ectasia associated to stenotic lesions after medical or surgical treatment.

[Left ventricular diverticulum at the subaortic level]. / Divertículo ventricular esquerdo a nível subaórtico.

We report a case of a left ventricular diverticulum located immediately under the aortic valve ring. The patient presented both aortic insufficiency and stenosis, and was submitted to valve replacement surgery and closure of the diverticulum. The peculiarity of this case relies on its non atherosclerotic etiology, its unusual location and also because of the calcification of the diverticulum's wall.

[Coronary ectasis: another form of atherosclerosis]. / La ectasia coronaria: otra forma de aterosclerosis.

In a review of 3,693 coronary angiographies carried out in our department for suspected coronary artery disease we evaluated the 69 patients (1.86%) in whom lesions of coronary ectasia were found. Most of them (n = 51) had associated stenotic lesions and only 18 patients had isolated ectasia. The most common localization of the 96 ectasia lesions found in these patients was the right coronary artery, followed by the left anterior descending and, finally, the circumflex coronary artery. The ectasia lesions were classified according to the morphological classification proposed by Ducceschi in the following types: I) fusiform; II) saccular; III) spherical; IV) linear or diffuse, and V) mixed. Most lesions in our series were diffuse. Regarding clinical features, significant differences were found in the higher incidence of atypical angina presentation in those patients with isolated ectasia lesions.

[Changes in rhythm and conduction after atrial correction of transposition of great vessels]. / Alteraciones del ritmo y de la conducción tras la corrección auricular de la transposición de las grandes arterias.

Disorders of rhythm or conduction after correction by baffle of transposition of the great arteries (TGA) has been widely reported. In order to avoid them, transformations on Mustard original technique have been carried out. We analize here the incidence of arrhythmias during the follow up of 20 patients operated, following a modification of the Mustard technique, as well as the postoperative changes on the P wave. The 75% of the patients remained in sinus rhythm during the postoperative first year, but only 28% continued on it after 6 years. The rest of the patients presented nodal or low auricular rhythm, alternating with sinus rhythm. Seven patients fulfilled diagnostic criteria of sick sinus syndrome. Ninety five percent of the patients were asymptomatic. The 9 patients that performed a stress testing after operation presented sinus rhythm and heart rate acceleration, in spite of the rhythm was nodal at the beginning in 4 of them. The modifications of the Mustard technique apparently do not avoid the arrhythmias and disorders of conduction. Nevertheless, the exercise tolerance remain acceptable.

[Sensitivity and specificity of the exertion test in elderly patients]. / Sensibilidad y especificidad de la prueba de esfuerzo en el paciente geriátrico.

One hundred and fifty four patients who presented at our Institution for suspected coronary artery disease were evaluated. They were divided in two groups: A) 77 patients older than 65 years (X = 68.35 +/- 2.99 years), and B) 77 patients younger than 65 years (X = 51.01 +/- 7.50 years). Diagnostic exercise test and coronary angiography were performed in all. Most tests in both groups were terminated due to physical exhaustion (71% and 74% in groups A and B, respectively). During the exercise test there was a higher incidence of ventricular premature beats and lower limb pain in the older group, while angina was more common in the younger group. The overall sensitivity of the test was similar in both groups (88%), with a high prevalence in both (86% in group A and 78% in group B). The sensitivity regarding the extension of coronary artery disease was higher for the detection of one-vessel disease in the younger group (76% vs 63%), while it was higher in the older group for the detection of two and three-vessel disease (86% and 91% vs 84% and 80% in the younger group).