Conhecimentos e sentimentos de usuários submetidos à cineangiocoronariografia / Knowledge and feelings of patients submitted to cardiac catheterization

This is a study that addresses users' knowledge and feelings about the cardiac catheterization exam. Objective: To describe the perception of the exam in users submitted to a coronary catheterization. Methods: This is a descriptive study with a qualitative approach carried outat the hemodynamics service in a university hospital in the state of Rio de Janeiro, from October to December 2013. Twenty 20 patients, aged between 18 and 79 years old participated in the study. Data collection was carried out through semi-structured interviews, followed by content analysis. Results: most patients were unaware of the purpose of the exam, and felt fear and anxiety associated with death, symbolically or not. Final considerations: patients are not clear about the therapeutic action of cardiac catheterization, opening space for the presence of feelings caused by ignorance. The educational actions carried out by the nurse are a facilitating strategy for health education for these people.

Trata-se de um estudo que aborda o conhecimento e sentimentos dos usuários relativo ao exame de cineangiocoronariografia. Objetivo: descrever a percepção dos usuários submetidos à cineangiocoronariografia em relação ao exame. Métodos: estudo descritivo com abordagem qualitativa, realizado no serviço de hemodinâmica em um hospital universitário no estado do Rio de Janeiro, no período de outubro a dezembro de 2013. Os participantes foram 20 usuários, com idades entre 18a 79 anos. A coleta de dados foi realizada por meio de entrevista semiestruturada, seguida da análise de conteúdo. Resultados: observou-se o desconhecimento quanto à finalidade do exame pela maioria dos usuários, e presença de medo e ansiedade associados à morte de forma simbólica ou não. Considerações finais: constatou-se que os usuários não possuem clareza quanto à ação terapêutica da cineangiocoronariografia, abrindo-se espaço para a presença de sentimentos que emergem ocasionados pelo desconhecimento. As ações educativas realizadas pelo enfermeiro constituem-se em estratégia facilitadora para a educação em saúde dessa clientela.

IL-10 IS DOWN-REGULATED IN THE CARDIOVASCULAR DISEASES SUSPECTED PATIENTS, INDEPENDENT OF ANGIOGRAPHY. / RIVEN' IL-10 ZNYZhENYY̆ U PATsIIeNTIV IZ SERTsEVO-SUDYNNYMY ZAKhVORIuVANNIaMY, NEZALEZhNO VID PROVEDENNIa ANGIOGRAFIChNYKh DOSLIDZhEN'.

IL-10 and interferon-gamma (IFN-γ) are the important anti and pro-inflammatory cytokines, respectively, which may participate in the cardiovascular disease pathogenesis. Additionally, environmental factors, such as the X-ray, can modulate cytokine expression. Due to the fact that X-ray is used during angiography, hence, angiography may alter expression of the cytokines. OBJECTIVE: Accordingly, this project was aimed to assess IL-10 and IFN-γ serum levels within cardiovascular patients (with and without vessel stenosis) versus healthy controls and also the effects of angiography on the serum levels of the cytokines. MATERIAL AND METHODS: This study was performed on the 80 participants, including twenty cases in each group (healthy controls and cardiovascular patients without vessel stenosis, stenosis of 1 vessel and stenosis of more than 1 vessel) to evaluate IL-10 and IFN-γ serum levels using ELISA technique. The IL-10 and IFN-γ serum levels also compared within group 2, 3 and 4 before and after angiography to explore the effects of the technique on the IL-10 and IFN-γ serum levels. RESULTS: IL-10, but not IFN-γ, serum levels were higher in the healthy controls than all cardiovascular patients. IL-10 and IFN-γ serum levels were not altered after angiography and also were not differ in the smoker versus non- smoker and opium consuming versus non-opium consuming participants. CONCLUSION: Due to the results it may be concluded that IL-10 can be considered as a plausible inhibitor of cardio- vascular diseases independent of angiography duration and X-ray, however, IFN-γ has no effects in the Iranian patients suffering from cardiovascular diseases.

TERT assists GDF11 to rejuvenate senescent VEGFR2+/CD133+ cells in elderly patients with myocardial infarction.

Growth differentiation factor 11 (GDF11) is a transforming growth factor ß superfamily member with a controversial role in rejuvenating old stem cells after acute injury in the elderly population. This study aimed to evaluate the effects of telomerase reverse transcriptase (TERT) on GDF11-mediated rejuvenation of senescent late-outgrowth endothelial progenitor cells (EPCs), defined as VEGFR2+/CD133+ cells, in elderly patients with acute myocardial infarction (AMI). We compared the quantity and capabilities of VEGFR2+/CD133+ cells from old (>60 years), middle-aged (45-60 years), and young (<45 years) AMI patients. The decline in circulating count and survival of VEGFR2+/CD133+ cells with age was accompanied by decrease in their TERT and GDF11 expression levels in patients with AMI. Further, upregulation of TERT could trigger GDF11-mediated rejuvenation of old VEGFR2+/CD133+ cells by renewing their survival and angiogenic abilities through activation of canonical (Smad2/3) and noncanonical (eNOS) signaling pathways. Depletion of GDF11 or TERT caused senescence of young VEGFR2+/CD133+ cells leading to impaired vascular function and angiogenesis in vitro and in vivo, whereas adTERT and rhGDF11 rescued this senescence. TERT cooperates with GDF11 to enhance regenerative capabilities of old VEGFR2+/CD133+ cells. When combined with TERT, GDF11 may represent a potential therapeutic target for the treatment of elderly patients with MI.

Early Assessment of Left Ventricular Function by Layer-Specific Strain and Its Relationship to Pulsatile Arterial Load in Patients with Coronary Slow Flow.

Previous studies reported a controversial left ventricular (LV) function impairment and pathophysiology in patients with coronary slow flow (CSF). Greater arterial load has been shown to increase aortic impedance and endothelial shear stress, potentially affecting coronary anatomy and function. We investigated LV systolic function by a new layer-specific strain technology and assessed the association between pulsatile arterial load and contractility.A total of 70 patients with CSF and 50 controls with normal coronary angiography were included in the study. Layer-specific longitudinal and circumferential strains were assessed from endocardium, mid-myocardium, and epicardium (global longitudinal strain (GLS)-endo, GLS-mid, GLS-epi and GCS-endo, GCS-mid, GCS-epi) by two-dimensional speckle tracking imaging (2D-STI). Pulsatile arterial load was estimated by indexed arterial compliance (ACI). Layer-specific GLS showed a decreasing gradient from the endocardium to the epicardium in both the controls and CSF group. GLS-endo and GLS-mid in the CSF group were significantly lower than the control group (all P < 0.05). Layer-specific longitudinal strain showed a good correlation with the number of affected coronary arteries (all P < 0.05) and the mean thrombolysis in the myocardial infarction frame count (TFC) (all P < 0.05). ACI was lower in patients with CSF (P = 0.005), and ACI was correlated negatively with layer-specific GLS (all P < 0.05).Layer-specific evaluation of the LV provides an understanding of the layer-specific properties of the LV wall and the possible process of the LV impairment in patients with CSF. Greater pulsatile arterial load, as manifested by a lower ACI, is coupled with worse LV longitudinal function in patients with CSF.

The frequency of asymptomatic urinary system abnormalities in children detected with cineurography imaging during angiocardiography.

IntroductionDiagnostic and interventional catheter angiography of the heart is frequently used in paediatric cardiology. It is also possible to detect urinary system anomalies with cineurography images that may be obtained during angiocardiography. In this study, the aim was to determine the frequency, distribution, and properties of urinary system anomalies accompanying heart diseases, and to find out the effectiveness of cineurographic images in detecting the urinary system anomalies. METHODS: The cineurographic images of 2022 children who had undergone angiocardiography between 1995 and 2015 were retrospectively examined. RESULTS: Urinary system anomalies were detected in 261 of the 2022 cases (12.9%). Of these 261 cases, 148 were males (56.7%), whereas 113 were females (43.3%). Among the heart diseases, the group most accompanied by urinary system anomalies was the non-cyanotic left-to-right shunted heart diseases, which was detected in 120 (39.1%) patients. Pelvicalyceal ectasia was the most common urinary system anomaly encountered and was detected in 89 patients (34.1%). Of the urinary system anomalies cases, 94 detected by cineurography were determined to be clinically severe. When the effectiveness of the cineurography was evaluated using the ultrasonography records of the patients, it was found to have 63.8% accuracy. CONCLUSION: Many of the patients with CHDs concomitantly have urinary system anomalies. It is possible to determine asymptomatic urinary system anomalies using cineurographic imaging during angiocardiography. This may lead to earlier treatments and improved prognosis for the patients, thus making it possible to prevent potential future problems.

Electrocardiography-gated cardiac CT angiography can differentiate brachycephalic dogs with and without pulmonary valve stenosis and findings differ from transthoracic echocardiography.

Pulmonary valve stenosis (PS) is one of the most commonly diagnosed congenital heart defects in dogs. Currently, transthoracic echocardiography (TTE) is the standard modality used to evaluate PS. Image acquisition by TTE can be challenging in some brachycephalic breeds of dogs. The use of echocardiographic-gated CT angiography (ECG-gated CTA) in veterinary medicine is limited. This retrospective method comparison study investigated right and left ventricular outflow diameters by sedated ECG-gated CTA and unsedated TTE in 14 brachycephalic dogs with PS and 12 brachycephalic dogs without PS. Measurements of ventricular outflow structures were made in early systole and end diastole for both modalities and then compared for significance between systolic and diastolic phases, as well as between the two modalities. Ratios of the pulmonary trunk diameter to the aorta at different locations (aortic valve, aortic annulus, and ascending aorta) and in different planes (transverse, sagittal) were compared between dogs with PS and without PS, as well as within dogs, by both TTE and ECG-gated CTA. Transthoracic echocardiography and ECG-gated CTA both detected significantly greater pulmonary trunk to aorta ratios in dogs with PS at all aortic locations (P < 0.05). Pulmonary valve to aortic valve ratios were significantly smaller in dogs with PS (P < 0.05). Pulmonary trunk to aorta and pulmonary valve to aorta ratios were achieved with good anatomic detail using ECG-gated CTA. Ratios of the pulmonary trunk and pulmonary valve relative to the aorta may be useful to evaluate for PS using a modality that is underutilized for cardiac assessment.

Cogan's syndrome - A rare aortitis, difficult to diagnose but with therapeutic potential / Síndrome de Cogan - Uma aortite rara, de diagnóstico difícil, mas com potencial terapêutico

Summary The inflammation of aortic wall, named aortitis, is a rare condition that can be caused by a number of pathologies, mainly inflammatory or infectious in nature. In this context, the occurrence of combined audiovestibular and/or ocular manifestations eventually led to the diagnosis of Cogan's syndrome, making it the rare case, but susceptible to adequate immunosuppressive treatment and satisfactory disease control.

Resumo A inflamação da parede da aorta, denominada aortite, é uma condição clínica rara, que pode ser causada por diversas patologias, principalmente as de fundo inflamatório e/ou infeccioso. Nesse contexto, a ocorrência de sintomas vestibulares e oftalmológicos associados ao quadro remete ao diagnóstico de síndrome de Cogan, tornando o caso raro, mas passível de tratamento imunossupressor adequado e controle satisfatório da doença.

Intravenous Contrast-Induced Nephropathy-The Rise and Fall of a Threatening Idea.

Contrast-induced nephropathy (CIN) has been considered to be a cause of renal failure for over 50 years, but careful review of past and recent studies reveals the risks of CIN to be overestimated. Older studies frequently cited the use of high-osmolality contrast media, which have since been replaced by low-osmolality contrast media, which have lower risks for nephropathy. In addition, literature regarding CIN typically describes the incidence following cardiac angiography, whereas the risk of CIN from intravenous injection is much lower. Most of the early published literature also lacked appropriate control groups to compare to those that received iodinated contrast, and thus attributed rises in creatinine to intravenous contrast without considering normal creatinine fluctuations (frequent in patients with kidney disease) and other acute pathologic states such as hypotension or nephrotoxic drug administration. The aim of this paper is to review the literature detailing CIN risk, discuss why CIN risk is often overestimated and how withholding contrast can lead to misdiagnosis and delay in appropriate patient management.

Aneurysm of the muscular septum associated with Wolf-Parkinson-White syndrome presenting as dilated cardiomyopathy; A report of two cases.

Muscular septal aneurysms are extremely rare without a ventricular septal defect and are diagnosed accidentally in most cases. Reported cases generally have rhythm disturbance or electrocardiographic findings of Wolf-Parkinson-White (WPW) syndrome. Presently described are 2 cases of ventricular septal aneurysm associated with WPW syndrome, which presented as dilated cardiomyopathy. Pre-excitation disappeared gradually in first patient. There was also concurrent decrease in degree of bulging of the interventricular septum and improvement of left ventricular systolic function. Second patient had complaints of palpitation and was referred for ablation of accessory pathway. Our findings suggest that presence of pre-excitation may lead to ventricular dyssynchrony and abnormal ventricular septal movement, resulting in appearance of aneurysm.

Cogan's syndrome - A rare aortitis, difficult to diagnose but with therapeutic potential.

The inflammation of aortic wall, named aortitis, is a rare condition that can be caused by a number of pathologies, mainly inflammatory or infectious in nature. In this context, the occurrence of combined audiovestibular and/or ocular manifestations eventually led to the diagnosis of Cogan's syndrome, making it the rare case, but susceptible to adequate immunosuppressive treatment and satisfactory disease control.

Transseptal puncture by CTP-2 method: Results from cardiac computed tomography analysis and clinical application.

The current used parameters for transseptal puncture (TSP) under fluoroscopic guidance is from left atriography and need to be verified by precise anatomic measurement. From February 2009 to July 2013, consecutive patients who received computed tomography (CT) were included. Landmarks and parameters were preliminary studied by right atriography, and further evaluated on the CT images of 1001 patients. A method (CTP-2) was proposed for guiding TSP. In right anterior oblique 45° view, the CTP-2 method was defined by points C, T, and P, and 2 areas: point C is in coronary sinus; point T is at a distance of dCT (usually 1.5 ±â€Š0.2 vertebral height) over point C; then point P, the optimal puncture site, was located at 0.5 ±â€Š0.2 vertebral body height posterior to point T; puncture should avoid the aortic root area and the rear triangle area; the aortic root area could be negatively revealed by right atriography at the orifice of inferior vena cava, and the rear triangle area is demarcated by points C, C', and T' (C' and T' are 2 points horizontally posterior to, and at dCT away from points C and T, respectively). The initial application of CTP-2 in 2820 patients showed that it might be helpful in reducing the need of left atriography and the possibility of cardiac perforation.

Bidirectional Glenn with interruption of antegrade pulmonary blood flow: Which is the preferred option: Ligation or division of the pulmonary artery?

We report a rare complication of massive aneurysm of the proximal ligated end of the main pulmonary artery which occurred in the setting of a patient with a functionally univentricular heart and increased pulmonary blood flow undergoing superior cavopulmonary connection. Awareness of this possibility may guide others to electively transect the pulmonary artery in such a clinical setting.