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

Edition: 27.4 - 12 Article(s)

Editorial

Time for change

Tempo de mudar

Claudio Tinoco Mesquita

Rev Bras Cardiol. 2014;27(4):238-239

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Original Article

Effect of concurrent training on platelet aggregation curve in adults with hypertension

Efeito do treinamento concorrente sobre a curva de agregação plaquetária em adultos hipertensos

Caroline Brand; Maria Amélia Roth; Luciana Caye Griebeler; Fábio Fernandes Mello; Anelise Reis Gaya

Rev Bras Cardiol. 2014;27(4):240-246

Abstract PDF PORT

BACKGROUND: Hypertension is associated with increased platelet aggregation, meaning that regular exercise may be beneficial, although the effects of concurrent training on platelet aggregation curves have not been not established.
OBJECTIVE: To ascertain the effects of a concurrent training program on the behavior of platelet aggregation curves in adults with hypertension controlled thru medication.
METHODS: We selected 17 adult men and women voluntarily: HG (n=8) hypertensive group controlled with medication and NG (n=9) normotensive group with a mean age of 54.0±3.0 years. Both groups engaged in concurrent training three times a week on alternate days for 28 weeks. We evaluated the anthropometric, hemodynamic and metabolic parameters, together with platelet aggregation curves.
RESULTS: During the pre-test phase for the HG and NG groups, the following variables showed statistically significant differences: body mass index (p= 0.01), systolic blood pressure (p= 0.009) and diastolic blood pressure (p= 0.03). Although both groups presented lower platelet aggregation after the concurrent training period, the values were not statistically significant.
CONCLUSION: Platelets are more prone to activation and aggregation in hypertensive individuals. Although alterations in platelet aggregation were not significant, the downtrend in the values for both groups indicated the efficiency of concurrent training.


Keywords: Physical exercise; Platelet aggregation; Hypertension

Characteristics of patients in private pediatric cardiology unit: seven-year analysis

Características dos pacientes em serviço privado de cardiologia pediátrica: análise de sete anos

Felipe Alves Mourato; Lúcia Roberta Didier Nunes Moser; Thamine de Paula Hatem; Mônica de Cássia Costa; Catarina Vasconcelos Cavalcanti; Lúcia Roberta Rego Villachan; Juliana Rodrigues Neves; Mônica Cristina Rezende Fiore; Sandra da Silva Mattos

Rev Bras Cardiol. 2014;27(4):247-253

Abstract PDF PORT

BACKGROUND: Despite advances in the diagnosis and treatment of heart diseases during childhood, congenital heart defects remain a prominent factor in neonatal morbidity and mortality. Acquired heart diseases, such as rheumatic fever, also have high impact on public health. Knowledge of these cardiac patient profiles is thus important for focusing resources and optimizing results.
OBJECTIVE: To describe the main diagnostic and clinical findings for patients seen at a private pediatric cardiology center, by age bracket.
METHODS: We analyzed 17,873 records for patients seen during the past seven years, emphasizing: gender, age, reason for referral, the main findings in the history of the current disease, main findings from physical examinations, supplementary tests and the main diagnoses through echocardiograms.
RESULTS: There was a predominance of males (53.7 %), with an average age of 63.5 months, with some 25 % of the sample younger than two years of age. The main reasons for referral were cardiological reports for patients more than two years old, and suspected CHD for younger children. On physical examination, 59.8 % presented anomalies, with murmurs found in 35.8 %. Echocardiography was performed for 96.93 % of the sample. The most frequent CHDs detected by echocardiography were left-to-right shunt lesions (62.75 %).
CONCLUSION: Most CHDS were found in younger children, on referral. The difference between the age brackets was essential for distinguishing CHDs and clinical findings.


Keywords: Heart defects, congenital; Pediatrics; Clinical symptoms

Cognitive assessment of patients undergoing CABG

Avaliação cognitiva em pacientes submetidos à revascularização cirúrgica cardíaca

Mariana Accioly Carrazedo; Giulliano Giovannino Accetta; Roberta Arb Saba Rodrigues Pinto; Fernando Augusto Alves da Costa

Rev Bras Cardiol. 2014;27(4):254-259

Abstract PDF PORT

BACKGROUND: Spurred by a worldwide upsurge in heart surgeries, interest in post-operative aspects (such morbidity and mortality statistics) has been very effective in medicine. Neurological damage arising from cardiovascular surgery may step up mortality rates, in parallel to devastating consequences such as loss of independence and poorer quality of life.
OBJECTIVE: To analyze the cognitive performance of patients undergoing coronary artery bypass graft (CABG) surgeries, correlating the outcomes with those found in the literature.
METHODS: 31 CABG patients between 40 and 75 years old were recruited in the cardiovascular surgery ward during the pre-operative period, completing two cognitive assessment questionnaires: the Montreal Cognitive Assessment (MoCa) and Mini Mental (MMSE) prior to surgery and then again the day prior to being discharged from hospital. The medical records of the respondents were used to obtain data about surgical procedures, use of circulatory support, complications, intra-operative occurrences and durations of stays in the ICU and in hospital.
RESULTS: Most patients scored lower in the second round of questionnaires (MMSE 25.1 to 23.1 and MoCa 21.7 to 20.1), indicating a decline in cognitive functions. Possible correlations between altered cognition and duration of surgery, anesthesia and CPB were also analyzed.
CONCLUSION: This study shows that CABG patients presented post-operative cognitive impairment, possibly related to previous myocardial infarctions, as described in previous studies.


Keywords: Cognition; Myocardial revascularization; Extracorporeal circulation; Cognition disorders

Identification of DM2 in cardiac patients with probable insulin resistance through glycated Hb

Identificação de diabetes mellitus 2 em cardiopatas com provável resistência insulínica através da hemoglobina glicada

Fernando Augusto Alves da Costa; Thalita Ruolla Barros; Roberta Coutinho Muniz; Raquel Franchin Ferraz

Rev Bras Cardiol. 2014;27(4):260-266

Abstract PDF PORT

BACKGROUND: The presence of diabetes mellitus (DM) requires different therapeutic approaches and follow-ups, especially in cardiac patients, with primary and secondary prevention of cardiovascular events being essential for these patients.
OBJECTIVES: To observe the presence of DM2 in cardiac patients with glycated hemoglobin levels between 5.7 and 6.4% by early requests for glycemic curves obtained through the Oral Glucose Tolerance Test (OGTT).
METHODS: A retrospective study analyzed the medical records of 113 patients (51 men and 62 women) with manifest or subclinical coronary artery disease, selected after clinical and laboratory evaluation, with the following measurements: fasting glycemia, glycated hemoglobin, glycemic curve, urea, creatinine, lipids profile, age, gender and BMI, as well as the presence of hypertension, atherosclerosis, heart failure, previous coronary artery disease and positive ischemic tests with no need for intervention.
RESULTS: Insulin resistance was diagnosed through glycemic curves in 37.2% of the men, of whom 5.9% had fasting glucose below 99 mg/L and 15.7% presented curves compatible with DM2. Based on glycemia at 2 hours, there were 38.8% cases of insulin resistance among the women, while 19.6% were normoglycemic fasting glucose and 8% had values greater than 200 mg/dL, of which 3.2% had fasting glucose below 99 mg/dL.
CONCLUSION: Patients with glycated hemoglobin in the insulin resistance range actually had DM, identified through the OGTT in the group with insulin resistance .The presence of increased BMI was associated with the presence of diabetic patients in this sample.


Keywords: Diabetes mellitus; Hemoglobin A, glycosylated; Cardiovascular diseases; Glucose tolerance test

Prevalence of chest pain and anti-angina medication at a university hospital in Vassouras, Rio de Janeiro state

Prevalência de dor torácica e medicação antianginosa em hospital universitário de Vassouras, RJ

Clarice Gusmão dos Santos; Paulla Rayane Chaves Utsch; Ana Gabriela Flori Chagas; Leonardo do Valle Souza Vasconcelos; Lucas Ribeiro Campos; Mohamed Ali Hijazi; Léo Guimarães Soares; Marlon Mohamud Vilagra; Sandra Maria Barroso Werneck Vilagra

Rev Bras Cardiol. 2014;27(4):267-275

Abstract PDF PORT

BACKGROUND: Although there are countless diseases causing chest pain, those arising from the cardiovascular system prompt the greatest concern. Their clinical classification is extremely important for initial patient management, helping distinguish life-threatening diseases.
OBJECTIVES: To analyze chest pain in patients seen at the Sul Fluminense University Hospital in Vassouras, Rio de Janeiro State, identifying frequency and type, and relating this to gender, age bracket and medications taken previously.
METHODS: This observational cross-sectional study was conducted from 2010 to 2012 using a structured questionnaire completed by patients complaining of chest pain. The following variables were analyzed: gender, age bracket and medications taken previously.
RESULTS: Among 236 patients admitted to this Hospital with chest pain, the most prevalent was type B (44%), although with no statistical difference compared to the others (p=0.844). No significant difference was found for gender or age for the various pain types. The most common medications were beta-blockers, ACE inhibitors and others.
CONCLUSIONS: Type B was most common pain type among these patients, followed by C, A and finally D. There was a significant difference in the medications taken by these patients and when relating medications to age brackets. However, no significant relationship was noted between medications and gender, nor pain type with age, gender and anti-angina medications.


Keywords: Cardiovascular diseases; Cardiomyopathies; Chest pain

Case Report

Extensive myocardial ischemia among young woman with systemic lupus erythematosus

Isquemia miocárdica extensa em mulher jovem com lúpus eritematoso sistêmico

Fernanda Pereira Leal; Claudio Tinoco Mesquita; Diógenes de Souza Ferreira Junior; Jader Cunha de Azevedo; Karina Serejo Ferreira Mocarzel; Sandra Marina Miranda

Rev Bras Cardiol. 2014;27(4):276-279

Abstract PDF PORT

Female patient, 24 years old, diagnosed six years ago with systemic lupus erythematosus, presented dyspnea on moderate exertion after preeclampsia and acute lung edema. Echocardiography disclosed an intracavitary thrombus in the LV with dyskinesia, requiring hospitalization for anticoagulation. Myocardial perfusion SPECT showed 99Tcm-sestamibi myocardial perfusion defects compatible with an area of ischemia estimated at 12%. This report discusses clinical aspects of cardiovascular complications resulting from systemic lupus erythematous.


Keywords: Lupus erythematosus, systemic; Ischemia; Perfusion; Radionuclide imaging

Hyperbaric oxygen therapy for treating an aeroembolic accident after heart surgery

Oxigenoterapia hiperbárica no acidente aeroembólico no pós-operatório de cirurgia cardíaca

Gerez Fernandes Martins; Barbara Jessen; Cláudio Assumpção; Tomaz de Aquino Brito; José Francisco Taty Zau

Rev Bras Cardiol. 2014;27(4):280-282

Abstract PDF PORT

Estimated at 0.1 % during extracorporeal circulation, systemic air embolisms may have different etiologies. However, the vast majority of complications are not reported or are imperceptible, depending on neurological involvement and the length of time after surgery. In general, air embolisms may cause cognitive disorders, focal damage, coma and death. This paper reports on the experience of the Aloysio de Castro State Cardiology Institute, treating these accidents during the post-operative period with hyperbaric oxygen therapy, with full recovery.


Keywords: Air embolism; Post-operative complications; Hyperbaric oxygen therapy

Dual origin of the anterior descending artery linked to heart failure

Dupla-origem do ramo descendente anterior associada à insuficiência cardíaca

Márcio Alves de Urzêda; Vicente Paulo Resende Junior; Alan Nascimento Paiva; Sergio Rodrigo Beraldo; José Fábio Fabris Junior; José Luis Attab dos Santos

Rev Bras Cardiol. 2014;27(4):283-285

Abstract PDF PORT

Coronary anomalies may be benign or severe, causing myocardial ischaemia, infarction and sudden death. This case report describes a patient undergoing cardiac catheterization due to progressive dyspnea with no chest pain. The echocardiogram showed a marked global contractile deficit due to a contractile deficit in the anterior wall. The scintigraphy showed discreet ischaemia and moderate fibrosis in a large area of the anterior wall. The cinecoronariography and angio-CT showed the proximal portion of the anterior descending artery in a normal position, with the center and distal portions originating in the right coronary artery. This case report describes a dual-origin anterior descending artery related to heart failure without angina.


Keywords: Coronary disease; Heart failure; Cardiac catheterization

Aerococcus viridans as etiological agent in native valve endocarditis

Aerococcus viridans como agente etiológico de endocardite em valva nativa

Juliane Agustini Orati; Alessandro Amorim; Marcia Terezinha Tardivo; Corrado Jose Guerzoni Simão; Daniela Sica Silva de Araújo; Nathália Antônio Monteiro Castro

Rev Bras Cardiol. 2014;27(4):286-288

Abstract PDF PORT

Aerococcus viridans is an uncommon human pathogen and reports of endocarditis caused by this agent are rare in the literature. This clinical case study describes a 56 year-old female patient admitted to hospital for spiking fevers. After investigation, this was diagnosed as native valve endocarditis, based on the Duke clinical criteria and confirmed through the growth of A. viridans in blood cultures, making this the first reported case in Brazil. There are also reports of this agent in urinary tract infections, bacteremia, meningitis and septic arthritis. In this case, the patient had a better clinical response after starting on ampicillin, confirmed by some articles that recommend treatment with penicillins.


Keywords: Endocarditis; Mitral valve; Aerococcus

Point of View

Masked hypertension: diagnosis and treatment

Hipertensão mascarada: diagnóstico e tratamento

Erika Maria Gonçalves Campana; Rafael Almeida de Faria; Andréa Araujo Brandão

Rev Bras Cardiol. 2014;27(4):289-292

Abstract PDF PORT

High blood pressure (BP) steps up cardiovascular risk, with in-office BP measurements long the gold standard for monitoring these patients. However, the advent of Ambulatory BP Monitoring (ABPM) and in-home BP measurements has ushered in new paradigms for concepts, classifications and management of these patients. Masked hypertension (MH) is characterized by normal BP during appointments with rising BP during ABPM or in-home BP measurements. In terms of cardiovascular risk, these patients are similar to those with sustained hypertension. In this paper, the authors discuss MH diagnosis and treatment.


Keywords: Masked hypertension; Blood pressure; Hypertension

Preliminary Communication

Different barriers to cardiac rehabilitation

Diferentes barreiras para reabilitação cardíaca

Aline Lange Barros; Rafaella Zulianello dos Santos; Christini Decker Batista Bonin; Gabriela Lima de Melo Ghisi; Sherry Grace; Magnus Benetti

Rev Bras Cardiol. 2014;27(4):293-298

Abstract PDF PORT

BACKGROUND: Although cardiac rehabilitation (CR) programs offer proven benefits, they are still underused, due partly to barriers that hamper patient participation and adherence to these programs.
OBJECTIVE: To describe and compare barriers hampering participation in a cardiac rehabilitation program.
METHODS: Cross-sectional study with an intentional sample stratified into two groups: 50 CR program participants and 50 non-participants. Patient perceptions of barriers hampering participation in CR programs were assessed on the Cardiac Rehabilitation Barriers Scale (CRBS), describing and comparing the barriers found in these two groups.
RESULTS: The non-participant group faced significantly more barriers than the CR participant group for comorbidity/functional status factors (p<0.001), perceived needs (p<0.001) and access (p<0.001). A comparison of the total CRBS scores of these groups showed that the non-participant group faced significantly more barriers than the participant group (10.7±2.4 and 8.1± .4, respectively) (p<0.001).
CONCLUSION: The main barriers hampering cardiac rehabilitation are related to comorbidities/functional status, perceived needs and access. In these areas, non-participant cardiac patients faced more CR barriers than participants in the program.


Keywords: Cardiovascular diseases; Rehabilitation; Patient participation; Questionnaires

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