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

Edition: 24.5 - 11 Article(s)



Ricardo Mourilhe Rocha

Rev Bras Cardiol. 2011;24(5):276


Original Article

Ultrasensitive troponin contribution to risk rating by the Timi risk score in patients with acute coronary syndrome without ST elevation

Contribuição relativa da troponina ultrassensível na classificação de risco pelo Timi risk score em pacientes com síndrome coronariana aguda sem supra de ST

Bruno Ferraz de Oliveira Gomes; Braulio Santos Rua; Rafael Aron Abitbol; Gunnar Glauco de Cunto Taets; Clério Francisco de Azevedo Filho; Bernardo Rangel Tura; Ricardo Guerra Gusmão de Oliveira; João Luiz Fernandes Petriz

Rev Bras Cardiol. 2011;24(5):277-281

Abstract PDF PORT

BACKGROUND: The role of ultrasensitive troponin (Tus) in TIMI risk scores (TRS) and clinical decisions has not been established.
OBJECTIVE: To evaluate the relative contributions of positive Tus data to final risk ratings for patients with ACS NSTEMI using the TRS.
METHODS: 59 consecutive patients were studied: 62% men, age=64.2±9 years, hospitalized with ACS NSTEMI and high Tus. All patients underwent coronary angiography. The risk distribution was evaluated through the TRS in subgroups with or without obstructive coronary artery disease (OCAD) >70%. A similar analysis was conducted for the negative Tus hypothesis.
RESULTS: In 43 (73%) patients with OCAD, 21 (48.8%), 16 (37.2%) and 6 (13.9%) patients were found at low, moderate and high risks, respectively. Among them, 11 (25.5%) patients were reclassified: 4 (9.3%) from high to medium risk and 7 (16.3%) from medium to low risk. In 16 (27%) patients without OCAD, 4 (25%), 8 (50%) and 4 (25%) were found with low, medium and high risks respectively. Among them, 10 (62.5%) patients were reclassified: 2 (12.5%) from high to medium risk and 8 (50%) from medium to low risk. A higher prevalence (62.5% vs. 25.5%, p=0.008) was noted among reclassified patients without OCAD.
CONCLUSIONS: The contributions of Tus to TRS ratings as medium or high were greater among patients without OCAD, suggesting that decisions on coronary angiography influenced by the Tus may be associated with lower prevalence of OCAD.

Keywords: Acute coronary syndrome/diagnosis; Acute coronary syndrome/mortality; Risk assessment; Biological markers; Troponin/blood

Significance of in-hospital evaluation of functional capacity in acute coronary syndrome

A significância da avaliação intra-hospitalar da capacidade funcional na síndrome coronariana aguda

Alexandre Gomes Sancho; Silvia Corrêa Bacelar; Samária Ali Cader; Jeferson Braga Caldeira; Carlos Cleverson Lopes Pereira; Newton Almeida Lima Júnior; André Japiassú; Estélio Henrique Martin Dantas

Rev Bras Cardiol. 2011;24(5):282-290

Abstract PDF PORT

BACKGROUND: Functional capacity (FC) can be assessed through the 6-minute walk test (6MWT), but is not usually performed for pre-discharge patients with acute coronary syndrome (ACS).
OBJECTIVE: To assess the significance of functional capacity (FC) through the 6-minute walk test (6MWT) among patients with acute coronary syndrome (ACS) in a coronary care unit (CCU).
METHODS: Experimental cross-section study of 23 patients with stable ACS: 14 men and 9 women, with a mean age of 57 years. All underwent 6MWT for FC assessment before discharge from hospital (4th to 6th day) in the unit hallway. The distance covered was measured together with the Borg scale, respiratory rate, heart rate, systolic, diastolic and mean blood pressure, as well as oxygen saturation, before and after the test.
RESULTS: The application of the 6MWT demonstrated that all the variables (other than the variable mean blood pressure) presented significant differences (p<0.05). Comparing the distance walked to the sample and predictive figures, the paired t-test revealed a significant difference (p=0.0001), but when compared to the predictive-based lower level, no significant difference appeared (p=0.085).
CONCLUSION: The results of this study point to a reduction in the FC of patients with stable ACS in the CCU, confirming the reproducibility of the 6MWT and the sensitivity of the test as required for safe evaluations of performance and FC prior to discharge.

Keywords: Myocardial infarction/diagnosis; Myocardial infarction/physiopathology; Angina, Unstable; Walking/physiology; Exercise test; Exercise tolerance

Conduct of cardiologists towards periodontal disease as a possible risk factor for cardiovascular diseases

Conduta dos cardiologistas frente à doença periodontal como possível fator de risco para as doenças cardiovasculares

Bruna Conde Guimarães de Oliveira; Joel Alves; Luiz Claudio Borges Silva de Oliveira

Rev Bras Cardiol. 2011;24(5):291-298

Abstract PDF PORT

BACKGROUND: Recent studies indicate periodontal disease (PD) as a possible risk factor for the development of atheroma.
OBJECTIVE: To evaluate the conduct and knowledge of practicing cardiologists on the possible relationship between PD and cardiovascular disease (CD).
METHODS: Using a questionnaire with ten questions relating PD to CD, eighty cardiologists were interviewed by email. Their replies were confidential and pertinent to the survey.
RESULTS: Among the respondents, 90% know and 10% do not know about PD; 86% confirm and 14% are unaware of possible links between PD and inflammatory diseases; 40% ask about dentist visits during anamnesis and 60% do not; 60% accept patient reports of gum disease and 40% ignore them; 65% ask patients about oral health and 35% do not; 85% have communicated with a dentist and 15% have not; 30% noted improved cardiac risk among patients with good oral health, 14% evaluate oral health and 56% do not; 79% had read papers relating PD to CD and 21% had not; 74% would attend a course on both subjects (CD and PD) and 26% would not; 89% felt that closer professional links could be built up among medical and dental practitioners and 11% felt this was not possible.
CONCLUSION: The sample studied reported knowledge of PD as a possible risk factor for CD. Despite countless research projects, further studies are needed to encourage interdisciplinary approaches in both specialties, in order to enhance the quality of life among patients.

Keywords: Periodontal diseases; Physicians; Cardiology; Questionnaires; Risk factors; Plaque, atherosclerotic; Cardiovascular diseases

Prevalence of cardiovascular risk factors among adults admitted to the chest pain unit, Vassouras, Rio de Janeiro state

Prevalência dos fatores de risco cardiovascular em adultos admitidos na unidade de dor torácica em Vassouras, RJ

Letícia Neves Martins; Luana Sara de Souza; Cinthia Ferreira da Silva; Rafael Silveira Machado; Carlos Eduardo Ferreira da Silva; Marlon Mohamud Vilagra; Carlos Vitor de Alencar Carvalho; Ana Beatriz Calmon Nogueira da Gama Pereira

Rev Bras Cardiol. 2011;24(5):299-307

Abstract PDF PORT

BACKGROUND: With cardiovascular diseases rated as the leading cause of death in Brazil, monitoring risk factors is an essential step towards reducing this problem.
OBJECTIVE: To estimate the prevalence of the main cardiovascular risk factors among adults living in Vassouras, Rio de Janeiro State, Brazil.
METHODS: Observational, descriptive and transversal study, with sample of 1,060 adults admitted to the Chest Pain Unit at the Sul Fluminense University Hospital in Vassouras, Rio de Janeiro State. It is based on a retrospective analysis of standardized questionnaires completed by patients presenting chest pain, evaluated by: sex, gender, hypertension, diabetes, overweight/obesity, sedentary lifestyles, prior history of acute myocardial infarction, family history, alcohol consumption, smoking and dyslipidemia. The data were stored and analyzed using Microsoft Excel software. A 95% Confidence Interval was used, together with the chi-square test for statistical analysis, with significance at 1% and 5%.
RESULTS: The sample consisted of 51.4% females and 48.6% males. The main risk factors were: 65% hypertension, 49.4% family history, 42.8% sedentary lifestyles, 25.3% overweight/obesity, 23% smoking, 22.9% dyslipidemia, 19.7% diabetes, 18.5% infarction and 8.6% alcoholism.
CONCLUSION: The magnitude of the prevalence of these risk factors suggests that health promotion and preventive strategies must be stepped up, in parallel to improving emergency care for patients at risk for coronary disease.

Keywords: Cardiovascular diseases/etiology; Chest pain; Risk factors; Prevalence; Epidemiology

Review Article

Metabolic syndrome: is cardiovascular risk higher than for its individual components?

Síndrome metabólica: o risco cardiovascular é maior que o risco dos seus componentes isoladamente?

Camillo de Léllis Carneiro Junqueira; Gerusa Maritimo da Costa; Maria Eliane Campos Magalhães

Rev Bras Cardiol. 2011;24(5):308-315

Abstract PDF PORT

The description of metabolic syndrome, which initially pursued a link between diabetes and cardiovascular disease, has changed as knowledge progressed. Several aspects have become more noteworthy, including discrepancies among diagnostic criteria that imply different prevalences for metabolic syndrome, depending on its definitions, and the exclusion of risk factors such as smoking and high LDL. Other pertinent doubts related to the validity of considering type 2 diabetes mellitus as a part of metabolic syndrome and to what extent its treatment should differ from the treatment of its individual components. This doubt is relevant as, once established as a disease, medications indicated for the specific treatment of the syndrome can be developed, rather than solely for its risk factors. This is why - particularly as there are many different definitions - there is considerable confusion and lack of comparability among studies. Thus, despite extensive investigation, there is still no gold standard for defining metabolic syndrome, which continues under discussion. This review examines whether and to what extent its individual components are associated with risk of cardiovascular disease.

Keywords: Cardiovascular diseases/ethiology ; Metabolic syndrome; Risk factors; Diabetes mellitus; Cross-sectional studies

Preliminary Communication

Percutaneous occlusion of the left atrial appendage in atrial fibrillation

Oclusão percutânea do apêndice atrial na fibrilação atrial com risco embólico

Eduardo Benchimol Saad; Charles Slater; Luiz Antonio Oliveira Inácio Jr; Arnaldo Rabischoffsky; Carlos Augusto Cardoso Pedra; Angelina Camiletti; Luiz Eduardo Montenegro Camanho; André Luiz Buchele d'Avila

Rev Bras Cardiol. 2011;24(5):316-319

Abstract PDF PORT

BACKGROUND: Atrial fibrillation is associated with an increased risk of embolic events. The left atrial appendage is the main source of thrombi.
OBJECTIVES: To describe and evaluate the safety of left atrial appendage occlusion technique.
METHODS: Two patients (one 79 year old man and one 91 year old woman) with atrial fibrillation and high thromboembolic risk, with counter-indications for anticoagulation therapy underwent percutaneous occlusion of the left atrial appendage.
RESULTS: In both cases, the device was deployed with no residual flow, with complete exclusion from the circulation and with no complications. Double antiplatelet therapy was maintained for 3 months.
CONCLUSIONS: Percutaneous occlusion of the left atrial appendage is a new and effective method for preventing thromboembolic events in patients with atrial fibrillation.

Keywords: Atrial appendage/physiopathology; Atrial fibrillation; Thromboembolism; Anticoagulants; Protheses and implants

Heart failure prevalence study among patients enrolled in the family health program, Niterói. The DIGITALIS Study: design and method

Estudo da prevalência de insuficiência cardíaca em indivíduos cadastrados no programa médico de família - Niterói. Estudo DIGITALIS: desenho e método

Antonio José Lagoeiro Jorge; Maria Luiza Garcia Rosa; Luiz Claudio Maluhy Fernandes; Monica Di Calafiori Freire; Ronaldo Campos Rodrigues; Dayse Mary da Silva Correia; Hye Chung Kang; Evandro Tinoco Mesquita; Investigadores do Estudo DIGITALIS

Rev Bras Cardiol. 2011;24(5):320-325

Abstract PDF PORT

BACKGROUND: Heart failure (HF) represents a major public health problem with high costs and increasing prevalence in the developed and developing countries. Data from Brazil's National Health System, which provides 80% of medical care for the Brazilian population, show that cardiovascular diseases rank third among causes of hospitalization, with HF the most common among them after sixty years of age. Epidemiological surveys examining the prevalence of HF are scarce in Brazil, particularly in the primary care segment.
OBJECTIVE: To estimate the prevalence of heart failure in the primary care segment.
METHODS: Observational cross-section study of 632 randomly selected individuals aged > 45 years, assisted by the Family Doctor Program in Niteroi, Rio de Janeiro State. Diagnoses of HF are confirmed or excluded through clinical examinations, electrocardiograms, echocardiograms and BNP measurements. All patients are classified in stages evaluating the pathophysiological progression of HF, as established in the III Brazilian Guidelines on Chronic HF.
CONCLUSION: This study intends to establish the prevalence of HF in an urban community, which will help in HF healthcare policy planning.

Keywords: Heart failure/epidemiology; Public health; Unified health system; Family Health Program; Brazil

Cardiovascular Image

Curable ventricular tachycardia in a patient with ischemic myocardiopathy

Taquicardia ventricular curável em paciente com miocardiopatia isquêmica

Fernando Senn; Iara Atié; Leonardo Siqueira; Jacob Atié

Rev Bras Cardiol. 2011;24(5):326-330

Abstract PDF PORT

In patients with conduction delays within the His-Purkinje system, macroreentries through the right and left branch bundles may cause sustained ventricular tachycardias that are called bundle branch reentrant or branch-to-branch reentry ventricular tachycardias. The diagnosis of this type of arrhythmia is very important as it does not generally respond to pharmacological treatment, with high recurrence rates, and may result in palpitations, syncope, sudden death or multiple therapies in patients with implantable cardiac defibrillators. It is extremely important to diagnose branch-to-branch reentry ventricular tachycardia, as it can be cured through catheter ablation.

Keywords: Tachycardia, ventricular; Bundle-branch block; Cardiomyopathies; Electrocardiography

Case Report

Angiographic diagnosis of ruptured left ventricular free wall in acute myocardial infarction

Diagnóstico angiográfico da ruptura de parede livre do ventrículo esquerdo no infarto agudo do miocárdio

Rafael Cordeiro Soares; Felipe Montes Pena; Nina Pimentel do Patrocínio; Jamil da Silva Soares

Rev Bras Cardiol. 2011;24(5):331-334

Abstract PDF PORT

A male patient with typical precordialgia was admitted with a delta T of 8 hours. Diagnosed as myocardial infarction with ST elevation in the anterior wall, he was referred for coronary angiography for primary angioplasty, revealing the total occlusion of the anterior descending artery and 90% for the right coronary artery, without success. During the procedure, the clinical signs of cardiac tamponade grew worse and ventriculography showed a rupture of the left ventricular wall. A pericardial puncture was performed, relieving the symptoms. Surgical treatment was indicated, but proved unsuccessful and the patient died.

Keywords: Myocardial infarction/complications; Ventricular dysfunction, left/complications; Angioplasty

Left main coronary intervention in nonagenarian with cardiogenic shock

Angioplastia de tronco em nonagenária com choque cardiogênico

Nathália Felix Araujo; Gisele Rodrigues de Abreu; Leonardo Baunworcel; Ricardo Mourilhe-Rocha

Rev Bras Cardiol. 2011;24(5):335-338

Abstract PDF PORT

Cardiogenic shock is the result of temporary or permanent disorders of the circulatory system, constituting the clinical expression of left ventricular failure, with a mortality rate of 50% to 60% and more severe outcomes among older patients. This report presents a case of acute myocardial infarction progressing to cardiogenic shock (Killip IV) in a patient in the tenth decade of life who progressed satisfactorily after coronary angioplasty and circulatory support. In view of the known low survival rate for this patient profile, this case allows a re-appraisal of investment levels in similar situations.

Keywords: Aged, 80 and over; Shock, cardiogenic, Myocardial infarction/complications; Angioplasty, balloon, coronary; Coronary artery disease