Infarto do miocárdio com supradesnível de ST sem lesões obstrutivas / Myocardial infarction with ST elevation without obstructive lesions

INTRODUÇÃO: MINOCA (Myocardial Infarction And Nonobstructive Coronary Arteries) refere-se ao infarto agudo do miocárdio (IAM) no qual as coronárias epicárdicas têm obstrução <50% à angiografia. Representa cerca de 10% dos IAMs, sendo mais frequente em mulheres jovens. Caso: Mulher, 57 anos, veio a nosso serviço em 31/08/2019 com precordialgia ao repouso há duas horas, irradiada para braço esquerdo, e náuseas. Era obesa e hipotireoidea. Negava tabagismo e antecedentes familiares de doença coronariana. Eletrocardiograma (ECG) da admissão: supradesnível de ST de 0,5 mm em D2, D3, AVF; 1 mm em V5 e V6; 0,5 mm em V3R e V4R e 1 mm em V7 e V8. Após trombólise com Alteplase, manteve dor e piora do supradesnível: 4,0 mm em D2, D3, AVF; 2 mm em V3 e V4; 1,5 mm em V3R e V4R. Transferida a hospital terciário para cateterismo na urgência, onde chegou já sem dor e supradesnível de ST de 1mm D2, D3, AVF; 0,5mm em V4,V5,V6, V7 e V8; sem supradesnível em V3R e V4R. Ecodopplercardiograma( 02/09/2019): acinesia inferior e inferolateral, fração de ejeção do ventrículo esquerdo (VE) 45% e função ventricular direita preservada. Cateterismo (03/09/2019): coronária direita com bom calibre e lesão de 40% no óstio, sem lesões nas demais coronárias; acinesia inferomedial de VE. Ressonância cardíaca (05/09/2019): disfunção discreta de VE, acinesia inferior, medioapical e inferolateral mediobasal; hipocinesia inferior basal, com edema; realce tardio padrão coronariano transmural, sugestivo de IAM recente. A paciente recebeu tratamento clínico com ácido acetilsalicílico, clopidogrel, betabloqueador, estatina e inibidor do receptor de angiotensina, recebendo alta assintomática. Discussão: Erosão de placa, vasoespasmo, disfunção microvascular e hipercoagulabilidade podem estar envolvidos na gênese do MINOCA Ressonância magnética é importante para diagnóstico diferencial com outras entidades, como síndrome de Takotsubo e miocardite. Há poucos ensaios clínicos específicos;o tratamento é individualizado e baseado no provável mecanismo envolvido, além de medidas cardioprotetoras gerais. .Figura 1: ECG da admissão. Figura 2: ECG admissão V3R e V4R. Figura 3: ECG admissão V7 e V8. Figura 4: ECG imediatamente após trombólise. Figura 5: Retorno do supradesnível de ST após trombólise. Figura 6: Coronária direita à angiografia. Figura 7: Óstio da coronária direita à angiografia. Figura 8: Coronária esquerda à angiografia. Figura 9: Ressonância magnética com realce tardio transmural.

B-Type Natriuretic Peptide as a Predictor of Short-Term Mortality in On-Pump Coronary Artery Bypass Grafting.

OBJECTIVE: The present study refers to a determination of the preoperative B-type natriuretic peptide is a predictor of short-term all-cause mortality in patients undergoing on-pump coronary artery bypass graft surgeries. METHODS: Two hundred and twenty-one patients undergoing on-pump coronary artery bypass graft surgeries were evaluated prospectively during a 30-day postoperative follow-up period. Serum B-type natriuretic peptide concentration was measured without a 24-hour period prior to the surgical procedure and the value obtained was correlated with a short-term all-cause mortality. RESULTS: Data analysis showed that all-cause mortality rates were equal to 9.5% in 30 days. Accuracy analysis by the receiver operating characteristic curve found an ideal cut-off value of B-type natriuretic peptide equal to 150 pg/mL in relation to mortality (AUC=0.82, 95% CI=0.71-0.87, P<0.001). Multivariate analysis showed that B-type natriuretic peptide value greater than or equal to 150 pg/mL (P=0.030, HR=3.99, 95% CI=1.14-13.98) was an independent predictor of all-cause mortality in a 30-day follow-up period. CONCLUSION: Preoperative serum B-type natriuretic peptide concentration is an independent predictor of short-term all-cause mortality in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

B-Type natriuretic peptide as a predictor of short-term mortality in on-pump coronary artery bypass grafting

Abstract Objective: The present study refers to a determination of the preoperative B-type natriuretic peptide is a predictor of short-term all-cause mortality in patients undergoing on-pump coronary artery bypass graft surgeries. Methods: Two hundred and twenty-one patients undergoing on-pump coronary artery bypass graft surgeries were evaluated prospectively during a 30-day postoperative follow-up period. Serum B-type natriuretic peptide concentration was measured without a 24-hour period prior to the surgical procedure and the value obtained was correlated with a short-term all-cause mortality. Results: Data analysis showed that all-cause mortality rates were equal to 9.5% in 30 days. Accuracy analysis by the receiver operating characteristic curve found an ideal cut-off value of B-type natriuretic peptide equal to 150 pg/mL in relation to mortality (AUC=0.82, 95% CI=0.71-0.87, P<0.001). Multivariate analysis showed that B-type natriuretic peptide value greater than or equal to 150 pg/mL (P=0.030, HR=3.99, 95% CI=1.14-13.98) was an independent predictor of all-cause mortality in a 30-day follow-up period. Conclusion: Preoperative serum B-type natriuretic peptide concentration is an independent predictor of short-term all-cause mortality in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

Caracterização dos idosos internados por doença respiratória aguda em um hospital escola terciário / Characterization of elderly inpatient with acute respiratory disease in a tertiary medical school hospital

Objetivo: Caracterizar o perfil sociodemográfico, clínico e de fatores de risco de idosos internados por Doença Respiratória Aguda (DRA) no Hospital de Base de São José do Rio Preto. Metodologia: Pesquisa quantitativa, descritiva e retrospectiva, com dados coletados através da análise de 94 prontuários médicos de idosos com idade igual ou superior a 60 anos, internados no período de agosto de 2012 a setembro de 2013 por DRA no Hospital de Base de São José do Rio Preto. Resultados: O estudo identificou que entre os 94 idosos internados por DRA, 56,4% eram homens (n=53), com 76 anos de idade ou mais (55,3%), brancos (88,3%), casados (54,2%), com baixa escolaridade (19,1% não alfabetizados e 53,3% com até 4 anos de estudo), portadores de pelo menos uma comorbidade (83%), e apresentavam pelo menos um fator de risco para DRA como tabagismo e/ou desnutrição. Dos classificados com dependência funcional, a maioria eram idosos acima dos 75 anos. Quanto à situação cognitiva, menos da metade dos idosos apresentava algum déficit relatado em prontuário, e entre estes a maioria era maior de 75 anos. Mais de 70% dos pacientes (n=68) receberam alta com melhora, sendo que mais da metade (n=38) tinham 75 anos de idade ou menos. Do total, 17 pacientes evoluíram a óbito, sendo que destes, 88,2% (n=15) tinham acima de 75 anos. Após a alta médica, um pequeno número de pacientes (n=11) foram contra-referenciados às suas Unidades Básicas de Saúde de origem. Conclusão: Os resultados do estudo apontam para a importância de se reforçar as redes de cuidados voltadas aos idosos comprometidos por DRA, especialmente aqueles com idade avançada, fatores de risco presentes, comorbidades associadas, dependência funcional e déficit cognitivo, devido à alta probabilidade de má evolução. A capacitação dos profissionais de saúde dos diferentes níveis de atenção à saúde e a criação de estratégias para educação da população são ações fundamentais para a consolidação destas redes de cuidados e, consequentemente, auxiliar na prevenção e no diagnóstico precoce, visando à redução das internações e a mortalidade por DRA

Objective: To characterize the sociodemographic and clinic profiles and risk factors of elderlies hospitalized by acute respiratory disease (ARD) in Hospital de Base de São José do Rio Preto. Metodology: A quantitative, descriptive and retrospective study, with data collected through the analysis of 94 medical records of elderly inpatient, 60 years or older, hospitalized from August 2012 to September 2013 due to ARD. Results: This study identified that among 94 elderly inpatient with acute respiratory disease, major were men (n = 53), 76 years old or more (n = 52), white (n = 83), and had at least one risk factor for ARDs, such as smoking and/or bad nutrition. Most of the elderly over 75 years were dependent on daily life activities. Less than a half had cognitive deficit reported in their medical records, and most of them were more than 75 years old. More than 70% of the patients were discharged with improvement (n = 68), and more than half were 75 years old or less (n = 38). Among the 94 patients, 17 have died, being 88.2% over 75 years old (n = 15). After discharge, a small number of patients were referred to their Primary Care Unit (n = 11). Conclusions: The results of this study appoint to the importance of increasing care networks for elderly people affected by ARD, especially the oldiest, with risk factors, associated comorbidities, functional dependence and cognitive deficit, due to the high probability of bad prognosis. Training professionals at different levels of health care and creation of strategies to instruct the population about ARD are fundamental actions, in order to consolidate these care networks and, consequently, support prevention and early diagnosis, targeting the reduction of hospitalizations and mortality due to ARD.

Melatonin Regulates Angiogenic Factors under Hypoxia in Breast Cancer Cell Lines.

Angiogenesis is the process of new blood vessel formation, regulated by a number of pro- and antiangiogenic factors and usually begins in response to hypoxia. Exogenous administration of melatonin has shown numerous anti-tumor effects and appears to inhibit tumor angiogenesis. However, many factors involved in the anti-angiogenic effect of melatonin are still under investigation. Here, we evaluate the effects of melatonin on cell viability and expression of angiogenic factors in MCF-7 and MDA-MB-231 breast cancer cells under hypoxic conditions. Cell viability was investigated by MTT and gene and protein expression of the hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF-A) were verified by qPCR and immunocytochemistry after melatonin treatment (1 mM) under hypoxic conditions. Additionally, a protein array with 20 different cytokines/factors was performed on tumor cell lysates. The results showed that 1 mM of melatonin reduced the viability of MCF-7 and MDA-MB-231 cells (p < .05). This treatment also decreased both gene and protein expression of HIF-1α and VEGF-A under hypoxic conditions (p < .05). Among the proteins evaluated by protein array, melatonin treatment during hypoxia reduced VEGF-C, VEGFR receptors (VEGFR2 and VEGFR3), matrix metalloproteinase 9 (MMP9) and Angiogenin in MCF-7 cells. In MDA-MB-231 cells, a significant decrease was observed in VEGFR2, epidermal growth factor receptor (EGFR) and Angiogenin (p < .05). Taken together, these results showed that melatonin acts in the regulation of angiogenic factors in breast tumor cells and suggests an anti-angiogenic activity, particularly under hypoxic conditions.