ABSTRACT
Integral health encompasses the way individuals live, considering their quality of life. An inadequate lifestyle can harm human health, increasing the risk of developing chronic non-communicable diseases, which represent 71% of the causes of death worldwide and 54.7% in Brazil. The COVID-19 pandemic has led to impacts on quality of life, resulting from lifestyle changes, especially among health professionals. This constitutes an important factor in the health-disease relationship and the core of the healthcare approach embraced by Ayurveda. The present study evaluated the role of daily Ayurvedic practices in improving the quality of life of health professionals working in the Family Health Strategy of SUS in Paty do Alferes/RJ, Brazil. Ayurveda practices based on Trayopastamba were introduced to 30 health professionals through lectures and guided activities from July to October 2021, spanning three months. Quality of life was assessed using the WHOQOL-BREF questionnaire before and after the intervention. An improvement in perceived quality of life was observed in the physical, psychological, and environmental domains (p > 0.05), while the social domain did not show statistically significant results. The physical domain demonstrated the most substantial score increase (10.95). Conversely, the social domain displayed the smallest rise in scores (5.83). In conclusion, the daily Ayurvedic practices demonstrated the potential to enhance the quality of life in this group, contributing to health promotion in a practical and economically accessible manner.
ABSTRACT
BACKGROUND: Anomalous origin of a coronary artery from the pulmonary trunk is a small group of rare congenital anomalies present in up to 1% of the population. These patients, in absence of an adequate collateral supply, may present with congestive heart failure secondary to ischaemia, arrhythmia, or sudden cardiac death in up to 90% of cases within the first months of life. CASE SUMMARY: We present four cases diagnosed in adulthood over 10 years in two high-volume centres. The first patient presented with dyspnoea and orthopnoea. The second with chest pain and episodes of non-sustained ventricular tachycardia. The third patient presented during her third pregnancy with chest pain, palpitations, and arrhythmia (non-sustained ventricular tachycardia). The fourth patient presented with sudden cardiac death. DISCUSSION: In all cases with anomalous origin of coronary arteries, it is recommendable to consider surgical correction to avoid the progression of ischaemia, congestive heart failure, arrhythmia, and sudden death.
ABSTRACT
AIMS: Limited data are available on prognostic indicators for HIV patients presenting with ACS. METHODS AND RESULTS: Data on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm(3) were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 months (10-41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval [CI]: 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% CI: 2.1-46: p=0.03); a CD4 cell count <200 cells/mm(3) was the only predictor of MI (hazard ratio=5.9 [95% CI: 1.4-25: p=0.016]). CONCLUSIONS: HIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm(3), suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability.
Subject(s)
Acute Coronary Syndrome/etiology , HIV Infections/complications , Thrombosis/etiology , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/therapy , Adult , Aged , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Cause of Death , Europe , Female , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/mortality , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/etiology , Myocardial Infarction/mortality , Percutaneous Coronary Intervention , Proportional Hazards Models , Recurrence , Registries , Retrospective Studies , Reverse Transcriptase Inhibitors/therapeutic use , Risk Factors , South Africa , Thrombosis/diagnosis , Thrombosis/mortality , Thrombosis/therapy , Time Factors , Treatment Outcome , United StatesSubject(s)
Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/pathology , Coronary Vessels/diagnostic imaging , Coronary Vessels/pathology , Multimodal Imaging , Vascular Diseases/congenital , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/pathology , Coronary Angiography , Humans , Male , Middle Aged , Tomography, Optical Coherence , Vascular Diseases/diagnostic imaging , Vascular Diseases/pathologyABSTRACT
Primary abnormalities of the autonomic nervous system had been postulated as the pathogenic mechanisms of myocardial damage, in patients with Chagas disease. However, recent investigations indicate that these abnormalities are secondary and amenable to treatment with beta-adrenergic blockers. Moreover, muscarinic cardiac autoantibodies appear to enhance parasympathetic activity on the sinus node. Therefore, the purpose of this paper is to analyze how knowledge on Chagas' disease evolved from being initially considered as a primary cardioneuromyopathy to the current status of a congestive cardiomyopathy of parasitic origin.
ABSTRACT
En la actualidad, la cirugía de bypass coronario es el método estándar de revascularización miocárdica para pacientes con enfermedad del tronco coronario izquierdo y enfermedad coronaria de tres vasos. Sin embargo, varios factores pueden conducir a la oclusión temprana de los injertos coronarios requiriendo de una reintervención quirúrgica. La angioplastia coronaria transluminal percutánea fue introducida por primera vez en 1977 como una alternativa menos invasiva que la cirugía de bypass coronario y en la actualidad sus aplicaciones se han extendido para incluir estenosis coronarias complejas, enfermedad multivaso, enfermedad de tronco coronario izquierdo y estenosis de injertos coronarios. Nosotros presentamos el caso de un paciente de 51 años de edad con infarto agudo de miocardio sin elevación del ST y shock cardiogénico tres meses después de practicarse cirugía de revascularización coronaria quien fue sometido a intervención percutánea simultánea de bypass de arteria mamaria interna izquierda y del tronco coronario izquierdo protegido con buen resultado angiográfico y recuperación clínica. Se discuten los aspectos técnicos y se hace una revisión de la literatura sobre la seguridad y eficacia de la intervención percutánea de los injertos de arteria mamaria interna.
Coronary artery bypass graft surgery is the standard of care for patients with left main coronary stenosis and/or CAD. However, several factors may lead to the early occlusion of the coronary grafts that needs a surgical reintervention. PTCA was introduced in 1977 as a less invasive alternative than coronary artery bypass graft surgery and its application has broadened to include multiple lesions, complex anatomical stenoses, multiple vessels and aortocoronary bypass grafts. We present the case of a 51-year-old patient with acute non-ST elevation myocardial infarction and cardiogenic shock three months after surgical coronary revascularization who was submitted to PTCA-stenting of the left internal mammary artery graft and left main coronary artery.
Subject(s)
Humans , Male , Middle Aged , Mammary Arteries/surgery , Myocardial Infarction/pathology , Cardiopulmonary Bypass/methods , Thoracic Surgery , CardiologyABSTRACT
El desarrollo de aneurismas en el tronco coronario izquierdo es una patología rara con una incidencia de 0,1% y cuya etiología puede ser congénita o adquirida. La importancia clínica de los aneurismas coronarios estriba en el riesgo de ruptura coronaria espontánea y de infarto de miocardio por trombosis, embolismo o espasmo. Este reporte describe el caso de un paciente de 26 años de edad, estudiante de licenciatura en educación física, con un aneurisma gigante sacular del tronco coronario izquierdo asociado con estenosis suboclusiva posaneurismática que condicionó la presencia de manifestaciones de isquemia miocárdica de alto riesgo. Presentamos la imaginología y una revisión sobre la etiología, los aspectos clínicos, diagnósticos y terapéuticos de los aneurismas del tronco coronario izquierdo.
The development of the left main coronary artery aneurysms is a rare pathologic process with an incidence of 0.1% and whose etiology can be either congenital or acquired. The clinical importance of the aneurysms of the left main coronary artery is based in the potential risk of spontaneous dissection and rupture and myocardial infarction for thrombosis, embolism or spasm. We report the case of a 26-year-old athlete with agiant aneurysm of the left main coronary artery associated with suboclusive stenosis and clinical manifestations of myocardiali schemia. We present the imagenological characteristics and bibliographic review about the clinical, diagnostic and therapeutic aspects of the left main coronary artery aneurysm.
Subject(s)
Humans , Male , Adult , Coronary Aneurysm/diagnosis , Coronary Aneurysm/etiology , Coronary Vessel Anomalies/pathology , Myocardial Ischemia/pathology , Athletic InjuriesABSTRACT
El propósito fue investigar si la naturaleza de la respuesta compensatoria de la masa ventricular izquierda (MVI) es un factor determinante del grado de labilidad temporal de la repolarización miocárdica. Se evaluaron 263 pacientes hipertensos y 52 sujetos controles normotensos mediante ecocardiografía y electrocardiografía de alta resolución. Se definió MVI inapropiada como un índice de compensación de la MVI (ICMVI) > 128%. El grado de labilidad temporal de la repolarización miocárdica se evaluó a través del índice de variabilidad del intervalo OT (IVQT) determinado en forma automatizada. Pacientes hipertensos con MVI inapropiada presentaron valores significativamente más altos del IVQT (-0,92 ± 0,25) en comparación con sujetos normotensos (-1,53 ± 0,21) y pacientes hipertensos con MVI apropiada (-1,24 2410,18) (P<0,001). El ICMVI se correlacionó en forma dirtecta con el IVQT (r=0,49, P<0,001). en el análisis multivariante de regresión lineal, el nivel de MVI inapropiada. medido a través del ICMVI, se comportó como un predictor independiente del grado de labilidad temporal de la repolarización miocárdica (ß=0,007; P<0,001). Los resultados de este estudio indican que, en pacientes con HTA-E, la presencia de MVI inapropiadamente alta para el estímulo hemodinámico del ventrículo izquierdo se relaciona con aumento de la variabilidad temporal del intervalo QT.
The goal of this study was to investigate whether the compensatory nature of left ventricular mass (LVM) is a determinant factor of the temporal lability of the myocardial repolarization. Two hundred and sixty three hypertensive patients and 52 normotensive control subjects were studied by Doppler echocardiography and high resolution electrocardiography. A compensatory index of LVM (CILVM) > 128% defined inapropiate LVM. The degree of myocardial repolarization lability was evaluated by the QT interval variability index (QTVI). Hypertensive patients with inapropiate LVM had QTVI values significantly higher (-0,92 ± 0,25) than those with appropriate MVI (-1.24 ± 0.18) and normotensive control subjects (-1.53 ± 0.21) (P<0.001). The CILVM was positively correlated with QTVI (r=0.49; P<0.001). A stepwise multivariate linear regtession analysis showed that the level of inappropriate LVM was an independent predictor of QTVI (ß=0.007; P<0.001). Our result indicate that inappropriately high LVM for hemodynamic stimuli are associated with increased QT temporal variability.
Subject(s)
Humans , Male , Female , Ventricular Dysfunction, Left/diagnosis , Blood Pressure/physiology , Myocardial Reperfusion/methodsABSTRACT
El higroma quístico es una malformación congénita de los vasos linfáticos yugulares que ocasiona la acumulación de la misma en una o mas cavidades (1). Se presenta en 1,7 de cada 10.000 embarazadas y su diagnóstico se realiza ecográficamente durante el primer trimestre del embarazo (2). Presentamos el caso de una paciente femenina de 39 años, IV Gesta I para II abortos, con gestación de 14 semanas con hallazgos ecográficos compatible con Higroma quístico, se interrumpió la gestación y se obtuvo un feto masculino de 130 gramos, con gran tumoración cervical, que ocupa toda la región nucal, se toma muestra de sangre intracardíaca para la realización de estudios de cariotipo.
