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

Edition: 24.2 - 11 Article(s)



Ricardo Mourilhe Rocha

Rev Bras Cardiol. 2011;24(2):76


Original Article

Left ventricular systolic dysfunction and prognosis after coronary artery bypass graft surgery

Disfunção sistólica do ventrículo esquerdo e prognóstico após cirurgia de revascularização do miocárdio

Antônio Sérgio Cordeiro da Rocha; Andrea Rocha De Lorenzo; Valmir Barzan; Alexandre Siciliano Colafranceschi; José Oscar Reis Brito; Felipe José Monassa Pittella; Paulo Roberto Dutra da Silva

Rev Bras Cardiol. 2011;24(2):77-84

Abstract PDF PORT

BACKGROUND: Coronary artery bypass graft (CABG) surgery prolongs the survival of patients with coronary artery disease (CAD) and left ventricular dysfunction (LVD).
OBJECTIVE: To verify whether CABG can match the survival times of CAD patients with and without LVD.
METHODS: 259 patients who survived CAGB performed between October 1, 2001 and January 31, 2004 were followed up for three years, with LVD characterized by a left ventricle ejection fraction of <40%. Two groups of patients were established, based on the presence (G1; n=45) or absence (G2; n=214) of LVD.
RESULTS: G1 patients presented more acute coronary syndromes before CABG (64.4% vs 40.2%; p=0.005), congestive heart failure (17.8% vs 1.9%; p<0.0001), previous history of acute myocardial infarction (80% vs 60.3%; p=0.016), and chronic obstructive pulmonary disease (11.1% vs 2.3%; p=0.016) than G2. The threeyear cumulative survival rate was significantly lower in G1 than in G2 (88.8±4.7% vs 95.7±1.3%, respectively; p=0.05). However, LVD was not an independent factor for shorter survival times during the follow-up period (p=0.119).
CONCLUSION: this study suggests that CABG is unable to match the survival of patients with CAD and LVD to the survival of patients with CAD without LVD.

Keywords: Myocardial revascularization/prognosis; Left ventricular dysfunction; Coronary artery disease; Survival

Estimated cost of acute coronary syndrome in Brazil

Estimativa de custo da síndrome coronariana aguda no Brasil

Vanessa Teich; Denizar Vianna Araujo

Rev Bras Cardiol. 2011;24(2):85-94

Abstract PDF PORT

BACKGROUND: Acute coronary syndrome (ACS) encompasses unstable angina and acute myocardial infarction. In 2009, ACS accounted for 7% of all deaths, associated with substantial direct and indirect costs burdening healthcare systems.
OBJECTIVE: To estimate the direct and indirect costs of ACS in Brazil and impacts on the public and private sectors of the Brazilian healthcare system in 2011.
METHODS: Based on a societal standpoint, this study includes the public (SUS) and supplementary (SHS) healthcare systems, retrieving the direct costs from Brazilian databases solely for hospitalization periods. The Human Capital Approach method was used for the indirect costs, with two major components: productivity loss for patients dying of myocardial infarctions (MI) or unstable angina, and productivity loss for the time between the main event (MI or angina) and returning to work (recovery period).
RESULTS: The estimated direct costs associated with ACS for 2011 reach R$522,286,726 for the SUS (0.77% of the total Government healthcare budget), and an estimated R$515,138,617 for the SHS. Indirect costs total R$2.8 billion from the societal standpoint, with the total direct and indirect costs of ACS in Brazil for 2011 estimated at R$3.8 billion.
CONCLUSION: Due to the impact of ACS on Brazil's healthcare budget for 2011, it is vital to adopt measures that allow better use of resources.

Keywords: Acute coronary syndrome/epidemiology; Acute coronary syndrome/economy; Health care costs; Unified health system; Brazil

Family health and antihypertensive and antidiabetic drug use

Saúde da família e utilização de medicamentos anti-hipertensivos e antidiabéticos

Milene Zanoni da Silva Vosgerau; Marcos Aparecido Sarriá Cabrera; Regina Kazue Tanno de Souza

Rev Bras Cardiol. 2011;24(2):95-104

Abstract PDF PORT

BACKGROUND: Accessing and taking prescription drugs for ongoing use is of great importance for the management of hypertension and diabetes mellitus.
OBJECTIVE: To assess the use of drugs for controlling hypertension and/or diabetes mellitus and examine where these drugs are acquired among adults living in the area covered by a Family Health Center in the town of Ponta Grossa, southern Brazil, in 2006 and 2007.
METHODS: Through a cross-sectional study with a systematic sampling approach, 374 people were interviewed with a recall period of seven days, followed by a descriptive statistical analysis of absolute and relative frequency.
RESULTS: The reported prevalence of hypertension and diabetes mellitus reached 22.2% and 8% respectively, with 70% of the diabetic respondents presenting high blood pressure. Among those reporting hypertension, 66.3% took antihypertensive drugs. Among the diabetics, 70% reported antidiabetic drug use. The combined antihypertensive drug therapy most commonly included diuretics and angiotensinconverting enzyme inhibitors (47.2%), with 12.5% of the respondents reporting nonsteroidal anti-inflammatory drug use concomitantly with antihypertensive drugs. Only 7.1% of the diabetic respondents reported insulin use. Drugs were acquired mainly (54.7%) from basic health units. More than 50% of the beta-blockers and diuretics had to be purchased, although appearing on the National List of Essential Medicines.
CONCLUSION: Despite advances in Brazil's National Health System, essential drugs are not always able at Family Health Centers to patients with hypertension and diabetes mellitus.

Keywords: Family health; Drug utilization; Antihypertensive agents; Hypoglycemic agents; Pharmacoepidemiology

Review Article

Skeletal myoblast: fair abandonment?

Mioblasto esquelético: um justo abandono?

Cristiano Freitas de Souza; Claudia Maria Rodrigues Alves; Antonio Carlos de Camargo Carvalho

Rev Bras Cardiol. 2011;24(2):105-111

Abstract PDF PORT

Myocardial ischemia is an increasingly frequent cause of heart failure and has long been considered irreversible, as adult cardiomyocytes are terminally differentiated cells with no proliferative capacity. In order to reverse heart failure, damaged myocytes would have to be replaced and blood flow restored. In recent years, special attention has been paid to the potential ability of cell therapy to repair an injured myocardium, due to the in vitro ability to distinguish between the develop of cardiomyocytes and endothelial cells. Stem cells are undifferentiated cells capable of self-renewal, proliferation and differentiation into multiple lineages. The ultimate goal of their use is tissue regeneration. Hematopoietic stem cells were the first to be identified as a potential cell source, followed by several other cell types, as well as partially differentiated progenitor cells capable of proliferation and differentiation into multiple lineages. This paper offers a detailed description of skeletal myoblasts - cells that were viewed during the 1990s as a potential cell source for cardiac regeneration but which were subject to prohibitive constraints on more extensive use, shown through the findings of early studies and related mainly to security issues.

Keywords: Cell transplantation; Myoblasts, skeletal;/transplantation; Myocardial infarction; Heart failure; Guided tissue regeneration

Preliminary Communication

Caffeine intake and cardiovascular responses after resistance exercise session

Ingestão de cafeína e respostas cardiovasculares após sessão de exercícios resistidos

Roberto Ruiz; Karla Goessler; Luiz Rissardi; Allan Araújo; Marcos Polito

Rev Bras Cardiol. 2011;24(2):112-115

Abstract PDF PORT

BACKGROUND: There is little information available on the effect of caffeine on cardiovascular responses after resistance exercise.
OBJECTIVE: To determine the acute effect of caffeine after a resistance exercise session on blood pressure (BP), heart rate (HR) and HR variability (HRV).
METHODS: Eight healthy men underwent a randomized cross-over and double-blind test. They were offered a capsule containing caffeine or a placebo 45min before a resistance exercise session. The cardiovascular variables were evaluated at rest and at 15min intervals for 60min after exercise.
RESULTS: Caffeine did not alter the at-rest values for BP, HR and HRV. After exercise, caffeine caused significant increases (p<0.05) in the systolic and diastolic BP compared to the placebo only at the 60min mark.
CONCLUSION: Caffeine has no effect on cardiovascular responses at rest and after resistance exercise.

Keywords: Caffeine/adverse effects; Exercise; Blood Pressure/drug effects

Cardiovascular Image

Kawasaki disease

Doença de Kawasaki

José Hallake; José Feldman

Rev Bras Cardiol. 2011;24(2):116-118

Abstract PDF PORT

Medical care was sought for a four-year-old boy presenting high fever, conjunctivitis, pharyngitis and adenomegaly. The electrocardiogram showed myocardial ischemia with coronary artery aneurysms indicated in the Doppler echocardiogram. These data led to a diagnosis of Kawasaki disease.

Keywords: Mucocutaneous lymph node syndrome; Myocardial ischemia; Coronary artery disease; Child

Hyperpotassemia and sinoventricular conduction in elderly patient with renal insufficiency and diabetic ketoacidosis

Hiperpotassemia - condução sinoventricular em paciente idoso, em insuficiência renal e cetoacidose diabética

Ernani Luiz Miranda Braga; Gerson Paulo Goldwasser

Rev Bras Cardiol. 2011;24(2):119-121

Abstract PDF PORT

An elderly patient with ischemic cardiomyopathy, hypertension, slight renal dysfunction and insulindependent diabetes developed ketoacidosis after suspending insulin use, with severe dehydration and severe hyperpotassemia, both reverted through medications. This paper analyzes interesting eletrocardiographic aspects of this case.

Keywords: Hypertension; Renal insufficiency; Diabetic ketoacidosis; Dehydration; Hyperkalemia

Point of View

Endothelial progenitor cells: a possible therapy?

Células endoteliais progenitoras: uma terapia possível?

Bruno Sevá Pessôa

Rev Bras Cardiol. 2011;24(2):122-124

Abstract PDF PORT

The proliferation and differentiation capabilities of endothelial progenitor cells (EPC) make them ideal candidates for vascular damage repair research. Despite encouraging findings, several factors affecting the numbers and functions of these cells are still unknown, imposing constraints on the identification and regulation of the factors involved, while strategies for reversing vascular damage are widespread. There is thus still a long way to go before EPCs can be used safely for effective repairs.

Keywords: Endothelial cells; Cardiovascular diseases; Vascular system injuries; Atherosclerosis

Case Report

Importance of early diagnosis and treatment of tachycardiomyopathy

A importância do diagnóstico precoce e tratamento da taquicardiomiopatia

Isabela Cabello Abouchedid; Fernando Augusto Alves da Costa; Antônio Esteves de Gouvea Netto; Marcos Cairo Vilela

Rev Bras Cardiol. 2011;24(2):125-127

Abstract PDF PORT

Tachycardiomyopathy is a rare disease characterized by ventricular systolic dysfunction and heart failure caused by persistent or repetitive tachyarrhythmias with rapid heartbeats, whose clinical manifestations may be reversed by bringing the cardiac rhythm back to normal in patients with no established structural cardiac disease. This case study reports on a patient with no heart disease presenting a stroke as the initial event, defined in the research as tachycardiomyopathy triggered by persistent tachyarrhythmia.

Keywords: Tachycardia, supraventricular / etiology; Ventricular dysfunction; Heart failure/diagnosis; Atrial fibrillation / etiology

Efficiency and safety of different drug combinations in peripartum cardiomyopathy

Eficácia e segurança com diferentes associações medicamentosas na cardiomiopatia periparto

Guilherme Lobosco Werneck; Eliane Veiga Moreira; Zenita Portela Pavani; Valdênia Pereira dos Santos

Rev Bras Cardiol. 2011;24(2):128-130

Abstract PDF PORT

This case study addresses a 38-year-old patient who developed heart failure thirty days after delivery. She received conventional treatment, but changes were required due to adverse effects and inadequate blood pressure response. In the light of evidencebased medicine, various drug combinations and their safety are discussed, for cases of peripartum cardiomyopathy.

Keywords: Dilated cardiomyopathy; Pregnancy complications cardiovascular/therapy; Heart failure; Drug utilization