Muscle electrical stimulation improves neurovascular control and exercise tolerance in hospitalised advanced heart failure patients.

BACKGROUND: We investigated the effects of muscle functional electrical stimulation on muscle sympathetic nerve activity and muscle blood flow, and, in addition, exercise tolerance in hospitalised patients for stabilisation of heart failure. METHODS: Thirty patients hospitalised for treatment of decompensated heart failure, class IV New York Heart Association and ejection fraction ≤ 30% were consecutively randomly assigned into two groups: functional electrical stimulation (n = 15; 54 ± 2 years) and control (n = 15; 49 ± 2 years). Muscle sympathetic nerve activity was directly recorded via microneurography and blood flow by venous occlusion plethysmography. Heart rate and blood pressure were evaluated on a beat-to-beat basis (Finometer), exercise tolerance by 6-minute walk test, quadriceps muscle strength by a dynamometer and quality of life by Minnesota questionnaire. Functional electrical stimulation consisted of stimulating the lower limbs at 10 Hz frequency, 150 ms pulse width and 70 mA intensity for 60 minutes/day for 8-10 consecutive days. The control group underwent electrical stimulation at an intensity of < 20 mA. RESULTS: Baseline characteristics were similar between groups, except age that was higher and C-reactive protein and forearm blood flow that were smaller in the functional electrical stimulation group. Functional electrical stimulation significantly decreased muscle sympathetic nerve activity and increased muscle blood flow and muscle strength. No changes were found in the control group. Walking distance and quality of life increased in both groups. However, these changes were greater in the functional electrical stimulation group. CONCLUSION: Functional electrical stimulation improves muscle sympathetic nerve activity and vasoconstriction and increases exercise tolerance, muscle strength and quality of life in hospitalised heart failure patients. These findings suggest that functional electrical stimulation may be useful to hospitalised patients with decompensated chronic heart failure.

Rendimento do suco e qualidade química do abacaxi sob lâminas e frequências de irrigação / Yield of pineapple juice and chemical quality in irrigation frequency and blades

A cultura do abacaxi apresenta uma demanda permanente por água, variável e dependente de seu estádio de desenvolvimento, que pode afetar a produção e a qualidade do fruto. Neste estudo objetivou-se avaliar a qualidade química dos frutos do abacaxi Smooth cayenne submetido a diferentes níveis e frequências de reposição de água no solo. Utilizou-se delineamento em blocos casualizados num esquema fatorial 4 x 2, constituído por quatro níveis de reposição de água no solo (50%, 75%, 100% e 125% da evapotranspiração da cultura) e duas frequências de irrigação (1 e 3 dias), com quatro repetições. Avaliou-se os parâmetros: rendimento de suco (RS), potencial hidrogeniônico (pH), sólidos solúveis totais (SST), acidez total titulável (ATT), relação SST/ATT, ácido ascórbico (AA). Observou-se que as lâminas e frequências de irrigação não influenciaram o rendimento de suco (RS) e ácido ascórbico (AA); o aumento das laminas de irrigação influenciou positivamente a qualidade do fruto, pois aumenta os valores de sólidos solúveis totais (SST), diminui a acidez titulável (ATT), eleva a relação SST/ATT e o potencial hidrogeniônico de suco (pH).

The pineapple crop has a permanent demand for water, variable and dependent on their stage of development, which may affect the production and fruit quality. This study aimed to evaluate the chemical quality of fruits Smooth cayenne pineapple submitted to different levels and frequency of water replacement in the soil. We used a randomized block design in a 4 x 2 factorial arrangement, consisting of four levels of soil water replenishment (50%, 75%, 100% and 125% of crop evapotranspiration) and two irrigation frequencies (1 and 3 days) with four replications. We evaluated the parameters: juice yield (RS), hydrogen potential (pH), total soluble solids (SST), titratable acidity (ATT), SST/ATT relationship, ascorbic acid (AA). It was observed that the blades and irrigation frequencies did not affect the juice yield (RS) and ascorbic acid (AA), the increase of the blades irrigation influenced positively the quality of the fruit as it increases the values of total soluble solids (SST) decreases the acidity (ATT), raises the relationship SST/ATT and hydrogen potential (pH).

Avaliação de um sistema de irrigação autopropelido aplicando água residuária de suinocultura / Evaluation of a self propelled irrigation system for application of swine wastewater

Este experimento foi conduzido na Unidade I do Centro Federal de Educação Tecnológica de Uberaba (CEFET-Uberaba), em Uberaba, MG, durante o ano de 2006. Conduziu esse experimento, com o objetivo de avaliar a influência da concentração de sólidos totais contidos na água residuária de suinocultura: nas perdas de cargas ocorridas no sistema, na uniformidade de distribuição, na distribuição de sólidos totais ao longo do raio de alcance do aspersor, no raio de alcance do aspersor. Os tratamentos constaram das concentrações de sólidos totais contidos em cada camada da lagoa retirada durante o ensaio. Utilizou-se um sistema de irrigação autopropelido da marca Metal Lavras, modelo mini 63/150, equipado com um canhão da marca Plona modelo RL 250 e um sistema de bombeamento composto por uma bomba da marca Schneider modelo MSA-22 R 1 »" acoplada a um motor trifásico de 15 cv. As perdas de carga foram influenciadas diretamente pela concentração dos sólidos contidos na água residuária, chegando a acréscimos de 30,77 por cento na adutora, 13,59 por cento na turbina e 22,02 por cento na mangueira, para a maior concentração de sólidos avaliada em relação a água sem resíduo. Na uniformidade de distribuição e no raio de alcance do aspersor, não houve influência significativa da concentração de sólidos. Na distribuição de sólidos ao longo do raio de alcance do aspersor, observou-se uma maior concentração nos coletores mais afastados do aspersor.

This experiment was carried out at Unit I at the Federal Technological Education Center in Uberaba (CEFET-Uberaba-MG), during the year of 2006. The aim was to evaluate the influence of solids concentration in swine wastewater on charge losses of the irrigation system, on water distribution uniformity, on distribution of solids along the sprinkler radius of throw. The treatment levels were solid concentration at different depths of a water pond. The irrigation self propelled system is manufactured by Metal Lavras, model mini 63/150, with a gun sprinkler model Plona RL 250 and a pump system with a Schneider unit model MSA-22R 1/14" with a three phase electrical engine 15 HP. The charge losses were influenced by the solids concentration increasing the losses in 30.77 percent at the main pipe, 13.59 percent at the turbine and 22.02 percent at the plastic hose, for the largest solid concentration compared to water only. At water distribution uniformity and radius of throw statistical differences were not observed. One observed that solid application varied along the radius of throw, being larger quantities applied at the larger distances.

Socioeconomic factors in the prognosis of heart failure in a Brazilian cohort.

A large body of evidence supports the concept that socioeconomic factors may influence the prognosis of cardiovascular diseases. We studied the influence of socioeconomic factors in the prognosis of heart failure in 494 patients consecutively admitted to the hospital due to worsening of symptoms of heart failure in São Paulo, Brazil. The ages ranged between 15 and 90 (mean 57.5, standard deviation 14.2) years; 345 (69.8%) were men and 149 (30.2%) were women. Patients were followed-up at least for two years after hospital discharge. Two hundred and forty-one patients died due to cardiac disease during the follow-up period. Hierarchical analysis was performed with demographic and socioeconomic variables analyzed in the first level and clinical variables in the second level. At the level of the demographic and socioeconomic characteristics, care under the Public Health System (odds ratio 3.46, 95% CI 1.91 to 6.27, p<0.001) was the most important predictive factor for mortality. At the second hierarchical level, the predictive factors of mortality were Chagas' heart disease (odds ratio 3.34, 95% CI 1.90 to 5 89, p<0.001), digoxin therapy (odds ratio 1.94, 95% CI 1.09 to 3.45, p<0.025), frequency of myocardial infarctions (odds ratio 1.75, 95% CI 1.25 to 2.44, p<0.001) and arterial hypertension (odds ratio 0.47, 95% CI 0.30 to 0.73, p=0.001). Care delivered through the Public Health System may be a marker of socioeconomic conditions related with higher mortality in patients with heart failure.

Por que, como e quando usar os betabloqueadores no tratamento da insuficiência cardíaca / Why, how and when use betablockers in the treatment of heart failure

Os pacientes estáveis, com disfunção ventricular sistólica, independentemente da classe funcional ou da presença de sintomas, devem sempre receber um betabloqueador, o que os beneficiará com menor progressão da doença, menor mortalidade e melhora da disfunção ventricular. O mesmo se aplica para os pacientes em formas mais avançadas da doença, embora sua utilização de droga seja mais trabalhosa. O tratamento deve ser iniciado sempre com dose baixa, que deve ser progressivamente aumentada até que seja atingida a dose-alvo ou a dose máxima tolerada pelo paciente. Considerando que a maioria dos conhecimentos sobre a insuficiência cardíaca foram gerados por estudos anteriores aos betabloqueadores, é possível que tenhamos que rever muitos deles, como o emprego do digital, da espironolactona e mesmo das doses dos inibidores da enzima de conversão da angiotensina, pois as evidências certamente sinalizam que os betabloqueadores são, em nossos dias, a principal droga para o manuseio da insuficiência cardíaca.

Duration of symptoms in patients with infective endocarditis.

Despite progress in the management of infective endocarditis, delays in diagnosis or prior antimicrobial treatment may adversely influence the symptom duration and outcome. The duration of symptoms in patients with infective endocarditis was studied in 683 cases among 653 patients with 703 episodes of the disease; patients were hospitalized within 10 days of symptom onset in 169 (24.7%) cases. Antimicrobial therapy before hospital admission was administered to 257 (36.5%) patients. Overall mortality was 25.6%. Symptom duration was longer when antimicrobials were administered before diagnosis (58.8+/-78.1 vs. 44.8+/-54.9 days), when vegetations were detected on echocardiogram (53.5+/-68.2 vs. 38.8+/-47.3) and among patients admitted before 1990 (42.3+/-67.1 vs. 54.2+/-62.4 days). Symptom duration was shorter in patients with prosthetic valve endocarditis (26.8+/-34.2 vs. 59.3+/-71.6 days). In 54 (26.5%) episodes of prosthetic valve endocarditis, patients had symptoms for more than 30 days. Staphylococcus aureus was the most frequent agent among patients with symptoms up to 10 days (41.2%) and Streptococcus among those with symptoms over 20 days (53.9%). Symptom duration did not significantly differ in regard to medical (51.3+/-69.2 days) or surgical (46.7+/-55.7 days) treatment. Mortality increased as symptom duration decreased and was highest for patients who experienced symptoms for less than 10 days (36.1%). In some patients medical care may be delivered relatively late in the course of infective endocarditis. Administration of antibiotics previous to hospital admission increased duration of symptoms, and cardiac valve prosthesis, staphylococcal infection and death were associated with more acute disease.

Aneurysm of the left atrial appendage.

We present the case of a 33-year-old woman with atrial tachyarrhythmias and chest pain. The transthoracic echocardiography demonstrated an intrapericardial liquid mass confirmed as an aneurysm of the left atrial appendage by a nuclear magnetic imaging study. Aneurysmectomy was performed with the assistance of cardiopulmonary bypass with a bilateral submammary skin incision and subsequent median sternotomy. The patient had an uneventful postoperative course. We suggest aneurysmectomy aided by cardiopulmonary bypass as a safer method of treatment for this rare cardiac anomaly.

Comparaçäo entre os efeitos da clortalidona e do diltiazem sobre a isquemia miocárdica em idosos hipertensos portadores de doença arterial coronariana / Effects of chlorthalidone and diltiazem on myocardial ischemia in elderly patients with hypertension and coronary artery disease

OBJECTIVE: Antihypertensive therapy with thiazides decreases coronary events in elderly patients. However, the influence of diuretics on myocardial ischemia has not been fully investigated. The aim of this study was to compare the effect of chlorthalidone and diltiazem on myocardial ischemia. METHODS: Following a randomized, double-blind, crossover protocol, we studied 15 elderly hypertensive patients aged 73.6 + or - 4.6 years with myocardial ischemia. All patients had angiographically documented coronary artery disease. We measured patients using 48- hour ambulatory electrocardiogram monitoring and exercise testing. After a 2-week period using placebo, patients received chlorthalidone or diltiazem for 4 weeks. RESULTS: Both treatments lowered systolic and diastolic blood pressures...

Embolia arterial periférica. Relato de casos internados / Peripheral arterial embolism. Report of hospitalized cases

OBJECTIVE: We analyzed the frequency of peripheral embolisms, the underlying heart disease,triggering factors, the sites of the emboli, and evolution of the patients. METHODS: We analyzed 29 cases of peripheral arterial embolism out of a total of 20,211 hospitalizations in a cardiology center in the city of São Paulo. The age was 51.89ñ18.66 years, and 15 were males. RESULTS: Embolism in the right lower limb occurred in 18 patients (62.0 percent),in the left lower 11(37.9 percent) and right upper 3 (10.3 percent) limbs, and in the left arm (1). Four patients had embolism in two limbs. The heart disease, mitral valvar heart disease (9 patients - 31.0 percent); infective endocarditis (7-24.1 percent); dilated cardiomyopathy (6 - 20.6 percent); ischemic coronary heart disease (6 patients - 20.6 percent); and one patient with cor pulmonale. Atrial fibrillation was observed in 20 patients (68.9 percent), chronic in 12 patients (41.3 percent ) and acute in 8 (27.5 percent). All patients with mitral valvar heart disease had atrial fibrillation, chronic in 8 patients (88.8percent); patients with cardiomyopathy and coronary heart disease, 4 in each group had atrial fibrillation, acute in 60 percent of the patients.Patients with infective endocarditis, 3 had staphylococcus and 2 Gram-negative bacteria. In the follow-up, 2 patients (6.8percent) required limbs amputation, and 5 (17.2 percent) died due to embolism. CONCLUSION: Most of the time, embolism does not cause permanent complications. Our data highlight the importance of anticoagulation for patients acute atrial fibrillation in myocardial dysfunction and for patients with chronic atrial fibrillation in cases of mitral valvar heart disease to prevent peripheral embolism.

Em que momento do tratamento o uso do captopril determina melhora mais acentuada do desempenho físico em pacientes com insuficiência cardíaca? / When does the Treatment with Captopril Show a Better Improvement in Exercise Capacity in Patients with Heart Failure?

OBJETIVO- Considerando que insuficiência Cardíaca reduz a capacidade física do paciente e que os inibidores da enzima conversora melhoram esta capacidade, procuramos verificar em que momento ocorre esta melhora,utilizando o teste de caminhada de 6min como forma deavaliaçäo.MÉTODOS- Foram estudados 21 pacientes, com aidade média de 48 anos, sendo 12 do sexo masculino, em insuficiência cardíaca congestiva (ICC) classe funcional (CF) II e III, todos com fraçäo de ejeçäo <45 por cento e diâmetro ventricular esquerdo >55mm ao ecocardiograma bidimensional.Os pacientes foram previamente tratados com digital e diuréticos e, quando compensados, medicados com captopril 25mg, três vezes ao dia, sendo submetidos a testes de caminhada de 6min ao ínicio, após quatro semanas e 16 semanas de tratamento.RESULTADOS- O emprego do captopril mostrou aumento importante na capacidade física dos portadores de ICC.A distância média caminhada e desvio padräo em 6min passou de 451 +- 110m para 476+-94m em quatro semanas e para 504+-68m após 16 semanas de tratamento (p<0,0001).COCLUSAO- Nossos resultados mostraram melhora significativa na capacidade física em 16 semanas de tratamento, 50 por cento ocorrida após quatro semanas de tratamento, concluindo que nesta amostra a melhora terapêutica foi observada já após quatro semanas de tratamento, persistindo até quatro meses após o inicío do tratamento

Purpose - Considering that heart failure reduces exercise capacity and that converting enzyme inhibitor increases this capacity, using the 6min walk test we try to demonstrate when the treatment with captopril shows a better improvement in exercise capacity in patients with heart failure. Methods - Twenty one patients with functional class II or III heart failure (NYHA), left ventricular diastolic diameter greater than 55mm and with ejection fraction less than 45% were studied. Twelve were male, and the patients mean age was 48 years. The patients were first treated with digital and diuretics and after stabilized they received captopril 25mg three times a day and underwent the 6min walk test before the treatment and after four and 16 weeks. Results - The use of captopril showed important improvement in exercise capacity in patients with heart failure. The mean walking distance on the 6min test was 451m at the beginning, 476m in four weeks and 504 in 16 weeks of treatment (p<0.0001). Conclusion - Our data show important improvement in exercise capacity with 16 weeks of treatment and that 50% of this improvement occured after four weeks of treatment. We concluded that the results are already observed within four weeks of treatment and continues to improve during at least four months of treatment

Tratamento cirúrgico da endomiocardiofibrose: substituiçäo valvar versus técnicas conservadoras / Surgical treatment of endomyocardial fibrosis: valvar replacement versus conservative techniques

No Instituto do Coraçao do HC da FM-USP, no período compreendido entre janeiro de 1978 e junho de 1990, 66 pacientes portadores de endomiocardiofibrose (EMF) foram tratados cirurgicamente com a finalidade de comparar as técnicas operatórias empregadas. Foi elaborado um estudo retrospectivo envolvendo dois subgrupos: 1() pacientes submetidos a endocardiectomia e substituiçao valvar e 2() pacientes submetidos a endocardiectomia e plastia valvar. No roteiro foram incluídos parâmetros clínicos, radiológicos, hemodinâmicos, cirúrgicos e de pós-operatório. Tratou-se de um estudo retrospectivo e as análises estatísticas foram realizadas por meio do teste do X(2) de Pearson e do teste de Loong-Rank. Embora a análise comparativa nao revele, no momento do estudo, diferenças significantes estatisticamente entre os subgrupos, a observaçao das curvas atuariais de sobrevida permitem identificar uma forte tendência para melhor (menor mortalidade hospitalar e maior sobrevida tardia) com a utilizaçao das técnicas conservadoras.

Limitaçöes da cardiomioplastia no tratamento das cardiomiopatias / Cardiomyoplasty limitations in the treatment of cardiomyopathies

A cardiomioplastia melhora a funçao ventricular esquerda e a sobrevida de pacientes portadores de cardiomiopatas severas. O objetivo deste estudo é identificar os fatores que influenciaram os resultados da cardiomioplastia em 22 pacientes operados entre maio de 1988 e dezembro de 1991. Todos os pacientes estavam em classe funcional III ou IV, apesar do uso de terapêutica clínica otimizada. Dezoito pacientes tinham diagnóstico de cardiomiopatia idiopática, a cardiomiopatia era chagásica em 2 e isquêmica em 2. Nao houve óbitos no período pós-operatório imediato e os pacientes foram seguidos por um período médio de 20,5 meses. Nove pacientes faleceram tardiamente e a sobrevida atuarial foi 76,1 por cento no primeiro ano e 63,8 por cento no segundo ano de seguimento. Seis pacientes estao, atualmente, em classe funcional I, e 7 em classe II. A mortalidade e a manutençao dos sintomas, no primeiro ano pós cardiomioplastia, foi relacionada a ocorrência de tromboembolismo pulmonar e a progressao da insuficiência cardíaca em pacientes com alteraçoes isquêmicas do enxerto muscular, no pós-operatório imediato (pico de liberaçao plasmática da creatinoquinase > 1500 U.I.) (p=O,O3). Paralelamente, a elevaçao da fraçao de ejeçao do ventrículo esquerdo, documentada aos seis meses de seguimento, foi mais importante em pacientes que apresentaram valores menores de liberaçao da creatinoquinase após a operaçao(p=O,O2). Já o tamanho da cavidade ventricular esquerda pareceu influenciar a variaçao da fraçao de ejeçao apenas quando foram retirados da análise os pacientes com comprometimento importante do enxerto muscular (p=O,O6). Apesar de nao ter havido influência da classe funcional pré-operatória sobre esse parâmetro e sobre a evoluçao clínica, no primeiro ano de seguimento, os pacientes operados em classe funcional IV apresentaram uma sobrevida, no segundo ano de pós-operatório, significativamente inferior à dos pacientes operados em classe III (33,3 por cento versus 78,1 por cento, p=O,O4). Em conclusao, a melhora da funçao ventricular esquerda e a melhor evoluçao clínica após a cardiomioplastia podem ser limitadas pela ocorrência de lesao isquêmica do enxerto muscular. A condiçao clínica pré-operatória, bem como o grau de dilataçao das câmaras ventriculares, sao, também, fatores importantes para o sucesso deste procedimento no tratamento das cardiomiopatias.