Português | English

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

Edition: 26.5 - 15 Article(s)


'Troponinemia' and the epidemy of pseudoinfarctation

"Troponinemia" e a epidemia do pseudoinfarto

Wolney de Andrade Martins; Humberto Villacorta Junior; William Frank Peacock

Rev Bras Cardiol. 2013;26(5):321-323


Use of high sensitivity cardiac troponin for diagnosing acute myocardial infarction

Uso da troponina de alta sensibilidade para diagnosticar infarto agudo do miocárdio

Lori B. Daniels

Rev Bras Cardiol. 2013;26(5):324


Point of View

Drug combinations for hypertension treatment: advantages and disadvantages

Combinação de fármacos no tratamento da hipertensão arterial: vantagens e desvantagens

Fábio Santiago Figueredo; Andréa Araujo Brandão

Rev Bras Cardiol. 2013;26(5):325-328

Abstract PDF PORT

The goal of anti-hypertension treatment is to act on the blood pressure (BP) control mechanisms in order to lower the BP and thus avoid harmful effects on the cardiovascular system. The use of drug combinations is the preferred strategy for most patients, with greater efficacy, fewer side effects and better compliance. The aim of this paper is to discuss the advantages and disadvantages of using anti-hypertensive drug combinations for treating arterial hypertension (AH).

Keywords: Compliance with medication; Cardiology; Hypertension

Original Article

Hypertensive crisis, pseudo-hypertensive crisis and symptomatic increase in blood pressure

Crise hipertensiva, pseudocrise hipertensiva e elevação sintomática da pressão arterial

Maria Alayde Mendonça da Silva; Ivan Romero Rivera; Arthur Correia Souza Santos; Carolina da Fonseca Barbosa; César Augusto de Souza Oliveira Filho

Rev Bras Cardiol. 2013;26(5):329-336

Abstract PDF PORT

BACKGROUND: For systemic high blood pressure (SHBP) surges, immediate and careful intervention is essential for reducing morbidity and mortality rates related to this complication.
OBJECTIVES: To identify the frequency of hypertensive urgency (HU), hypertensive emergency (HE), pseudo-hypertensive crisis (PHC) and symptomatic blood pressure increase (SBPI). Compare prior knowledge of SHBP, previous use of anti-hypertensive (AH), pressure levels presented and hospital outcomes in both groups.
METHODS: Analytical, case and control study with consecutive selection and retrospective analysis of patients with acute increase in blood pressure, admitted to the emergency cardiac care unit at a private hospital, between November 2009 and October 2010. The cases were patients with hypertensive crisis (HC): HU + HE. The controls were patients without HC: PHC + SBPI.
RESULTS: A total of 216 cases related to SHBP were studied, consisting of 113 (52 %) women between 25 and 95 years old, with a median age of 58 years. HE was diagnosed in 18 (8 %) patients, HU in 29 (13 %), PHC in 8 (4 %) and SBPI in 161 (75 %). Prior diagnosis and treatment of SHBP did not differ between the groups with and without HC. Cardiovascular symptoms, hospitalization and AH prescriptions were more frequent among those with HC (p <0.05), but only 7 % of the patients did not receive AH. There were no deaths.
CONCLUSIONS: In this population studied, HC was identified in 21 % of the cases and AH treatment was administered in 93 % of cases diagnosed with SHBP. Prior AH treatment did not differ among patients with and without HC.

Keywords: Malignant hypertension; Myocardial infarction; Stroke; Heart failure; Pulmonary edema

Impact on quality of life after coronary angioplastyor coronary artery bypass graft

Impacto na qualidade de vida pós-angioplastia coronariana ou revascularização do miocárdio

Joana Kátia Veras Rodrigues Sampaio; José Albuquerque de Figueiredo Neto; Lorena Lauren Chaves Queiroz; Rosângela Maria Lopes de Sousa; Lívia Mariane Castelo Branco Reis; Flor de Maria Araújo Mendonça Silva

Rev Bras Cardiol. 2013;26(5):337-346

Abstract PDF PORT

BACKGROUND: Quality of life (QoL) is related to cardiovascular diseases, making this essential for its evaluation in clinical practice.
Objective: To evaluate the impact of coronary artery bypass graft (CABG) and percutaneus transluminal coronary angioplasty (PTCA) on the QoL for patients with coronary artery disease.
METHODS: A prospective cohort and analytical study of 114 patients (male/female) undergoing both procedures (CABG group and PTCA group) between June 2010 and June 2011. The SF-36 questionnaire was used as an evaluation tool, completed during the pre-operative stage and at three and six months follow-up.
RESULTS: The baseline QoL mean scores for the sample population ranged from 24.79 to 74.65, with greater involvement of the physical, emotional and functional capacity fields in both groups. Improvements were observed after three months, except for the social and emotional fields in the CABG group. In the sixth month, no improvement was noted in the physical and emotional fields for the CABG group, and the social field for both groups. The CABG patients posted higher scores in the mental field, while those undergoing PTCA scored higher in the physical field. In terms of perceptions of their current health compared to a year previously, the PTCA patients showed significant improvements compared to the CABG group.
CONCLUSION: Improvement in the QoL at six months for PTCA and CABG patients, with neither method proving superior.

Keywords: Quality of life; Coronary artery bypass graft; Angioplasty

Outpatient adherence to statin treatments

Aderência de pacientes ambulatoriais ao tratamento com estatinas

Maria Cristina Batista dos Santos; Lenora Gandolfi

Rev Bras Cardiol. 2013;26(5):347-355

Abstract PDF PORT

BACKGROUND: Real-life adherence to lipid-reduction treatments does not reach the levels observed in clinical trials.
OBJECTIVES: To assess adherence to statin treatments among cardiac outpatients, exploring possible associations among socio-demographic aspects, risk factors and co-morbidities, in addition to describing patient profiles in terms of their medications.
METHODS: Cross-sectional quantitative and qualitative descriptive study. Using convenience sampling, we assessed individuals treated at cardiac out-patient clinics at the Base Hospital, Federal District, Brazil. The Morisky medication adherence scale was used as a tool for assessing the effectiveness of statin medications, correlated through questionnaires adjusted for factors related to socio-demographic aspects.
RESULTS: There were statistically significant associations between adherence to statin use and the following variables: 70-85 years old age bracket (PR= 1.65; 95 % CI: 1.10-2.48); examination frequency every three months (PR= 3.33; 95 % CI: 1.15-9.65); every six months (PR= 2.87; 95 % CI: 1.02-8.10); once a year (PR= 3.23; 95 % CI: 1.4-9.17); and an association with acquiring statins through the government health network for the 70-85 years old age bracket.
CONCLUSIONS: Most of the patients studied adhered to statin treatments, with the highest adherence among those over 75 years old acquiring the medication through the government health network, with laboratory examinations every three months.

Keywords: Medication adherence; Hydroxymethylglutaryl-CoA reductase inhibitors; Dyslipidemia

Determination of cardiovascular risk in spontaneous check-up population through the Framingham score

Determinação do risco cardiovascular em população de check-up espontâneo através do escore de Framingham

Nathalia Ishimaru Galvão; Regina de Fátima Jesus Távora Junqueira Vilela; Bianca Maria Maglia Orlandi; Raquel Franchin Ferraz; Fernando Augusto Alves da Costa; Djalma José Fagundes

Rev Bras Cardiol. 2013;26(5):356-363

Abstract PDF PORT

BACKGROUND: Cardiovascular diseases (CVD) are among the leading causes of death all over the world. Many sudden deaths occur among formerly asymptomatic patients, underscoring the importance of concern over screening for cardiovascular disease. The probability of coronary disease among the general population may be calculated on the basis of the Framingham Heart Study findings.
OBJECTIVE: To determine the cardiovascular risk in an asymptomatic spontaneous check-up population, using the Framingham score.
METHODS: Information was collected from the medical records of 83 asymptomatic individuals (50 men and 33 women) between 30 and 79 years old having their first consultation in the past two years. Data on sedentary lifestyles, smoking and diabetes mellitus were analyzed separately though the chi-square test. The Framingham scale variables were analyzed on a numerical scale through the Mann-Whitney test.
RESULTS: Cardiological evaluations were sought by 52 % of men in the moderate to high risk range with an average Framingham score of 9.8 and cardiovascular risk of 14.2 % for developing cardiovascular disease within five years, with 72.7 % of the women seeking cardiological evaluations when in the low risk range and an average Framingham score of 7.2 with a cardiovascular risk of 8.3 % for developing cardiovascular disease within five years.
CONCLUSION: In an asymptomatic spontaneous check-up population, using the Framingham score, the men presented moderate to high cardiovascular risks, with these risks being far lower among the women.

Keywords: Cardiovascular diseases; Dyslipidemias; Risk factors

Factors preventing referrals to supervised cardiac rehabilitation

Fatores de impedimento ao encaminhamento para a reabilitação cardíaca supervisionada

Jefferson Petto; Pollyane Lopes de Araújo; Natália da Luz Garcia; Alan Carlos Nery dos Santos; Giulliano Gardenghi

Rev Bras Cardiol. 2013;26(5):364-368

Abstract PDF PORT

BACKGROUND: Supervised cardiac rehabilitation (SCR) is designed to help heart disease patients rejoin society, with lower treatment costs. However, the number of people with heart disease undergoing SCR is still low, mainly because few cardiologists refer their patients.
OBJECTIVE: To identify the reasons why cardiologists do not refer their patients to SCR facilities.
METHODS: A sample of 81 cardiologists in Salvador, Bahia State, Brazil completed a self-administered questionnaire consisting of objective questions exploring basic concepts and prescriptions of SCR.
RESULTS: Of these 81 cardiologists, 67 (82 %) state that they recommend SCR, of whom 25 (37 %) and 17 (25 %) reported that they do not refer their patients in some situations: not knowing an SCR center and believing that their patient profiles were not suitable, respectively. Among the 67 practitioners recommending SCR, 45 (67 %) stated that they did know any rehabilitation centers. Together, cardiologists not recommending SCR and recommending it but not knowing an SCR center for patient referrals totaled 56 (70 %).
CONCLUSION: Only a small proportion of cardiologists in Salvador, Bahia State, Brazil recommend SCR, with the main stumbling-block being their lack of knowledge about SCR centers for referring their patients.

Keywords: Cardiovascular diseases; Communication barriers; Physical and rehabilitation medicine; Rehabilitation

Control of anticoagulation with warfarin in a specialized outpatient clinic

Controle da anticoagulação com varfarina realizada em ambulatório especializado

André Grossi Dantas; Juliano Novaes Cardoso; Cristina Martins dos Reis Cardoso; Milena Novaes Cardoso Curiati; Marcelo Villaça Lima; Nilson Silveira Aranha; Euler Cristovan Ochiai Brancalhão; Camila Naomi Matsuda; Ana Lucia Zarzana; Antonio Carlos Pereira Barretto

Rev Bras Cardiol. 2013;26(5):369-373

Abstract PDF PORT

BACKGROUND: In several cardiopathies anticoagulation prevents thromboembolic events. Although warfarin is the most widely used oral anticoagulant, its efficacy and safety depend on monitoring the prothrombin time (PT) and its standardization by INR. Maintaining adequate INR is challenging, especially in populations with low educational, social and economic levels. Clinics specializing in anticoagulation are important allies.
OBJECTIVE: To evaluate INR control among patients monitored at an anticoagulation clinic.
METHODS: For two months, patients taking warfarin were selected and monitored at a PT control clinic, seen at least every four weeks and receiving guidance on the risks and benefits of anticoagulation, with specific monitoring cards. Appropriate INR values were taken as between 2.0 and 3.5, using the Student t test and a significance of p<0.05.
RESULTS: Having evaluated 96 patients, with 50 men (56.25 %) and a mean age of 59±14.9 years, the indication for anticoagulation was atrial fibrillation / atrial flutter for 55.21 %; prosthetic valve for 26.04 %; previous thromboembolism for 9.38 % and intracardiac thrombus for 9.37 %. The median follow-up time at the clinic was 361.26±216.34 days, and 66 (68.75 %) of the patients had an appropriate INR. The mean daily dose of warfarin was 4.93±3.13 mg/day. The average age, monitoring time and mean daily dose were similar for both groups, with adequate and inadequate INR.
CONCLUSION: Anticoagulation guided by specialized staff is effective and safe for patients with lower income and educational levels, allowing it to be prescribed for these patients.

Keywords: Warfarin; Atrial fibrillation; Out-patient care

Use of chest pain protocol in a reference cardiology hospital emergency room

Uso de protocolo de dor torácica em pronto atendimento de hospital referência em cardiologia

Mariangela Tuzzolo Missaglia; Eduardo Santos Neris; Maria de Lourdes Teixeira da Silva

Rev Bras Cardiol. 2013;26(5):374-381

Abstract PDF PORT

BACKGROUND: Increasingly large numbers of patients are walking into emergency rooms with chest pain symptoms. Some 5 %-10 % of all patients in U.S. emergency rooms come in because of chest pain. Between 2 %-3 % of chest pain patients released from ERs are in fact suffering acute myocardial infarctions (AMI), with 40 %-65 % of AMI deaths occurring during the first hour after the onset of the disease and 80 % in the first 24 hours.
OBJECTIVE: To investigate the outcomes of patients complaining of chest pains admitted to the ER in a reference cardiology hospital in Sao Paulo, Brazil.
METHODS: A total of 574 patients with chest pains were evaluated, admitted to the ER at the Beneficência Portuguesa hospital in Sao Paulo, Brazil. Non-parametric tests with one-sided hypothesis were applied, a risk analysis for patients with chest pains who progressed to AMI, a comparison of the lengths of time between arrival and effective care, and triage colors through the Kruskal-Wallis test.
RESULTS: 45 % of the patients treated were diagnosed with cardiac causes and 73 % had ischemic disease. Most (60 %) were male, between 41 and 70 years old, hospitalized mainly in the intensive care unit, with the main approach adopted being catheterization and angioplasty.
CONCLUSION: The application of the chest pain protocol in an ER allowed patient progress to be ascertained, streamlining and directing care while fostering proper recognition of cardiac-origin chest pain.

Keywords: Myocardial infarction; Acute coronary syndrome; Emergency medical services; Chest pain

Percutaneous coronary intervention in patients with multivessel coronary disease and low to medium syntax scores

Intervenção coronariana percutânea em multiarteriais com syntax score baixo e intermediário

Rodrigo de Moura Joaquim; Mário Sérgio Soares de Azeredo Coutinho; Luiz Eduardo Koenig São Thiago; Marcos Venicio Garcia Joaquim

Rev Bras Cardiol. 2013;26(5):382-389

Abstract PDF PORT

BACKGROUND: Coronary artery disease is a major and highly prevalent cause of death. Although coronary artery bypass grafts are rated as the gold standard treatment for patients with complex arterial lesions, percutaneous coronary intervention may also be used. Patients must be risk-rated in order to evaluate which offers the best therapeutic benefits. One way of ranking risks is through stratifying systems like the Syntax score.
OBJECTIVES: Evaluate patients with multivessel coronary disease with low to medium Syntax scores and their clinical characteristics in terms of cardiovascular events, myocardial infarction, cardiovascular death or needing further intervention.
METHODS: Cross sectional study of 76 patients seen at a cardiology unit in Florianópolis between January 2007 and November 2009, in order to evaluate their clinical and angiographic characteristics with relation to cardiovascular events. The Fisher's exact test was used for the statistical analysis.
RESULTS: Patients with low Syntax scores had fewer cardiovascular events compared to those with medium Syntax scores (p=0.0296). Other clinical variables studied, including hypertension, diabetes mellitus, dyslipidemia, smoking, chronic kidney diseases and prior myocardial infarctions, showed no association with cardiovascular events.
CONCLUSIONS: Percutaneous coronary intervention should be reserved for patients with multivessel coronary disease and low Syntax scores.

Keywords: Angioplasty; Cardiovascular diseases; Cardiac catheterization

Review Article

Inflammation and atherosclerosis: new biomarkers and outlooks for treatment

Inflamação e aterosclerose: novos biomarcadores e perspectivas terapêuticas

Nadia Alice Vieira da Motta; Milla Machado Fumian; Juliana Pereira de Castro; Fernanda Carla Ferreira de Brito

Rev Bras Cardiol. 2013;26(5):390-399

Abstract PDF PORT

Atherosclerosis is currently considered as a chronic inflammatory disease, probably caused by an endothelial dysfunction associated with factors inherent to the activation of the immune system. Endothelial dysfunction may be caused by several factors such as high cholesterol, free radicals, associated with external factors, hypertension, diabetes mellitus, genetic disorders and others. An inflammatory response occurs at the location where the endothelium becomes dysfunctional, stimulating the migration and proliferation of smooth muscle cells, clumping in the inflammation area and forming a more complex lesion, together with the recruitment of leukocytes and platelet adhesion to the endothelium in the atheromatous plaque region. Despite the undoubted utility of the lipid profile in atherosclerotic risk assessment, these data provide an incomplete overview of the patient, as many cardiovascular events occur in patients with cholesterol and LDL plasma concentrations rated as adequate. Considering the prominent role assigned to the inflammatory process for the development of atherosclerosis, it is necessary to observe new biomarkers in order to predict cardiovascular risk more effectively. This paper summarizes important aspects related to matrix metalloproteinases (MMPs), C-reactive protein (CRP), adhesion molecules, TNF-α, interleukins (ILs) and adiponectin. Knowledge of these potential markers is of vital importance for efficiently targeting new therapeutic approaches, opening up a new horizon for atherosclerosis treatment.

Keywords: Atherosclerosis; Biomarkers, pharmacological; Inflammation

Case Report

Secondary organizing pneumonia after abciximab use: case report

Pneumonia em organização secundária ao uso de abciximab: relato de caso

Paulo Roberto Dutra da Silva; Antônio Chibante; Denise Castro de Souza Côrtes; Antônio Sérgio Cordeiro da Rocha; Luiz Antônio de Carvalho; André Luiz Sousa Silveira

Rev Bras Cardiol. 2013;26(5):400-405

Abstract PDF PORT

This report presents the case of an octogenarian female patient with acute myocardial infarction who developed an acute inflammatory pulmonary condition compatible with a diagnosis of secondary organizing pneumonia after intracoronary abciximab during percutaneous coronary angioplasty. This diagnosis was grounded on typical clinical, radiographic and tomographic alterations and the regression of these alterations after corticoid treatment.

Keywords: Bronchiolitis obliterans; Cryptogenic organizing pneumonia; Bronchiolitis obliterans organizing pneumonia

Spondylodiscitis as an infectious complication of cardiac catheterization

Espondilodiscite como complicação infecciosa de cateterismo cardíaco

Flávia Lara Barcelos; Daniel França Vasconcelos; Paulo Henrique Gonçalves Pereira; Isabela Novais Medeiros; Werciley Saraiva Vieira Júnior; Joel Paulo Russomano Veiga

Rev Bras Cardiol. 2013;26(5):406-409

Abstract PDF PORT

Spondylodiscitis is the main manifestation of hematogenous vertebral osteomyelitis in patients over 50 years old, with Staphylococcus aureus the agent involved in most cases. Clinical diagnosis is complicated by nonspecific symptoms and low incidence. The consequences can be disastrous, especially when affecting the spine. This report presents a case of spondylodiscitis caused by S. aureus after percutaneous coronary angioplasty.

Keywords: Spondylodiscitis; Cardiac catheterization; Staphylococcus aureus

Letter to the editor

Carta ao Editor

Kivia Linhares Ferrazzo

Rev Bras Cardiol. 2013;26(5):410-412