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

Edition: 23.6 - 11 Article(s)



Ricardo Mourilhe Rocha

Rev Bras Cardiol. 2010;23(6):306


Original Article

Electrocardiogram accuracy in left ventricular hypertrophy diagnosis

Acuidade do eletrocardiograma no diagnóstico de hipertrofia ventricular esquerda

Dinarte Ilídio Azevedo Matos

Rev Bras Cardiol. 2010;23(6):307-314

Abstract PDF PORT

BACKGROUND: As left ventricular hypertrophy (LVH) is a reliable independent risk factor for cardiovascular morbidity and mortality, this paper examines the effectiveness of electrocardiograms (ECG) for diagnosing this serious pathological process, as the most accessible technique.
OBJECTIVE: To compare the accuracy of LVH diagnoses by different electrocardiographic criteria, including the Sokolow-Lyon, Sokolow-Lyon-Rappaport, Cornell, Lewis, Gubner-Ungerleider voltage criteria, the Sokolow-Lyon and Cornell QRS voltage x duration product and finally, the Romhilt-Estes, Framingham and Perugia system scores.
METHODS: The echocardiograms and ECGs of 107 patients were analysed. The receptor-operator characteristics (ROC) curves defined the sensitivity and specificity values of the electrocardiographic criteria in relation to the LVH diagnosis obtained by echocardiographic criteria indexed to body surface (>96g/m2 for women and 116g/m2 for men).
RESULTS: In this sample with 52 men and 55 women, the prevalence of LVH through echocardiography was 56%, with 38% hypertensive patients. The Cornell and Lewis voltage criteria showed the highest sensitivities (21.67% and 25%) for high specificities (97.87% and 100%). The Perugia score revealed 30% sensitivity and 95.74% specificity. The new Cornell index cut-off points (14.5mm for men and 13.5mm for women) showed 55% sensitivity and 82.98% specificity.
CONCLUSION: Although all the electrocardiographic criteria for LVH diagnoses revealed low sensitivity the accuracy can be improved using new cut-off points.

Keywords: Left ventricular hypertrophy; Electrocardiography; Echocardiography; Diagnosis

Heart rate variability, depression, anxiety and stress among intensive care practitioners

Variabilidade da frequência cardíaca, depressão, ansiedade e estresse em intensivistas

Allan Longhi; Carlos Alberto Bezerra Tomaz

Rev Bras Cardiol. 2010;23(6):315-323

Abstract PDF PORT

BACKGROUND: Anxiety, depression and stress have been considered risk factors to cardiovascular diseases among Intensive Care Unit (ICU). These risk factors may be associated with low heart rate variability (HRV)
OBJECTIVE: To determine the prevalence of alterations in HRV variables and anxiety, stress and depression levels among ICU doctors and nurses.
METHODS: HRV analysis through continuous electrocardiogram recording (Holter) during a 12-hour shift, together with questionnaires evaluating anxiety, stress and depression, as well as shift ratings (light, moderate or intense) and rest periods (absent, up to 1 hour or over 1 hour).
RESULTS: Most of HRV indications for the population under study altered when compared to the normal population, especially HF (high frequency) and the LF/HF (high frequency / low frequency) ratio. The shift ranking showed a significant statistical effect for the root mean square successive difference (rMSSD) and LF (low frequency), with effects on the percentage difference between adjacent N-N intervals more than 50 ms (pNN50) and rMSSD at rest. Anxiety, stress and depression levels were rated as minimal or absent in the population under study and do not correlate with alterations in the HRV levels.
CONCLUSIONS: The HF and LF/HF ratios among intensive care practitioners altered when compared to the healthy population. Stress, anxiety and depression levels did not affect the HRV parameters. The at-rest and shift rating variables were correlated to physiological responses reflecting parasympathetic activity.

Keywords: Ambulatory eletrocardiography monitoring; Depression; Anxiety; Health Personnel; Intensive Care Units

Metabolic syndrome among adolescents assisted by a healthcare program in Viçosa, Minas Gerais state, Brazil

Síndrome metabólica em adolescentes atendidos em programa de saúde de Viçosa - MG

Cristiana Araújo Gontijo; Eliane Rodrigues de Faria; Renata Maria Souza Oliveira; Silvia Eloiza Priore

Rev Bras Cardiol. 2010;23(6):324-333

Abstract PDF PORT

BACKGROUND: Epidemiological studies have shown increased prevalence of metabolic syndrome and its risk factors among adolescents.
OBJECTIVE: To verify the prevalence of metabolic syndrome and its risk factors among adolescents.
METHODS: Fasting glycemia, lipid profile, waist girth (WG), hip girth (HG), age, weight and height data were collected from the records of 199 youngsters between 10 and 19 years old assisted by the Adolescent Healthcare Program at Viçosa, Minas Gerais State. The fasting glycemia and lipid profile data refer to the first examinations, with age, weight and height data recorded at the first appointment.
RESULTS: Regarding nutritional status, according to the WHO (2007) standards, 44.2% of the adolescents showed eutrophy, 27.1%, overweight, 19.6%, obesity, 9.1%, underweight and 0.5%, short stature. For biochemical alterations, 73.4; 44.7; 49.7; 41.2 and 5.5% showed alterations in the total cholesterol levels, LDL, HDL, triglycerides and fasting glycemia, respectively. The prevalence of metabolic syndrome reached 16.6%, rising to 35.5% when considering only overweight youngsters, and noting that adolescents with metabolic syndrome presented statistically higher weight, BMI, WG, HG, waist/hip proportion, triglycerides, LDL, fasting glycemia and VLDL (p<0.05) figures. There were more family histories of chronic diseases among individuals with metabolic syndrome, although this finding was not statistically different.
CONCLUSION: The prevalence of metabolic syndrome expressive in the population under study, underscoring the importance of specific adolescent healthcare programs.

Keywords: Metabolic syndrome; Overweight; Adolescents; Dyslipidemias; Hyperglycemia; Viçosa (MG)

Survival in coronary artery bypass grafts and coronary angioplasties paid privately or by health insurance in Rio de Janeiro state: 2000 - 2007

Sobrevida nas reperfusões miocárdicas cirúrgicas e nas angioplastias coronarianas pagas por seguros de saúde e privados no estado do Rio de Janeiro, 2000 a 2007

Paulo Henrique Godoy; Carlos Henrique Klein; Nelson Albuquerque de Souza e Silva; Lúcia Helena Álvares Salis; Gláucia Maria Moraes de Oliveira

Rev Bras Cardiol. 2010;23(6):334-343

Abstract PDF PORT

BACKGROUND: Coronary artery bypass grafts (CABG) and coronary angioplasties (CA) are common medical procedures that must be continually evaluated.
OBJECTIVE: To study survival rates among patients undergoing CABG or CA in Rio de Janeiro State, Brazil, paid privately or by health insurance from 2000 to 2007.
METHODS: Study using databases to identify individuals undergoing these procedures and deaths among them, in order to estimate survival rates. Information on CABG and CA came from Hospital Admission Notifications (CIH) and deaths from death certificates. A probabilistic link was constructed between the databases using the RecLink® program to identify individuals who died after the procedures.
RESULTS: Only 980 procedures were reported in eight years for 937 individuals living in Rio de Janeiro State, with 32.4% of the 509 CABG patients undergoing the procedure in upstate areas and the remainder in other States, 66.6% in São Paulo. We identified 428 individuals with CA, 71.7% in upstate Rio de Janeiro and the others elsewhere, with 22.8% in São Paulo State. No notifications were found of any CABG or CA procedures at private hospitals in the Rio de Janeiro. Municipality. The survival rates for CABG at 7 years were 88.0% and 86.9% for CA.
CONCLUSION: Assessed by survival rates after CA or CABG procedures conducted under the aegis of the supplementary or private health system in Rio de Janeiro State between 2000 and 2007, this performance was not satisfactory, resembling that of the government health system, according to records available from the Hospital Admission Notifications.

Keywords: Survival; Myocardial revascularization; Angioplasty, Balloon, Coronary; Insurance, Medigap

Quality of life among hypertensive patients in outpatient treatment and exercise programs

Qualidade de vida de hipertensos em tratamento ambulatorial e em programas de exercício físico

Daiana Cristine Bündchen; Rafaella Zulianello dos Santos; Maria Helena Antunes; Cícero Augusto de Souza; Artur Haddad Herdy; Magnus Benetti; Tales de Carvalho

Rev Bras Cardiol. 2010;23(6):344-350

Abstract PDF PORT

BACKGROUND: When evaluating the quality of life in terms of Health as a basic parameter for understanding the repercussions of chronic illnesses and their various treatments, there a gap with regard to hypertension.
OBJECTIVE: To evaluate the health-related quality of life among sedentary hypertensive patients attended at a clinic and active hypertensive patients who participate regularly in exercise programs.
METHODS: 87 subjects were divided into two groups: sedentary (n=47; 54.2±11.4 years, 65.2% women) and active (n=40, 64.7±9 years, 75.6% women), using the Quality of Life Mini-Questionnaire for Hypertension (MINICHAL) to evaluate the health-related quality of life among them. The groups were compared through the Student t, Mann Whitney U and Chisquare tests, in addition to the Spearman correlation coefficient.
RESULTS: The mental status of the sedentary group reached an average of 6.57±5.1 and 3.78±3.8 points average for active group, with somatic manifestations for the sedentary group at 4.68±4.3 and 2.93±2.6 for the active group.
CONCLUSION: Hypertensive patients who are physically active enjoy a better health-related quality of life than sedentary hypertensive patients, particularly with regard to their emotional status, although the active group is older and with a higher incidence of cardiovascular events and cardiovascular diseases.

Keywords: Hypertension; Quality of life; Exercise; Sedentary lifestyle

Cardiovascular Image

Electrocardiogram - left atrial rhythm

O eletrocardiograma no ritmo de átrio esquerdo

Ana Flávia Cassini Cunha; Paulo Ginefra

Rev Bras Cardiol. 2010;23(6):351-353

Abstract PDF PORT

The left atrial rhythm was described by Mirowski in 1960. This electrical anomaly is characterized by negative P waves in leads D1 and V6 and positive P waves in lead V1. Subsequently, new studies demonstrated negative P waves in D2, aVL and V6 as well, indicating that the P space vector slants right, from top to bottom and forwards. That same year, Harris and et al. reproduced this rhythm in human beings, through the use of pacing at the right inferior pulmonary / veno-atrial junction, obtaining negative P waves occurred in D2, D3, aVF and V4 to V6, confirming the mechanism of this electrical anomaly.

Keywords: Electrocardiography; Cardiac arrhythmias; Diagnostic techniques and procedures

Inactive area and left bundle-branch block

Zona inativa e bloqueio de ramo esquerdo

Rodrigo do Souto da Silva Sá; Leonardo Rezende de Siqueira

Rev Bras Cardiol. 2010;23(6):354-357

Abstract PDF PORT

Electrocardiograms are crucial for coronary disease management and patient follow-up. After an acute event, the appearance of an inactive area has prognostic value, with its recognition being important, although limited by several factors. A left bundle branch block may hamper this visualization by altering the normal ventricular activation sequence. Knowledge of the ventricular vector sequence activation in these situations and the modifications imposed by the presence of a necrotic zone may allow correct electrocardiographic diagnosis.

Keywords: Electrocardiography; Left bundle-branch block; Myocardial infarction

Point of View

Catheter ablation for atrial fibrillation using oral anticoagulation with therapeutic INR

Ablação por cateter de fibrilação atrial em uso de anticoagulação oral e INR terapêutico

Eduardo Benchimol Saad

Rev Bras Cardiol. 2010;23(6): 358-361

Abstract PDF PORT

Different anticoagulation strategies were studied in order to allow left atrial instrumentation during catheter ablation for atrial fibrillation. The most common is a bridging therapy with low molecular weight heparin used before and after the procedure; however, this strategy is associated with unprotected anticoagulation period and bleeding risks at puncture sites. An alternative is to perform the procedure without suspending the oral anticoagulant and therapeutic INR in order to avoid periods without adequate anticoagulation levels. This strategy has shown to be safe, efficacious and more cost-effective in large centers performing these procedures.

Keywords: Atrial fibrillation; Catheter ablation; Anticoagulants; Warfarin

Case Report

Acute myocardial infarction after taking amphepramone

Infarto agudo do miocárdio após uso de anfepramona

Fernanda Brandão de Oliveira; Luciana da Silva Nogueira de Barros; Wolney de Andrade Martins; Carolina Isabella Gonçalves Costa

Rev Bras Cardiol. 2010;23(6):362-364

Abstract PDF PORT

This case study describes a patient who suffered an acute myocardial infarction after taking amphepramone, an amphetamine analog. Its side effects are discussed, together with its injury mechanisms and risks x benefits for treating obesity in terms of cardiovascular diseases, concluding that this drug should be used with caution, always taken under medical supervision.

Keywords: Myocardial infarction; Obesity; Diethylpropion; Appetite depressants

Wellens syndrome

Síndrome de Wellens

Marcos Antonio Leão de Araújo; Carla Daniela Fank; Ciça Teixeira Penedo; Gustavo Cavalcante Maio de Aguiar; Marlúcia do Nascimento Nobre

Rev Bras Cardiol. 2010;23(6):365-368

Abstract PDF PORT

Wellens Syndrome manifests as an electrocardiography pattern with T wave alterations in precordial leads associated with critical proximal lesions in the anterior descending artery, with high risk of death and myocardial infarction.

Keywords: Wellens Syndrome; Eletrocardiography; Coronary artery disease; Coronary artery