High-output Cardiac Failure: A Forgotten Phenotype in Clinical Practice.

INTRODUCTION: The knowledge on High-Output Cardiac Failure (HOCF) has greatly improved in the last two decades. One of the advances was the identification of a new phenotype of HOCF, characterized by the absence of ventricular dilation, already associated with liver disease, Arteriovenous Fistulas (AVF), lung disease, myelodysplastic syndromes, and obesity. However, it has been noted that any aetiology can present with one of the two phenotypes, depending on the evolution. OBJECTIVE: The study aims to describe, through an integrative review, the physiopathology and aetiologies of HOCF and to discuss phenotypes associated with this condition. METHODS: Revisions, guidelines, case-controls, cohort studies and clinical studies were searched in MEDLINE and LILACS, using the connectives in the "cardiac output, high" database (MeSH Terms) OR "high cardiac output" (All Fields). DISCUSSION: Two distinct phenotypes are currently described in the HOCF, regardless of the aetiology: 1) one with enlarged cardiac chambers; and 2) with normal heart chambers. The mechanisms related to HOCF are vasodilation, arteriovenous shunts that cause increased microvascular density, Reduced Systemic Vascular Resistance (RSVR), and high metabolism. These mechanisms lead to activation of the renin-angiotensin-aldosterone system, sodium and water retention, activation of neprilysin, of the sodium-glucose-2 transporter, which promote interstitial fibrosis, ventricular remodeling and a consequent increase in cardiac output >8L/min. CONCLUSION: Many aetiologies of HOCF have been described, and some of them are potentially curable. Prompt recognition of this condition and proper treatment may lead to better outcomes.

Pericardite constritiva por tuberculose, uma condição de difícil diagnóstico / Constrictive pericarditis due to tuberculosis a difficult diagnosis condition

A pericardite constritiva (PC) é uma condição clínica caracterizada pela presença de inflamação do tecido pericárdico, culminando em constrição cardíaca. A tuberculose pode acometer o pericárdio e levar à uma condição clínica conhecida como pericardite tuberculosa (PT). Relata-se o caso de um paciente jovem, internado com queixas de insuficiência cardíaca e quadro de PC em que o diagnóstico etiológico de PT foi confirmado por exclusão e resposta à terapêutica.

Pericarditis constrictiva por tuberculosis, una condición de difícil diagnóstico / Constrictive pericarditis due to tuberculosis, a difficult diagnosis condition

La pericarditis constrictiva (PC) es una condición clínica caracterizada por la presencia de inflamación del tejido pericárdico, culminando en constricción cardíaca. La tuberculosis puede afectar al pericardio y llevarlo a una condición clínica conocida como pericarditis tuberculosa (PT). Se relata el caso de un paciente joven, internado con síntomas de insuficiencia cardíaca y cuadro.

Phase angle measured by electrical bioimpedance and global cardiovascular risk in older adults.

AIM: Population aging is a worldwide phenomenon associated with physiological and metabolic changes that contribute to the increased prevalence of risk factors for cardiovascular disease. The phase angle (PA) is a variable calculated by bioelectrical impedance analysis, interpreted as a direct measure of cell stability. The objective of the present study was to investigate the correlation of PA with the anthropometric measures, metabolic profile and the cardiovascular risk estimated by the Global Cardiovascular Risk Score in the elderly population. METHODS: A cross-sectional study was carried out with 402 patients aged >60 years (70.4 ± 6.9 years, 74% female) treated in primary care. Patients were evaluated by blood pressure, anthropometric measurements and body composition. The score of the risk and the stratification of the cardiovascular risk were calculated using the criteria from the Framingham Heart Study. RESULTS: Age, systolic blood pressure, neck circumference and fat-free mass correlated with PA in female patients. In men, age and systolic blood pressure were the variables that correlated with the PA in the bivariate analysis. In the multiple linear regression, for the female group the risk score presented an independent variation with PA (P = 0.051) and age (P < 0.0001). The same correlation was observed for the male group both for PA (P = 0.042) and age (P < 0.0001). CONCLUSIONS: The present data show an independent association of PA with overall cardiovascular risk in the elderly population. Geriatr Gerontol Int 2018; 18: 732-737.

Association of types of dyspnea including 'bendopnea' with cardiopulmonary disease in primary care. / Associação dos tipos de dispneia e da "flexopneia" com as patologias cardiopulmonares nos cuidados de saúde primários.

INTRODUCTION: Dyspnea is the symptom most commonly reported by patients with heart failure (HF) and/or pulmonary disease, the obese and the elderly. Recently 'bendopnea' (shortness of breath when bending forward) has been described in patients with HF. OBJECTIVE: To determine the association of exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea and bendopnea with chronic disease, especially heart failure, and their phenotypes in primary care. METHODS: This cross-sectional study included 633 individuals aged between 45 and 99 years enrolled in a primary care program in Niteroi, Brazil. Participants underwent clinical assessment and laboratory tests and completed a questionnaire, all on the same day. RESULTS: Paroxysmal nocturnal dyspnea and bendopnea were associated with HF (unadjusted OR 2.42, 95% CI 1.10-5.29 and OR 2.59, 95% CI 1.52-4.44, respectively). In multivariate models, chronic obstructive pulmonary disease, coronary heart disease and myocardial infarction were not associated with bendopnea. CONCLUSIONS: Bendopnea was the only type of dyspnea not linked to respiratory disease or coronary heart disease. Even after adjusting for depression and body mass index, the association remained with HF with or without preserved ejection fraction, and bendopnea thus appears to be a promising symptom to differentiate HF from the other two disease groups.

Two potentially fatal surprises in the preoperative assessment of an asymptomatic young adult. / Duas surpresas potencialmente fatais em avaliação pré-operatória de adulto jovem assintomático.

Isolated left ventricular non-compaction is a rare disease classified as a primary genetic cardiomyopathy and is characterized by heart failure, systemic embolism and ventricular arrhythmias. The diagnosis is established by Doppler echocardiography. We report the case of an asymptomatic young adult, with no history of heart disease, who underwent preoperative assessment for low-risk orthopedic surgery. The electrocardiogram showed left bundle branch block, which prompted further investigation with Doppler echocardiography, cardiac computed tomography angiography and cardiac magnetic resonance imaging. A diagnosis of isolated left ventricular non-compaction and pulmonary embolism was made. Some aspects of preoperative assessment in low-risk surgical patients are discussed.

Left ventricular remodeling and diastolic function in chronic hypertensive pregnant women.

UNLABELLED: Hypertension during pregnancy is a problem that impacts maternal morbidity and mortality. Dyspnea and edema are common symptoms, often secondary to physiological changes, but may raise doubts as to ventricular dysfunction. OBJECTIVE: To evaluate the ventricular geometry pattern and diastolic function in chronic hypertensive pregnant women (HPW). METHODS: Prospective, cross-sectional study on 62 pregnant women over a 29-month period, from March 2009 to July 2011, in Brazil was done. Thirty-one HPWs and 31 normotensive pregnant women (NPW) underwent clinical and cardiovascular evaluations, and were subjected to transthoracic echocardiogram. RESULTS: LV mass (HPW: 220.9 ± 43.3 vs. NPW: 192.9 ± 39.8 g, p = 0.01), posterior wall thickness (HPW: 9.9 ± 1.1 vs. NPW: 9.2 ± 0.9 mm, p = 0.005), mitral flow A wave velocity (HPW: 0.60 ± 0.16 vs. NPW: 0.52 ± 0.10 m/s, p = 0.02), tissue Doppler A' wave velocity (HPW: 10 ± 2 vs. NPW: 8.9 ± 1cm/s, p=0.02), and E/E' ratio (HPW: 6.8 ± 2.2 vs. NPW: 5.5 ± 1.6, p = 0.01) were higher in HPWs. Septal and lateral walls E' wave velocities (HPW: 13 ± 2 vs. NPW: 15 ± 3 cm/s, p=0.001), and E'/A' ratio (HPW: 1.26 ± 0.38 vs. NPW: 1.77 ± 0.49, p = 0.00003) were lower in HPWs. There was a positive linear correlation between body mass index (BMI) and ventricular mass, A wave, systolic, diastolic blood pressures, and a negative correlation between BMI, E' wave and E'/A' ratio. CONCLUSION: Ventricular remodeling showed a direct relationship with body weight, and both groups showed a predominant pattern of eccentric ventricular hypertrophy. The LV diastolic function was abnormal in HPWs.

Síndrome de Kearns-Sayre: Relato de caso / Síndrome de Kearns-Sayre: Reporte de un caso / Kearns-Sayre syndrome: Case report

A síndrome de Kearns-Sayre é uma mitocondriopatia caracterizada por disfunções multiorgânicas que classicamente se desenvolve antes dos vinte anos de idade. Os critérios diagnósticos mais aceitos na literatura são a tríade: oftalmoplegia externa progressiva, retinopatia pigmentar e distúrbio de condução cardíaco. O prognóstico da SKS está relacionado ao número de tecidos acometidos, bem como a gravidade das alterações. Neste artigo relata-se caso de um paciente de 18 anos que apresentou características clínicas compatíveis com a síndrome de Kearns-Sayre.

Kearns-Sayre syndrome The Kearns-Sayre syndrome (KSS) is a mitochondriopathies characterized by multiorgan dysfunction that typically develops before the age of twenty. The diagnostic criteria most widely accepted in the literature are a triad: progressive external ophthalmoplegia, pigmentary retinopathy and disorders of cardiac conduction. KSS prognosis is related to the number of tissues affected and the severity of the alterations. In this article we report on a patient who presented 18 clinical features consistent with the Kearns-Sayre syndrome.

Síndrome de Kearns-Sayre El síndrome de Kearns-Sayre (SKS) es una mitocondriopatía caracterizada por disfunciones multiorgánicas que clásicamente se desarrolla antes de los veinte años de edad. Los criterios de diagnóstico más ampliamente aceptados en la literatura son una tríada: oftalmoplejía externa progresiva, retinopatía pigmentaria y trastornos de la conducción cardíaca. El pronóstico del SKS está relacionado con el número de los tejidos afectados y la severidad de las alteraciones. En este artículo, se presenta un caso de un joven de 18 años que presentaba características clínicas compatibles con el síndrome de Kearns-Sayre.