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

Edition: 23.4 - 7 Article(s)

Editorial

Editorial

Ricardo Mourilhe Rocha

Rev Bras Cardiol. 2010;23(4):214

PDF PORT


Original Article

Intra-operative factors in coronary artery bypass graft (CABG) surgery in government hospitals, Rio de Janeiro, Brazil

Fatores intraoperatórios nas cirurgias de revascularização do miocárdio em hospitais públicos do município do Rio de Janeiro

Marcio Roberto Moraes de Carvalho; Nelson Albuquerque de Souza e Silva; Gláucia Maria Moraes de Oliveira; Carlos Henrique Klein

Rev Bras Cardiol. 2010;23(4):215-223

Abstract PDF PORT

BACKGROUND: Although surgical performance depends largely on pre- and post-operative conditions, intra-operative events may also be associated with these outcomes.
OBJECTIVE: To evaluate the association between intraoperative factors and times of death among patients undergoing CABG surgery in four government hospitals in the City of Rio de Janeiro, between January 1999 and December 2003.
METHODS: Random weighted samples of 150 patient records with survivors and deaths were selected at four government hospitals in the City of Rio de Janeiro. Information on intra-operative characteristics and times of death was collected retrospectively from the medical records and declarations of death. The lethality rates were estimated for several timeframes extending up to a year after the operation.
RESULTS: 7.4% of the deaths occurred in the operating theater; 40.3% by Day 3 and by Day 15, 69% of the deaths occurring during the first year. By the end of the first year, 14.9% of the patients were deceased. Longer extracorporeal circulation or aortic clamping times were found among patients who died during surgery. Low debit, cardio-respiratory failure (CRF) and severe intra-operative ventricular arrhythmia were significantly associated with early death. Intra-operative atrial fibrillation was associated more frequently with death on the second and third days after surgery.
CONCLUSION: Intra-operative factors contributed to the occurrence of early deaths, representing two thirds of deaths during the first year after surgery.


Keywords: Coronary artery bypass graft (CABG) surgery, Lethality, Intra-operative complications

Factors associated with lower radiation doses in patients undergoing 64-slice computed tomography

Fatores associados à menor dose de radiação em pacientes submetidos à angiotomografia de artérias coronárias de 64 canais

Ilan Gottlieb; Renato Kaufman; Patricia Rizzi; Iugiro Roberto Kuroki; Amanda Cardoso Berensztejn; Daniela Paiva; Fabio Luis Silva; João Augusto Costa Lima; Ronaldo de Souza Leão Lima

Rev Bras Cardiol. 2010;23(4):224-229

Abstract PDF PORT

BACKGROUND: In parallel to an upsurge in the use of computed tomography coronary angiography (CTCA), the literature varies widely in terms of radiation doses, prompting worldwide concern about radiation exposure in medical procedures, with strong support for strategies aimed at reducing these doses.
OBJECTIVES: To determine the radiation dose employed in CTCA studies in a private clinic at Rio de Janeiro, Brazil, and the factors associated with lower radiation doses.
METHODS: Retrospective observational study of 232 consecutive patients clinically referred for 64-slice CTCA with radiation dose reduction techniques.
RESULTS: The mean radiation dose was 7.6mSv, with no difference between men and women (7.9mSv vs. 7.0mSv, respectively, p=0,15). Electrocardiogram (ECG) dose modulation and reduced 100kV tube voltage are associated with dose reductions of approximately 50% each. Factors such as increasing age and the presence of coronary stents are associated with higher exposure.
CONCLUSIONS: The routine radiation dose used with exposure minimization techniques is substantially lower than that reported in the literature, and approximately half of that usually employed in 99mTc sestamibi nuclear myocardial perfusion studies. ECG dose modulation and 100kV tube voltage of should be used whenever possible.


Keywords: Coronary angiography, Computed tomography, Coronary artery disease, Radiation

Less adherence to supervised exercise program among obese patients

Obesos apresentam menor aderência a programa de exercício supervisionado

Fernanda de Souza Nogueira Sardinha Mendes; Claudia Lucia Barros de Castro; Claudio Gil Soares de Araújo

Rev Bras Cardiol. 2010;23(4):230-237

Abstract PDF PORT

BACKGROUND: The current upsurge in obesity and the chronic degenerative diseases related to this condition underscore the need to develop preventive primary interventions that could counteract this process. Among these interventions, it is known that regular physical exercise and greater aerobic fitness offer benefits by reducing cardiovascular and all-cause morbidity and mortality.
OBJECTIVE: To determine the association between obesity and adherence with a medically-supervised exercise program (MEP).
METHODS: Selected from a MEP between January 2007 and September 2009, 267 patients underwent pre-participation medical evaluations that included anthropometric measurements. Participants adherent to the MEP were taken as being: (A) those who attended at least, five exercise sessions in the first three months of 2010, ranking the others as non-adherent (NA). The selected variables were compared and the body mass index (BMI, kg/m2) stratified in five levels: <25; 25 to 29.9; 30 to 34.9; 35 to 39.9 and> 40.
RESULTS: The BMI was higher for the NA Group - 28.2kg/m2 versus 26.6kg/m2 (p=0.004) with a higher percentage of obese individuals in this group (29.7% in the NA Group versus 18.5% in Group A), generating relative non-adherence risks of 1.61 for BMI>30kg/m2, 1.97 for BMI>35kg/m2 and 2.63 for BMI>40kg/m2.
CONCLUSION: A strong link was noted between obesity and abandoning a MEP.


Keywords: Obesity, exercise, Physical training, Exercise, Adherence

Seasonal fluctuation of head-up tilt-table test outcomes in the tropics

Efeito da sazonalidade tropical sobre os resultados do teste da mesa de inclinação

Camila dos Santos Moreira de Souza; Paulo Roberto Benchimol-Barbosa; Eduardo Corrêa Barbosa; Alfredo de Souza Bomfim; Beatriz Timbó Neves Regadas; Ricardo Frederico Ferreira; Thiago do Souto da Silva Sá; Ricardo Luiz Ribeiro; Paulo Ginefra

Rev Bras Cardiol. 2010;23(4):238-243

Abstract PDF PORT

BACKGROUND: High-temperature environments are rated as triggers for vaso-vagal orthostatic intolerance (VOI). However, there is little information on seasonal fluctuations of head-up tilt table test (HUT) outcomes.
OBJECTIVE: To evaluate seasonal fluctuation in HUT outcomes in a tropical city.
METHODS: We assessed 501 consecutive HUTs conducted at two institutions in the city of Rio de Janeiro, from June 2003 to August 2008 (6 y.o to 90.y.o, 39% males). The test response was defined as positive by the VASIS criteria. The VOI positive (+) outcome rate was compared during the period with the average monthly and seasonal rates. Having tested normality assumption and homocedasticity through the Bartlett test, the findings were compared through one-way ANOVA tests for nonrepeated measurements. The outcomes are presented as mean±DP.
RESULTS: The VOI was positive in 30.3%. Normality (Std Skewness: 1.5±0.4; Std Kurtosis: -0.4±0.8) and homocedasticity assumptions were accepted in all groups. No significant differences were observed in the monthly or seasonal average rates of VOI+ outcome in all comparisons (respectively, p=NS and p=NS).
CONCLUSIONS: In the city of Rio de Janeiro, positive outcomes for HUT present uniform distribution throughout the year for months and seasons.


Keywords: Tilt-table testing, Neurocardiogenic syndrome, Seasonality

Review Article

Stress test evaluation of dysautonomia in heart failure patients

Avaliação de disautonomia nos pacientes com insuficiência cardíaca através de teste de esforço

Leandro Rocha Messias; Maria Angela Magalhães de Queiroz Carreira; Cláudio Tinoco Mesquita

Rev Bras Cardiol. 2010;23(4):244-250

Abstract PDF PORT

A non-invasive method with ample clinical application in cardiology, stress testing is no longer limited to diagnosing coronary artery disease, due to the broad range of information that it provides. Associating changes in clinical, metabolic and hemodynamic responses with electrocardiographic alterations has extended its diagnostic and prognostic capacities. More recently, evaluating the behavior of the autonomic nervous system during dynamic exercise has proven extremely valuable for severe cardiovascular diseases, such as heart failure. This paper describes how new stress test parameters may be deployed to evaluate the autonomic nervous system in heart failure patients, in addition to describing its prognostic implications.


Keywords: Heart failure, Stress test, Autonomic dysfunction

Case Report

Acute myocardial infarction as presentation of spontaneous coronary artery dissection

Infarto agudo do miocárdio como apresentação de dissecção espontânea coronariana

Hellen Ast de Andrade; Luiz Augusto Feijó; Guilherme Cruz Lavall; Angelo Leone Tedeschi

Rev Bras Cardiol. 2010;23(4):251-254

Abstract PDF PORT

This case study presents a previously healthy young woman with acute myocardial infarction, initially treated with thrombolytic therapy, and transferred to our institution. She underwent cardiac catheterization that showed an image compatible with a long stretch of dissection in the right coronary artery, treated through angioplasty, with two bare metal stents implanted and complete restoration of vessel flow, progressing well from the clinical standpoint.


Keywords: Dissection, Myocardial infarction, Angioplasty, Thrombolytic therapy

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