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

Edition: 24.6 - 13 Article(s)



Ricardo Mourilhe Rocha

Rev Bras Cardiol. 2011;24(6):346


Original Article

Ambulatory blood pressure monitoring and chronic heart failure prognosis

Monitoração ambulatorial da pressão arterial e prognóstico de insuficiência cardíaca crônica

Marcos Ferreira da Silva; Nathália Baptista Nicolay; Evandro Tinoco Mesquita

Rev Bras Cardiol. 2011;24(6):347-353

Abstract PDF PORT

BACKGROUND: Studies using continuous blood pressure monitoring demonstrate its association with prognoses of heart failure. However, the disease must be broken down into stages.
OBJECTIVE: To determine the association between ambulatory blood pressure monitoring variables and prognoses of chronic heart failure.
METHODS: For 32 months, 76 patients were evaluated, with chronic heart failure in functional classes II and III of the New York Heart Association, stratified by left ventricle ejection fraction (LVEF<50% and LVEF>50%). Ambulatory blood pressure monitoring was used to test these variables, with an outcome of death together with hospitalization.
RESULTS: In the sample population, the average systolic pressure when awake (ABPSv/p=0.014) (with outcome vs. without outcome); systolic when asleep (ABPSs/p=0.017); and casual systolic (BPS off/p=0.005) were lower among patients with the outcome, but did not present any independent association therewith. For patients with LVEF <50%, systolic pressure at 24 hours (ABPS-24h/p=0.038), ABPSs (p=0.015) and systolic load during sleep (LSISTs/p=0.040) were lower with the outcome. In a multivariate analysis, the MPSs [beta coefficient = -0.3912±0.1290 (CI 95% = -0.3423 - -3.0323)]; [RR=2.77 (CI 95% =1.16 - 8.11 / p=0.004)] was the only ABPM variable associated independently with the outcome, and when < 108.5mmHg, the same occurred [Kaplan-Meier (log rank = 0.032)]. For patients with LVEF>50%, the small sample and low number of events limited the statistical analysis.
CONCLUSION: Ambulatory blood pressure monitoring seems to be useful for prognostic assessments of stable chronic heart failure with LVEF<50%.

Keywords: Blood pressure monitoring, ambulatory; Heart failure; Prognosis; Ambulatory care; Hypertension

Hypotensive effects of resistance exercises performed at different intensities by the elderly

Efeito hipotensivo de exercícios resistidos realizados em diferentes intensidades em idosos

Mônica Menezes Oliveira; Vinícius de Oliveira Damasceno; Jorge Roberto Perrout de Lima; Arise Garcia de Siqueira Galil; Elisa Maria Rodrigues dos Santos; Jefferson da Silva Novaes

Rev Bras Cardiol. 2011;24(6):354-361

Abstract PDF PORT

BACKGROUND: There are few studies investigating postexercise hypotension (PEH) in elderly hypertensive patients.
OBJECTIVE: To determine the PEH of resistance exercise (RE) performed at different intensities by elderly stage I hypertensives.
METHODS: Ten men with stage I hypertension, aged 66.0±4.4 years, after 10RM test and exercise familiarization, completed two training sessions: at 80% and 100% of 10RM with an interval of 48h. During the activity and up to 24h afterwards, the subjects were overseen through ambulatory blood pressure monitoring (ABPM), evaluating their systolic and diastolic blood pressure and pulse pressure. The normality of the data was ascertained through the Shapiro-Wilk test, using descriptive statistics to describe the variables. The mean variable differences between pre-stressing - awake, and post-exercise - awake and post-exercise - sleep at were measured both intensities through variance analysis, with repeated measurements followed by Tukey's post hoc HSD test (p <0.05).
RESULTS: PEH was noted in elderly hypertensive patients during the post-exercise - awake period at the different intensities used, but was significantly different from pre-exercise - awake only at 80% of 10RM.
CONCLUSION: The findings suggest that a single session of RE performed at different intensities (80% and 100% of 10RM) can promote PEH in elderly hypertensive patients (stage I). Working at lower intensities, such as 80% of 10RM, may be more efficient for these reductions.

Keywords: Blood pressure; Hypotension; Elderly

Aerobic and resistance exercises: influence of intensity on post-exercise hypotension

Exercícios aeróbios e resistidos: influência da intensidade na hipotensão pós-esforço

Francisco Zacaron Werneck; Jorge Roberto Perrout de Lima; Marcos Doederlein Polito; Emerson Filipino Coelho; Luiz Scipião Ribeiro

Rev Bras Cardiol. 2011;24(6):362-368

Abstract PDF PORT

BACKGROUND: There is little information available on self-selected effort intensity in terms of post-exercise cardiovascular responses.
OBJECTIVE: To compare the acute effects on after-exertion blood pressure (BP) of a resistance exercise session and treadmill running at pre-set and self-selected intensities.
METHODS: Eighteen healthy men (22.4±6.5 years, 72.3±11kg, 176.7±7.8cm, VO2max=51.9±5.9ml.kg-1.min-1) experienced in exercise sessions completed seven random sessions on different days: 1) resistance exercise with 50% of eight maximum repetitions (8RM); 2) resistance exercise with 100% 8RM; 3) resistance exercise with self-selected intensity; 4) Run at 60-65% of maximal heart rate (HRmax); 5) Run at the 85-90% HRmax; 6) Run at self-selected intensity; and 7) control without exercise. BP was measured before each session and then 1min and 30min afterwards.
RESULTS: Post-exercise hypotension at 30 min was noted after the end of the session, with no significant difference in post-exercise hypotension related to the type or intensity of the exercises. Post-exercise hypotension for aerobic exercise ranged from 4-9mmHg and 3-6mmHg for systolic and diastolic BP, respectively, ranging from 3-10mmHg to 5-10mmHg respectively for the fall resistance exercise.
CONCLUSION: Both resistance exercise and treadmill running at pre-set (low and high) and self-selected (moderate) intensities may cause post-exercise hypotension at similar magnitudes in normotensive individuals.

Keywords: Blood pressure/physiology; Exercise/physiology; Post-exercise hypotension; Hypertension/physiopathology

Epidemiological profile for coronary artery bypass grafting surgery

Perfil epidemiológico na cirurgia de revascularização miocárdica

Renato Kaufman; Maria Cristina Caetano Kuschnir; Regina Maria Aquino Xavier; Marco Aurelio Santos; Rogério Brant Martins Chaves; Regina Elizabeth Müller; Márcia Cristina Chagas Macedo Pinheiro; Antônio Luiz Pinho Ribeiro; Vitor Manuel Pereira Azevedo

Rev Bras Cardiol. 2011;24(6):369-376

Abstract PDF PORT

BACKGROUND: Coronary heart disease is the main cause of death worldwide and patients undergoing coronary artery bypass grafting (CABG) form a higher risk group.
OBJECTIVE: To analyze epidemiological aspects of CABG from August 2004 to June 2009 in a hospital specializing in heart surgery, in Rio de Janeiro, Brazil.
METHOD: Conducted from August 2004 to June 2009, this retrospective study analyzed the first CABG in 1,029 consecutive patients more than 18 years old. Pre-operative data were analyzed, together with the type of hospital progression (release versus death).
RESULTS: Average age 61.2±10.3 years old; 67.3% were male, weight 72.0±13.6kg, height 1.63±0.09m, Body Mass Index 26.9±4.3kg/m2 and body surface area 1.77±0.19m2. Skin color by observed self-classification: 75.8% white, 16.5% mixed race and 7.7% black versus, compared to an expected (IBGE - 2008): 54.3% white, 33.8% mixed race, 11.5% black and 0.3% Asian or indigenous (p<0.0001). Cardiovascular risk factors: 88.3% systemic hypertension, 66.4% dyslipidemia, 173±50.2mg/dl serum cholesterol, 50.4% family history, 32.9% diabetes mellitus, and 56.6% previous smoking. EuroSCORE 4.91%±6.81% (quartiles 1.40% and 5.26%). The mortality rate (8.89%) was higher than expected (4.91%) (p<0.0001).
CONCLUSION: Better knowledge of risk factors allows prevention, assists physicians when taking decisions, and ensures better resource allocation. There was an unexpected and disproportionate prevalence of patients classified as white and a high prevalence of cardiovascular risk factors, with mortality higher than expected in this group of patients.

Keywords: Myocardial revascularization/mortality; Survival analysis; Risk assessment; Hospitals, special; Coronary diseases; Epidemiology

Heart rate decline anomalies during treadmill tests for diabetics

Anormalidades no descenso da frequência cardíaca ao teste ergométrico em diabéticos

Maria Angela Magalhães de Queiroz Carreira; Felipe Montes Pena; Karina Seixas Garcia; Igor Natário Pinheiro; Ananda Altoé; Luana Alves Rocha de Carvalho; Maria Rômulo Fernandes; Lyvia Cabral Pereira

Rev Bras Cardiol. 2011;24(6):377-381

Abstract PDF PORT

BACKGROUND: Studies have shown that autonomic cardiovascular dysfunction measured by heart rate variability is associated with increased cardiovascular risk.
OBJECTIVES: To compare the presence of dysautonomia in diabetic and nondiabetic patients through treadmill tests, determining autonomic dysfunction predictors in diabetics.
METHODS: Retrospective study with patients who underwent elective treadmill testing with individualized ramp protocols. The patients were divided into two groups: diabetic (G1) and non-diabetic (G2). Dysautonomic patients were defined as those achieving HR reduction of > 12bpm during the first minute of recovery. The G1 and G2 groups were compared. Variables with p values of <0.10 were submitted to logistic regression analysis.
RESULTS: Among 1433 patients undergoing treadmill tests, the average age was 52.65±13.06 years, ranging from 18 to 92 years old. Notable among the G1 anthropometric and clinical variables were patients who were older, obese and dyslipidemic, compared with G2. In the exercise test, differences in FHR were noted in the first minute, in addition to peak effort HR, functional capacity and chronotropic deficit between the groups. Logistic regression of the variables for the entire sample (diabetics and nondiabetics) indicated a single dysautonomia predictor: functional capacity (CI95% 0.083/0.031; p<0.0001); among diabetics, the only independent dysautonomia predictor was the body mass index (CI95% 0.002-0.025; p=0.02).
CONCLUSION: HR recovery is slower among diabetic patients compared to non-diabetics, with increased autonomic dysfunction and reduced physical capacity; overweight diabetics present greater involvement of the autonomic system.

Keywords: Diabetes mellitus; Primary dysautonomias; Heart rate; Exercise test

Review Article

Role of echocardiograms for evaluating cardiotoxicity in breast cancer treatment

Papel do ecocardiograma na avaliação da cardiotoxicidade no tratamento do câncer de mama

Mauricio Pimentel Costa; Márcia Bueno Castier; Constantino Gonzalez Salgado

Rev Bras Cardiol. 2011;24(6):382-386

Abstract PDF PORT

Breast cancer is among the most important public health issues in Brazil, with an estimated 49,400 new cases in 2010. However, 25% to 35% of patients are already in advanced stages of the disease on arrival at specialized cancer treatment centers, requiring chemotherapy. Doxorubicin and trastuzumab are currently the most active drugs for treating breast cancer, but with myocardial damage as a side effect. The most widely used method for diagnosing and monitoring damage caused by anticancer therapy is the echocardiogram. This is due to several factors such as: highly reliable findings; availability even in low-complexity centers; low cost; non-invasive and easy to perform. Usually viewed as echocardiography limitations, the low reproducibility of the findings and the fact that the ejection fraction is the sole cardiac function indicator can be largely offset by including the Doppler tissue analysis method for diastolic function, strain and three-dimensional echo tests. This paper reviews the latest echocardiographic techniques and their application in oncocardiology.

Keywords: Breast neoplasm/drug therapy; Doxorubicin/adverse effects; Ventricular dysfunction echocardiography; Heart failure

Cardiovascular Image

Hard-to-control ventricular tachycardia in an unusual case of myocarditis with involvement of the right ventricle

Taquicardia ventricular de difícil controle em caso atípico de miocardite com acometimento de ventrículo direito

Eduardo Costa Gonçalves; Martha Demetrio Rustum; Thaís Mendonça Lips de Oliveira; Washington Maciel

Rev Bras Cardiol. 2011;24(6):387-390

Abstract PDF PORT

The clinical presentation of myocarditis ranges from asymptomatic cases through to sudden death. Among symptomatic cases, heart failure is the most common manifestation. Arrhythmia, heart block and symptoms suggestive of coronary syndrome may occur. The diversity of clinical presentations, together with dependence on myocardial biopsy, makes diagnosis a challenge. New methods, such as cardiovascular magnetic resonance imaging, are becoming more important and assisting in investigations of suspected cases. The authors report a case of ventricular tachyarrhythmia that was hard to control, with a suggestive center at the apex of the right ventricle. The diagnostic hypothesis of myocarditis was confirmed by MRI.

Keywords: Tachycardia ventricular; Myocarditis; Myocardium/pathology; Magnetic resonance spectroscopy/diagnostic use

Point of View

Percutaneous occlusion of the left auricular appendage in patients with atrial fibrillation: an alternative to anticoagulation therapy

Oclusão percutânea da auriculeta esquerda em pacientes com fibrilação atrial: uma alternativa à terapia anticoagulante

Eduardo Benchimol Saad

Rev Bras Cardiol. 2011;24(6):391-394

Abstract PDF PORT

Patients with atrial fibrillation are at increased risk of thromboembolic events. Long term anticoagulation therapy is recommended for those with a CHADS2 score >2. The left auricular appendage is the most common source of thrombus. As such, its exclusion can reduce the risk of embolic accidents. This paper discusses the use of new devices for percutaneous occlusion of the auricular appendage.

Keywords: Atrial fibrillation/complications; Anticoagulants/therapeutic use; Heart catheterization; Embolism/etiology; Hemorrhage/chemically induced; Atrial Appendage

Risk of sudden death during marathons: an evidence-based opinion

Risco de morte em maratonas: uma opinião baseada em evidências

Claudio Gil Soares de Araújo

Rev Bras Cardiol. 2011;24(6):395-400

Abstract PDF PORT

Regular physical exercise is an important instrument for public health. During the past few years, interest in street sports events has been increasing, particularly running marathons. Almost all the world's major cities now organize such events, with some attracting over 40,000 runners, often more than 40 years old. Occasional reports appear of sudden deaths related to these events, contributing to doubts among physicians about allowing their patients to participate, even when apparently healthy. This paper briefly reviews the main evidence, finding that the actual risk is quite low, estimating one death for around 100,000 participations, and stressing that there are no appropriate medical strategies for wide-scale scale use that could reduce this very low rate even further. On the other hand, there are countless health benefits for participants that certainly outweigh these very low risks of unfavorable events. It is thus suggested that physicians adopt an evidence-based risk stratification approach, while avoiding hypermedicalization or generating difficulties that might well clash with healthy decisions to become more active physically and participate in mass street sports.

Keywords: Running/physiology; Death sudden; Physical exertion/physiology; Risk factors

Case Report

Hypertensive emergencies as the initial clinical manifestation of acute coronary syndrome

Emergências hipertensivas como manifestação clínica inicial de síndrome coronariana aguda

Henrique Wolfgang Besser; Luiz Antônio Ferreira Carvalho

Rev Bras Cardiol. 2011;24(6):401-404

Abstract PDF PORT

This report addresses three elderly patients with arterial hypertension and chronic coronary artery disease, asymptomatic and clinically well controlled until sudden unexpected blood pressure spikes indicated the start of an acute coronary event. The patients completed ECG tracings, serial enzymes, chest X-rays and echocardiograms, opting for emergency coronary angiography. The absence of chest pains, poor compliance with treatment and significant emotional/ physical stress was noted in all of them, with critical obstructive lesions and the presence of fresh thrombi in major bloodvessels with functional relevance (culprit artery), returning to normal blood pressure levels after correction of the ischemia through coronary angioplasty.

Keywords: Acute coronary syndrome; Hypertension/physiopatology; Endothelins

Clinical exacerbation of Brugada syndrome in a patient with fever

Exacerbação clínica da síndrome de Brugada em paciente com febre

Marina Bucar Barjud; Miguel Angel Torralba Cabeza; Juan Ignacio Pérez Calvo; Belen Loren Artigas

Rev Bras Cardiol. 2011;24(6):405-407

Abstract PDF PORT

Brugada syndrome (BrS) is an electrical alteration without apparent underlying structural heart disease, handed down through an autosomal dominant gene. Mutations have been identified in the SCN5A subunit encoding gene of the Nav1.5 voltage-gated sodium channel. This paper presents a case report on a 56-year old male patient diagnosed with BrS and contamination of a migrated vascular endoprosthesis, leading to implantable automatic defibrillator (IAD) dysfunction and two types of complications: arrythmogenic episodes associated with fever that led to appropriate discharges of the IAD and episodes characterized by inappropriate discharges of the IAD.

Keywords: Brugada Syndrome/complications; Brugada Syndrome/physiopathology; Heart arrest/etiology; Fever/complications; Arrhythmia; Sudden death


Erratum. Tibana RA, Balsamo S, Prestes J. Association between muscle strength and at-rest blood pressure among sedentary women. Rev Bras Cardiol. 2011;24(3):163-8.

Erratum. Tibana RA, Balsamo S, Prestes J. Associação entre força muscular relativa e pressão arterial de repouso em mulheres sedentárias. Rev Bras Cardiol. 2011;24(3):163-8.

Rev Bras Cardiol. 2011;24(6):408-409

Abstract PDF PORT

The original paper addressed by this Erratum was published in the May-June 2011 issue of the Revista Brasileira de Cardiologia (Rev Bras Cardiol.), volume 24, Nº 3, pages 163-168. After publication, a mistake was noted in the use of the body adiposity formula of Bergman et al. The authors present a new Table with the data calculated by the correct formula, and conclude that the alteration in the anthropometric measurement used in the equation does not affect the findings and conclusions of the study.

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