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ISSN (Print): 2359-4802 | ISSN (Online): 2359-5647

Edition: 27.1 - 10 Article(s)

Editorial

Constant change

Mudança constante

Claudio Tinoco Mesquita

Rev Bras Cardiol. 2014;27(1):08-09

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Point of View

Exercise and atherosclerosis: paradox between lipids profile and clinical outcomes

Exercício e aterosclerose: paradoxo entre perfil lipídico e desfechos clínicos

Tales de Carvalho; Daiana Cristine Bundchen

Rev Bras Cardiol. 2014;27(1):10-12

Abstract PDF PORT

Patients with coronary artery disease (CAD) present a paradox: modest changes in lipids profiles - lower total cholesterol, LDL-C and triglycerides and slightly higher HDL-C - triggered by exercise produce outcomes that fall far short of the therapeutic goals currently proposed, and are not consistent with dramatic reductions in clinical endpoints (death, myocardial infarction) that are also associated with the regression of atherosclerosis. Some functional aspects of lipoproteins - mainly HDL - are reported here, together with their responses to exercise, allowing possible mechanisms to be ascertained for functional alterations without altering HDL-C plasma levels, as quantitative values do not always reflect lipoprotein functionality.


Keywords: Exercise; Atherosclerosis; Lipids

Original Article

Congenital heart disease in northeast Brazil: 10 consecutive years of records in Paraiba state, Brazil

Cardiopatia congênita no nordeste brasileiro: 10 anos consecutivos registrados no estado da Paraíba, Brasil

Juliana Sousa Soares de Araújo; Cláudio Teixeira Régis; Renata Grigorio Silva Gomes; Christiana Souto Silva; Cristina Maria Batista Abath; Felipe Alves Mourato; Sandra da Silva Mattos

Rev Bras Cardiol. 2014;27(1):13-19

Abstract PDF PORT

BACKGROUND: Different congenital heart disease rates are described in the literature, depending on the age of the population studied and the types of malformations included. In Brazil, especially in the North and Northeast, there are no data on actual congenital heart disease rates.
OBJECTIVE: To describe the profile of congenital heart diseases (CHD) observed in a government-run reference facility in Paraíba State, Northeast Brazil.
METHODS: A descriptive retrospective study based on institutional data drawn from the Collaborative Latin American Study of Congenital Malformations (ECLAMC) compiled between January 2001 and December 2011. The variables analyzed were: birthweight, gestational age, gender, birthplace (municipality), type of congenital heart defect, age and education levels of parents, family history of congenital defects, consanguinity and family precedents.
RESULTS: Through an analysis of 70,857 consecutive births, 290 diagnoses of CHD were reported, with defect types established for 232 of them: 37.8% left-to-right shunt lesions, 9.1% acyanotic obstructive lesions, 5.6% cyanotic obstructive and 10.3% complex congenital heart diseases. Heart defects were an isolated finding in 81% of cases.
CONCLUSION: The CHD rate in this series was below that reported in the literature, probably reflecting difficulties is establishing early diagnoses.


Keywords: Cardiovascular diseases; Epidemiology; Risk factors; Congenital heart defects

Prevalence of metabolic syndrome in menopausal women

Prevalência de síndrome metabólica em mulheres climatéricas

Gilson Gabriel Viana Veloso; Ana Luiza Santos David; Aneliese Canuto Pereira; Juliana Sousa Almeida; Rosilene Barbosa do Carmo; Ronilson Ferreira Freitas; Vivianne Margareth Chaves Pereira Reis; Betânia Maria Araújo Passos; Michelle Aparecida Ribeiro Borges; Josiane Santos Brant Rocha

Rev Bras Cardiol. 2014;27(1):20-27

Abstract PDF PORT

BACKGROUND: Despite the importance of metabolic syndrome in the context of metabolic and cardiovascular diseases, its prevalence during the climacteric and other epidemiological characteristics are still little known.
OBJECTIVES: To identify the presence of metabolic syndrome in menopausal women, correlated with socio-demographic, clinical and anthropometric factors.
METHODS: Cross-sectional descriptive study of 85 menopausal women conducted in May-June 2013 at the Center for Health Care and Vocational Practice (NASPP), Faculdades Integradas Pitágoras college (FIPMoc). The presence of metabolic syndrome (MS) was assessed in compliance with the criteria established by the International Diabetes Federation (IDF) and laboratory blood analyses, using a questionnaire to assess socio-demographic and clinical data. Anthropometric data were assessed by Body Mass Index (BMI) and Waist Circumference (WC). A descriptive analysis of the data was performed, expressed as means and percentages, using the binomial and Spearman tests to correlate the variables, with a significance level of 5%.
RESULTS: MS was found in 50.6% of the women, with the most common components being low HDL cholesterol (61.2%) and large waist circumference (85.9%). The other syndrome determinants were not significant individually, although MS showed moderate correlation with the determinants.
CONCLUSIONS: MS was present in the menopausal women studied, with the most altered factors being waist circumference and HDL cholesterol. Additionally, SM was significantly correlated with waist circumference, triglycerides and glycemia. The socio-demographic profile of the study population showed that most were mixed race, with little education and low socio-economic status.


Keywords: Cardiovascular diseases; Climacteric; Epidemiology

Heart failure on death certificates in three Brazilian states: 1999-2005

A insuficiência cardíaca nas declarações de óbito de três estados brasileiros de 1999 a 2005

Eduardo Nagib Gaui; Glaucia Maria Moraes de Oliveira; Carlos Henrique Klein

Rev Bras Cardiol. 2014;27(1):28-34

Abstract PDF PORT

BACKGROUND: Heart failure (HF) is extremely prevalent with high mortality rates.
OBJECTIVES: To analyze associations between HF when selected as the underlying cause of death (I50-CID10) and other causes mentioned in death certificates (DC) and mentions of causes that include references to the HF set (HFS) in DC with other underlying causes of death.
METHODS: DO data were obtained in Rio de Janeiro, Sao Paulo and Rio Grande do Sul States for 1999-2005. The HF set (HFS) was established by the ICD-10 codes when HF was present. Absolute and percentage quantities were calculated when HF was the underlying cause and mentions of HFS when other underlying causes were selected.
RESULTS: When HF was the underlying cause, about half the mentions referred to the circulatory system and almost 25% to the respiratory system, with I50 corresponding to some 30% of the entries. When some cause was mentioned for the HFS, the underlying causes selected most frequently were circulatory (69%) and respiratory (11%). In the total number of DCs, the average number of causes mentioned was 2.99; mentions of causes of HFS reached 3.65, and when I50 was the underlying cause, this reached only 2.88.
CONCLUSIONS: Stand-alone assessments of underlying causes of death underestimate mortality rates due to HF. The inclusion of multiple causes provides a more comprehensive evaluation of the importance of chronic conditions such as HF in defining the causes of death.


Keywords: Heart failure; Mortality; Underlying cause of death; Multiple causes of death

Chronic non-communicable diseases and association with risk factors

Doenças crônicas não transmissíveis e associação com fatores de risco

Sheila Cristina Rocha-Brischiliari; Cátia Millene Dell Agnolo; Angela Andréia França Gravena; Tiara Cristina Romeiro Lopes; Maria Dalva de Barros Carvalho; Sandra Marisa Pelloso

Rev Bras Cardiol. 2014;27(1):35-42

Abstract PDF PORT

BACKGROUND: An ageing population has increased the prevalence of chronic non-communicable diseases.
OBJECTIVE: To analyze the association between chronic non-communicable diseases and risk factors.
METHODS: This cross-sectional population-based study interviewed 453 adults >18 years old in the town of Maringa, Paraná State during 2011 and 2012. These interviews were conducted through a questionnaire proposed by the Ministry of Health.
RESULTS: 453 adults were assessed, between 18 and 87 years old, with a mean age of 52.0±16.2 years and chronic non-communicable diseases noted in 44.8% (n=203). Among these respondents, 77.5% were women, most >60 years old, with 54.3% reporting 0-8 years of schooling; 65.3% were married / cohabiting and most (66.4%) were white. After the logistic regression analysis, the presence of chronic non-communicable diseases was associated with older adults (p<0.01), self-declared as black (p=0.01), BMI >25 kg/m2 (p<0.01) and rating their health in general as fair (p<0.01), poor and very poor (p<0.01).
CONCLUSIONS: The present study showed that chronic non-communicable diseases were more prevalent among older people with little schooling and no partners. The risk components associated with chronic non-communicable diseases were smoking, overweight/obesity and self-reported health status as poor/fair.


Keywords: Risk factors; Epidemiology; Chronic disease

Non-invasive ventilation after cardiovascular surgery: a randomized clinical trial

Ventilação não invasiva após cirurgia cardiovascular: um ensaio clínico randomizado

Alessandra Preisig; Verlaine Balzan Lagni; Vinícius Lovatto de Almeida; Fernando Nataniel Vieira; Eraldo de Azevedo Lucio; Laura Jurema dos Santos; Silvia Regina Rios Vieira

Rev Bras Cardiol. 2014;27(1):43-52

Abstract PDF PORT

BACKGROUND: Hypoxemia is the most common complication during the post-operative stage of cardiovascular surgery, due mainly to atelectasis, alveolar interstitial edema and accumulations of pulmonary secretions. These changes may increase the incidence of lung infections with longer ICU stays and consequently higher hospital costs.
OBJECTIVE: To evaluate gas exchanges and hemodynamic alterations in hypoxemic patients under non-invasive ventilation (NIV) during the immediate post-operative period subsequent to cardiovascular surgery.
METHODS: A randomized clinical trial conducted in the surgical ICU of a cardiology hospital of patients with hypoxemia (300>PaO2/FiO2>150) one hour after orotracheal extubation during the post-operative period immediately after elective cardiovascular surgery who underwent pulmonary artery catheterization in the surgical ward. The control group received oxygen therapy, while the intervention group received NIV plus oxygen for three consecutive hours. For the statistical analysis, we used the Student t, Mann-Whitney, Fisher's exact tests, as well as ANOVA and generalized estimating equations (GEE).
RESULTS: Among the 42 patients studied, the intervention group (n=21) presented significant improvements in the PaO2/FiO2 ratio (p=0.007), with little difference between the groups for pulmonary capillary pressure (p=0.012), cardiac index (p=0.006) and central venous pressure (p=0.022).
CONCLUSIONS: The results suggest that NIV administered for three consecutive hours improves oxygenation in patients after cardiovascular surgery, with these benefits maintained even one hour after stopping treatment, although this therapy did not alter the clinical outcomes. There were no clinically significant hemodynamic changes related to the use of NIV.


Keywords: Noninvasive ventilation; Thoracic surgery; Clinical trial

Review Article

Effects of noninvasive ventilation on cardiac autonomic modulation

Efeitos da ventilação mecânica não invasiva sobre a modulação autonômica cardíaca

Lucas Lima Ferreira; Luiz Carlos Marques Vanderlei; Vitor Engrácia Valenti

Rev Bras Cardiol. 2014;27(1):53-58

Abstract PDF PORT

This review is intended to gather together recent studies that explore the effects of different types of noninvasive ventilation (NIV) on the autonomic nervous system, assessed through heart rate variability (HRV). A search for papers was conducted in the PubMed, PEDro, SciELO and Lilacs databases with the following descriptors: noninvasive ventilation, CPAP ventilation, intermittent positive pressure breathing and autonomic nervous system, for the period between 2008 and 2012. After eliminating papers not addressing the topic, we selected six studies, of which five applied NIV in CPAP mode and one used biphasic positive airway pressure. In general, the findings suggest that NIV promotes changes in autonomic modulation that are dependent on the conditions of the subjects analyzed and the time when these rates are assessed, meaning acute or long-term effects.


Keywords: Noninvasive ventilation; Autonomic nervous system; Types of physiotherapy

Case Report

Primary percutaneous coronary intervention with intracoronary chemical thrombolysis

Intervenção coronariana percutânea primária com trombólise química intracoronariana

Renato Giestas Serpa; Roberto Ramos Barbosa; Darlan Dadalt; Denis Moulin dos Reis Bayerl; Walkimar Ururay Veloso; Pedro Abílio Ribeiro Reseck

Rev Bras Cardiol. 2014;27(1):59-62

Abstract PDF PORT

Case report on a 55-year-old male with antero-lateral ST elevation myocardial infarction, Killip class III. Urgent coronary angiography revealed an occluded left main coronary artery and high thrombotic load that extended to the aortic root. Primary percutaneous coronary intervention was performed with a balloon catheter, associated with aspirative thrombectomy and intracoronary chemical thrombolysis, with no need for a stent implant. The patient presented good clinical progress and was discharged from the hospital fifteen days later.


Keywords: Myocardial infarction; Angioplasty, balloon, coronary; Coronary thrombosis; Thrombolytic treatment

Apical hypertrophic cardiomyopathy

Cardiomiopatia hipertrófica apical

Marcelo Machado de Castro; Alexandre Fuchs; Marcos Calzada da Rocha; Lorraine Furlaine Rosa; Priscila Valente Fernandes; Renato Kaufman

Rev Bras Cardiol. 2014;27(1):63-66

Abstract PDF PORT

A 43 year-old man with no risk factors for coronary artery disease visited the out-patient clinic complaining of burning chest pain that began five years ago with average effort. The electrocardiogram showed negative T waves wider than 10mm. Myocardial scintigraphy showed the 'solar polar' sign in the polar map. Cardiac magnetic resonance imaging disclosed significant left ventricular hypertrophy with predominance of the apical segment with greater wall thickness of 22mm and delayed enhancement, showing ample delayed contrast uptake with diffuse mesocardial distribution, confirming the hypothesis of Yamaguchi disease.


Keywords: Hypertrophic cardiomyopathy; Sudden death, Scintigraphy

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