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

Edition: 24.3 - 11 Article(s)

Editorial

Editorial

Ricardo Mourilhe Rocha

Rev Bras Cardiol. 2011;24(3):138

PDF PORT


Original Article

Prevalence of major postoperative complications in cardiac surgery

Prevalência das principais complicações pós-operatórias em cirurgias cardíacas

Gustavo Mattos Teixeira Soares; Diego Costa de Souza Ferreira; Mariana Paula Cunha Gonçalves; Thales Gontijo de Siqueira Alves; Flégon Lopes David; Karina Magalhães de Castro Henriques; Larissa Rodrigues Riani

Rev Bras Cardiol. 2011;24(3):139-146

Abstract PDF PORT

BACKGROUND: Studies in different populations reveal differing levels of complications after cardiac surgery, depending on the criteria and characteristics of population studied. As data is sparse in Brazil, studies are needed to characterize these complications more effectively.
OBJECTIVE: To identify the most frequent complications and how they are presented in the immediate postoperative period among patients undergoing cardiac surgery in the town of Juiz de Fora, Minas Gerais State, Brazil Methods: Cross-section study with 204 patients undergoing cardiac surgery at the Santa Casa de Misericordia hospital in Juiz de Fora from June 1 to December 31, 2009, calculating the prevalence of major complications during the immediate postoperative period through an analysis of medical records.
RESULTS: The prevalence of complications was 58%, mainly (31%) pulmonary, followed by cardiac (15.78%) and neurological (13.9%). Among the infectious complications (9.89%), the lung was the most common site. The most prevalent hydroelectrolytical disorder was hypernatremia, with hyperglycemia more common than hypoglycemia. Bleeding was more prevalent than thrombotic events.
CONCLUSIONS: There was a significant prevalence of complications, mainly pulmonary, in the population. These findings can guide the high-priority care that will be implemented for these patients and thus contribute to better interventions.


Keywords: Postoperative complications; Cardiac surgical procedures; Prevalence; Intensive care

Does post-infarction unstable angina increase the risk of coronary artery bypass graft surgery?

Angina instável pós-infarto aumenta o risco de complicações na cirurgia de revascularização miocárdica?

Áureo do Carmo Filho; Felipe José Monassa Pittella; Andrea Rocha De Lorenzo; Valmir Barzan; Alexandre Siciliano Colafranceschi; José Oscar Reis Brito; Paulo Roberto Dutra da Silva; Marco Antonio de Mattos; Antônio Sérgio Cordeiro da Rocha

Rev Bras Cardiol. 2011;24(3):147-152

Abstract PDF PORT

BACKGROUND: It is assumed that post-infarction unstable angina increases the risk of post-operative complications.
OBJECTIVE: To ascertain whether post-infarction unstable angina (Braunwald class C) increases the risk of major cardiovascular events (MACE) for coronary artery bypass surgery (CABG) in comparison to stable coronary syndromes.
METHODS: In patients undergoing individual CABG consecutively for a period of two years, the incidence of MACE (hospital mortality, non-fatal Q-wave myocardial infarction [AMI], and stroke) was compared for patients with stable coronary syndromes (G1) and patients with class B unstable angina (G2), and patients with Braunwald class C unstable angina (G3).
RESULTS: Among 333 patients operated during that period, 238 (71%) belonged to G1, 56 (17%) to G2, and 39 (12%) to G3. More G2 and G3 patients presented COPD (12.5% and 10.0% vs 2.9%, p=0.005), and the need for emergency / urgent surgery (18.0% and 33.0% vs 0.4%; p=0.0001) than in G1. No significant difference appeared in hospital mortality (4.6%, 8.9%, and 5.1%; p=0.45), non-fatal AMI (2.9%, 3.6%, and 5.1%; p=0.69), and stroke (5.5%, 0%, and 5.1%; p=0.17) or MACE (10.9%, 12.5%, and 12.8%; p=0.85) among G1, G2, and G3 respectively.
CONCLUSION: This study suggests that post-infarction unstable angina did not increase the risk of MACE in CABG compared to stable coronary syndromes.


Keywords: Angina, unstable; Acute coronary syndrome; Myocardial revascularization; Complications

Molecular determinants of cardiac hypertrophy induced by different amounts of aerobic exercise training

Determinantes moleculares da hipertrofia cardíaca induzida por diferentes volumes de treinamento aeróbio

Nara Yumi Hashimoto; Tiago Fernandes; Úrsula Paula Reno Soci; Edilamar Menezes de Oliveira

Rev Bras Cardiol. 2011;24(3):153-162

Abstract PDF PORT

BACKGROUND: Aerobic exercise training (ET) induces cardiovascular adaptations, including cardiac hypertrophy (CH). Molecular markers differentiate between physiological and pathological CH.
OBJECTIVE: To investigate the amount of CH induced by different amounts of ET, ascertaining whether these adaptive responses are associated with pathological CH molecular markers.
METHODS: Twenty-one female Wistar rats were divided into 3 groups: sedentary control (SC), trained protocol 1 (T1) and trained protocol 2 (T2). T1: swimming for 60 min, 1xdayx10 weeks, with 5% workload. T2 was the same as T1 until the 8th week, with training 2xday in the 9th week and 3xday in the 10th week.
RESULTS: ET promoted resting bradycardia, CH, increased effort tolerance and peak oxygen uptake in the T1 group, with these responses increased in the P2 group. In T1 the cardiac gene levels of α- myosin heavy chain (MHC), β- MHC, α/β- MHC, atrial natriuretic factor (ANF) and skeletal α-actin did not change, with an improvement in this genetic profile noted in T2 with increased α- MHC, lower β-MHC, higher α/β- MHC and lower skeletal α-actin. Protein kinase B (Akt) activity increased in parallel to the amount of ET.
CONCLUSIONS: The magnitude of the CH was dependent on the increase in the amount of ET and the molecular markers that it activates differ from those found in pathological CH, thus indicating physiological CH.


Keywords: Aerobic exercise; Hypertrophy, left ventricular; Biologic markers; Protein kinases

Association between muscle strength and at-rest blood pressure among sedentary women

Associação entre força muscular relativa e pressão arterial de repouso em mulheres sedentárias

Ramires Alsamir Tibana; Sandor Balsamo; Jonato Prestes

Rev Bras Cardiol. 2011;24(3):163-168

Abstract PDF PORT

BACKGROUND: Low levels of physical activity and cardiovascular capacity are associated with abnormal blood pressure values. However, no study has yet associated relative muscle strength with blood pressure levels among women.
OBJECTIVES: To compare the blood pressure levels of sedentary Brazilian women with different levels of relative muscle strength and associate these levels with systolic (SBP), diastolic (DBP), mean blood pressure (MBP) and resting heart rate (RHR) values.
METHODS: A transversal study was conducted during 2010/2011 with 83 pre-menopausal volunteers. Based on relative muscle strength values, this sample was divided into tertiles in order to compare SBP, DBP, MBP and RHR by using ANOVA one-way, followed by the Bonferroni test when appropriate, while correlations among variables was tested by the Pearson correlation test, with a significance level of p<0.05.
RESULTS: Women in the 1st tertile presented higher relative muscle strength with lower SBP and MBP values than those in the 3rd and 2nd tertiles for relative muscle strength (p<0.001). The DBP was significantly lower (p<0.001) for the 1st and 2nd tertiles than the 3rd tertile. Additionally, the 1st and 2nd tertiles presented lower values for body mass, body mass index, waist circumference, height-to-waist ratio and body adiposity index than the 3rd tertile (p<0.001). Inverse correlations were noted between relative strength and the SBP, DBP and MBP values.
CONCLUSION: Women with less relative muscle strength present higher at-rest blood pressure levels.


Keywords: Coronary disease/prevention & control; Muscle strength; Blood pressure; Women; Sedentary lifestyle

Review Article

Healthcare safety and quality applied to cardiology: contributions of the american experience

Qualidade e segurança assistencial aplicada à cardiologia: as contribuições da experiência americana

Mayra Faria Novello; Evandro Tinoco Mesquita; Marcelo Rivas; Pedro Gemal Lanzieri; Bruno Afonso Lagoeiro Jorge; Julio Maria Teixeira Motta; Maria Luiza Garcia Rosa

Rev Bras Cardiol. 2011;24(3):169-179

Abstract PDF PORT

Despite massive progress in medicine, cardiovascular diseases (CVD) are still the leading causes of morbidity and mortality worldwide, boosting healthcare system costs. Good quality care is directly related to adoption of the best practices as recommended by the guidelines. Evidence indicates that compliance may well lower morbidity and mortality rates and reduce the costs of diseases such as acute myocardial infarction and heart failure. There is much concern in the USA over measuring quality and certifying institutions as a strategy for ongoing improvement in healthcare quality and safety, building up more than a century of experience. Although more recent, this certification process is encompassing more hospitals in Brazil. The quality indicators are selected on the basis of the Clinical Guidelines established by Medical Societies, which are grounded on Evidence-Based Medicine. Especially in the USA, Cardiology Societies were pioneers in establishing guidelines. However, even in cardiology, there are wide variations in the use of these guidelines and consequently an equally wide and unjustified variation in clinical practice that downgrades healthcare quality. This paper offers an overview of the quality and safety movement in the US healthcare system, discussing its impact on medical practice and highlighting current proposals for changes in remuneration for medical activities, also considered as an alternative in Brazil.


Keywords: Quality of health care/trends; Safety; Quality indicators, health care; Cardiovascular diseases

Importance of physical exercise in the treatment of erectile dysfunction

Importância do exercício físico no tratamento da disfunção erétil

Cícero Augusto de Souza; Fernando Luiz Cardoso; Rozana Aparecida da Silveira; Priscilla Geraldine Wittkopf

Rev Bras Cardiol. 2011;24(3):180-185

Abstract PDF PORT

Characterized as the persistent inability to maintain an erection sufficient for sexual satisfaction, erectile dysfunction is rated as an important public health issue. Its prevalence increases with age, associated mainly with cardiovascular risk factors such as obesity, smoking, hypertension, diabetes and physical inactivity. In contrast, regular physical exercise is strongly associated with sexual functions and should be indicated for the control of risk factors and erectile dysfunction.


Keywords: Erectile dysfunction/therapy; Risk factors; Exercise therapy; Age factors

Case Report

Heart failure secondary to systemic lupus erythematosus

Insuficiência cardíaca secundária a lúpus eritematoso sistêmico

Alessandro Pinheiro Olimpio de Souza; Carla da Fontoura Dionello; Monique Resende

Rev Bras Cardiol. 2011;24(3):186-188

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Systemic lupus erythematosus (SLE) is a multifactorial systemic disease of unknown etiology. It is associated with several cardiovascular manifestations, such as accelerated atherosclerosis, pericarditis, myocarditis, valvulopathies and Libman-Sacks endocarditis, among others, contributing to patient morbidity and mortality. It thus follows that this collagenosis should be recalled as a cause of cardiomyopathy.


Keywords: Systemic lupus erythematosus; Heart failure; Myocarditis

Coronary artery no mirror for the heart

Quem vê coronária não vê coração

Guilherme Brenande Alves Faria; Andrea Rocha De Lorenzo; Felipe José Monassa Pittella; Antônio Sérgio Cordeiro da Rocha

Rev Bras Cardiol. 2011;24(3):189-191

Abstract PDF PORT

In general, occlusion of one or more coronary arteries is associated with significant weakening of the left ventricular function. This case study describes a 64-yearold man with no history or electrocardiographic signs of prior acute myocardial infarction, with proximal occlusion of two main coronary arteries and preserved left ventricular function.


Keywords: Coronary occlusion; Ventricular function; Collateral circulation; Myocardial revascularization

Dextrocardia with situs inversus - Wrong may be right

Dextrocardia em situs inversus - O errado pode estar correto

Gustavo Luiz Gouvêa de Almeida; Luiz Claudio Maluhy Fernandes

Rev Bras Cardiol. 2011;24(3):192-195

Abstract PDF PORT

A 58-year-old female ambulatory patient reported atypical right chest pain. Heart sounds were heard in the right hemithorax, with no anormalies. The chest radiograph showed dextrocardia with situs inversus. On the ECG, the P waves were negative in D1 and aVL while in the thoracic leads the QRS decreased from V1 to V6. After reversing the arm electrodes and repositioning the chest leads on the right side, the electrocardiogram became "normal". The vectorcardiogram showed inversion of the atrial and ventricular activation loops, confirming the electrocardiographic diagnosis.


Keywords: Heart defects, congenital/radiography; Dextrocardia; Situs inversus/radiography

Doxorubicin cardiomyopathy in patients with breast cancer: two case studies

Cardiomiopatia por doxorrubicina em pacientes com câncer de mama - A propósito de dois casos

Wolney de Andrade Martins; Vinicius Barbosa de Souza; Luis Felipe Cordeiro Rocha; Humberto Villacorta Junior

Rev Bras Cardiol. 2011;24(3):196-198

Abstract PDF PORT

Cardiovascular lesions due to cancer treatment have increased, especially cardiomyopathies (CMP). Widely used in chemotherapy, doxorubicin (DX) is related to the development of CMP. Two case studies are presented of breast cancer patients admitted for decompensated heart failure (HF) and dilated CMP attributed to DX chemotherapy, with no evidence of previous HF or CMP. Deep venous thrombosis, cavitary thrombus and pleural effusion occurred during treatment. Both patients progressed to compensated HF, with DX cardiotoxicity being the cause of the CMP.


Keywords: Cardiomyopathies; Heart failure; Breast neoplasms; Doxorrubicin; Drug therapy

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