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

Edition: 27.5 - 15 Article(s)


Scientific visibility and the International Journal of Cardiovascular Sciences

Visibilidade científica e o International Journal of Cardiovascular Sciences

Claudio Tinoco Mesquita

Rev Bras Cardiol. 2014;27(5):306-307


Point of View

Is sleep apnea a secondary cause of arterial hypertension?

Apneia do sono é causa secundária de hipertensão arterial?

Claudia Maria Nogueira Correa; Patrícia Paiva Bartholo; Andréa Araujo Brandão

Rev Bras Cardiol. 2014;27(5):308-310

Abstract PDF PORT

Obstructive sleep apnea (OSA) and arterial hypertension are conditions that coexist in many patients. The main underlying mechanism of arterial hypertension for people with sleep apnea is sympathetic activation triggered by apneic episodes. The classification of sleep apnea as a secondary cause of hypertension appears to be inadequate. A recent meta-analysis showed that long-term treatment for OSA with CPAP was not associated with reductions in blood pressure levels and did not lessen the need for high blood pressure medications.

Keywords: Sleep apnea, obstructive; Hypertension; Continuous positive airway pressure

Identifying anxiety disorders in patients with suspected coronary artery disease

Identificação de transtornos de ansiedade em pacientes com suspeita de doença arterial coronariana

Graziele Zwielewski; Theo Fernando Bub

Rev Bras Cardiol. 2014;27(5):311-313

Abstract PDF PORT

Prompted by an upsurge of patients in emergency rooms presenting symptoms similar to those of anxiety disorder (AD) together with symptoms of coronary artery disease (CAD), an attempt was made to clarify the relationship between CAD and AD through hands-on experience in a specialized hospital ER, in addition to the specialized literature on this subject. The medical records of fifteen patients were analyzed, followed by semi-structured interviews with each of them. Cognitive patterns were noted in these patients and, as a contribution, the use of two auxiliary elements is suggested for diagnosing AD in ERs: catastrophization and hypervigilance.

Keywords: Anxiety disorders; Evidence-based emergency medicine; Cardiology unit, hospital; Diagnostic techniques, cardiovascular

Robotics in hybrid myocardial revascularization: a highly promising concept

Tecnologia robótica em revascularização do miocárdico híbrida: um conceito altamente promissor

Leonardo Secchin Canale

Rev Bras Cardiol. 2014;27(5):314-317

Abstract PDF PORT

Hybrid coronary revascularization blends a bypass between the left internal mammary artery and the anterior descending artery performed in a minimally invasive manner (including robotic assistance), with percutaneous coronary intervention for other targets. In multivessel coronary artery disease, this approach offers a safe and effective alternative to conventional sternotomies or multiple stenting.

Keywords: Myocardial revascularization; Thoracoscopy; Surgical procedures, minimally invasive

Original Article

Simultaneity of modifiable cardiovascular risk factors: population-based study

Simultaneidade de fatores de risco cardiovascular controláveis: etudo de base populacional

Mariana Maldonado D'Amico; Regina Kazue Tanno de Souza

Rev Bras Cardiol. 2014;27(5):318-326

Abstract PDF PORT

BACKGROUND: Cardiovascular diseases are related to the presence of risk factors, whose combinations result in higher risks for diseases, rising substantially with each additional risk factor.
OBJECTIVE: To analyze the simultaneity of cardiovascular risk factors among adults aged 40 years and more, by the presence of diabetes mellitus and hypertension.
METHODS: This population-based cross-sectional study randomly interviewed 1,180 subjects residing in all urban census tracts in Cambé, Paraná State. The study variables were nine cardiovascular risk factors: smoking, excessive alcohol consumption, physical inactivity, overweight, abdominal obesity, low fruit, greens and vegetable consumption, diabetes mellitus, low HDL cholesterol and hypertension.
RESULTS: Among the respondents, 54.3% were women and 45.7% men. The most prevalent risk factors were physical inactivity, overweight, low consumption of fruits, greens and vegetables and hypertension. Only 1.4% of this population did not present risk factors and one person had all of them. No significant differences in risk factors were noted when stratified by gender. The average number of risk factors was significantly higher among the elderly and people with hypertension and diabetes.
CONCLUSION: There was a massive presence of risk factors in the adult population, especially the high prevalence of concurrent factors. Furthermore, the simultaneity of cardiovascular risk factors among those with hypertension and diabetes shows that people at the highest risk cluster more factors together, boosting the probability of cardiovascular events.

Keywords: Cardiovascular diseases; Risk factors; Prevalence

Takotsubo Disease (Broken Heart Syndrome): an underdiagnosed disease?

Doença de Takotsubo (Síndrome do Coração Partido): uma doença subdiagnosticada?

Bianca Eliza Hoekstra; Elise Souza dos Santos Reis; Bruno Ribeiro; Mario Augusto Cray da Costa

Rev Bras Cardiol. 2014;27(5):327-332

Abstract PDF PORT

BACKGROUND: Takotsubo cardiomyopathy, more commonly known as Takotsubo disease, is a reversible dysfunction of the left ventricle (LV) in the absence of obstructive coronary disease. Often caused by severe stress, its clinical features are similar to those of acute myocardial infarction (AMI), although with different pathophysiology and treatment.
OBJECTIVES: To assess the rate of Takotsubo disease in the Santa Casa de Misericordia hospital, Ponta Grossa, Paraná State, between 2007 and 2012, analyzing risk factors, complications and conditions related to this disease, together with patient outcomes during hospitalization.
METHODS: Descriptive cross-sectional study and review of the literature with an analysis of data collected from the medical records of the Hemodynamics Unit, Santa Casa de Misericordia hospital, Ponta Grossa, Paraná State, between 2007 and 2012. Drawn from retrospective diagnoses of Takotsubo disease, the data were expressed as means and standard deviations or as absolute values and percentages. Variables were compared using the Student's t and chi- squared tests, with significance levels of p<0.05.
RESULTS: We found 24 patients with Takotsubo disease, of whom only five were diagnosed during hospitalization. Most (71,0%) patients were female, with a prevalence (75,0%) of systemic arterial hypertension (SAH) among all patients.
CONCLUSION: Takotsubo disease is underdiagnosed, with only one in five cases diagnosed during hospitalization. There was a strong association between this disease and SAH, with a higher prevalence among post-menopausal women.

Keywords: Takotsubo cardiomyopathy; Cardiac catheterization; Acute coronary syndrome

Preliminary assessment of prescriptions for elderly patients in the cardiology unit of a teaching hospital

Avaliação preliminar de prescrições para Idosos em serviço de cardiologia de um hospital de ensino

Tiago Aparecido Maschio de Lima; Marcelo Arruda Nakazone; Adriana Antonia da Cruz Furini

Rev Bras Cardiol. 2014;27(5):333-341

Abstract PDF PORT

BACKGROUND: Indicators are useful tools for examining drug prescription profiles.
OBJECTIVE: To analyze drug prescription indicators recommended by the World Health Organization in prescriptions for elderly patients in a cardiology ward under Brazil's Unified National Health System (SUS).
METHODS: This exploratory descriptive study uses a qualitative approach through analyzing 1,382 prescriptions issued during the hospitalization of 223 elderly patients in the clinical cardiology ward of a teaching hospital.
RESULTS: The average number of drugs per prescription was 11.66, with a total of 16,117 medications prescribed: 72.69% prescribed by their generic names; 99.39% listed as approved by the institution; 2.86% antimicrobials; 41.87% injectables; and 4.39% psychotropics. The medications most frequently prescribed were dipyrone (7.84%), omeprazole (4.80%) and enalapril maleate (4.78%). At the first ATC classification level, the classes most used were: cardiovascular system (35.18%), gastrointestinal tract (23.42%); and blood or blood-forming organs (17.81%). At the second level, the predominant classes were: antithrombotics (17.61%), analgesics (9.30%) and antiemetics (8.20%).
CONCLUSIONS: In the prescriptions analyzed, average drug consumption was high, justified by the complexity, age and concomitant diseases of the patients, with some medications prescribed by brandname, breaching Brazilian National Health System law. This leads to the conclusion that, in order to ensure safer and more rational use of medicationsfor elderly patients in cardiology units, minimum indicator standards must be established for the number of injectable, antimicrobial and psychotropic drugs prescribed, tailored to the complexity of the hospital environment for the age bracket addressed by this study.

Keywords: Indicators; Drug prescriptions; Aged; Cardiology

Assessment of INR variations in anticoagulated patients through a differentiated methodology

Avaliação da variação de razão normalizada internacional em pacientes anticoagulados através de metodologia diferenciada

Sílvia Tieko Kitahara; Elizangela Andrea da Silva; Djalma José Fagundes; Leandro Menezes Alves da Costa; Raquel Franchin Ferraz; Fernando Augusto Alves da Costa

Rev Bras Cardiol. 2014;27(5):342-348

Abstract PDF PORT

BACKGROUND: Warfarin has a narrow therapeutic range and variable response. The risk of hemorrhagic complications or the occurrence of thromboembolic events impose strict therapeutic controls on patients.
OBJECTIVE: Verify fluctuations of the International Normalized Ratio (INR) in patients on anticoagulation therapy with warfarin through differentiated control.
METHODS: Uncontrolled retrospective study of fifty patients with atrial fibrillation, embolic events or prosthetic valves who completed a questionnaire on: demographic characteristics; clinical data on the disease; treatment; anticoagulants being taken; knowledge of treatment; perceptions of taking anticoagulants; adherence to treatment (Morisky). The last five INRs were collected from patient records and checked for at least three measurements between 2.0<INR<3.0.
RESULTS: Adherence to treatment occurred in 64,0% of the reports, with 54,0% confirmed by INR controls. The sample consisted predominantly (50,0%) of university graduates with incomes of more than five times the minimum wage (56%). Despite differentiated INR control, 30,0% remained off-target, although INR control in this population exceeded the results obtained through conventional control. Social and economic levels were directly associated with better control outcomes.
CONCLUSION: Despite differentiated INR control, some patients remained off-target, with education levels being the factor for obtaining better control. The supply of anticoagulants is questioned, when no INR control is required for patients with nonvalvular AF.

Keywords: Warfarin; Medication adherence; International normalized ratio; Anticoagulants

Review Article

Myocardial infarction: morphological changes and brief approach to the influence of exercise

Infarto do miocárdio: alterações morfológicas e breve abordagem da influência do exercício físico

Marcos Tadeu Ferreira Siervuli; Angélica de Souza Silva; Adriana Cristina da Silva; Ruthneia Aparecida Lázaro Muzzi; Giancarla Aparecida Botelho Santos

Rev Bras Cardiol. 2014;27(5):349-355

Abstract PDF PORT

Cardiovascular diseases are the leading cause of mortality and disability in Brazil and worldwide, with acute myocardial infarction (AMI) being one of the most common coronary diseases. This reflects cardiac myocyte death caused by an imbalance between the supply and demand of nutrients to the tissue caused by obstruction of the coronary flow, which may be a transient or permanent condition. Based on this information, a review of the literature was conducted in bibliographical databases and book collections, providing input for a study of morphological changes in AMI and morphological variations that may lead to the appearance of this pathology. There are several works on this subject, although few explore morpho-functional alterations to the cardiovascular system. Some studies reported improved cardiac function and remodeling, together with a decrease in atherosclerotic plaque, among patients undergoing cardiac rehabilitation.

Keywords: Rehabilitation; Coronary vessels; Myocardial Infarction; Anatomy

Vitamin D deficiency: a new cardiovascular risk factor?

Deficiência de vitamina D: um novo fator de risco cardiovascular?

Francisco das Chagas Monteiro Júnior; Natália Ribeiro Mandarino; João Victor Leal Salgado; Joyce Santos Lages; Natalino Salgado Filho

Rev Bras Cardiol. 2014;27(5):356-365

Abstract PDF PORT

The role of vitamin D in bone metabolism regulation is already well established. However, during the past few years, several studies have shown that the function of vitamin D extends well beyond bone health, including immune system regulation and antiproliferative effects in cells, while also playing an important role in cardiovascular system physiology. Growing evidence is demonstrating strong associations between hypovitaminosis D and hypertension, metabolic syndrome, diabetes and atherosclerosis, thus possibly indicating an emergent cardiovascular risk factor. The mechanisms through which vitamin D exerts its protective cardiovascular effects are not yet fully elucidated, but there is ample evidence that it may play important roles in renin-angiotensin system regulation, as well as insulin secretion and sensitivity mechanisms and the actions of inflammatory cytokines, in addition to direct cardiac and vascular actions. This review presents several studies associating vitamin D deficiency with cardiometabolic risk and atherosclerosis markers, as well as some minor randomized clinical trials assessing the cardiovascular effects of vitamin D supplements. However, although it is plausible to consider vitamin D supplementation as a promising way of intervening favorably in cardiovascular risk, major randomized placebo-controlled trials, with adequate statistical power for evaluating hard endpoints, are still needed in order to definitively confirm its role in the prevention and treatment of cardiovascular diseases.

Keywords: Vitamin D deficiency; Cardiovascular diseases; Supplementary nutrition

Case Report

Left atrial wall endocarditis complicated by brain abscess: case report

Endocardite mural de átrio esquerdo complicada por abscesso cerebral: relato de caso

Fabíola Araújo de Siqueira; Julyana Gomes de Oliveira; Lissa Carrilho Goulart; Melaynne Sahium Barbosa Meira; Nathalia Meireles Lima; Vitor Lucena Carneiro

Rev Bras Cardiol. 2014;27(5):366-369

Abstract PDF PORT

A 19 year-old female patient was admitted to the ER with daily fever and headache, progressing to altered gait, unclear speech, mental confusion, dysarthria, dyspnea, tachycardia, petechiae on the soles of the feet and subungual hemorrhage. Transesophageal echocardiography shows thickening of the mitral valve leaflets, lack of coaptation, moderate insufficiency and large vegetation (10mm x 4mm) adhering to the endocardium of the posterior left atrial wall. The blood culture was positive for Staphylococcus aureus. The patient was diagnosed with infective endocarditis according to the modified Duke criteria, and antibiotic treatment was started. Although progressing well in clinical terms, the fever persisted. Cranial tomography showed a brain abscess that was drained, thus lowering the fever.

Keywords: Endocarditis, bacterial; Brain abscess; Staphylococcus aureus; Heart atria

Spontaneous coronary artery dissection

Dissecção coronariana espontânea

Carlos Eduardo Daflon de Albuquerque; Eduardo Nani; Wolney de Andrade Martins; André Luiz Silveira Souza

Rev Bras Cardiol. 2014;27(5):370-373

Abstract PDF PORT

Report on a female (54 years old) admitted to the Emergency Department with ischemic chest pain that began while at rest, during a period of severe emotional stress. An electrocardiogram (ECG) showed changes in ventricular repolarization, high myocardial necrosis markers and coronary angiography indicating anterior descending coronary artery dissection. The patient was treated conservatively, with satisfactory clinical progression in hospital and during outpatient follow-up.

Keywords: Acute coronary syndrome; Cardiac catheterization; Coronary artery disease

Complicated peripartum cardiomyopathy with bicuspid aortic valve and Wolff-Parkinson-White syndrome

Miocardiopatia periparto complicada associada à valva aórtica bicúspide e síndrome de Wolff-Parkinson-White

Marcos de Thadeu Tenuta Júnior; Felipe Augusto de Paiva Dias; Aletheia Carpine Favini; Vivian Botosso Galindo; Angela Alcântara Magnani Bezerra; Ali Kassen Omais

Rev Bras Cardiol. 2014;27(5):374-377

Abstract PDF PORT

Peripartum cardiomyopathy is a rare syndrome of unknown etiology, characterized by new left ventricular dysfunction in the last month of pregnancy or during the first six months postpartum. Risk factors include multiparous, twin pregnancy, black ethnicity and maternal age above 30 years. This report describes a case of peripartum cardiomyopathy in black female (13 years old), primiparous, single fetus, associated with cardipatias (bicuspid aortic valve and Wolff- Parkinson-White syndrome) who developed thromboembolic complications with an unfavorable outcome.

Keywords: Cardiomyopathies; Peripartum period; Wolff-Parkinson-White syndrome; Aortic valve failure

Coronary, cerebral and abdominal aortic aneurysms: a rare association

Aneurismas coronarianos, cerebral e de aorta abdominal: uma rara associação

Gustavo Luiz Gouvêa de Almeida Junior; Bibiana Almeida da Silva; Kelly Kerolayne Marinho Marques; Luciana da Camara Pacheco; Paula Medeiros Pache de Faria

Rev Bras Cardiol. 2014;27(5):378-381

Abstract PDF PORT

This case study describes an association of coronary, cerebral and abdominal aortic aneurysms in an elderly male patient hospitalized for dyspnea, whose investigation showed severe mitral regurgitation. His previous history included brain and abdominal aortic aneurysms, the latter corrected by a stent, as well as several comorbidities. Coronary angiography during a pre-operative assessment for possible valve repair disclosed severe coronary atherosclerosis and large aneurysm formations in major coronary branches. Due to the complexity of correcting the coronary aneurysms and other associated comorbidities, the patient, his family and his attending physician opted for clinical treatment.

Keywords: Coronary aneurysm; Aneurism; Aortic aneurysm, abdominal; Intracranial aneurysm

Catecholaminergic polymorphic ventricular tachycardia with reversed sudden death

Taquicardia ventricular polimórfica catecolaminérgica com morte súbita abortada

Alyne Ranaci Florêncio de Oliveira; Gustavo Sérgio Lacerda Santiago; Edvaldo Ferreira Xavier Júnior; Lúcia Roberta Didier Nunes Moser; Felipe Alves Mourato; Sandra da Silva Mattos

Rev Bras Cardiol. 2014;27(5):382-384

Abstract PDF PORT

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare genetically inherited arrhythmia that affects children without structural heart disease and with normal QTc interval. Affected children present normal at-rest electrocardiograms (ECG) with arrhythmia triggered at heart rates between 110 and 120bpm, sometimes leading to syncope and sudden death. This case report describes a female patient with a history of frequent syncope and sinus bradycardia. With no syncope improvement, the family sought out a facility specializing in cardiac arrhythmia. During the stress test, the patient presented CPVT and progressed to sudden death, which was then reversed.

Keywords: Arrhythmias, cardiac; Death, sudden; Exercise test