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

Edition: 24.4 - 11 Article(s)

Editorial

Editorial

Ricardo Mourilhe Rocha

Rev Bras Cardiol. 2011;24(4):206

PDF PORT


Original Article

Influence of sodium bicarbonate in myocardial scintigraphy with 201TL for myocardial viability assessment

Influência do uso do bicarbonato de sódio na cintilografia miocárdica com Tálio-201 para pesquisa de viabilidade miocárdica

Bernardo Nóbrega de Oliveira; Marcos Pinto Pellini; Maria Carolina Landersmann; Ronaldo de Souza Leão Lima

Rev Bras Cardiol. 2011;24(4):207-215

Abstract PDF PORT

BACKGROUND: Published studies have already demonstrated that sodium bicarbonate administered 30 minutes before a 201Tl injection increases 201Tl uptake during physical stress. The influence of transient blood alkalosis in humans prior to injecting 201Tl at rest is unknown.
OBJECTIVE: To evaluate the influence and safety of sodium bicarbonate used during myocardial scintigraphy with 201Tl for myocardial feasibility assessment.
METHODS: Between April and December 2009, fifteen patients underwent rest-redistribution 201Tl myocardial perfusion scintigraphy (standard protocol), repeated 1 week later, when 2mEq/kg of sodium bicarbonate were injected intravenously 30 minutes before the radiotracer injection.
RESULTS: The bicarbonate protocol images revealed more normal segments, with lower perfusion scores and fewer reversible segments than in the standard protocol. The percentage of non-reversible segments was equivalent in both protocols. There were no complications related to the bicarbonate protocol.
CONCLUSIONS: Sodium bicarbonate injections before 201Tl are safe and enhance the 201Tl uptake by the myocyte resulting in fewer segments with perfusion defects, compared to the standard protocol. Despite a reduction in the number of reversible segments in the later images, there was no increase in nonviable segments in the bicarbonate protocol.


Keywords: Myocardial ischemia; Coronary disease; Radionuclide imaging; Thallium radiosotopes/diagnostic use; Sodium bicarbonate/diagnostic use

Influence of arteriovenous fistula on the heart rate response to dipyridamole in chronic renal patients undergoing myocardial scintigraphy

Influência da fístula arteriovenosa sobre a resposta da frequência cardíaca ao dipiridamol em pacientes renais crônicos submetidos à cintilografia miocárdica

Aline Alves Vargas Gonçalves, Ronaldo de Souza Leão Lima

Rev Bras Cardiol. 2011;24(4):216-224

Abstract PDF PORT

BACKGROUND: An abnormal heart rate (HR) response to dipyridamole occurs in patients with chronic renal disease for unknown reasons. A broad-ranging review of the literature did not disclose any studies on the contribution of arteriovenous fistula (AVF) to this phenomenon.
OBJECTIVE: To evaluate the role of AVF in reduced HR response to dipyridamole in patients with CRF undergoing myocardial perfusion scintigraphy.
METHODS: 516 adult patients were studied, 45 with CRF (25 with AVF and 20 without AVF) and 471 with normal kidney function, consecutively undergoing myocardial scintigraphy in a tertiary care hospital between 2006 and 2009. Hemodynamic responses to dipyridamole were evaluated in all these patients, as well as clinical and scintigraphic parameters. An abnormal HR response to dipyridamole was defined as the peak HR/basal HR<1.2 ratio and the difference as the peak HR-HR basal<12bpm.
RESULTS: The reduced HR response to dipyridamole was equivalent in both groups of CRF patients (with or without AVF), although more frequent than in patients without CRF (68% vs 70.0% vs 29.7%, p<0.001, respectively). Using logistic regression, the predictors of an abnormal HR response to dipyridamole were found to be the presence of CRF, older age and left ventricular dysfunction.
CONCLUSIONS: There is a link between CRF and the abnormal HR response to dipyridamole, but the presence of AVF does not explain the influence of kidney disease on this response.


Keywords: Kidney failure, chronic; Arteriovenous fistula; Ventricular dysfunction left/radionuclide imaging; Heart rate; Dipyridamole/administration & dosage

Cardiac arrhythmia treated in the emergency room of a tertiary university hospital

Atendimento de arritmia cardíaca em emergência de hospital universitário terciário

Paula Menezes Luciano; David José Oliveira Tozetto; André Schmidt; Antonio Pazin Filho

Rev Bras Cardiol. 2011;24(4):225-232

Abstract PDF PORT

BACKGROUND: Treating patients with cardiac arrhythmias is a challenge, due to a variety of clinical and electrocardiographic presentations. Although accepted worldwide, protocols do not address the impact of the prevalence of arrhythmias and may vary, with implications on the training and skills of emergency room physicians.
OBJECTIVE: To assess cardiac arrhythmia treatment in the emergency room of a tertiary university hospital, characterizing the assisted population, identifying the prevalence of cardiac arrhythmias presented, monitoring patient progress and ascertaining the efficacy of the selected treatment.
METHODS: All non-trauma patients more than 12 years old treated for an acute cardiac arrhythmia episode were included prospectively. Patients were registered through completing a specific form, with documentation and electrocardiographic diagnoses. All patients had ejection fractions documented through echocardiography after the resolution of these arrhythmia events.
RESULTS: A total of 182 patients (50.0% male; 64.6±16.1 years) were studied for nineteen months, corresponding to 1.9% of all non-trauma treatments during the period. The most prevalent types of cardiac arrhythmia were: supraventricular tachycardia (n=86; 47.3%) followed by bradycardias caused by atrioventricular blocks (n=39; 21.4%). Ventricular tachycardia was associated with clinical instability. The specific arrhythmia treatment was effective and the mortality rate (22.0%) was not directly associated with the arrhythmias.
CONCLUSION: Cardiac arrhythmias are rare compared to other clinical conditions seen in emergency rooms, and are generally associated with severe clinical conditions.


Keywords: Arrhythmias, cardiac/epidemiology; Emergency service, hospital; Hospitals, teaching

Cardiorespiratory fitness and aging as obesity risk indicators

Aptidão cardiorrespiratória e envelhecimento como indicadores de risco de obesidade

Igor Conterato Gomes; Aline Francielle Mota Segatto; Vanessa Ribeiro dos Santos; Clara Suemi da Costa Rosa; Thais Reis Silva de Paulo; Ismael Forte Freitas Júnior

Rev Bras Cardiol. 2011;24(4):233-240

Abstract PDF PORT

BACKGROUND: Low levels of cardiorespiratory fitness (CF) and excess body fat are factors related to chronic diseases and reduced life expectancy.
OBJECTIVE: To determine whether women with different CF results present changes in cardiovascular risk (CR), and whether there are differences among the same variables for women in different age groups.
METHODS: The sample consisted of 689 women (40 to 79 years), measuring their weight, height, waist and hip circumferences. The Body Mass Index (BMI), waist to hip ratio (WHR), conicity index (CI) and waist to height ratio (WHR) were calculated as CR indicators, while CF was assessed by the six-minute walk test (6MWT). A one-way variance analysis was used to compare the averages for the total adiposity (BMI) and CR indicators in the different age groups, according to the 6MWT interquartile values, supplemented by post-hoc LSD test (p<5%).
RESULTS: Women between 70 and 79 years old have lower BMI values (p=0.01), less cardiorespiratory fitness (p=0.001) and higher CR indicators (p=0.02) compared to younger women, while women with lower AC had higher BMI and RC indicators, especially >50 years.
CONCLUSION: In each age group, women with lower CF tend to have higher BMI values and CR indicators.


Keywords: Physical fitness; Aging; Body mass index; Cardiovascular disease; Risk factors

Evaluation of the functional benefits of a cardiac rehabilitation program

Avaliação dos benefícios funcionais de um programa de reabilitação cardíaca

Henrique Cotchi Simbo Muela; Roberto Bassan; Salvador Manoel Serra

Rev Bras Cardiol. 2011;24(4):241-250

Abstract PDF PORT

BACKGROUND: A great number of studies have confirmed that physical training is one of the most effective methods of improving functional capacity and well-being in patients with heart disease.
OBJECTIVE: To evaluate the clinical and functional benefits of the Cardiac Rehabilitation Program in patients referred to the Cardiac Exercise Center at the Aloysio de Castro State Institute of Cardiology in Rio de Janeiro, Brazil.
METHODS: A retrospective comparative cohort study was conducted of a sample of 88 individuals (60 men and 28 women) between 37 and 81 years old. Most of the patients had stable coronary artery disease. The main parameters analyzed for the treadmill tests were exercise duration, peak oxygen consumption (peak VO2), metabolic equivalent (MET), functional aerobic impairment (FAI), peak exercise double product (peak DP), reduction in heart rate for the first minute of recovery, presence of ischemia, NYHA functional class and American Heart Association cardiorespiratory fitness.
RESULTS: There was significant improvement in most of the parameters analyzed, such as functional capacity, exercise duration, peak VO2, MET achieved, FAI and cardiorespiratory fitness (p<0.0001). There was no significant difference for the double product (p=0.1359).
CONCLUSION: The Cardiac Rehabilitation Program used in this study provided significant improvements in the physiological, hemodynamic, functional and autonomic parameters of the patients and consequently their cardiovascular and metabolic exercise performance.


Keywords: Coronary disease/rehabilitation; Coronary disease; Exercise; Exercise test; Treatment outcome

Cardiovascular Image

Narrow QRS complex rhythm without atrial activity: what is the mechanism?

Ritmo com complexos QRS pouco alargados e sem atividade atrial: qual é o mecanismo?

Marcio Luiz Alves Fagundes; Márcio da Silva Campista; Anderson Madeira; Felipe Cícero Miranda; Paulo Ginefra

Rev Bras Cardiol. 2011;24(4):251-253

Abstract PDF PORT

A patient admitted with acute myocardial infarction presented an unusual electrocardiographic record. The relevant aspects of the record for confirming the diagnosis are discussed.


Keywords: Myocardial infarction; Heart conduction system; Bundle-branch block; Electrocardiography; Arrhythmia

Case Report

Endomyocardial fibrosis as a rare cause of mitral insufficiency: case study and literature review

Endomiocardiofibrose como causa rara de insuficiência mitral: relato de caso e revisão da literatura

Danielli Oliveira da Costa Lino; Francisco Hedilberto Feitosa Filho; Ane Karoline Medina Néri; Frederico Augusto de Lima e Silva

Rev Bras Cardiol. 2011;24(4):254-257

Abstract PDF PORT

Case study of a female patient, 62 years old, with prior heart failure (etiology not defined) presenting dyspnea acutely on exertion, and sudden neurological deficit. An echocardiogram showed moderate mitral failure and left ventricular infiltrative obliteration. Ventriculography confirmed an appearance suggestive of endomyocardial fibrosis. Medical treatment (current NYHA I) was selected, with good response. The intention is to present a clinical study of an unusual case with general aspects of this entity according to the latest updates.


Keywords: Cardiomyopathy, restrictive; Endomyocardial fibrosis/classification; Endomyocardial fibrosis/epidemiology; Chagas disease

Pericardial effusion as a form of presentation of hypothyroidism secondary to radioiodine ablation

Derrame pericárdico como forma de apresentação do hipotireoidismo secundário à radioablação com iodo

Aryana Isabelle de Almeida Neves; Nilton Cavalcanti de Macêdo Neto; Cecília de Oliveira Maia; Aline Araújo Padilha

Rev Bras Cardiol. 2011;24(4):258-261

Abstract PDF PORT

Case study of pericardial and pleural effusion accompanied by hemodynamic compromise whose etiology was attributed, through an exclusionary diagnosis, to hypothyroidism secondary to radioiodine ablation two months before the clinical condition. The treatment consisted of pericardiocentesis with pericardial window and hormone replacement therapy with levothyroxine.


Keywords: Per icardial effusion/diagnosis; Hypothyroiudism/complications; Pericardiocentesis; Thyroxine/therapeutic use

Dilated cardiomyopathy secondary to persistentjunctional reciprocating tachycardia

Cardiomiopatia dilatada secundária à taquicardia juncional recíproca persistente

Luís Antônio Lima da Cunha; Hélcio Garcia Nascimento; Guilherme Kopik Bongiorno; Gustavo Rodrigues Marques

Rev Bras Cardiol. 2011;24(4):262-265

Abstract PDF PORT

A woman presented persistent supraventricular tachycardia refractory to pharmacological treatment and with electrocardiographic characteristics consistent with persistent junctional reciprocating tachycardia, including inverted P waves in lower leads and long RP' interval with regard to the RP'/P'R>1. The patient also presented dilated cardiomyopathy secondary to persistent tachycardia, with a significant reduction of the ventricular diameter and important improvement in the ejection fraction of the left ventricle after ablation of the anomalous pathway.


Keywords: Cardiomyoapathy, dilated; Tachycardia, supraventricular; Catheter ablation; Tissue plasminogen activator; Atrial flutter/complications

Conservative treatment of aortic thrombosis in a mechanical heart implant

Tratamento conservador de trombose de prótese mecânica aórtica cardíaca

Luís Antônio Lima da Cunha; Gustavo Rodrigues Marques; Guilherme Kopik Bongiorno; Diego Anselmini

Rev Bras Cardiol. 2011;24(4):266-268

Abstract PDF PORT

This case study presents a male patient with a prosthetic mechanical aortic valve who, after discontinuation of oral anticoagulation in order to perform non-cardiac surgery, developed clinical signs of class II functional heart failure (NYHA) with the disappearance of the metallic click in the aorta. Transthoracic echocardiography indicated the presence of an organized thrombus in the aortic prosthesis with moderate dysfunction. The selected treatment was conservative and non-surgical, incrementing the coumarin effect (INR> 3.0). The patient progressed with the disappearance of the signs of class II HF, restoration of the aortic metallic click and transesophageal echocardiogram showing the disappearance of the organized thrombus.


Keywords: Heart valve prosthetics/adverse effects; Thrombosis; Anticoagulants/therapeutic use; Echocardiography, Transesophageal

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