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

Edition: 25.1 - 11 Article(s)

Editorial

Mosquito de outrora, dengue de agora, na terra das incertezas

Wolney de Andrade Martins

Rev Bras Cardiol. 2012;25(1):8-10

PDF PORT


Original Article

Drug interactions in patients with coronary artery disease

Interações medicamentosas em pacientes coronariopatas

Silvia Regina Secoli; Naury de Jesus Danzi; Francisco Fabio Ferreira de Lima; Geraldo Lorenzi Filho; Luiz Antonio Machado Cesar

Rev Bras Cardiol. 2012;25(1):11-18

Abstract PDF PORT

BACKGROUND: Patients with coronary artery disease (CAD) require multiple medications that may trigger adverse reactions through drug interactions, with adverse effects on treatment safety and efficacy.
OBJECTIVES: To determine the prevalence, severity and implications of potential drug interactions in CAD patients under ambulatory care at the Heart Institute, São Paulo.
METHODS: Cross-sectional study evaluating the prescriptions of ninety CAD patients. Potential double-drug interactions were analyzed, based on the Drug Interactions Facts and Drug Interactions Handbook.
RESULTS: Sample of ninety CAD patients: age (59±10 years old); 75.6% males; hypertension (75.6%); Body Mass Index >30 (43.3%); patients taking 6.6±2.0 drugs per day and potential drug interaction prevalence of 93.3%. The main drug interactions occurred with beta-blockers (43.3%), angiotensinconverting enzyme inhibitors (27.8%), angiotensinconverting enzyme inhibitors + acetylsalicylic acid (63.3%) and beta-blockers + calcium channel blockers (28.9%). Most (83.4%) of these potential drug interactions presented moderate severity, with treatment monitoring recommended for 53.4%. The main implications were a reduction in the effects of the angiotensin-converting enzyme inhibitors and the risk of bradycardia or atrioventricular block.
CONCLUSION: Although potential drug interactions were frequent among CAD patients, this does not necessarily mean that apparently adverse combinations must be avoided, but rather that risk-benefit assessments must conducted for each patient. The data show the importance of implementing careful monitoring of these CAD patients as a strategy for preventing adverse events.


Keywords: Drug interactions; Drug prescriptions; Drug utilization; Coronary artery disease

High-sensitivity C-reactive protein in patients with metabolic syndrome: comparison between patients with AIDS and the general population

Proteína C-reativa ultrassensível em portadores de síndrome metabólica: comparação entre pacientes com AIDS e sem AIDS

Thaís Barbosa dos Anjos; Hamilton Domingos; Fernando Aguilar Lopes

Rev Bras Cardiol. 2012;25(1):19-25

Abstract PDF PORT

BACKGROUND: The use of highly active antiretroviral therapy for the treatment of AIDS has attenuated immune deficiency and consequently lowered the morbidity and mortality rates associated with this disease. However, longer survival times underscore the risk of early cardiovascular events among AIDS patients. Furthermore, metabolic side effects are caused by this treatment, including lipodystrophy, insulin resistance and dyslipidemia.
OBJECTIVE: To compare ultrasensitive C-reactive protein levels in metabolic syndrome patients with and without AIDS, establishing a possible relationship between inflammatory vascular activity and HIV-induced atherothrombotic risk and / or the metabolic effects associated with antiretroviral therapy.
METHODS: A cross-section comparative observational study of ultrasensitive C-reactive protein levels in two groups of patients: with metabolic syndrome without AIDS patients (n=55) and with metabolic syndrome and AIDS (n=51).
RESULTS: In the MS group without AIDS, 16.4% (n=9) had CRP values of <1.0; 34.5% (n=19) had CRP values between 1.0 and 3.0; and 49.1% (n=27) had CRP values of >3.0. In the MS + AIDS group, 13.7% (n=7) had CRP values of <1.0; 29.4% (n=15) had CRP values between 1.0 and 3.0 and 56 9% (n=29) had CRP values of >3.0.
CONCLUSIONS: No significant association was found between the ultra-sensitive CRP rating and the group assessed (p=0.725). The findings suggest that statins induce a dose-dependent drop in ultrasensitive CRP levels for the MS gr oups with and without AIDS.


Keywords: C-reactive protein; Metabolic syndrome X; Comparative study; Acquired immunodeficiency syndrome

Decreased left ventricular torsion with distorted dynamics at advanced stages of Chagas' heart disease

Torção do ventrículo esquerdo é reduzida e sua dinâmica alterada em estágios avançados da forma cardíaca da doença de Chagas

Sabrina Karla Silva; Carla Renata Ferreira dos Santos; Pedro Emmanuel Alvarenga Americano do Brasil; Andréa Rodrigues da Costa; Andréa Silvestre de Sousa; Sérgio Salles Xavier; Alejandro Marcel Hasslocher-Moreno; Roberto Magalhães Saraiva

Rev Bras Cardiol. 2012;25(1):26-34

Abstract PDF PORT

BACKGROUND: The most serious expression of Chagas' disease is heart failure (HF). Left ventricular (LV) torsion is decreased in HF with other etiologies and may be an important tool for evaluating cardiac performance in Chagas' disease.
OBJECTIVE: To analyze LV torsion at different stages of Chagas' disease.
METHODS: A longitudinal study was conducted between March and October 2010, assessing echocardiograms from 17 controls and 139 patients, of whom 44 were indeterminate (no apparent cardiopathy), 27 in stage A (changes limited to the electrocardiogram), 31 in stage B (without HF findings but with global or segmental changes in LV systolic function), 26 in stage C (compensable HF), and 11 in stage D (refractory HF).
RESULTS: The LV torsion was similar among the controls (12.7±3.9º), indeterminate (11.7±5.5º) and stage A patients (9.9±4.6º), but decreased progressively from stage B to D (B:8.6±6.3º; C:4.7±4.1º; D:0.1±3.1º, p<0.0001). While the controls presented a normal LV torsion pattern with apical counterclockwise and basal clockwise rotation movement, the torsion pattern was abnormal in 15% of the indeterminate and stage A patients; 37% of the stage B patients; 35% of the stage C patients; and 82% of the stage D patients.
CONCLUSION: LV torsion is decreased and its dynamics distorted in patients at advanced stages of Chagas' heart disease. The contribution of those changes to the progression and prognosis of Chagas' disease remains to be determined.


Keywords: Chagas disease; Heart failure; Ventricular Dysfunction, left/physiopathology; Torsion abnormality/pathology; Echocardiography/methods

Systolic augmentation index analysis in patients over 55 years old using atenolol, associated with a diuretic or not

Análise do índice de amplificação sistólico em pacientes acima de 55 anos utilizando atenolol associado ou não a diurético

Naiayde Monte Almeida Neta; Marco Antônio Mota Gomes; Celia Akemi Kanashiro; Clarissa Carvalho de Miranda; Annelise Machado Gomes de Paiva; Demetrius Lucena Sampaio; Larissa Gouveia Aragão

Rev Bras Cardiol. 2012;25(1):35-40

Abstract PDF PORT

BACKGROUND: Blood pressure (BP) is one of the main adjustable cardiovascular risk factors. However, merely lowering peripheral BP might not explain lower risks of cardiovascular disease: it is important to assess BP in other segments of the arterial tree, such as central blood pressure (CBP). The estimated average CBP may be obtained through applanation tonometry in the radial artery. The increase in the CBP may be determined through Augmentation Index (AI) derived from an analysis of the aorta CBP curve.
OBJECTIVE: To determine whether BP measurements performed traditionally in the brachial artery faithfully represent the average CBP in patients over 55 years old taking atenolol beta-blockers, associated or not with hydrochlorothiazide / chlorthalidone diuretics.
METHODS: Patients aged 55 years old or more were included, with stand-alone use of atenolol or in association with specific diuretics. Selected from a heart clinic database, 33 patients with a mean age of 64 years underwent applanation tonometry procedures, using the OMRON device validated by the FDA, HEM9000AI model. The average values reached were 122.2mmHg for SBP, 68.9mmHg for DBP, 118.0mmHg for CBP and 92% for AI.
CONCLUSION: This study demonstrated through an applanation tonometry procedure that athenolol lowered brachial artery blood pressure with no changes in the aorta CBP (high AI).


Keywords: Blood pressure/physiology; Blood pressure determination/methods; Atenolol; Vascular stiffness/drug effects

TG/HDL-c ratio and anthropometric indicators as cardiovascular disease risk predictors

Razão TG/HDL-c e indicadores antropométricos preditores de risco para doença cardiovascular

Aline Rafaelly Apolônio da Silva; Keila Fernandes Dourado; Patrícia Brazil Pereira; Denise Sandrelly Cavalcanti de Lima; Adriana de Oliveira Fernandes; Amanda Moreira de Andrade; Marcela Araújo de Miranda Henriques

Rev Bras Cardiol. 2012;25(1):41-49

Abstract PDF PORT

BACKGROUND: Cardiovascular disease prevention is a public health priority, especially for high-risk individuals. Consequently, the use of coronary artery disease (CAD) development predictors such as the triglyceride/HDL-cholesterol ratio (TG/HDL-c) and anthropometric indicators of central body fat distribution are important in clinical practice.
OBJECTIVE: To ascertain whether excess weight and central obesity (as determined by anthropometric indicators) influence mean TG/HDL-c ratios.
METHODS: A case-control study was carried out with 27 male and female adult and elderly patients with CAD, hospitalized in a cardiology ward at an institution in Brazil from April through August 2009. For each patient, two healthy individuals of the same gender and similar age were selected, totaling 54 individuals in the control group.
RESULTS: The mean age was 50.2±6.0 years and 68.8% of the participants were male. Among the cases, 70.4% presented excess weight and 55.6% had high TG/HDL-c ratios. Among the controls, 77.4% presented excess weight [95%CI: 63.79-87.72] and 30.2% had high TG/HDL-c ratios. In terms of anthropometric indicators, the prevalence of cardiovascular risk was highest by the waist-stature ratio (96.3% and 86.8% for the cases and controls, respectively). Although all the anthropometric indicators were capable of distinguishing differences in the mean TG/HDL-c ratios, the waist-height ratio was the most satisfactory for distinguishing high TG/HDL-c ratios.
CONCLUSION: The waist-height ratio, waist circumference and body mass index are suggested as tools for detecting possible alterations in TG/HDL-c ratios.


Keywords: Cardiovascular diseases; Metabolic syndrome X; Obesity; Anthropometry; Body mass index

Prognostic value of nutritional status in acute coronary syndrome

Valor prognóstico do estado nutricional na síndrome coronariana aguda

Armando Marcio Gonçalves dos Santos; Marco Antonio de Mattos; Aristarco Gonçalves de Siqueira Filho

Rev Bras Cardiol. 2012;25(1):50-58

Abstract PDF PORT

BACKGROUND: Nutritional disturbances, including obesity and malnutrition, are known to have significant effects on health, as either aggravating or risk factors for diseases. Although obesity is a risk factor for coronary heart disease, its impact on acute coronary syndrome (ACS) is not established. Few studies have addressed this issue, with conflicting findings.
OBJECTIVE: To investigate the relationship between nutritional status and the occurrence of events in patients with ACS.
METHOD: This is a cohort study of 171 patients, admitted between June 2004 and October 2005. Patients were evaluated by body mass index (BMI), body fat percentage (BFP) and serum albumin. The combined events (death, CABG, percutaneous coronary intervention, re-infarction and angina) were observed until hospital discharge.
RESULTS: There were 64 patients without and 105 with events. In the events group 44.1% were classified as undernourished by serum albumin. In the no-events group, 29% were considered as undernourished and 71% as normal (p=0.05). Patients with acute myocardial infarction without ST-segment elevation presenting BFP (p=0.017) and BMI (p=0.035) were lower than those without events. Through logistic regression, only albumin <3.5g/% was significant for predicting the occurrence of these events.
CONCLUSION: Nutritional status affects the outcomes of patients with ACS. Low albumin and low BMI and BFP ratings are related to increased risks of events among patients with ACS.


Keywords: Nutritional status; Obesity; Protein malnutrition; Body mass index; Acute coronary syndrome

Review Article

Measuring blood pressure through auscultation method during resistance exercises

Aferição da pressão arterial durante exercícios resistidos pelo método auscultatório

Antonio Gil Castinheiras-Neto; Bruna Medeiros Neves; Paulo de Tarso Veras Farinatti

Rev Bras Cardiol. 2012;25(1):59-66

Abstract PDF PORT

Blood pressure measurements have been taken through the indirect auscultation method during resistance exercises. In order to assess blood pressure measurement methodology in different studies, using the auscultation method during resistance exercises, fifteen studies that met the inclusion criteria were analyzed for: 1) observed exercises; 2) description of reliability within and among reviewers; 3) compliance with existing recommendations for measuring blood pressure during resistance exercise; 4) gauges used; 5) collection through double-blind system. The findings indicate that 80% of the studies observed healthy young individuals (26±5 years), with the remaining 20% focused on the elderly (70±7 years). Almost all (93%) of the studies measured blood pressure during resistance exercises for the legs. Only 20% of the studies assessed the reproducibility of blood pressure measurements (intraclass correlation). Specific recommendations for measuring blood pressure during resistance exercises were followed by 73% of the studies, although many applied them incompletely or incorrectly. Only 7% of the studies adopted the double-blind approach. This leads to the conclusion that the methodological quality of studies using the auscultation method to measure blood pressure during resistance exercises is questionable, particularly with regard to measurement reproducibility and margins of error. Further studies are needed to define standardized measurement protocols for comparing different resistance exercise situations in assorted populations.


Keywords: Resistance training; Blood pressure/physiology; Blood pressure monitoring, ambulatory; Heart auscultation; Exercise test; Heart rate

Cardiovascular Image

Electrical turbulence and risk of ventricular arrhythmia in myocardial infarction in an elderly patient

Turbulência elétrica e risco de arritmia ventricular no infarto do miocárdio em paciente idoso

Paulo Ginefra; Eduardo Correa Barbosa; Grupo de Estudos de Eletrocardiografia da SOCERJ

Rev Bras Cardiol. 2012;25(1):67-69

Abstract PDF PORT

An elderly patient complaining of dizziness, palpitations and a recent history of myocardial infarction was admitted to hospital. Some premature beats were observed during physical examination. The at-rest electrocardiogram (ECG) recorded a myocardial infarction. A bidimensional echocardiogram, vectorcardiogram and high resolution electrocardiogram (SAECG) were performed in order to stratify the risk of cardiac arrhythmias and sudden death. The ECG recorded the presence of an inferior wall myocardial infarction, with the presence of fragmented ventricular potential and ventricular turbulence detected by the SAECG, but ventricular tachycardia was not registered during the study.


Keywords: Arrhythmias, cardiac; Electrocardiography; Vectocardiography; Myocardial infarction; Aged

Case Report

Pulmonary hypertension: diagnostic difficulties

Hipertensão arterial pulmonar: dificuldades diagnósticas

Paula Maíra Alves Haffner; Luciana Silveira Simões; Fernanda Silva Goulart; Humberto Villacorta Junior

Rev Bras Cardiol. 2012;25(1):70-73

Abstract PDF PORT

A 54-year-old woman reported an episode of pulmonary embolism in 2007 that progressed to chronic cor pulmonale. From July 2011, she presented progressive worsening of dyspnea, jugular stasis, liver failure and lower limb edema. The echocardiogram showed significant right ventricular dysfunction associated with severe pulmonary hypertension. The patient progressed into cardiogenic shock, refractory hypoxemia and death. This paper discusses possible pathophysiological mechanisms related to the occurrence of pulmonary hypertension and related diagnostic difficulties, as well as clinical implications and therapeutic approaches.


Keywords: Pulmonary hypertension/diagnosis; Pulmonary hypertension/therapy; Pulmonary heart disease; Pulmonary embolism

Trivalve endocarditis caused by Streptococcus bovis

Endocardite trivalvar por Streptococcus bovis

Kárila Scarduelli Luciano; Miguel de Patta; Antônio Alexandre Pinheiro de Carvalho; Thais Rossoni Weber

Rev Bras Cardiol. 2012;25(1):74-76

Abstract PDF PORT

Infective endocarditis (IE) is a severe disease through which micro-organisms cause inflammation and damage to the endocardial surfaces. It usually involves a single heart valve or two valves in the same heart chamber. Multivalve IE is rare, especially involving right and left side valves. Congenital heart disease is the main risk factor for multivalve IE and some clinical risk factors can be identified in patients without structural heart diseases. This report presents a clinical study of a patient with a rare case of trivalve Streptococcus bovis IE, affecting the aortic, mitral and pulmonary valves.


Keywords: Endocarditis; Heart valve diseases; Streptococcus bovis

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