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

Edition: 25.5 - 13 Article(s)


Mega-events: opportunities and challenges of the 2014 FIFA world cup for Brazil's Unified National Health System (SUS)

Megaeventos no Brasil: oportunidades e desafios da copa do mundo FIFA 2014 para o Sistema Único de Saúde

Adriano Massuda

Rev Bras Cardiol. 2012;25(5):358-361


Is Brazil prepared for urgent and emergency care at major sports events?

Está o Brasil preparado para o atendimento de urgência e emergência em grandes eventos desportivos?

Sergio Timerman

Rev Bras Cardiol. 2012;25(5):362-363


Point of View

Do platelet reactivity tests help my decisions?

Testes de agregação plaquetária ajudam na minha decisão?

Humberto Villacorta Jr; Aline Sterque Villacorta

Rev Bras Cardiol. 2012;25(5):365-367

Abstract PDF PORT

Platelet function tests can predict major cardiac events, and may be useful in selected cases if this information is used to guide treatment strategies. However, their routine use is not recommended until ongoing studies are published.

Keywords: Platelet agregation inhibitors/therapeutic use; Platelet function tests; Acute coronary syndrome/therapy; Drug combinations; Drug-eluting stents

Original Article

Impact of chest pain protocol on compliance with society guidelines: a clinical trial

Impacto de protocolo de dor torácica sobre a adesão às diretrizes societárias: um ensaio clínico

Masterson Marian de Farias; Daniel Medeiros Moreira

Rev Bras Cardiol. 2012;25(5):368-376

Abstract PDF PORT

BACKGROUND: Coronary events decrease when acute coronary syndrome (ACS) is treated according to proven evidence of efficacy, established by society guidelines. The use of protocols arises as a tool for optimizing the quality of care.
OBJECTIVE: To assess the impact of using a protocolbased approach to ACS in terms of compliance with the recommendations set forth in society guidelines.
METHODS: A randomized single-blind controlled clinical trial was conducted through a cluster. Eight resident physicians were randomly selected to receive or not receive the ACS approach protocol, with the medical records of 112 patients admitted for ACS eligible for assessment. Compliance with guideline recommendations was analyzed through a scoring system that awarded one point for each of the 18 lines of conduct recommended in the protocol.
RESULTS: There was a significantly higher average compliance in the protocol group (8.9±3.9 vs. 5.4±3.2, p <0.001), with the following aspects also noted more in the protocol group (p<0.001): pain classification (74.5% vs. 22.8%); electrocardiogram within 10 minutes (43.6% vs. 12.3%); repeat electrocardiogram at 6h (47.3% vs. 12.3%) and risk rating (41.8% vs. 7%). The following were prescribed significantly more in the protocol group (p <0.05): AAS (83.6% vs. 64.9%); oxygen (44.4% vs. 22.2%); clopidogrel (52.7% vs. 29.8%); morphine (32.7% vs. 10.5%); beta-blockers (49.1% vs. 22.8%); enoxaparin (47.3% vs. 26.3%); statins (38.2% vs. 15.8%) and ACE inhibitors (36.4% vs. 17.5%). There was no significant difference in mortality rates or the average lengths of hospitalization or observation.
CONCLUSION: The use of the protocol in the emergency promoted greater adherence to the recommendations of the corporate guidelines.

Keywords: Acute coronary syndrome; Chest pain; Advance directive adherence; Clinical trial

Cardio-frequency meter does not replace EKG for orthostatic 4-second exercise test

Cardiofrequencímetro não substitui ECG no teste de 4 segundos em posição ortostática

Brunno Santos Silva; Brenno Santos Silva; Rogério Brandão Wichi; Joselina Luzia Menezes Oliveira; Marcos Bezerra de Almeida

Rev Bras Cardiol. 2012;25(5):377-383

Abstract PDF PORT

BACKGROUND: The orthostatic 4-second exercise test (4sET) is intended to evaluate the cardiac vagal reflex during sudden exercise. However, dependence on the electrocardiogram (EKG) hampers the use of this resource outside the laboratory.
OBJECTIVE: to compare a Polar S810i cardio-frequency meter with the EKG in order to assess the cardiac vagal reflex in an orthostatic 4sET.
METHODS: A sample of thirteen university students (1 female) between 19 and 24 years old was evaluated, after reading and signing the deed of informed consent. The cardiac vagal reflex was measured simultaneously by a digital EKG and a cardio-frequency meter.
RESULTS: There was little agreement between the instruments for most of the orthostatic 4sET variables, with the intraclass correlation coefficients for the cardiac vagal reflex measured at ri=0.434 (p=0.05) and ri=0.23 (p=0.209) for the first and second tests respectively.
CONCLUSION: The Polar S810i cardio-frequency meter is not valid for assessing the cardiac vagal reflex by orthostatic 4sET, indicating that the EKG must be used for this version of the test.

Keywords: Equipment and supplies; Heart rate; Electrocardiography; Exercise; Autonomic nervous system

Clinical and angiographic study of procedures and polymorphisms: major events and restenosis after percutaneous coronary intervention

Estudo clínico, angiográfico, de procedimento e polimorfismos: eventos maiores e reestenose após intervenção coronariana percutânea

Rosemaria Gomes Dutra de Almeida; Edison Carvalho Sandoval Peixoto; Georgina Severo Ribeiro; Rodrigo Trajano Sandoval Peixoto; Ricardo Trajano Sandoval Peixoto

Rev Bras Cardiol. 2012;25(5):384-391

Abstract PDF PORT

BACKGROUND: There are genetic differences between patients with coronary artery disease (CAD) and normal coronary arteries. There are risk factors for events and restenosis after percutaneous coronary intervention (PCI).
OBJECTIVES: To compare the genotype frequency of patients with normal coronary arteries with CAD patients, evaluating clinical, angiographic, procedural and genetic characteristics, outcomes, and progress with events or restenosis, and possible risk factors.
METHODS: Prospective non-randomized study of 182 patients undergoing PCI from October 2001 to December 2007 and 36 patients with normal coronary arteries, in order to evaluate outcomes, clinical progress and ACE I/D and AT1R A/C polymorphisms.
RESULTS: A total of 182 patients were evaluated, 26.9% female and 73.1% male, undergoing 221 PCI procedures. The frequency of AT1R genotype in patients was: AA=74.2%, AC=23.1% e CC=2.7%, which was significantly different from the control group (p=0.0026). The progression period was 22±11 (2-60) months. Reference diameters were 2.81±0.60 and 2.80±0.52mm with lesion lengths of 17.1±6.6mm and 15.8±8.8mm in the groups with and without restenosis respectively. Restenosis took place in 29 (13.48 %) of the procedures. There was no association between death and ACE I/D and AT1R A/C, nor revascularization, myocardial infarction and restenosis after PCI.
CONCLUSIONS: There was a significant difference between the control group and the CAD patients for the genotype frequency of AT1R polymorphism, with no difference noted between angiographically documented clinical restenosis, quantitative angiographic data and AT1R and ACE polymorphisms. No difference was noted between AT1R and ACE polymorphisms and survival, major event-free survival and restenosis.

Keywords: Coronary reestenosis/genetics; Angioplasty, balloon, coronary; Gene delection; Polymorfism, genetic; Renin-angiotensin system

Impact of aging on metabolic and cardiovascular dysfunctions in an experimental model of menopause

Impacto do envelhecimento nas disfunções metabólicas e cardiovasculares em modelo experimental de menopausa

Danielle da Silva Dias; Nathalia Bernardes; Janaina de Oliveira Brito; Filipe Fernandes Conti; Maria Cláudia Irigoyen; Bruno Rodrigues; Kátia De Angelis

Rev Bras Cardiol. 2012;25(5):392-399

Abstract PDF PORT

BACKGROUND: Aging and ovarian hormone deprivation are associated with increased cardiovascular risk.
OBJECTIVE: Investigate the effects of aging on cardiovascular and metabolic parameters in female rats submitted to ovarian hormone deprivation.
METHODS: 16 adult female Wistar rats and 16 aged Wistar rats were divided into four groups (n= 8 in each group): adult control (CS) and ovariectomized (OS); aged control (VC) and aged ovariectomized (VOS). Ovariectomy was performed by bilateral ovary removal. Blood pressure (BP) was evaluated by direct recording. The baroreflex sensitivity (BRS) was evaluated by tachycardic (RT) and bradycardic (RB) responses.
RESULTS: Body weight was higher in aged rats (OS, VC and VOS) compared to the CS group. Blood triglycerides were higher in VC and VOS groups compared to the CS group. The diastolic AP was increased by aging. There was a mean AP increase in the OS group (124.0±1.3mmHg) compared to the CS group (110.0±2.8mmHg). The VOS group (130.0±5.1mmHg) presented an increased mean AP compared to the CS and VC (116.0±2.5mmHg) groups, with an additional systolic AP increase as compared to OS group. The BRS was impaired in OS and VC groups compared to the CS group. There were additional impairments in the BR and TR in the VOS group (-0.68±0.06 and -1.07±0.12bpm/mmHg) compared to the OS group (-1.10±0.11 and -2.09±0.19bpm/mmHg).
CONCLUSION: Aging in rats induced metabolic impairment and AP increase associated with reduced BRS. Ovarian hormone deprivation in adult rats resulted in cardiovascular and SBR impairments, with these changes exacerbated by aging.

Keywords: Menopause; Aging; Blood pressure; Triglycerides; Rats

Preliminary Communication

Vitamin D supplementation in normal ejection fraction heart failure: impact on quality of life. FITNESS study

Suplementação de vitamina D na insuficiência cardíaca com fração de ejeção normal: impacto na qualidade de vida. Estudo FITNESS

Bruno Afonso Lagoeiro Jorge; Pedro Gemal Lanzieri; Ana Paula Chedid Mendes; Jader Costa dos Reis; João Gabriel Batista Lage; Antonio José Lagoeiro Jorge; Evandro Tinoco Mesquita

Rev Bras Cardiol. 2012;25(5):400-405

Abstract PDF PORT

BACKGROUND: Studies have shown a significant prevalence of vitamin D (Vit. D) deficits in heart failure patients with reduced ejection fraction (HFREF), related to poorer quality of life and reductions in functional performance. With an aging population, heart failure with preserved ejection fraction (HFPEF) will become the most common type of heart failure (HF), with similar results for HFREF predictions. Despite evidence of the beneficial action of vit. D on the cardiovascular system in HFREF patients, there are no clinical studies demonstrating cardiovascular morphofunctional improvement through vit.D supplementation in HFPEF patients.
OBJECTIVE: To demonstrate improvements in the quality of life and diastolic function for FPEF patients taking vit. D supplements.
METHODS: Prospective, double-blind, randomized, placebo-controlled study, with 40 patients with HFNEF and vit. D deficiency (25OHD <30ng/mL) for 20 weeks of treatment. Patients will receive supplements of 100,000IU of cholecalciferol (Vit. D3) or placebo at baseline and at 10 weeks under medical supervision. They will be assessed by: functional tests (timed up-and-go test and 6-minute walk test), laboratory examinations, the Minnesota Living with Heart Failure Questionnaire, electrocardiogram, evaluating systolic and diastolic functions and ventricular remodeling at baseline, and at 10 and 20 weeks.
CONCLUSION: The FITNESS study will evaluate cardiovascular morphofunctional impacts and effects on the quality of life during 20 weeks of cholecalciferol supplementation in HFPEF patients with vit. D deficits.

Keywords: Vitamin D deficiency; Heart failure, Diastolic; Stroke volume; Quality of life

Case Report

Multiple coronary artery aneurysms in a patient with acute coronary syndrome

Múltiplos aneurismas coronarianos em paciente com síndrome coronariana aguda

Caroline de Faria Campos Caffaro; Felipe Montes Pena; Jamil da Silva Soares; Carlos Augusto Cardozo de Faria

Rev Bras Cardiol. 2012;25(5):406-409

Abstract PDF PORT

Male patient, 49 years, was admitted to the ER with signs of ventricular tachycardia after acute coronary syndrome. Non-invasive stratification performed initially with a transthoracic echocardiogram showed a left ventricular aneurysm and moderate systolic dysfunction. The segment analysis showed anteroapical akinesis, as well as moderate mitral regurgitation and mild aortic regurgitation. The patient then underwent coronary angiography that indicated occlusion of the anterior descending artery, aneurysm in the right coronary artery, circumflex, diagonal, and organized thrombus in the left ventricle. Clinical treatment was selected.

Keywords: Acute coronary syndrome; Tachycardia ventricular; Coronary aneurism; Echocardiography

Tortuous mammary: treatment of native left anterior descending artery

Mamária tortuosa: abordagem do leito nativo da artéria descendente anterior

André Pereira Duque Estrada; Carlos Henrique Eiras Falcão; Waldir Malheiros; Constantino González Salgado

Rev Bras Cardiol. 2012;25(5):410-412

Abstract PDF PORT

Male patient, 51, presented unstable angina with a history of myocardial revascularization: left internal thoracic artery (ITA) to anterior descending artery (ADA) and saphenous vein to right coronary artery (RCA). Coronary angiography showed patent ITA with severe tortuosity and 90% stenosis in the distal third of the native ADA bed. Native ADA bed angioplasty was attempted unsuccessfully by ITA grafting through conventional methods. Due to the severe tortuosity of the ITA and the failure of the conventional technique, neurointervention materials were used (extremely tortuous vessels) with a very flexible guidewire for easy passage through tortuous areas and a guide catheter with a flexible distal tip that allowed it to be positioned in the middle third of the graft. The use of these materials ensured that the procedure was performed successfully.

Keywords: Mammary arteries; Internal mammary-coronary artery; Coronary artery bypass; Myocardial revascularization; Angioplasty

Unprotected left main coronary artery angioplasty: report on two cases

Angioplastia de tronco de coronária esquerda não protegido: relato de dois casos

André Eduardo Gomes; Rodrigo Gimenez Pissutti Modolo; Gabriela Scriptore Braz; Bruno Battiston Vilela Vicente; Walasse Rocha Vieira; Eduardo Arantes Nogueira

Rev Bras Cardiol. 2012;25(5):413-417

Abstract PDF PORT

Percutaneous intervention in the left main coronary artery (LMCA) is still a great challenge. However, with the advent of drug-eluting stents, it has become more common over the past few years. Angioplasties with stent implantation present immediate technical outcomes at close to 100% success, with mortality rates from all causes similar to surgical approaches. This safety and new devices allow more complex cases to be treated, such as LMCA lesions. This report addresses two cases of unprotected left main coronary artery angioplasty in patients counter-indicated for surgical coronary artery bypass graft (CABG) surgery, performed in Brazilian government hospitals using bare metal stents, with excellent immediate outcomes.

Keywords: Angioplasty, balloon, coronary; Coronary angiography; Coronary artery disease; Stents

Review Article

Intermittent training for rehabilitation of heart failure patients: a systematic review

Treinamento intermitente na reabilitação de pacientes com insuficiência cardíaca: revisão sistemática

Daniel Fossati Silveira; Jerri Luiz Ribeiro; Thiago Rozales Ramis

Rev Bras Cardiol. 2012;25(5):418-427

Abstract PDF PORT

Many studies have investigated the effects of moderate continuous training for patients with heart failure. Intermittent training has also proven effective in the treatment of these subjects, as it allows higher intensity exercise. However, the optimal intensity for obtaining the greatest benefits from a training program has not yet been established. In this context, the purpose of this paper is to review the literature on studies using intermittent training in patients with heart failure, summarizing their findings and identifying areas for future research. Seven randomized controlled trials were found and analyzed, involving 417 patients (347 men). All the trials showed improvements resulting from intermittent training in the rehabilitation programs of patients with heart failure, with no cardiac events recorded during the exercises. Despite the wide variation in the exercise intensity prescription models in the studies, intermittent training seems to be an interesting strategy for the rehabilitation of this population. Further investigation is needed to standardize the prescription model and identify the most appropriate intensities for physical training programs working with heart failure patients.

Keywords: Aging; Metabolic diseases; Cardiovascular diseases; Menopause, Rats

Blood pressure goals in diabetic patients: evidence and recommendations

Metas pressóricas em diabéticos: evidências e recomendações

Ricardo Bedirian; Camillo de Léllis Carneiro Junqueira; Andréa Araújo Brandão

Rev Bras Cardiol. 2012;25(5):428-436

Abstract PDF PORT

Since the relationship was established between systemic arterial hypertension (SAH) and increased cardiovascular (CV) risk, efforts have been under way to prevent the occurrence of CV outcomes through effective antihypertensive treatment. Lowering blood pressure (BP) is the most important goal in SAH treatment and blood pressure goals should be pursued. A group directly affected by this recommendation is diabetic patients. This is due to the notable increase in CV risks among patients with coexisting SAH and diabetes mellitus (DM). Studies have tested various blood pressure reduction goals in this group, but this issue is still under discussion. Most guidelines suggest a systolic goal of 130mmHg and 80mmHg for diastolic BP in hypertensive patients with diabetes. Greater BP reductions in diabetics are difficult and require multiple drug combinations, showing no additional benefits in reducing cardiovascular outcomes. These data come from meta-analysis studies of several clinical trials and also the guidelines established by cardiology societies. Systolic BP below 130mmHg presents heterogeneous results in terms of CV protection, with a reduction in stroke, no additional benefits for other cardiovascular outcomes and increased adverse effects. This article reviews studies on blood pressure goal achievement in diabetic patients and their impacts on relevant clinical outcomes, as well as the recommendations set forth in Brazilian and international guidelines on this topic.

Keywords: Hypertension/prevention & control; Diabetes mellitus/therapy; Goals