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

Edition: 27.3 - 11 Article(s)

Original Article

Indication myocardial revascularization in dialysis patients

Indicação de revascularização miocárdica em pacientes dialíticos

Andréa Bezerra de Melo da Silveira Lordsleem; Brivaldo Markman Filho; Ana Paula Santana Gueiros; Jose Edevanilson Barros Gueiros; Fernando Ribeiro de Moraes Neto

Rev Bras Cardiol. 2014;27(3):147-157

Abstract PDF PORT

BACKGROUND: Dialysis patients are at high risk for atherosclerosis, with increased indications for myocardial revascularization (MR) in this group.
OBJECTIVES: To assess clinical, laboratory, echoDoppercardiographic and coronary angiography parameters among dialysis patients and in a subgroup with MR indications.
METHODS: 94 dialysis patients undergoing coronary angiography were analyzed and divided into two groups: with and without coronary artery disease (CAD).
RESULTS: 94 patients; 57.4% men, mean age 53.9±10.1 years, 95.7% on hemodialysis, median dialysis time of 60.0 months. Mean ejection fraction in echocardiography: 61.07±12.06% (n=84), normal diastolic function in 16.9%, type I diastolic dysfunction in 63.9%, type II in 12.0% and type III in 7.2%. The population was divided into two groups: with CAD (n = 47) and without CAD (n = 47). In the CAD group, 27.7% had three-vessel, 12.8% one-vessel and 9.6% two-vessel disease, with prior CAD (17.0% vs. 2.1%; p=0.003), parietal calcification in coronary angiography (76.6% vs. 10.6%; p<0.001), with prior use of beta-blockers (55.3% vs. 27.7%; p=0.007) being more frequent in the CAD group. Among non-diabetic patients, those with diastolic dysfunction were four times more likely to have CAD (OR 4.26 CI 1.03-23.55; p=0.048). There was a high level (61.7%) of MR indications among CAD patients, with surgery indicated for 51.7% of those suitable for revascularization.
CONCLUSIONS: Prior CAD, parietal calcification in coronary angiography and prior use of beta-blockers were more frequent in the CAD group. Diastolic dysfunction in the echoDopplercardiograms was the only independent CAD predictor among dialysis patients, with MR indications high for coronary heart disease patients.

Keywords: Coronary artery disease; Kidney failure, chronic; Echocardiography; Myocardial revascularization

Heart rate variability while using incentive spirometers

Variabilidade da frequência cardíaca durante a utilização de espirômetros de incentivo

Floripes Alves Lacerda; Sara Alexandra Garro; Stephanie Grayce de Aguiar; Bruno Porto Pessoa; Pedro Henrique Scheidt Figueiredo; Gisele do Carmo Leite Machado Diniz

Rev Bras Cardiol. 2014;27(3):158-164

Abstract PDF PORT

BACKGROUND: Due to the influence of breathing on the autonomic system, some studies have evaluated heart rate variability (HRV) while using respiratory physiotherapy techniques.
OBJECTIVES: To assess and compare the effects of flow-oriented (FIS) and volume-oriented (VIS) incentive spirometry on HRV in healthy subjects.
METHODS: A crossover prospective study with 33 volunteers (25.88 ± 4.65 years old). The subjects underwent FIS and VIS randomly. Their HRV was recorded during a day at five moments: initial rest, first incentive spirometry, at rest, second incentive spirometry and final rest, with each phase lasting five minutes. The pNN50 and rMSSD variables were analyzed, comparing the effects of FIS and VIS on HRV through two-way variance analysis, followed by post-hoc analysis using the Tukey test, when necessary. Differences were considered significant when p<0.05.
RESULTS: During both incentive spirometry sessions, the pNN50 increased significantly compared to the respective initial rest time (FIS: 8.11±7.31% vs. 13.12±7.15%, p<0.001; VIS: 7.12±5.39% vs. 13.44±6.79%, p<0.001;) The same occurred with the rMSSD rating (FIS: 36.56±19.34ms vs. 50.91±20.48ms, p<0.001; VIS: 34.93±13.48ms vs. 50.75±18.93ms, p<0.001). However, there were no significant differences between the types of incentive spirometry.
CONCLUSION: Incentive spirometry causes increased vagal modulation in healthy individuals, occurring similarly in the flow and volume devices.

Keywords: Types of physiotherapy; Breathing exercises; Autonomic nervous system

Analysis of hemodynamic variables among elderly revascularized patients after early in-bed mobilization

Análise das variáveis hemodinâmicas em idosos revascularizados após mobilização precoce no leito

Klebson da Silva Almeida; André Filipe Morais Pinto Novo; Saul Rassy Carneiro; Larissa Nazaré Queiroz de Araújo

Rev Bras Cardiol. 2014;27(3):165-171

Abstract PDF PORT

BACKGROUND: During the post-operative phase after coronary artery bypass (CAB) surgery, prolonged bed rest increases the possibility of systemic complications resulting from immobilization.
OBJECTIVE: To ascertain the behavior of peak expiratory flow and hemodynamic variables among elderly patients during the CAB postoperative period undergoing three types of physiotherapy interventions.
METHODS:Thirty elderly patients were studied, divided into three groups: Group A - mobilization with an ergometric bicycle; Group B - mobilization without an ergometric bicycle but with physiotherapy; and Group C - no mobilization but with non-invasive ventilation, analyzing the heart rate (HR), respiration rate (RR), blood pressure (BP), peripheral oxygen saturation (SpO2) and expiratory peak flow. The Wilcoxon test was used for variations in the intra-group results for the pre- and post-test phases, using the Kruskal-Wallis test for the inter-group comparison of the pre and post-test phases, with a statistical significance of p<0.05.
RESULTS: A significant increase was observed in the peak flow values for the three groups (pre- and post-test); with a significant reduction in the systolic blood pressure for group A and higher heart rates and respiration rates in group B. The inter-group analysis presented a statistically significant reduction in the diastolic blood pressure for group C.
CONCLUSIONS: The hemodynamic variables behaved as expected, confirming that exercise is safe for elderly patients after CAB in an intensive care setting. Care is required when using positive pressures for non-invasive ventilation, due to effects on cardiac output and consequently diastolic blood pressure.

Keywords: Breathing exercises; Ergonomic bicycle; Elderly; Myocardial revascularization

Effect of a regular aerobic exercise program on C-reactive protein among people at risk for cardiovascular disease

Efeito de um programa regular de exercício físico sobre a proteína C-reativa de indivíduos com risco de doenças cardiovasculares

Patrícia Alcântara Doval de Carvalho Viana; Jefferson Petto; Alan Carlos Nery dos Santos; Marcos Machado Barojas; Francisco Tiago Oliveira de Oliveira; Luis Cláudio Lemos Correia

Rev Bras Cardiol. 2014;27(3):172-179

Abstract PDF PORT

BACKGROUND: Although observational studies suggest that exercise has anti-inflammatory effects, this possibility has not been confirmed definitively through randomized clinical trials.
OBJECTIVE: To assess the effects of aerobic activities on systemic inflammatory processes among people at cardiovascular risk.
METHODS: A randomized clinical trial encompassing sedentary subjects with at least two risk factors for heart disease or established cardiovascular disease. These volunteers were assigned randomly to three months of supervised aerobic training (training group) or just counseling on healthy lifestyle habits (control group). C-reactive protein (CRP) was measured by a highly sensitive method before and after these interventions.
RESULTS: Assessing 68 subjects. The training and control groups had similar baseline characteristics. There was improvement in functional capacity among only the training group patients. After three months, an increase in the CRP was noted in the control group, whose median rose from 2.2mg/L (IQR=1.0 to 4.3mg/L) to 3.2mg/L (IQR=2.4 to 5.5mg/L) - p=0.006. This phenomenon was not found in the training group, which presented a baseline median of 1.7mg/L (IQR =0.97 to 4.8mg/L), statistically similar to the final value of 2.5mg/L (1.0 to 4.7mg/L) - p=0.46. When the percentage variation in the CRP was compared for these groups, there was a greater increase in the control group (+58%, IQR=11% to 151%), compared to the training group (+17%, IQR= -36% to 79%) - intergroup p=0.046.
CONCLUSION: An aerobic exercise program seems to lessen CRP elevation among people at cardiovascular risk.

Keywords: C-reactive protein; Physical and Rehabilitation Medicine; Coronary artery disease

Metabolic syndrome among patients enrolled in a cardiac rehabilitation program

Síndrome metabólica em pacientes atendidos em programa de reabilitação cardíaca

Clarissa dos Santos Povill Quirino; Raquel Veloso de Albuquerque Maranhão; Denise Tavares Giannini

Rev Bras Cardiol. 2014;27(3):180-188

Abstract PDF PORT

BACKGROUND: Metabolic syndrome is a major risk factor for the development of cardiovascular disease, resulting in a high (and still rising) mortality rate when associated with cardiopathies.
OBJECTIVE: To estimate the frequency of metabolic syndrome in a Cardiac Rehabilitation Program at a university hospital in Rio de Janeiro.
METHODS:Cross-sectional descriptive study conducted with patients participating in a Cardiac Rehabilitation Program, grounded on anthropometric and laboratory assessments, with metabolic syndrome diagnosed through the criteria established by the International Diabetes Federation, 2005.
RESULTS: Forty subjects were assessed (26 men and 14 women), with a mean age of 61.1±8.4 years. Based on the Body Mass Index, 77.5% were overweight and obese. The mean waist circumference and waist/ height values were higher than recommended for both genders, with the overall prevalence of metabolic syndrome reaching 83.0% (77.0% males and 93.0% females). Among patients diagnosed with metabolic syndrome, the mean anthropometric measurements were significantly larger than among those without this diagnosis.
CONCLUSIONS: A high frequency of metabolic syndrome was found among patients in a Cardiac Rehabilitation Program, underscoring the importance of implementing therapeutic actions aimed at reversing metabolic syndrome among patients with heart disease.

Keywords: Metabolic syndrome X; Cardiovascular diseases; Rehabilitation; Nutritional status

Anemia in heart failure patients: development risk factors

Anemia em pacientes com insuficiência cardíaca: fatores de risco para o seu desenvolvimento

Rovênia Maria Oliveira Ximenes; Antonio Carlos Pereira Barretto; Esther Pereira da Silva

Rev Bras Cardiol. 2014;27(3):189-194

Abstract PDF PORT

BACKGROUND: Although anemia is prevalent in heart failure patients, there are few studies addressing risk factors in the context of this disease.
OBJECTIVE: To characterize anemia risk factors among heart failure patients in a hospital environment.
METHODS:A cross-sectional study using a quantitative approach was conducted at a university hospital in the city of João Pessoa, Pernambuco State, collecting data from the medical records of heart failure patients between 2010 and 2012. The risk factors - age, education level, family income, weight, BMI, systolic and diastolic blood pressure and left ventricular ejection fraction (LVEF) - were analyzed by comparing values (mean ± SD) for groups of patients with and without anemia.
RESULTS: Anemia was associated with older age (p=0.0065), lower education level (p=0.0284), lower weight (p=0.093), lower BMI (p=0.0149) and higher LVEF (p=0.0201).
CONCLUSION: Older age, lower education level, lower weight and BMI and higher LVEF are aspects that warrant closer attention from specialized health facilities in order to prevent anemia in heart failure patients.

Keywords: Heart failure; Anemia; Risk factors

Evaluation of adherence to medication among elderly hypertensive patients treated through polypharmacy

Avaliação da adesão medicamentosa de pacientes idosos hipertensos em uso de polifarmácia

Liliana Batista Vieira; Silvia Helena de Bortoli Cassiani

Rev Bras Cardiol. 2014;27(3):195-202

Abstract PDF PORT

BACKGROUND: Polypharmacy and non-adherence to medication may cause health complications among the elderly. Understanding medication use patterns is vital for ensuring patient safety.
OBJECTIVES: To assess medication use profiles in a group of elderly hypertensive patients under treatment at a Basic Health Unit in Brazil, evaluating their adherence to medication and knowledge of prescribed drug treatments.
METHODS: Descriptive cross-sectional study of 32 elderly hypertensive patients taking multiple drugs. These medications were classified by the Anatomical Therapeutic Chemical system, while adherence was assessed by the Morisky and Green test, with arterial blood pressure control.
RESULTS: Their average age was 71.4±5.6 years, taking an average of 8.0±2.3 different types of drugs, mainly cardiovascular (50.2%). In terms of adherence, 81.2% were rated as 'less adherent', with average scores of 39.9±17.7% in the prescribed treatment knowledge test. The average blood pressure was 151.9±15.4 mmHg (systolic) and 78.9±10.1 mmHg (diastolic).
CONCLUSIONS: The number of medications taken by these elderly patients was high, with poor adherence to drug treatment and little knowledge of their prescribed medications. It is important to conduct intervention studies that would help ensure correct drug use, lessening polypharmacy risks while enhancing adherence.

Keywords: Medication adherence; Elderly; Hypertension; Polypharmacy

Anthropometric indicators of obesity among patients with acute myocardial infarction

Indicadores antropométricos de obesidade em pacientes com infarto agudo do miocárdio

Talita Ariane Amaro Lobato; Rosileide de Souza Torres; Aldair da Silva Guterres; Wanderson André Alves Mendes; Adrianne Pureza Maciel; Francy Correa Costa Santos; Shirlene Viana Leal; Ana Lúcia Silva Araújo Sato

Rev Bras Cardiol. 2014;27(3):203-212

Abstract PDF PORT

BACKGROUND: Obesity is associated with increased mortality for many chronic diseases, particularly cardiovascular diseases, thus constituting one of the risk factors for its occurrence. In Brazil obesity is rated as an independent risk factor for the prevalence of acute myocardial infarction.
OBJECTIVE: To characterize obesity through different anthropometric indicators among patients with acute myocardial infarction.
METHODS: A cross-sectional study was conducted of 34 adult and elderly male and female patients with acute myocardial infarction, treated between March and June 2013 at the Fundação Hospital de Clínicas Gaspar Vianna in Belém, Pará State. Social and demographic information was collected on lifestyles, comorbidities and anthropometric indicators of obesity.
RESULTS: High BMI and neck circumference values were found among the overall anthropometric indicators of obesity. The anthropometric indicators for central obesity presented higher risks for the conicity index and waist circumference, as well as the waist-height and waist-hip ratios. Waist circumference and waist-height ratio were the measurements most closely correlated with other anthropometric variables.
CONCLUSION: Most of the studied population presents high risks of further cardiovascular events, due mainly to high anthropometric indicators of obesity, highlighting the importance of anthropometry, which enables the early detection of obesity.

Keywords: Myocardial infarction; Indicators of morbidity and mortality; Anthropometry; Obesity

Case Report

Isolated cardiac amyloidosis: case report

Amiloidose cardíaca isolada: relato de caso

Julia Vieira Oberger; Celso Nilo Didoné Filho; Luiz Augusto Garcia; Mariana Uliano Cordeiro

Rev Bras Cardiol. 2014;27(3):213-216

Abstract PDF PORT

Cardiac amyloidosis is caused by amyloid deposits in cardiac fibers that can lead to conduction disturbance, restrictive cardiomyopathy, low output and isolated atrial involvement. This case report described a female patient, 66 years old, with significant weight loss (40.4kg) that began three years ago, progressing to lower limb edema. On investigation, overall cardiac enlargement was noted, with the echocardiogram showing infiltrative restrictive cardiomyopathy and pericardial effusion. High clinical suspicions prompted a request for a cardiac MRI that strongly suggested cardiac amyloidosis. Although definitive diagnoses require endomyocardial biopsies, cardiac MRI is described as a good diagnostic method with rare false-positive results.

Keywords: Amyloidosis; Cardiomyopathy, restrictive; Pericardial effusion

Review Article

Exercise testing in patients with cardiac implantable electronic devices

Teste ergométrico em portadores de dispositivos cardíacos eletrônicos implantáveis

Carlos Alberto Cordeiro Hossri; Sandro Pinelli Felicioni; Uelra Rita Lourenço; Paulo Christo Coutinho da Silva; Enrique Indalécio Pachón; Susimeire Buglia; Luiz Eduardo Mastrocolla; Rica Dodo Buchler

Rev Bras Cardiol. 2014;27(3):217-227

Abstract PDF PORT

The number of patients fitted with cardiac implantable electronic devices has grown substantially over the past few years. Pacemakers with countless programming options and defibrillators with or without resynchronization devices are increasingly more common, with confusing electrocardiographic findings. Consequently, general practitioners must understand their basic principles and techniques, in addition to developing stronger links with electro-physiologists. Knowledge of these basic principles is crucial for managing these patients, meaning that people administering ergometric testing must be aware of the type of device and its programming, minimum and maximum command frequency and defibrillator, as well as its treatment and defibrillation frequencies. This will ensure greater safety during ergometric and ergospyrometric exercise testing and exercise programs. This paper describes several points of interest in ergometric testing for patients fitted with cardiac implantable electronic devices.

Keywords: Defibrillators, implantable; Rehabilitation; Exercise test; Pacemaker, artificial; Cardiac resynchronization therapy

Point of View

Healthy gums slow the progression of carotid atherosclerosis

Gengivas saudáveis retardam a progressão de aterosclerose nas carótidas

Allan Abuabara

Rev Bras Cardiol. 2014;27(3):228-230

Abstract PDF PORT

Studies have linked periodontal disease to atherosclerosis and cardiovascular diseases. This paper presents the results of a major study that underscores this relationship. This is the first evidence showing that better periodontal conditions, defined through clinical and microbiological aspects, are associated with less progression in carotid atherosclerosis. This population-based cohort study highlights the importance of a multidisciplinary approach to patients, especially for physicians and dentists, in order to prevent and control cardiovascular diseases. Future studies might well show that oral health could be an important prognostic indicator of general patient health.

Keywords: Carotid artery diseases; Atherosclerosis; Periodontitis